Pseudoseizures: Any Psychosocial Determinants.

A sample of 80 subjects; 15 male and 65 female in age group of 5 to 45 years well educated; were diagnosed for pseudo-seizures in Neurology OPD and were included in the study. Subjects were excluded who were with any psychiatric or major physical illness. The patients, as the diagnosed case of pseudo seizures, were referred for psychosocial evaluation and were included in the study. Several sessions were held with such patients, their family members and friends to explore the psychosocial stressors as well as secondary gain if any. We observed no significant difference in relation to marital, socioeconomic and educational status among the males and females. But there were significant differences in the findings of the study in relation to the sociodemographic profile of the patients in relation to age, marital status, education and occupation of the patients. Other variables like gender, socio economic status, habitat, religion and family did not reveal any significant difference. These results are in conformity to other reported studies on patients with pseudoseizures, who have a number of stressors i.e. financial burden, family conflicts, marital disharmony, love affairs, disruption in career related issues and academic failure etc.

Uncommon Neurological Presentation due to Non-Ketotic Hyperglycemia (NKH) –Report to two cases.

Two patients of uncommon neurological presentation due to non-ketotic hyperglycemia (NKH) are being described in this report. Generalized choreo-athetosis and epilepsia partialis continua as presenting symptoms in non-ketotic hyperglycemia is rare. The abnormal movements responded completely to insulin therapy. In acute onset of abnormal movements, besides other causes, metabolic disorders such as non-ketotic hyperglycemia should also be ruled out as they are treatable.

Post-traumatic dissecting aneurysms of bilateral cervical carotid arteries with delayed complications.

Carotid dissection is an uncommon complication of trauma. They can present with immediate or delayed complications. We describe the case of a young patient with bilateral carotid dissections and acute infarcts. Brief review of literature and treatment options are discussed.

Hallucinations in Parkinson's disease--a study of forty three patients.

OBJECTIVE: To see the prevalence of hallucinations in patients with Parkinson's disease and to compare the various parameters between hallucinators and non-hallucinators. METHODS: Forty-three patients of Parkinson's disease were included. Detailed motor assessment was done with UPDRS scales. Assessment was done for the presence of depression and sleep disturbances. The patients were enquired for the presence of depression and sleep disturbance. The patients were enquired for the presence of hallucinations. Hallucination types and associated emotional experience were probed into. Comparative analysis was subsequently done between hallucinators and non-hallucinators. RESULTS: The mean age of the patients was 61.47 years while mean duration of symptoms of PD was 4.30 years. The mean UPDRS II and III scores were 15.18 and 38, respectively. Fifteen patients (34.9%) had experienced hallucinations. The hallucinations described were visual as well as auditory in nature. Majority of these patients (12 out of 15, 80%) had not volunteered about their hallucinations on their own. On analysis of various parameters between the hallucinators and non-hallucinators, it was observed that hallucinators were older and had a higher mean duration of symptoms of PD. The patients with hallucinations had a higher severity of motor symptoms and signs. Hallucinators more commonly had depression and sleep disturbances. Mean dosage of L-dopa equivalent dose was higher in patients with hallucinations as compared to those without hallucinations. On statistical analysis, however, only two parameters were found to be different in a statistically significant manner. These were the duration of illness and the Hoen and Yahr scale (p < 0.05). Also, hallucinations occurred independent of dopaminergic drugs. CONCLUSION: Hallucinations are common source of distress but are often neglected. One should always probe actively into the presence of hallucinations.

Botulinum toxin in the treatment of dystonias--a hospital based study.

BACKGROUND: Dystonia is a neurological disorder usually of idiopathic etiology with a wide spectrum of clinical manifestations. The advent of botulinum toxin has revolutionized the treatment of focal dystonias. This study was a prospective long term study to see the efficacy of botulinum toxin in the treatment of dystonias. MATERIAL AND METHODS: There were a total of 215 injection sessions of botulinum toxin during a period of 4 years and 8 months. Patients were evaluated in detail and their severity of dystonias was graded on objective scales. Botulinum toxin injection were administered depending on the type and severity of dystonias. The response to treatment was gauged in terms of latency, and the degree and duration of improvement. The dosages were repeated as and when required, with minimal interval of 3 months. RESULTS: We had a total number of 215 injection sessions, with maximum patient sessions with blepharospasm and hemifacial spasm (59 and 61, respectively). The lowest dosages of botulinum toxin were required for writer's cramps and blepharospasm (92.5 +/- 5.3; and 122 +/- 5.1) while highest dosages were required for generalized and cervical dystonias (512 +/- 10.5; and 452.5 +/- 8.5). The best response in terms of different parameters assessed was seen with blepharospasm and hemifacial spasm while it was lowest for the generalized dystonia group. We did not observe any declining responsiveness to botulinum toxin with repeated injections. The side effects were minimal and self-limiting. CONCLUSION: Botulinum toxin injection is an effective and safe modality for the treatment of disabling dystonias. Cost is one of the major hinderances to its widespread use.

Paradoxical response in patients with CNS tuberculosis.

AIM: To report paradoxical response, i.e. recurrence of appearance of fresh symptoms, physical and radiological signs in a patient who had previously shown improvement with appropriate anti-tubercular medicines. MATERIAL AND METHODS: Ten out of 58 patients of CNS tuberculosis, diagnosed on basis of clinical, laboratory and radiological data that initially showed clinical response to therapy only to deteriorate later were included in the study. RESULTS: Out of ten, three were males and seven were female with age range 13 to 28 years. The duration of time between initiation of therapy and worsening of patient was from one to seven months. Nine out of ten patients developed fresh intracranial tuberculoma while one case otherwise showing improvement developed expansion of tuberculoma and other one of empyema developed tuberculoma while on therapy. All these cases responded to addition of second line therapy or increase in dose of drugs previously prescribed and introduction or increased dose of steroid. CONCLUSIONS: Clinical judgement, regular follow up, guarded reassurance of patient is required to detect parodoxial response in CNS tuberculosis.