Design and Analysis of an SPR Sensor Based on Antimonene and Platinum for the Detection of Formalin.

Detection of formalin to prevent food adulteration, especially in tropical countries, is of primary concern for public health issues. Life-threatening diseases such as leukaemia and lymphoma occur due to the regular consumption of formalin with food. Traditionally, spectrophotometry and chromatography-based sensors have been employed to detect formalin, which have limitations related to their ability to achieve high sensitivity, selectivity, and fast response. In this paper, a surface plasmon resonance (SPR) sensor for improved sensing of formalin is proposed. The Kretschmann configured SPR sensor probe is designed using silver (Ag), platinum (Pt), antimonene, and chitosan, which increases the sensitivity and selectivity. The maximum sensitivity achieved for the proposed SPR sensor is 206.86 °/RIU. The distribution of the electric field (Ey) component of the electric field is also evaluated to analyze the field enhancement at different layer interfaces and to calculate the penetration depth (176.75 nm).

Decoding the Role of Melatonin Structure on Plasmodium falciparum Human Malaria Parasites Synchronization Using 2-Sulfenylindoles Derivatives.

Melatonin acts to synchronize the parasite's intraerythrocytic cycle by triggering the phospholipase C-inositol 1,4,5-trisphosphate (PLC-IP3) signaling cascade. Compounds with an indole scaffold impair in vitro proliferation of blood-stage malaria parasites, indicating that this class of compounds is potentially emerging antiplasmodial drugs. Therefore, we aimed to study the role of the alkyl and aryl thiol moieties of 14 synthetic indole compounds against chloroquine-sensitive (3D7) and chloroquine-resistant (Dd2) strains of Plasmodium falciparum. Four compounds (3, 26, 18, 21) inhibited the growth of P. falciparum (3D7) by 50% at concentrations below 20 µM. A set of 2-sulfenylindoles also showed activity against Dd2 parasites. Our data suggest that Dd2 parasites are more susceptible to compounds 20 and 28 than 3D7 parasites. These data show that 2-sulfenylindoles are promising antimalarials against chloroquine-resistant parasite strains. We also evaluated the effects of the 14 compounds on the parasitemia of the 3D7 strain and their ability to interfere with the effect of 100 nM melatonin on the parasitemia of the 3D7 strain. Our results showed that compounds 3, 7, 8, 10, 14, 16, 17, and 20 slightly increased the effect of melatonin by increasing parasitemia by 8-20% compared with that of melatonin-only-treated 3D7 parasites. Moreover, we found that melatonin modulates the expression of kinase-related signaling components giving additional evidence to investigate inhibitors that can block melatonin signaling.

Malaria parasites and circadian rhythm: New insights into an old puzzle.

•Discuss molecular components for the coordination of circadian rhythm of malaria parasites inside the vertebrate host.•Synthetic indole compounds show antimalarial activity in vitro against P.falciparum 3D7.•Plasmodium falciparum synchronizes in cell culture upon melatonin treatment.

A nanolayered structure for sensitive detection of hemoglobin concentration using surface plasmon resonance.

The objective of the proposed work is to design a biosensor that monitors hemoglobin (Hb) concentration using the combination of nanolayer, i.e., barium titanate (BaTiO3) and antimonene based on surface plasmon resonance (SPR) technique. Antimonene is used here as bio-recognition element (BRE) layer to attach the Hb analyte through physical adsorption due to its hydrophilic nature, higher adsorption energy and larger active surface area. The use of BaTiO3 adlayer (7 nm) just before antimonene is to enhance the refractive index (RI) sensitivity up to 1.90 times for the proposed SPR biosensor. The reason behind sensitivity enhancement is its high dielectric constant which enhances the electromagnetic field with in analyte medium. The performance of the biosensor is demonstrated with performance parameters namely sensitivity, detection accuracy (DA), figure of merit (FOM) and resolution. The proposed biosensor has potential to achieve much higher performance in terms of RI sensitivity of 303.83°/RIU, FOM of 50.39 RIU-1 and resolution of 0.021 g/l in comparison with reported biosensors in the literature for detection of Hb concentration. Thus, based on the obtained results one can say that the proposed work unlocks a reliable sensing in the field of medical science to detect hemoglobin-related diseases in human being.

