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Biomedical subjects

M Behari

Publications and source records attributed to M Behari.

At least 19 recordsLinked to original sources
PubMed1999

Motor fluctuations in Parkinson's disease.

OBJECTIVES: To assess patterns, prevalence, and risk factors of motor fluctuations in an unselected population of Parkinson's disease patients attending Movement Disorders Clinic of a tertiary hospital. MATERIAL AND METHODS: Eighty patients with Parkinson's disease were interviewed and data about their clinical characteristics, motor fluctuations, i.e. dyskinesia, dystonia, motor blocks and details of drug therapy, were collected. RESULTS: Forty patients had at least one type of motor fluctuation. Twenty three patients had motor blocks, 20 had dyskinesia and 11 had dystonia. Interval between onset of symptom and start of levodopa therapy and duration of levodopa therapy correlated with presence of motor fluctuations in general and to dyskinesia in particular. Patients with dyskinesia had younger age of onset of disease. Motor blocks showed a positive relationship to duration of disease. CONCLUSIONS: Fifty percent of unselected patients of Parkinson's disease had motor fluctuations after a mean duration of 5 years of illness. Early initiation and longer duration of levodopa therapy were identified as risk factors for motor fluctuations. Younger patients had more risk of developing dyskinesias. Motor blocks were more common in patients with a longer duration of illness.

Adult↗
PubMed1999

Risk factors for thrombosis in nonembolic cerebrovascular disease.

Thirty-seven young patients (less than 42 years of age) presenting with sudden onset of idiopathic nonembolic cerebrovascular disease were evaluated for underlying prothrombotic factors. Activated protein C resistance (APC-R) was measured by Dahlback's method and the modified method using factor V-deficient plasma. Activities of antithrombin (AT) III, protein C and S were measured. Anticardiolipin antibody was estimated by ELISA and lupus anticoagulant by kaolin clotting tests. APC-R was the most common defect (21.62%) followed by AT III deficiency and presence of anticardiolipin antibodies (5.6% each). The latter two were present together in one case. It is thus concluded that APC-R is the most common defect underlying idiopathic nonembolic cerebrovascular infarction in young individuals.

Activated Protein C Resistance↗
PubMed1999

Specific muscle EMG biofeedback for hand dystonia.

Currently available therapies have only limited success in patients having hand dystonia (writer's cramp). We employed specific muscle EMG biofeedback (audio feedback of the EMG from proximal large muscles of the limb that show abnormally high activity during writing) in 10 of 13 consecutive patients (age, 19-62 years; all males) with a duration of illness from 6 months to 8 years. In three patients, biofeedback was not applicable due to lack of abnormal EMG values. Nine patients showed dystonic posture during writing and had hypertrophy of one or more large muscles of the dominant hand. The remaining four patients showed either involvement of small muscles or muscle wasting. Ten patients were given four or more sessions of EMG audio biofeedback from the proximal large limb muscles, which showed maximum EMG activity. They also practiced writing daily with the relaxed limb for 5 to 10 min. Nine patients showed improvement from 37 to 93% in handwriting, alleviation of discomfort, and pain (assessed on a visual analogue scale). One patient did not show any improvement. Thus EMG biofeedback improved the clinical and electromyographic picture in those patients with hand dystonia who showed EMG overactivity of proximal limb muscles during writing. This specific type of EMG biofeedback appears to be a promising tool for hand dystonia and might also be applied to other types of dystonias.

Adult↗
PubMed1999

Botulinum toxin in the treatment of writer's cramp.

BACKGROUND: Writer's cramp is a task specific focal dystonia. The treatment of writer's cramp is very disappointing. AIM: Study the effect of botulinum toxin (BTX) in the treatment of writer's cramp. MATERIAL AND METHODS: Sixteen patients of writer's cramp (15 men, 1 woman) with mean age of 35.75 years and mean duration of symptoms for 3.64 years received 22 treatment sessions of botulinum toxin-A (BTX). All patients were evaluated before, 3 and 12 weeks after BTX therapy on a rating scale from 0-4 for ease of writing, abnormal posture and pain (0 = normal, 4 = very severe disability). The speed of writing was also recorded before and 3 and 12 weeks after therapy. Each patient also gave a global subjective assessment 12 weeks after BTX therapy. RESULTS: Follow up was available after 19 treatment sessions. Significant improvement was seen in all the parameters studied i.e. abnormal posture (p = 0.0039), pain (p = 0.0092), ease of writing of (p = 0.0025) and speed of writing (p = 0.0025). An improvement of 50% or more was observed after 13 treatment sessions. Asymptomatic weakness in the injected limb was seen in all patients but four patients complained of weakness of fingers. The mean onset of improvement was 10.68 +/- 4.32 days and mean duration of effect was 9.47 +/- 5.34 weeks. CONCLUSION: BTX is effective in the treatment of writer's cramp. The draw-backs are short duration of action and prohibitive cost.

