Bindu Menon

Oxidative stress in patients with epilepsy is independent of antiepileptic drugs

PURPOSE Oxidative stress has been implicated in many pathological processes. The brain is highly susceptible to oxidative stress because of its high lipid content. In this study, the oxidative parameters in patients with epilepsy and those of a control group were measured. The studys aim was to determine whether there are differences between the oxidative levels of treated and untreated patients and whether there are differences between individual antiepileptic drugs. METHODS Oxidative parameters such as Malondialdehyde (MDA), Protein Carbonylation (PC) and Nitric Oxide (NO) levels were evaluated in 100 patients with epilepsy and compared to an equal number of age and sex matched healthy subjects. In the study group, the oxidative parameters of 25 untreated patients were compared to treated patients and the control group. The treated patients were divided into 2 groups based on their antiepileptic drugs (AEDs). Group 1 consisted of patients on a single AED, and group 2 was composed of patients taking more than one AED. A comparative study was performed on the oxidative parameters of medicated patients on single drug regimens and multidrug regimens. RESULTS The MDA and PC levels were significantly higher in patients than in the control group (P<0.0001). However, there was no significant difference in the NO levels of patients and those of the control group. The 25 untreated patients had higher MDA and PC levels compared to both the control group (P<0.0001) and treated patients (P<0.0001). There was no difference in the oxidative levels between untreated patients and treated patients, group 1 and group 2, and individual AEDs. CONCLUSIONS In this study, we demonstrated the presence of significantly increased levels of oxidative markers in patients with epilepsy as compared to the control group. AEDs did not influence the oxidative markers, suggesting the presence of seizure-induced oxidative stress.

The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism—A longitudinal study

BACKGROUND Chronic antiepileptic drug use is associated with bone loss. We sought to assess the longitudinal effect of antiepileptic drug on serum 25-hydroxyvitamin D [25(OH)D] levels and bone mineral metabolism markers. METHODS Patients in the emergency services or those in neurology outpatient department with history of seizure were characterized and included in the study prospectively. Daily dietary intake of calories, calcium, phosphorus and phytates were characterized by dietary recall method. Base line bone mineral parameters - serum calcium, phosphorus, alkaline phosphatase (SAP), tartrate resistant acid phosphatase (TRACP), 25(OH)D levels, parathyroid hormone (PTH) and urinary calcium creatinine ratio (Ca.Cr), urinary calcium/kg/bodyweight (BW) and phosphate excretion index (PEI) were determined. Patients on AED therapy with normal 25(OH)D levels were followed up and were re-evaluated at the end of 6 months. RESULTS The daily dietary calcium intake of the subjects was lower than the RDA (Recommended Dietary Allowance) by ICMR (Indian Council of Medical Research). The diet was high in phytates. Two-thirds of the recruited subjects were vitamin D deficient. Subjects with normal 25(OH)D levels at base line showed a significant fall of 25(OH)D levels, urinary calcium, urinary calcium/kg/BW and TRACP levels at the end of 6 months irrespective of the AED used or the plasma level of AED. CONCLUSIONS Hypovitaminosis D is common in our population. Subjects with normal 25(OH)D levels, irrespective of the type of antiepileptic medications even at sub-therapeutic serum levels of the drug, went into 25(OH)D deficiency and insufficiency states. Theoretically it can be worthwhile to supplement calcium and vitamin D even before initiation of antiepileptic therapy.

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Background and Objective: The objective of our study was to describe risk factors, mechanisms and outcome of young Asian women with ischemic stroke. Methods: Twelve tertiary-care centers in 8 Asian countries participated. Women aged 15–45 years were included if they had an ischemic stroke supported by neuroimaging. Data on age, risk factor history, stroke mechanism and discharge status were collected. Results: A total of 958 subjects were included, their mean age was 34 years. Large-vessel thrombosis comprised 24%, cerebral venous thrombosis 21%, cardioembolism 19% and small-vessel thrombosis 15%. The stroke risk factors included hypertension (29%), diabetes (14%), pregnancy (11%), valvular heart disease (10%) and cigarette smoking (3%). Anemia was found in 42%, and mortality was 4%; at discharge, 17% had modified Rankin score (mRS) >4 and 83% mRS 0–3. Conclusion: Unlike among Caucasians, large-vessel thrombosis, cerebral venous thrombosis and cardioembolism are common among young Asian women with stroke. A high proportion are pregnancy-related. More studies are needed.