Role of Melatonin in the Synchronization of Asexual Forms in the Parasite Plasmodium falciparum.

The indoleamine compound melatonin has been extensively studied in the regulation of the circadian rhythm in nearly all vertebrates. The effects of melatonin have also been studied in Protozoan parasites, especially in the synchronization of the human malaria parasite Plasmodium falciparum via a complex downstream signalling pathway. Melatonin activates protein kinase A (PfPKA) and requires the activation of protein kinase 7 (PfPK7), PLC-IP3, and a subset of genes from the ubiquitin-proteasome system. In other parasites, such as Trypanosoma cruzi and Toxoplasma gondii, melatonin increases inflammatory components, thus amplifying the protective response of the host's immune system and affecting parasite load. The development of melatonin-related indole compounds exhibiting antiparasitic properties clearly suggests this new and effective approach as an alternative treatment. Therefore, it is critical to understand how melatonin confers stimulatory functions in host-parasite biology.

Discovery of Marinoquinolines as Potent and Fast-Acting Plasmodium falciparum Inhibitors with in Vivo Activity.

We report the discovery of marinoquinoline (3 H-pyrrolo[2,3- c]quinoline) derivatives as new chemotypes with antiplasmodial activity. We evaluated their inhibitory activities against P. falciparum and conducted a structure-activity relationship study, focusing on improving their potency and maintaining low cytotoxicity. Next, we devised quantitative structure-activity relationship (QSAR) models, which we prospectively validated, to discover new analogues with enhanced potency. The most potent compound, 50 (IC503d7 = 39 nM; IC50K1 = 41 nM), is a fast-acting inhibitor with dual-stage (blood and liver) activity. The compound showed considerable selectivity (SI > 6410), an additive effect when administered in combination with artesunate, excellent tolerability in mice (all mice survived after an oral treatment with a 1000 mg/kg dose), and oral efficacy at 50 mg/kg in a mouse model of P. berghei malaria (62% reduction in parasitemia on day 5 postinfection); thus, compound 50 was considered a lead compound for the discovery of new antimalarial agents.

Association of Polymorphism of Neuronal Nitric Oxide Synthase Gene with Risk to Parkinson's Disease.

Environmental factors are implicated in aging as well as genetic predisposition-induced Parkinson's disease (PD) pathogenesis. Wrongdoers increase oxidative stress and nitrosative burden, which eventually degenerate the nigrostriatal dopaminergic neurons. Inhibition of the expression of nitric oxide synthase (NOS), an enzyme responsible for nitric oxide (NO) biosynthesis, prevents the demise of the nigrostriatal dopaminergic neurons. Polymorphism of NOS is thus expected to alter PD susceptibility. The study therefore aimed to examine an association of neuronal NOS (nNOS) gene polymorphism with nitrite, an indicator of nitrosative load; lipid peroxidation, an index of oxidative stress and PD susceptibility. An age-matched case-control study was performed in the north Indian residents enrolled at the Neurology Department of the King George's Medical University, Lucknow, India. While nNOS exon 29 TT variant genotype [odds ratio (OR) = 2.20, 95 % CI = 1.08-5.34, P = 0.040], combined TT and CT variants [OR = 1.68, 95 % CI = 1.05-2.69, P = 0.031] and T allele [OR = 1.58, 95 % CI = 1.10-2.28, P = 0.014] were found to be significantly associated with PD susceptibility, no association between nNOS exon 18 [OR for TT carriers = 1.97, 95 % CI = 0.89-4.20, P = 0.09 and OR for T allele = 1.35, 95 % CI = 0.94-1.93, P = 0.098] and PD risk was observed. Lipid peroxidation was augmented in all patients irrespective of their genotype. While genotype independent increase in nitrite content was observed in PD patients of exon 29 polymorphic groups, only heterozygous variant genotype of exon 18 was associated with augmentation in nitrite level as compared with respective control. The results obtained thus demonstrate that selected nNOS polymorphisms do not significantly contribute to PD risk in north Indian population.

