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Ravindra Kumar Garg

Publications and source records attributed to Ravindra Kumar Garg.

11 recordsLinked to original sources
PubMed2004

Prednisolone-responsive headache in patients with solitary cysticercus granuloma and seizures.

BACKGROUND: Solitary cysticercus granuloma is the commonest imaging abnormality in Indian patients with new-onset seizures. Few patients, in addition, complain of disabling headache. OBJECTIVE: To report our experience of 16 patients with new-onset headache, seizures, and solitary cysticercus granuloma. METHODS: Sixteen consecutive patients, who had moderate to severe new-onset headache and fulfilled the diagnostic criteria of solitary cysticercus granuloma, were included in the study. The inclusion criteria were: occurrence of seizures, minimal or no neurologic deficit, absence of papilledema, no evidence of any systemic disorder, and computed tomography showing a single ring/disk-enhancing lesion of <20 mm in diameter. Patients received antiepileptic monotherapy, oral analgesics, and prednisolone (1.5 mg/kg/day for 7 days). Prednisolone was then tapered over the next 7 days. Patients were followed for 6 months. Follow-up computed tomography was performed after 2 months; in all 16 patients, the scans showed complete disappearance of the lesion. RESULTS: After 14 days (at first follow-up), all patients reported significant improvement in headache. Follow-up after 2 months revealed that all patients were headache-free. None of the patients reported any recurrence of headache. CONCLUSION: This open-label study suggests the effectiveness of prednisolone for disabling headache in Indian patients with solitary cysticercus granuloma and seizures. There is a need, however, for more scientifically rigorous studies for further confirmation of our results.

Adult↗
PubMed2004

Diagnostic criteria for neurocysticercosis: some modifications are needed for Indian patients.

In India and other less developed countries the diagnosis of neurocysticercosis is frequently difficult because several other prevalent neurological disorders can present with a similar clinical and neuroimaging picture. Currently available international criteria seem to be helpful for the diagnosis of neurocysticercosis, however, these criteria have been criticized for not being effective in differentiating several other infective and neoplastic diseases of central nervous system (CNS), like CNS tuberculosis, from neurocysticercosis. In this article, modifications in the recent diagnostic criteria given by Del Brutto et al (2001) are being suggested, so, it can become more suitable for Indian patients. In India the overwhelming majority of patients with neurocysticercosis have either single enhancing or less frequently multiple enhancing CT lesions. Imaging and clinical features of various infective conditions, like tuberculoma, fungal granuloma, and parasitic granuloma, and of neoplastic conditions like cerebral metastasis, are remarkably similar. Keeping this in mind, the modification suggested in this article is to replace epidemiological criteria with the section diagnosis of neurocysticercosis with caution in certain situations. These situations are middle or old age, evidence of pre-existing tuberculosis or malignancy, pre-existing HIV infection and in patients with grossly abnormal neurological examination. In these situations, in the absence of one of the absolute criteria, it should be essential to consider and exclude all other likely possibilities before making a diagnosis of neurocysticercosis. However, because of the high prevalence of several disorders with similar features it is difficult to make reliable diagnostic criteria for neurocysticercosis, which are easy to use, and have a high specificity and sensitivity.

Central Nervous System Diseases↗
PubMed2003

Short course of prednisolone in Indian patients with solitary cysticercus granuloma and new-onset seizures.

PURPOSE: To evaluate the role of a short course of oral corticosteroids in Indian patients with solitary cysticercus granuloma with seizures. METHODS: In this open-label, randomized, prospective follow-up study, 97 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either antiepileptic monotherapy alone (n = 48) or antiepileptic monotherapy with prednisolone (n = 49). The patients in the latter group received prednisolone, 1 mg/kg/day for 10 days, followed by tapering over next 4 days. The patients were followed up for 6 months. Repeated CT scans were performed after 1 and 6 months. RESULTS: The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 1 and 6 months demonstrated a significantly better response for prednisolone as far as complete resolution of CT lesion was concerned. Kaplan-Meier analysis suggested significantly less probability of seizure recurrence for prednisolone-treated patients. At 6 months, Kaplan-Meier estimated risk of seizure after first seizure was 2% in prednisolone-treated patients in comparison to 13% for those who were not given prednisolone. CONCLUSIONS: Short-term prednisolone therapy helps in rapid resolution of solitary cysticercus granuloma in Indian patients with new-onset seizures. Resolution of lesions is associated with improved seizure-related prognosis.

Adolescent↗
PubMed2002

Single enhancing computerized tomography-detected lesion in immunocompetent patients.

Single enhancing computerized tomography (CT)-documented lesions may occur in several infectious and neoplastic diseases of the central nervous system and are the most common radiological abnormality seen in patients with acute-onset seizures in India and many other developing countries. Similar CT-documented lesions have also been reported in the developed world where these lesions are often considered to be caused by neoplasms or tuberculoma. Histopathological studies in India and even in some developed countries revealed that neurocysticercosis (NCC) is the most likely cause of these lesions provided they fulfill a rigid set of clinical and radiological criteria. Single cysticercus granuloma measures less than 20 mm in diameter, may be associated with cerebral edema not severe enough to produce midline shift, and occur in patients with seizures, normal neurological status, and no evidence of active systemic disease. When these lesions resolve spontaneously, either disappearing or changing into a calcified nodule, the diagnosis of NCC is very likely. The second most common cause of these CT-detected lesions is tuberculoma; in patients with these lesions similar clinical and neuroimaging features are also present. Few authors believe that in poor and developing countries, where both tuberculosis and NCC are common, it is difficult to differentiate between tuberculoma and a single cysticercal granuloma. The most interesting feature of these solitary enhancing lesions is their spontaneous disappearance within weeks or months. Some lesions "heal" by becoming calcified. These patients require only antiepileptic therapy, and this medication may be withdrawn safely after the lesion has resolved on CT scanning. In several studies provision of anticysticercal drugs has been attempted, but because of conflicting results, their role in the management of these single lesions is uncertain. Neurosurgeons have a very limited role to play. In very rare situations, if the lesion increases in size and if focal neurological deficits manifest or seizures are uncontrolled, a brain biopsy sample may be required and histopathological evaluation performed to establish the correct diagnosis.

Diagnosis, Differential↗
PubMed2002

Refractory epilepsy: diagnosis and management.

Persistence of seizures despite appropriate medical treatment is called refractory epilepsy. Persistent seizures have enormous psychosocial, behavioural and cognitive effects in addition to effects on mortality. Almost 2,40,000 to 3,20,000 patients of refractory epilepsy in India are potential candidates for epilepsy surgery. Causes of refractory or intractable epilepsy are inadequate anti-epileptic treatment, difficulty in treating some epileptic syndromes and difficulty in controlling seizures due to structural brain diseases. Careful evaluation of historical details, especially based on an eyewitness account is the most important aspect in establishing the diagnosis of epilepsy. Raised serum prolactin level helps in differentiating convulsive seizures from non-epileptic convulsions. Video electroencephalographic monitoring is proved effective and efficient mean to establish the rightful diagnosis. Recent developments in neuro-imaging have revolutionised the diagnosis of underlying pathology in patients with refractory epilepsies. Patients with refractory epilepsy should be referred to a specialised epilepsy centre where facilities for epilepsy surgery are available. When medical therapy fails, other options are helpful like use of newer anti-epileptic drugs, vagus nerve stimulation or consideration of epilepsy surgery.

Anticonvulsants↗