Prevalence and characteristics of migraine in medical students and its impact on their daily activities

Background: Migraine is a common neurological disorder with significant impact on quality of life. The aim of this study was to investigate the prevalence and characteristics of migraine headaches in medical students, to measure its impact on their life, and to assess their knowledge about the ailment. Information about lifestyle variables was also collected. Materials and Methods: All medical students who confirmed of having headache for more than 1 year formed the study group. Students filled a detailed questionnaire focusing on demographics, pain characteristics, accompanying factors, triggers, and family history of migraine. Lifestyle variables were enquired and migraine associated disability was assessed by MIDAS (Migraine Disability Assessment). The diagnosis of migraine was made according to the International Headache Society criteria. Results are expressed in n = numbers and percentage. Results: Sixty-eight percent of medical students had headache. The prevalence of migraine in the whole cohort was 28%; however, of the headache group, migraine constituted 42%. There was a female preponderance. One-fourth of the students had weekly or daily attacks with 31% students reporting increase in their headache intensity and frequency. Forty-four percent of students had severe headaches. Dizziness, allodynia, and neck stiffness were reported as accompanying symptoms. Trigger factors were identified in 99% students, predominant of which were poor sleep hygiene, environmental changes, head movements, and mental stress. Only 4% of students did regular exercise. Twenty-seven percent of students reported self-medication use of analgesics. One-fourth of the students had migraine-associated disability but only 6% realized that they had migraine. Conclusion: Our study found a high prevalence of headache with migraine in medical students. The students’ awareness of the disease was very low with one-fourth of the students resorting to self-medication. Our study identified previously less-recognized triggers like head movement and accompanying symptoms like neck stiffness. Migraine-attributed burden was high in medical students.

Low plasma antioxidant status in patients with epilepsy and the role of antiepileptic drugs on oxidative stress

Background: Oxidative stress has been implicated in various disorders including epilepsy. We studied the antioxidant status in patients with epilepsy and aimed at determining whether there was any difference in the antioxidant levels between patients and controls, patients who are not on antiepileptic drugs (AEDs), and on treatment, between individual AEDs and patients on monotherapy and polytherapy. Materials and Methods: Antioxidant levels like catalase, glutathione peroxidase (GPx), vitamin E, glutathione (GSH), thiol group (SH), uric acid, and total antioxidant capacity (TAC) were compared between 100 patients with epilepsy and equal number of controls. Twenty-five patients who were not on AEDs were compared with patients on AEDs and the control group. Patients were divided into monotherapy and polytherapy group and antioxidant status was compared between the two groups and between individual drugs. Results: Catalase, SH, vitamin E, and TAC were significantly low in patients with epilepsy than those in the control group (P < 0.001). GSH and uric acid did not show any difference; GPx in patients was significantly higher than those in the control group There were no differences in the antioxidant levels between the treated and the untreated groups; however, it was lower in untreated patients than controls (P < 0.001), suggesting that AEDs do not modify the oxidative stress. Patients on Valproate (VPA) showed higher catalase and GPx levels. Catalase was higher in the monotherapy than polytherapy group (P < 0.04). Conclusion: Our study found significantly low levels of antioxidant in patients as compared to controls. AED did not influence the antioxidant status suggesting that seizures induce oxidative stress.