Giant malignant peripheral nerve sheath tumor with cauda equina syndrome and subarachnoid hemorrhage: Complications in a case of type 1 neurofibromatosis.

Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache. He had a weakness in both legs, could walk only with the support of a stick for the last 3 months and suffered from constipation and intermittent urinary retention for the past 1 week. The patient had a history of swelling in the back of left thigh for which surgical resection was done 6 months back. Cutaneous examination revealed multiple nodules of varying sizes all over the body, along with many café-au-lait spots and Lisch nodule in iris. Patient had weakness in bilateral hip abduction, extension, knee flexion, extension and ankle dorsiflexion and plantiflexion. Bilateral ankle reflexes were absent while other deep tendon reflexes were sub-optimal. A noncontrast computed tomography brain indicated subarachnoid hemorrhage in left perisylvian region. Ultrasound of left thigh showed a hypoechoic solid lesion in the posterior aspect of left thigh in muscle plane. Histopathology of the lesion following resection showed features suggestive of a low-grade pleomorphic rhabdomyosarcoma. Histology of cutaneous nodules was consistent with neurofibroma. Magnetic resonance imaging of the lumbosacral spine demonstrated a tumor arising from cauda equina. Histopathological examination of the tumor suggested high-grade MPNST. Unfortunately, the patient's MPNST was inoperable, and he received palliative radiotherapy for local control of the disease. The care of a patient with neurofibromatosis requires a comprehensive multisystem evaluation. MPNST occurs in 8-13% patients with neurofibromatosis. Early diagnosis and surgical resection are key to prolong survival. Though rare, rhabdomyosarcoma can occur with a higher frequency in NF1, necessitating through clinical investigation. Subarachnoid hemorrhage can occur due to aneurismal rupture or vascular friability in NF1 patients.

Single dose intravenous methyl prednisolone versus oral prednisolone in Bell's palsy: a randomized controlled trial.

OBJECTIVES: Corticosteroids have been used in the treatment of Bell's palsy and several other postinfectious neurological conditions. We hypothesized that administration of a single dose of intravenous (IV) methylprednisolone might be an effective alternative to oral prednisolone. MATERIALS AND METHODS: In this open label, randomized trial, patients with acute Bell's palsy were randomized into two groups. One group received single dose (500 mg) of IV methylprednisolone while the other group received 10 days of oral prednisone. Outcome was assessed at 1 and 3 months with House-Brackmann scale. RESULTS: At 3 months, 93 (79.48%) patients had completely recovered. IV methylprednisolone and oral prednisolone groups had similar recovery rates (80% vs. 78.33%, P > 0.05). Patients with Grade 2 and 3 recovered completely. In patients with Grade 6, the recovery rate was 20%. A better outcome was observed if corticosteroids were administered within 3 days of onset of palsy. CONCLUSION: Intravenous methylprednisolone and oral prednisolone showed equivalent benefit in patients with acute Bell's palsy.

Seizures in patients with cerebral hemiatrophy: A prognostic evaluation.

PURPOSE: Cerebral hemiatrophy is a common childhood disease. It clinically manifests with seizures, hemiparesis and mental retardation. MATERIALS AND METHODS: In this prospective study, previously untreated patients with seizures and cerebral hemiatrophy were recruited. Cerebral hemiatrophy was diagnosed on the basis of hemispheric ratio. Patients with acquired hemiconvulsion, hemiplegia, and epilepsy (HHE) syndrome were included in group A. Group B included patients with congenital HHE syndrome. Patients were followed up for 6 months for seizure recurrence. RESULTS: Out of 42 patients 26 were in group A and 16 were in group B. After 6 months, there was significant reduction in seizure frequency (P < 0.0001) in both the groups. At least 50% reduction in seizure frequency was noted in all the patients. Complete seizure freedom was observed in 15 (35.7%) patients. Seizure recurrences were significantly higher (P = 0.008) in group A. On univariate analysis, predictors of seizure recurrences were history of febrile seizures (P = 0.013), hippocampal sclerosis (P = 0.001), thalamic atrophy (P = 0.001), basal ganglia atrophy (P = 0.001), cerebellar atrophy (P = 0.01), ventricular dilatation (P = 0.001), epileptiform discharges at presentation (P = 0.023), complex partial seizures (P = 0.006) and status epilepticus (P = 0.02). On multivariate analysis, hemispheric ratio was the only significant factor for seizure recurrence. CONCLUSION: Patients with congenital hemiatrophy had better seizure control than that in patients with HHE syndrome.