Adult↗
PubMed1999

Effect of selegiline on cognitive functions in Parkinson's disease.

BACKGROUND: Selegiline hydrochloride, a selective MAO-B inhibitor is known to improve motor functions in Parkinson's disease (PD). The present study was undertaken to study the effect of selegiline on memory and intelligence of PD patients. MATERIAL AND METHOD: Thirty two patients of PD were divided in two groups: selegiline group (n = 17) received 10 mg selegiline per day and control group (n = 15) did not receive selegiline. Patients receiving trihexyphenidyl and selegiline were excluded. All other treatment remained unchanged. All patients were examined at baseline and after three months for change in UPDRS score, WAIS score, memory test and P300. RESULTS: Patients in selegiline group had less severe disease (UPDRS score 24.11 +/- 14.07) as compared to controls (UPDRS score 40.53 +/- 18.52). There was significant improvement in UPDRS score (p < 0.05), WAIS (p < 0.001) and memory (p < 0.001) in selegiline group. In the control group there was a significant prolongation of P300 latency (p < 0.05). CONCLUSION: The study suggests that selegiline improves memory functions and intelligence in PD patients in addition to motor functions. It also prevents prolongation of P300 latency which is a marker of cognitive function.

Adult↗
PubMed1999

Botulinum toxin A--injection for cervical dystonia.

Spasmodic torticollis or cervical dystonia is the commonest focal dystonia. Botulinum toxin-A (BTX-A) was first used in its treatment in 1985. We are reporting our experience of treating 17 patients of cervical dystonia with 29 treatment sessions of BTX-A. The patients consisted of 13 men and four women with a mean age of 44.17 +/- 16.25 years who had tried medical therapy earlier. All patients had a combination of two or more abnormal postures of neck. Both Botox and Dysport were used as per availability. The mean dose of BTX-A in splenius capitus was 283.3 +/- 59.86 U of Dysport and 61.3 +/- 5.16 U of Botox and in sternocleidomastoid it was 210 +/- 53.47 U of Dysport and 46 +/- 18.97 U for Botox. After BTX-A injection, the response was observed after a mean of 9.7 +/- 5.7 days and the mean duration of effect was 15.56 +/- 7.13 weeks. Significant improvement of dystonia (global rating > or = 2) was seen after 25 of 29 treatment sessions (86%) and of pain was seen after four of five patients. Only three treatment sessions were followed by complications (10.4%) of these two had mild dysphagia and one had mild "flu-like" syndrome. We conclude BTX-A is safe and effective treatment of cervical dystonia.

Adolescent↗
PubMed1997

Multiple sclerosis in India: a case-control study of environmental exposures.

OBJECTIVES: To compare the rate of prior environmental exposures between Indian multiple sclerosis (MS) patients and controls in order to identify potential disease triggering factors. MATERIAL AND METHODS: A standard self-administered questionnaire regarding prior exposures was presented to 56 Indian MS patients and 147 other neural disease and healthy controls at two large medical centers in India. RESULTS: The rate of prior foreign travel, surgeries, blood transfusions, clinical chicken pox and mumps infections and exposure to cats and farm animals was not significantly different between MS patients and controls. However, clinical measles infection and dog exposure occurred significantly more often in the MS patients. CONCLUSION: These findings are consistent with but do not prove an association between prior measles infection, dog exposure and MS.

Adult↗
PubMed1996

Electrophysiological studies in patients with blepharospasm before and after botulinum toxin A therapy.

