Bhagavatheeswaran Rajesh

PubMed2006

Putaminal involvement in Rasmussen encephalitis.

BACKGROUND: Rasmussen encephalitis (RE) is a rare devastating disease of childhood causing progressive neurological deficits and intractable seizures, typically affecting one hemisphere. Characteristic MRI features include progressive unihemispheric focal cortical atrophy and grey- or white-matter high-signal changes and basal ganglion involvement, particularly of the caudate nucleus. OBJECTIVE: To analyse the pattern of involvement of different brain structures in a series of patients with RE and to attempt clinical correlation. MATERIALS AND METHODS: We reviewed the medical records and neuroimaging data of 12 patients diagnosed with RE satisfying the European Consensus Statement diagnostic criteria. RESULTS: The disease manifested as seizures in all patients and was refractory; epilepsia partialis continua was a notable feature (nine patients). Hemiparesis of varying grades was noted in all but one patient; none had extrapyramidal signs. Neuroimaging showed cortical involvement in the insular/periinsular regions in 11 patients. Caudate atrophy was noted in ten patients. Putaminal atrophy was seen in nine patients, six of whom had additional hyperintense signal changes. CONCLUSIONS: Our study highlights frequent putaminal atrophy and signal changes in RE, which suggests a more extensive basal ganglion involvement than emphasized previously. Recognition of putaminal changes may be a useful additional tool in the radiological diagnosis of RE.

Child↗

PubMed2006

A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy.

OBJECTIVE: The objective was to assess the efficacy of a yoga meditation protocol (YMP) as an adjunctive treatment in patients with drug-resistant chronic epilepsy. DESIGN: The design was a prospective, nonrandomized, open-label, add-on trial with a 12-week baseline period, followed by a 12-week supervised YMP administration phase. The frequency of complex partial seizures (CPS) was assessed at 3, 6, and 12 months of the treatment period. SETTING: The setting was a comprehensive epilepsy care center attached to a tertiary referral medical institution situated on the southwest coast of the Indian peninsula. SUBJECTS: The subjects were 20 patients (14 males and 6 females, age range 15 to 47 years, median 27 years) with unequivocally established diagnoses of epilepsy with at least 4 CPS (with or without secondary generalization) during the preceding 3 months. INTERVENTION: Intervention consisted of a YMP 20 minutes twice daily (mornings and evenings) at home, and supervised sessions of a YMP every week for 3 months. Continuation of the YMP beyond 3 months was optional. OUTCOME MEASURE: The outcome measure was the seizure frequency at 3, 6, and 12 months of the treatment period. The subjects with > or = 50% reduction in monthly seizure rate from baseline were classified as responders, and subjects with <50% seizure reduction as nonresponders. RESULTS: At 3 months, a reduction in seizure frequency was noted in all except 1 patient, six of whom had > or = 50% seizure reduction. Of 16 patients who continued the YMP beyond 3 months, 14 patients responded at 6 months; 6 of them were seizure-free for 3 months. All eight patients who continued the YMP beyond 6 months responded; three of them were seizure free for 6 months. CONCLUSIONS: If confirmed through randomized trials involving a larger number of patients, this YMP may become a cost-effective and adverse effect-free adjunctive treatment in patients with drug-resistant epilepsies.

Adolescent↗