Cerebrospinal fluid cytokines and matrix metalloproteinases in human immunodeficiency seropositive and seronegative patients of tuberculous meningitis.

BACKGROUND: Some important clinical differences exist between human immunodeficiency virus (HIV)-seropositive and HIV-seronegative patients. Alterations in the cerebrospinal fluid (CSF) cytokines and matrix metalloproteinase have been noted in tuberculous meningitis. In HIV-infected patients, the immunopathogenesis is expected to be different. MATERIALS AND METHODS: In this study, 64 patients of tuberculous meningitis (28 HIV seropositive and 36 seronegative) were included. The patients were followed up for six months. Cerebrospinal fluid (CSF) samples of tuberculous meningitis patients and 20 controls were subjected to tissue necrosis factor (TNF)-α, interleukin (IL)-1ß, interferon (IFN)-γ, IL-10, matrix metalloproteinase (MMP)-2, and MMP-9 estimations. The levels were correlated with the patients' baseline clinical characteristics, CSF parameters, neuroimaging findings, and the outcome. The outcome was assessed and modified with the Barthel index. RESULTS: The CSF cytokines and MMP levels were significantly elevated in tuberculous meningitis when compared with the controls. There was no significant difference seen between HIV seropositive and seronegative tuberculous meningitis, except for the IL-1ß level, which was significantly lower in the HIV-infected patients. The cytokine and MMP levels did not correlate with the baseline clinical characteristics, disease severity, cerebrospinal fluid characteristics, neuroimaging findings, and outcome. CONCLUSION: In conclusion, HIV infection did not affect a majority of the CSF cytokines and MMP levels in tuberculous meningitis except for IL-1ß level. None of the estimated inflammatory parameters correlated with the outcome.

Acute confusional state/delirium: An etiological and prognostic evaluation.

INTRODUCTION: Acute confusional state/delirium is a frequent cause of hospital admission, in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. MATERIALS AND METHODS: In this retrospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 52 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery blood biochemical examination, cerebrospinal fluid analysis and neuroimaging. Disability was assessed by using modified Barthel index (MBI). Patients were followed-up for 3 months. RESULTS: The mean age of our cohort was 65.04 ± 10.6 years. 32 (61.5%) patients were male. In 33 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. The mean duration of the hospital stay was 10.73 ± 3.6 days (range 5-21 days). Patients with an abnormal work-up (possible precipitating cause) had significantly lower mortality, less duration of hospital stay and less severe disability after 3 months. Age, underlying illness, serum creatinine, abnormal neuroimaging and MBI were identified as a significant prognostic indicator. 18 (34.6%) of our patients died, of these in 10 patients we could not find a precipitating cause. CONCLUSION: Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay.

Diffusion tensor tractography and neuropsychological assessment in patients with vitamin B12 deficiency.

INTRODUCTION: Structural imaging of the brain does not demonstrate any changes in a vast majority of patients with vitamin B12 deficiency, even in advanced stages. In this study, we aimed to assess and correlate the functional integrity of the brain fiber tracts using diffusion tensor tractography with neuropsychological examination in patients with vitamin B12 deficiency. METHODS: The study was conducted at two tertiary care centers. Thirty-two patients with vitamin B12 deficiency were enrolled and subjected to diffusion tensor tractography, as an extension of diffusion tensor imaging, and neuropsychological assessment. Tests of significance were done to detect changes, pre- and post-vitamin B12 supplementation in the diffusivity parameters (fractional anisotropy and mean diffusivity) and the neuropsychological test scores. RESULTS: Statistically significant changes were observed in the diffusivity parameters and the neuropsychological test scores between the controls and the patients with vitamin B12deficiency in the pre- and post-treatment phases. CONCLUSIONS: This is the first study to evaluate the diffusion tensor tractography (DTT) parameters in the light of clinical neuropsychological assessment in patients with vitamin B12 deficiency. Utilization of DTT parameters may antedate structural changes and may quantify the neurocognitive deficits.

