Sonal Chitnis

Objective. Although rare, temporal encephalocele is an important causative agent in surgically remediable drug‐refractory epilepsy. The ideal treatment for temporal encephalocele remains unclear with a variety of resective surgeries recommended. Here, we analyse patient data on temporal encephalocele with a view to highlighting diagnostic clues and management strategies.Methods. Comprehensive databases at Deenanath Mangeshkar Hospital, Pune from January 2015 to June 2019 were reviewed for this observational study. Of 107 temporal lobe epilepsy surgery patients, nine individuals with temporal encephalocele were identified, who formed the study cohort. Their clinical, neuropsychological, EEG, imaging and long‐term outcome data were analysed.Results. The study cohort consisted of seven males and two females with a mean age of 22 years. Epilepsy onset age varied from 4.5 to 19 years. Seven patients had focal non‐motor seizures with impaired awareness, while two patients had focal motor ...

INTRODUCTION The present study aims to describe epilepsy surgery outcomes in the pediatric population from a tertiary center in India. METHODOLOGY Children less than 18 years who underwent epilepsy surgery between June 2015 and December 2019 for whom at least a 1-year follow-up was available, were retrospectively evaluated for clinical presentation, radiology, surgical intervention, and seizure outcomes. OBSERVATIONS Out of a total of 355 epilepsy surgeries performed, 242 were in the pediatric group (140 males, 80 females). The mean age at surgery was 9.4 years ±4.8 years (range 4 months-18 years). The mean duration of epilepsy was 5.64 years ±3.91 (range 2 months-17 years). 126 patients experienced daily seizures, 45 weekly and 39 reported monthly seizures. Six had refractory status epilepticus. All the patients were on multiple anti-epileptic drugs (AEDs): the mean number of AEDs was 3.27 ± 0.98 (range 2-7 AEDs). Focal seizure was the most common seizure type seen in 72.27% of children (159/220). The most frequent etiology was focal cortical dysplasia (70), followed by bilateral parieto-temporo-occipital gliosis (48). All the patients underwent standard pre-surgical evaluation. Eleven patients needed stage 2 evaluation (intracranial EEG). The different surgeries performed were electrocorticography (ECOG) and navigation-guided resection (65), anterior temporal lobectomy and hippocampectomy (ATLAH) (48), functional hemispherotomy (39), callosotomy (28), disconnection surgeries (16), and multilobar resection (12). Twelve patients underwent more than one surgery. The patients were followed up between a minimum of 12 months and a maximum of 66 months (median 32 months; IQR 20 months). Engel class 1 outcome was observed in 81.38% in definitive surgeries. Outcomes of temporal lobe (TL) surgeries (92.3%) were better compared to hemispheric (87.17%) and extratemporal lobe (ETL) surgeries (75.32%). We encountered unexpected transient motor deficits in 2 patients and culture-proven meningitis in 8 patients. Post-surgery drug freedom (P-value 0.003) was the most important factor for better developmental, cognitive and behavioral outcomes. CONCLUSION Epilepsy surgeries are safe and seizure outcomes are excellent in properly selected cases with thorough presurgical evaluation. Early referral to a tertiary epilepsy center is needed for timely intervention.

Exploring clinical dementia syndromes is an enigmatic journey, it's more of viewing it from bundle of various clinicoanatomical ,neurophysiological, and pathological aspects rather from a single point of view. Professor Josephs K. 2008 ascertained the same in his review article on Frontotemporal dementia (FTD) and related disorders. As the mortality and morbidity rate is increasing , researchers in the field of cognitive neuroscience are probing important clinical precursors for early diagnosis, various factors contributing risk of developing dementia, and prevention of the same before it's symptoms are evident in the presence or absence of familial clinical history. This challenging work up requires all the medical and health care professionals to be well equipped and updated regarding the complexity of the disease, it's clinical markers, methods of early identification and intervention from the very stage of preclinical symptom to the advanced stages of dementia. Cogni...