Botulinum toxin (BTX) is the treatment of choice for blepharospasm. To investigate if the locally injected BTX influences the central nervous system and in particular the brain stem, amplitude and latency of compound muscle action potential (CMAP) of orbicularis oculi, blink reflex and brain stem auditory evoked potential were studied in 12 blepharospasm patients before BTX therapy, 9 patients after BTX therapy and 9 age and sex matched healthy controls. The mean amplitude of orbicularis oculi in patients was significantly lower before BTX therapy (p < 0.05) and after BTX therapy (p < 0.02). The amplitudes of R1, R2 and contralateral R2 (CR) was higher in patients than controls but did not reach statistical significance. Following BTX therapy there was a reduction in amplitude of R1, R2 and CR (p < 0.001) and prolongation of latency of R2 and CR (p < 0.05). The ratio of blink reflex amplitude/CMAP amplitude of orbicularis oculi showed a significant decline after BTX therapy (p < 0.01). This small study suggests the involvement of brain stem pathways following BTX therapy in patients with blepharospasm.

Action Potentials↗
PubMed1996

Evaluation of polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous meningitis.

SETTING: Since conventional bacteriological methods rarely detect Mycobacterium tuberculosis in cerebrospinal fluid (CSF) and are of limited use in the diagnosis of tuberculous meningitis (TBM), clinical features suggestive of TBM supported by indirect evidence such as CSF examination and computerized tomography (CT) of the head have been used for the early diagnosis of TBM. OBJECTIVE: We evaluated the efficacy of polymerase chain reaction (PCR) in the diagnosis of TBM. METHODS: Coded CSF samples from 40 patients with TBM and from 49 patients with other neurological disorders were processed. In the absence of a reliable sensitive and specific test for M. tuberculosis in CSF, we used a set of established clinical criteria as the gold standard. Accordingly, the patients were divided into definite, highly probable, probable and possible TBM. The samples were decoded only after completion of the laboratory tests. RESULTS: PCR was positive in 2/4, 19/20, 13/16 patients with highly probable, probable and possible TBM respectively. None of the samples were positive by conventional bacteriological methods. However, 3/49 CSF samples from non-TBM patients were also found positive by PCR. PCR detected M. tuberculosis genomic DNA in the CSF of 85% of clinically suspected TBM cases and 6.1% of non-tuberculous controls. CONCLUSION: PCR, along with the suggested clinical criteria, offers a rapid and fairly accurate diagnosis of TBM.

Adolescent↗
PubMed1996

Comparison between multiple sclerosis in India and the United States: a case-control study.

The prevalence of MS in India is low, and it is unclear whether the manifestations of the disease in India are similar to the United States. We carried out a case-control study to compare the disease in the two populations and used clinical, evoked potential, and MRI criteria to assess similarities and differences. Our results indicate that the rate of disease progression and frequency of involvement of the cerebral hemispheres, cerebellum, spinal cord, and brainstem were similar in the two populations. The visual system was more frequently involved in Indian patients. No Indian patient had a family history of MS; this suggests an environmental disease-triggering agent.

Adult↗
PubMed1996

Clinical and demographic features of Meige's syndrome.

Fifty five patients with Meige's syndrome were examined for clinical and demographic features. The mean age of onset was 52.3 years. The peak age of onset was in the sixth decade with a male to female ratio of 1.11:1. The mean duration of illness was 3.7 years. Commonest initial symptom was increased blinking, seen in 30 cases (54.5%). Twenty five patients (45.4%) had complete syndrome of blepharospasm with oromandibular dystonia, whereas 24 patients (43.6%) had blepharospasm alone and the rest (6 patients, 10.9%) had oromandibular dystonia. The extension of spasm beyond cranial muscles was observed in 10 patients (18.1%). Eleven patients had family history of dystonia or other extrapyramidal disorders. Incidence of depression was high in these cases.

Adult↗
PubMed1996

Multiple sclerosis in India: A.I.I.M.S. experience.

Fifty patients of multiple sclerosis were reviewed. The commonest initial neurologic symptom was motor weakness (30%) followed by visual impairment (26%). Absence of internuclear opthalmoplegia was noted in addition to the infrequent occurrence of optic nerve involvement and Devic's disease. Evoked potential studies and radiological investigations were in agreement with others series reported.

Adolescent↗