Focal neuromyotonia as a presenting feature of lumbosacral radiculopathy.

Neuromyotonia is characterized by motor, sensory, and autonomic features along with characteristic electrophysiologic findings, resulting from hyperexcitability of the peripheral nerves. We describe the case of a 36-year-old man, who presented with the disabling symptoms suggestive of focal neuromyotonia involving both the lower limbs. His neurological examination revealed continuous rippling of both the calf muscles with normal power, reflexes, and sensory examination. Electrophysiology revealed spontaneous activity in the form of doublets, triplets, and neuromyotonic discharges along with the neurogenic motor unit potentials in bilateral L5, S1 innervated muscles. Magnetic resonance imaging lumbosacral spine revealed lumbar intervertebral disc protrusion with severe foraminal and spinal canal stenosis. Patient had good response to steroids and carbamazepine. The disabling focal neuromyotonia, occurring as a result of chronic active radiculopathy, brought the patient to medical attention. Patient responded to medical management.

Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients.

BACKGROUND: Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis. MATERIALS AND METHODS: We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability. RESULTS: In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn's syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover. CONCLUSION: In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.

Evaluation of cerebral white-matter micro-structural alterations in patients with medically refractory epilepsy using diffusion tensor tractography.

INTRODUCTION: Diffusion tensor tractography (DTT) is a newer magnetic resonance imaging (MRI) technique that helps in evaluation of white matter. Presurgical planning with tractography may be valuable for evaluation of white matter tracts and their relationship with epileptogenic focus and for evaluation of cortical fibres around the epileptogenic zone. METHODS: This study was carried out on 33 patients diagnosed with medically refractory epilepsy (males, 27; females, 6) with a mean age of 31.93 (range: 19-50) years. Twenty age and sex matched controls were also included. DTT evaluation was done using a 3.0 TexlaMRI scanner. Single-shot spin-echo echo-planar imaging (with 32-different diffusion gradient directions) was acquired for reconstruction of the white matter tracts. Diffusion metrics within fibre bundles that were reconstructed by a continuous fibre-track algorithm were compared between groups. RESULTS: Patients had either partial seizures (21 patients; simple partial, complex partial or secondarily generalized seizure) or generalized seizures (12 patients; tonic clonic, tonic or myoclonic). Out of the 33 patients, 23 patients were classified into the lesional group and the rest into the non-lesional group. The lesions observed on conventional MRI included focal gliosis, hippocampal sclerosis, post-hypoxic encephalopathy, calcification and post-traumatic cavitation, in various parts of the brain. Significant differences were observed in terms of fractional anisotropy and mean diffusivity values amongst controls and patients, as well as on the lesional and non-lesional side of the brain; patients with a normal conventional imaging showed fractional anisotropy and mean diffusivity changes as well. CONCLUSION: We conclude that widespread diffusion abnormalities occur in the white matter tracts on the side of lesion as well as distant from the epileptic focus.

Evaluation of prognostic factors in medically treated patients of spinal tuberculosis.