The COVID19 pandemic in India is causing significant morbidity and disruptions of healthcare delivery. The rapidly escalating contagion is straining our public health system, which is already under pressure due to a shortage of infrastructure and inadequate workforce. Neuro rehabilitation services that are still in its infancy in our country have been significantly interrupted in the last six months. An expert group from Indian Federation of Neurorehabilitation (IFNR) have formulated the guidelines and consensus recommendations for Neurologists, Physiatrists, and Therapists managing neurological disabilities during COVID 19. The aim of this consensus paper is to sensitize the clinicians and therapists about maintaining the continuum of care and rehabilitation needs of Covid patients as well as non Covid patients with neurological disorders during the ongoing COVID 19 pandemic

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Diagnosing dementia and its clinical classification have always been a challenging topic for medical and healthcare professionals. Medical work up, clinical correlation of cognitive behavioural characteristics and neuroimaging is mainstay of the clinical assessment. Neurological examination, premortem and post mortem neuropathological correlates, genetic analysis along with cognitive linguistic account can facilitate and answer many questions and clinical issues in the assessment of dementia. It also aids in decision making and differential diagnosis of dementia ascertaining future line of treatment. Assessment of neuropsychological, neuropsychiatric, cognitive behavioural attributes in person with dementia (PWD) along with praxis and gnostic skills holistically in accordance with both hemispheric lobar functions becomes an idealistic deal for the clinicians today. Testing verbal, spatial, & social cognition in PWD and remediating the same can be considered as an important as well a...

Presented at National Seminar on Assessment of Neurogenic Communication Disorders: Illustrative Case Studies SRC ISH ,Bangalore India , August 2014


                                                Abstract 
Exploring clinical dementia syndromes is  an enigmatic journey, it’s more of viewing it from bundle of various clinicoanatomical ,neurophysiological, and pathological aspects rather from a single point of view. Professor Josephs K. 2008 ascertained the same  in his review article on  Frontotemporal dementia (FTD) and related disorders.
As the mortality and morbidity rate is increasing , researchers in the field of cognitive neuroscience are probing important clinical precursors for early diagnosis, various factors contributing  risk of developing dementia, and prevention of the same before it’s symptoms are evident in the presence or absence of familial clinical history. This challenging work up requires all the medical and health care professionals to be well equipped and updated regarding the complexity of the disease, it’s clinical markers, methods of early identification and intervention from the very stage of preclinical symptom to the advanced stages of dementia.
Cognitive dysfunction is considered as clinical hallmark of the dementia. one may think of labeling it as an entity of complex cognitive behavioral disorders due pathological aging of  brain.  There is considerable overlap in many patients who present clinical dementia syndrome with  cortical,  subcortical and mixed features. This should not cloud and hinder differential diagnosis among many dementias such as Alzheimer’s disease ( AD) from  Non AD such as FTD, Corticobasal syndrome (CBS) and Cerebrovascular diseases (CVD),etc.
Investigating  and documenting specific type and pattern of cognitive behavioural impairment across multiple domains such as basic cognitive processes, verbal working memory, visuospatial perceptual and constructional memory, anterograde vs retrograde memory  , social pragmatics and other extra linguistic skills in different types of dementias with various etiologies at different stages on larger population across the world can definitely help clinicians correlate and understand complex clinical dementia syndromes.

Again the confirmation of dementia is  based on the clinical picture of  neuroimaging such as MRI, PET/ SPECT,  premortem brain biopsy and postmortem autopsy , and other neurological –neuropsychological, neuropsychiatric findings reported as well as observed.  Few essential clinical findings  such as presence or absence of extrapyramidal features, motor vs sensory impairment, presence of progressive fluent vs. nonfluent aphasia,  ideomotor vs. ideational apraxia, severity of cognitive decline, impaired or preserved  ADL and personality  along with microscopic neuropathological findings. This can further help clinicians classify dementia into cortical vs subcortical or mixed category towards better clinical diagnosis and management.