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26Th Annual National Conference of the Indian Academy of Neurology

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26Th Annual National Conference of the Indian Academy of Neurology CONFERENCE PROCEEDINGS IANCON 2018: 26th Annual National Conference of the Indian Academy of Neurology SEPTEMBER 27-30 | PANDIT DEENDAYAL UPADHYAY AUDITORIUM, SCIENCE COLLEGE CAMPUS, RAIPUR BILATERAL GREATER OCCIPITAL NERVE BLOCK IN neurogenesis, angiogenesis, immune modulation, neural TREATMENT OF CHRONIC MIGRAINE: EXPERIENCE plasticity, secretion of growth factors, etc. Translation of FROM A MULTISPECIALTY HOSPITAL IN NORTH INDIA these advances into meaningful therapeutic options is required. A meta-analysis was conducted with the aim Dr Ruby Chopra, Bathinda; to assess the effectiveness and safety of cell therapies, Prof Debashish Chowdhury, New Delhi studied as monotherapy in adult patients with stroke Greater occipital nerve (GON) block is the most widely and published in English language. Trials investigating used peripheral nerve block for different primary the use of stem cell therapy in adult patients who had headache disorders. It is cheap, minimally invasive, has experienced a stroke and in any phase from acute to no side effects, is associated with a reasonable duration chronic phase, were included. of pain relief and reduces pill burden and toxicity of Trials investigating combination therapies including abortive and prophylactic medication. There is no stem cells with other therapies were excluded. This Indian data on the use of GON block for treatment of review and meta-analysis provides evidence for the primary headaches. safety, feasibility and preliminary efficacy of cell A study was therefore conducted with patients therapies for stroke. There is substantial heterogeneity attending Neurology OPD from December 2016 to due to differences in stroke type, route of intervention, April 2018 who were diagnosed with chronic migraine timing of intervention, cell types, dose, etc. Further according to ICHD 3b. Response was estimated by progress in this field will require execution of well- reduction in headache days as compared to baseline. designed phase 2/3 clinical trials with high quality. It was categorized as complete (100%) if there was no headache in 1 month after GON block, significant DIFFERENTIATING CLUSTER HEADACHE AND SIDE- (76-99%), moderate (50-75%) and mild (<50%). LOCKED MIGRAINE: A CLINIC-BASED STUDY FROM NORTH INDIA At 1-month follow-up, complete response was noted in 42.7% patients, significant in 13.8% patients, moderate Dr Amit Shankar Singh, Chandigarh; in 18% patient, and mild in 4.2% patients. Twenty out Prof Debashish Chowdhury, New Delhi of 94 patients (21.3%) did not respond. Average time  Although migraine and cluster headache (CH) to develop pain relief after block was 3.5 + 3.18 days are considered 2 different entities with different (range 1-15 days). It was concluded that GON block features, overlap does exist between them. is an effective treatment option in chronic migraine with or without MOH. Presence or absence of OT  Probably the excessive activity of the trigeminal does not affect the response to GON block. Severity autonomic reflex in this subset of migraine patients of pain, duration of migraine history, and presence of is the cause of overlap. comorbid psychiatric disorders do not affect response.  It is possible that they both share a common Side effects are mild and self-limiting. pathophysiological step, probably a functional alteration in hypothalamic or brainstem circuits. STEM CELL THERAPY IN STROKE: A META-ANALYSIS  Similarities between CH and side-locked migraine Dr Amit Kumar, New Delhi (SLM): Side-locked headaches; Comparable severity There are limited therapeutic options available for the of headaches; Common location of headache treatment of stroke, with limited time window. Pre- (orbito-temporal); Throbbing character of pain. clinical research suggests that stem cells potentially  Differences in CH and SLM: Male preponderance modulate multiple pathways involved in endogenous in CH; Duration of attacks - less in CH, more in IJCP SUTRA 702: Fruits and vegetables are rich in antioxidants, which can help ward off diseases. 