This study was aimed to determine the prognostic factors in medically treated patients of spinal tuberculosis. In this longitudinal observational study, from July 2010 to December 2011, 70 consecutive patients (40 males and 30 females) spinal tuberculosis were enrolled. Diagnosis of spinal tuberculosis was based on characteristic clinical and neuroimaging features. Diagnosis was histopathologically and/or bacteriologically verified. Patients received antituberculous treatment as per World Health Organization guidelines and were followed for 6 months. Disability was evaluated with modified Barthel index (MBI). Outcome was defined as good (MBI > 12) and poor (MBI ≤ 12). Various clinical and neuroimaging parameters, likely to affect the outcome, were analyzed using univariate and multivariate analysis. After 6 months, 45 patients had a good outcome, while 25 patients had a poor outcome. On univariate analysis, duration of illness >6 months (OR 0.062, CI 0.018-0.212), bladder involvement (OR 0.102, CI 0.033-0.317), spinal deformity (OR 0.050, CI 0.013-0.196), spastic paraparesis (OR 0.572, CI 0.190-1.723), and flexor spasms (OR 0.077, CI 0.021-0.280) were found as important clinical predictors of poor outcome. Involvement of more than 2 vertebrae (OR 0.095, CI 0.028-0.328), complete collapse (OR 0.072, CI 0.022-0.241), cord compression (OR 0.025, CI 0.003-0.204), spinal extension of the abscess (OR 0.044, CI 0.005-0.350), and thick/septate abscess wall (OR 0.062, CI 0.016-0.240) were the neuroimaging parameters associated with poor prognosis. However, on multivariate analysis, duration of illness >6 months (Exp-b 0.086, CI 0.019-0.378), cord compression (Exp-b 0.035, CI 0.003-0348), and spinal extension of the abscess (Exp-b 0.109, CI 0.017-0.91) were significant. Medical management results in clinical improvement in a majority of the patients of spinal tuberculosis. Duration of illness >6 months, cord compression, and spinal extension of abscess are associated with poor outcome.

Seizure recurrence in patients with solitary cystic granuloma or single parenchymal cerebral calcification: a comparative evaluation.

BACKGROUND: Solitary cysticercus granuloma and single parenchymal calcified lesion are two common neuroimaging abnormalities in Indian patients with epilepsy. In this study, we evaluated the frequency and predictors of seizure recurrence in patients presenting with new onset epilepsy or single epileptic seizures and these two different imaging findings. MATERIALS AND METHODS: We enrolled 115 patients with newly diagnosed epilepsy. All patients were clinically evaluated and were treated with oxcarbazepine. No anti-helminthic treatment was prescribed. The patients were followed up for 6 months. In the solitary cystic granuloma group, repeat computed tomography was done after 6 months. RESULTS: The study included 80 patients with solitary cysticercus granuloma and 35 patients with a single calcified lesion. Twenty (25%) patients with solitary cysticercus granuloma and 12 (34.3%) patients with parenchymal calcified lesion had a seizure recurrence during the study period (p = 0.307). After 6 months, 57 (71.3%) patients in the solitary cysticercus granuloma group demonstrated complete resolution of the granuloma and in 21 (26.2%) patients the granuloma transformed into a calcified lesion. In the solitary cysticercus granuloma group, a family history of seizure, serial seizures and calcification on follow-up neuroimaging (p < 0.05) were significantly associated with recurrence of seizures. In patients with a single parenchymal calcified lesions, electroencephalographic abnormalities and serial seizures (p = < 0.05) were significant predictors of recurrence. Kaplan-Meier statistics revealed that the seizure recurrence rate was insignificantly higher in patients with calcified lesions than in patients with solitary cysticercosis granulomas. CONCLUSION: In conclusion, in patients with solitary cysticercus granuloma, a family history of seizures, serial seizures and calcification of the granuloma, and in patients with a calcified brain lesion, electroencephalographic abnormalities, family history of epilepsy and serial seizures were associated with an increased risk of seizure recurrence.

Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies.

BACKGROUND: Vitamin B12 deficiency is a well recognized cause of posterolateral myelopathy. In Indian subcontinent, it may coexist with nutritional copper deficiency producing partial response of patients to B12 supplementation. Hence the study was planned to look for association of hypocupremia and B12 deficiency. METHODS: Twenty-three patients with posterolateral myelopathy (Romberg sign positive) were enrolled and investigated for levels of vitamin B12, copper and zinc and followed up for six months. RESULT: In three patients, copper deficiency alone was found to be the cause. In another three, both copper and vitamin B12 were deficient. In all these six patients, ceruloplasmin and 24h urinary copper were found to be low suggesting dietary copper deficiency. Hyperzincemia was found in four of these patients. Magnetic resonance imaging of spine was normal in lone Cu deficient patients but showed T2 hyperintensity of posterior column in lone B12 or combined B12 and copper deficiency. CONCLUSION: In cases of B12 deficiency myelopathy not responding to supplementation, copper deficiency must be sought at the earliest to avoid and treat persistent neurological disability.