Association Between Benign Positional Vertigo and Migraine in Indian Population.

Benign positional vertigo (BPV) occurs when freely floating otoconia which are normally attached to the utricular macula, enter the posterior semicircular canal and move under the influence of gravity. It is the most common cause of peripheral vertigo. Migraine is a common headache disorder which is characterized by hemicranial, throbbing pain and may be preceded by aura. The relation between vertigo and migraine is intriguing and in day to day practice, often not clear. 100 diagnosed patients of BPV, aged more than 20 years, were evaluated for presence of headache specifically migraine based on International Headache Classification 3rd Edition, beta version. We also compared the success of epley's manoeuvre in patients having BPV & headache as compared to patients with complaints of vertigo alone. Overall seventy-four patients had successful epley's manoeuver and the rest did not show improvement even after four trials. Thirty-four patients reported headache and migraine was diagnosed in only ten patients. 67.6% of patients with headache had successful epley's maneuver however fifty-one of the 66 patients without headache had successful epley's manoeuver. Prevalence of migraine was only 10% in patients with BPV in our population and we observed that presence of headache does not suggest success or failure of epley's manoeuvre.

Is Depression Related to Low Folate Levels in People with Epilepsy? An Observational Study and Meta-analysis.

BACKGROUND: Both depression and low serum levels of folate are common in people with epilepsy (PWE), the latter especially in patients on hepatic enzyme-inducing antiepileptic drugs (AEDs). We did a cross-sectional study and a meta-analysis to assess if lower folate levels have any relation with depression in PWE. MATERIALS AND METHODS: Two hundred and one PWE were recruited and assessed for depression using the Inventory of Depressive Symptomatology-Self-Rated (IDS-SR) and Inventory of Depressive Symptomatology-Clinician Rated; serum folate levels were measured in them at the same time. Literature search was carried out and studies with data on depression as well as folate levels in PWE were included. Statistical analysis to determine frequency of depression, low folate levels, and relation between them among our cases and the pooled data from the included studies was done. RESULTS: Depression was observed in 65.68% and low serum folate (<4 ng/ml) in 48.75% of PWE (over 80% on older AEDs); there was no statistically significant correlation between them. However, on analyzing the pooled data of six studies including the present, the Fisher's z-transformed correlation coefficient was -0.1690 (95% confidence interval [-0.3175, -0.0124], P = 0.0464). CONCLUSIONS: Depression and low folate levels are common in PWE. Low folate levels have a mild but significant negative correlation with depression in this population, and folate supplementation would be advisable for those on the older AEDs.

Cardiac arrhythmia in Wilson's disease: An oversighted and overlooked entity!

Wilson's disease is a multisystem disorder which manifests with hepatic, neurological, musculoskeletal, hematological, renal, and cardiac symptoms. The hepatic and neurological manifestations often overshadow the other system involvement including cardiac symptoms and signs, which may prove fatal. We report a case of a young female who presented with progressive parkinsonian features and dystonia for around 4 months followed 2 months later by the complaint of episodes of light-headedness. She was diagnosed to have Wilson's disease based on the presence of Kayser-Fleischer ring and laboratory parameters of copper metabolism. Electrocardiography of the patient incidentally revealed 2nd degree Mobitz type-1 atrioventricular block explaining her episodes of light-headedness. She was started on penicillamine and trihexyphenidyl. The heart block improved spontaneously. Cardiac autonomic function tests including blood pressure response to standing and heart rate response to standing were observed to be normal. We review the literature on cardiac manifestations of Wilson's disease and emphasize that patients with Wilson's disease should be assessed for cardiac arrhythmia and cardiac dysfunction as these may have therapeutic and prognostic implications.

Impact of sleep quality on the quality of life of patients with Parkinson's disease: a questionnaire based study.

OBJECTIVE: Poor sleep quality contributes to the inferior quality of life of patients with Parkinson's disease (PD) despite appropriate treatment of motor symptoms. The literature about the impact of sleep quality on quality of life of patients with PD is as yet sparse. MATERIAL AND METHODS: One hundred patients of PD diagnosed as per UK Brain Bank criteria were assessed for severity and stage of PD using UPDRS and modified Hoehn &Yahr scales. The quality of sleep was assessed by Pittsburgh Sleep Quality Index and excessive daytime somnolence (EDS) was evaluated using Epworth Sleepiness Scale. Parkinson's Disease Questionnaire -39 (PDQ-39) was used to determine quality of life of the patients. Comorbid depression and anxiety were assessed using Inventory of Depressive Symptoms-Self Rated and Hamilton Anxiety Rating Scale. Pearson's correlation and multiple linear regressions were used to analyze relation of sleep quality with quality of life of patients. RESULTS: Fifty patients had poor sleep quality. EDS was present in only 9 patients. Co-morbid depression and anxiety were present in 52 and 34 patients respectively. While the motor severity assessed by UPDRS-III was observed to adversely affect quality of life, it did not negatively impact quality of sleep. Higher score on UPDRS-total and UPDRS IV suggesting advanced disease correlated with poor sleep quality. Depression and anxiety were significantly more frequent in patients with poor sleep quality (p<0.01). Patients with poor sleep quality had worse quality of life (r=0.338, p<0.05). Depression and anxiety were also observed to have significant negative impact on quality of life of PD patients (p<0.01). Poor sleep quality was not found to be an independent predictor of quality of life using multiple linear regression analysis. CONCLUSION: Poor sleep quality along with comorbid depression, anxiety and advanced stage of disease is associated with poor quality of life.

Primary angiitis of central nervous system: The story of a great masquerader.

Primary angiitis of central nervous system (PACNS) is characterized by non-caseating granulomatous angiitis restricted to CNS. The condition often masquerades as migraine, stroke, epilepsy, dementia, demyelinating disorder and CNS infection. The protean manifestations frequently lead to misdiagnoses. We present a case of a young male from rural background that remained undiagnosed for years as the possibility of PACNS was not considered. He had history suggestive of migraine-like headaches followed by seizures. Subsequently, he developed rapidly progressive dementia and two episodes of hemorrhagic strokes over a short period. The diagnosis was finally clinched by the absence of evidence of systemic vasculitis and the presence of characteristic non-caseating granuloma around vessels of duramater and cerebral parenchyma on brain biopsy. He was started on pulse therapy with intravenous cyclophosphamide and methylprednisolone. The current literature about the condition and its management is reviewed in this report.

Etiological beliefs of patients with neurological disorders attending a tertiary care center: A cross-sectional study.

BACKGROUND: The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed. AIM: To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal. MATERIALS AND METHODS: One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers. RESULT: Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having 'no idea' about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and 'jadu tona' topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers ('Dhami Jhakri') before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in 'jadu-tona'. Of those interviewed, 16% were planning to go to a faith healer in near future. CONCLUSION: The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.