875 Indian Journal of Clinical Practice, Vol. 29, No. 9, February 2019 SLM; Restlessness (universal in CH); Differences N-METHYL-D-ASPARTATE ENCEPHALITIS - OUR in CAS - Florid ipsilateral CAS in CH in terms of EXPERIENCE WITH DIAGNOSTIC DILEMMAS, severity, consistency and number. CLINICAL FEATURES AND OUTCOME COMPARISON OF EFFICACY AND SAFETY OF Dr SR Chandra, Bengaluru AMITRI PTYLINE WITH GABAPENTIN IN MIGRAINE A total of 29 cases were observed by the team. PROPHYLAXIS: RANDOMIZED DOUBLE-BLINDED Surprisingly, only three were males. Their age group DOUBLE DUMMY TRIAL ranged from 3 to 31 years and the mean age was Dr Satish J Wagh, Puducherry 17 years. Age-wise distribution showed maximum incidence in 12-18 years age group. Referral diagnosis Migraine is a chronic incapacitating neurovascular in the patients ranged from viral encephalitis in five, disorder. In the United States, only 1 in 5 (19.6%) eligible catatonia in six, attention-deficit disorder in two, autism patient currently receives migraine specific preventive spectrum disorder in three, rheumatic chorea in two, care. Both amitriptyline (AMT) and gabapentin (GP) autoimmune encephalitis in five, psychiatric illness are effective in migraine prophylaxis. AMT and GP unspecified in five, rabies in one and schizophrenia in have similar efficacy and side effect profile. Migraine one. prophylaxis does not affect adiponectin levels. Higher responder rates of both drugs indicate that: AMT Of the 29 patients, 20 reported minor respiratory may be re-considered as first-line therapy (presently infection preceding the problem by 4-10 days. One second-line); GP may be evaluated as a novel migraine patient had global developmental delay with congenital prophylactic medication. heart disease, one patient had hydronephrosis that was operated 4 years ago, and one patient was bitten by TRANSITION FROM CHILDHOOD TO ADULTHOOD IN dog and received anti-rabies vaccine 30 days before LENNOX-GASTAUT SYNDROME - COGNITIVE AND symptom onset. All patients had psychiatric symptoms. THERAPEUTIC OUTCOMES Severe mania-like features were seen in one and Dr Nitin K Sethi, New York schizophreniform symptoms in one, severe panic in nine, unexplained anxiety in 11, catatonia in six, mutism in  There are very few well-performed studies. one, biting self and others in one, and delusions and Impairments are not always necessarily permanent. hallucinations in seven. Neurological features observed The outcomes can vary. Babies who have West in patients were hemiplegia and aphasia in one, mutism syndrome and children who have Dravet syndrome in one, seizures in 21, cognitive decline in 29, and chorea (severe myoclonic epilepsy in infancy) usually will in three. have long-term cognitive and behavioral problems. Two patients had benign ovarian teratoma. EEG showed  Lennox-Gastaut syndrome (LGS) also often has a poor prognosis. Children with Landau-Kleffner slowing of background in 23 patients, epileptiform syndrome have a variable prognosis; some regain discharges in nine, and extreme delta brush in 11. MRI speech while others have permanent speech was normal in seven cases. Though reported normal, impairment. Cognitive and behavioral outcome of signal changes in limbic structures were observed in at least some children with these syndromes can be five cases. All others showed clear-cut features of limbic influenced greatly by early effective treatment with encephalitis. None had any other tumors. either antiepileptic medication or surgery. Cerebrospinal fluid (CSF) test showed moderate  Antiepileptic drugs, ketogenic diet, vagus nerve antibody titers with less than 10% of transfected stimulation and epilepsy surgery are effective for cells showing two to three plus granular cytoplasmic seizure control in LGS patients, but not necessarily fluorescence, and serum test showed very high titers of for improvement in cognitive and behavioral up to 40-60% in seven cases, reverse in 12 cases, and outcomes. both were moderately positive in 10 cases.  The cause is more than just seizures (likely During follow-up at 6 months, only two patients underlying genetic causes of cognitive and remained positive in serum test. CSF was not tested behavioral deficits). Multidisciplinary treatment during follow-up. N-methyl-d-aspartate (NMDA) is the need: adult neurologist/epileptologist, antibody-related encephalitis seems to be more neuropsychologist, psychiatrist, social workers, commonly present with a rapid-onset neuropsychiatric special needs school/teachers, family and friends. syndrome in children and young girls. Autonomic 876 IJCP SUTRA 703: A continuous reduced calorie diet is the cornerstone lifestyle intervention to reduce the risk of developing type 2 diabetes and cardiovascular disease in overweight people. CONFERENCE PROCEEDINGS involvement was not seen in this cohort as against the within the red blood cells (RBCs). This abnormal literature. Immunotherapy with a single responsive hemoglobin (HbS) causes distortion of the RBCs drug was sufficient in most of the patients. Majority of (sickling), making them prone to rupture. This patients are left with cognitive behavioral sequelae and leads to anemia (sickle cell anemia) and blocking of hence, high-degree of suspicion is essential for early blood vessels causing tissue damage, especially in diagnosis and treatment. Some of the aggressive and the brain (stroke) and abdomen (crisis). panicky behavior of the patients can even mimic the  Sickle cell anemia primarily affects Africans
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