Prevalence of low dietary calcium intake in patients with epilepsy: A study from South India

BACKGROUND The effects of antiepileptic drugs (AED) on bone health are well documented. Inadequate dietary intake of calcium and vitamin D plays a vital role and further compromises the bone health. OBJECTIVE To assess the dietary pattern with special reference to calcium and related minerals in people with epilepsy (PWE) on AED. MATERIALS AND METHODS The dietary assessment in PWE was documented by dietary recall method. Patients were categorized according to age: group I: <14 years; group II: between 15-20 years; group III: between 21-45 years; group IV: >46 years. From the raw weights, total energy, dietary calcium, dietary phosphorous intake and phytate calcium ratio was calculated using a food composition table by Indian Council of Medical Research (ICMR) and analyzed statistically. RESULTS A total of 362 patients with mean age of 29 + 15 years were studied. There were 190 women. The mean duration of AED treatment was 4 + 3 yrs, 64% on monotherapy 64% and 36% on polytherapy. The mean dietary intake of the total chohort was 2,007 + 211 Kcal/day, carbohydrate 335 + 33 gm/day; protein 31 + 7 gm/day; fat 18+2 gm/day; calcium 294 + 40 mg/day; phosphorus 557 + 102; phytates 179 + 30 mg/day; and phytate/calcium ratio 0.56+0.2. Milk and milk products were consumed by 42% of the total cohort. The daily dietary calcium (301 + 40 mg/day) intake of men was significantly higher than women (287 + 39 mg/day) (P < 0.001). This was more evident in group II (P < 0.01) and group III (P < 0.03). There was a positive correlation between dietary calcium and dietary phytates (P < 0.001), dietary proteins (P < 0.001), dietary fat (P < 0.001), and total energy (P < 0.001). CONCLUSIONS The dietary consumption of calcium of all the patients was far below the recommended daily dietary allowance (RDA) by Indian Council of Medical Research (ICMR). Low dietary calcium could have a confounding effect on PWE on AED in all age groups. There is a need to formulate consensus guidelines to supplement dietary calcium to PWE.

Sleep quality and health complaints among nursing students

Sir, Sleep plays a vital role in maintaining the equilibrium of human psychosocial behavior. Sleep-wake cycle is one of the biological rhythms which are determined by a circadian timing system, predisposed by some factors like physiological function, work schedules, etc. Sleep deprivation results in psychosocial stress, psychiatric disorders, decreased work effectiveness, and learning disability. Nursing is a demanding profession with occupational stress which involves academics, shift duties, and sleep deprivation.[1-4] The purpose of the present study was to identify the sleep pattern, quality of sleep, sleep disturbances, day time sleepiness and its influence on academics, and routine activities of daily life in nursing students.

Poor Awareness of Stroke—A Hospital-Based Study from South India: An Urgent Need For Awareness Programs

BACKGROUND Stroke treatment has reached a new benchmark with thrombolytic therapy. However, India has witnessed a tremendous increase in morbidity and mortality of stroke over the past few decades. The prime deciding factor is initiation of treatment within the time window, which requires early recognition of stroke symptoms. We wished to analyze the lacunae in the stroke knowledge in our population. This hospital-based study assessed awareness of the public regarding stroke. METHODS Two trained medical students interviewed accompanying relatives using a structured questionnaire. Data were analyzed using Statistical Package for the Social Sciences, version 20. Univariate and multivariate analyses were done. Descriptive results are presented as mean ± SD. P less than .05 was considered as statistically significant. RESULTS In total, 350 individuals formed the study group; mean age was 40.23 ± 13.4 years constituting 145 males (47.5%) and 205 females (58.5%). Only 50 (14%) respondents could identify that the patient had developed stroke; however, 35% respondents identified brain as the organ involved for the presenting complaints and 34% could identify the warning symptoms of stroke, limb weakness being the most common (30%). Sources of information were friends and media (8%). Median time of reaching the hospital was 10 hours with patients transported by ambulance reaching early (P < .03); 80% of patients were fed in drowsy state during transport. More than 50% of the respondents were not able to identify the risk factors nor were aware that stroke is a preventable or a life-threatening disease. Multivariate logistic regression analysis confirmed that higher level of education was the only variable, which correlated with the organ identification (P < .001), stroke recognition (P < .002), and identification of the warning symptoms (P < .001). CONCLUSIONS This hospital-based study reveals that there is a poor knowledge of recognition of stroke, its warning signs, risk factors, and prehospital care. There is an urgent need to design stroke awareness programs in the country with emphasis on ambulance service to minimize the time to thrombolysis.

Study of Ischemia Modified Albumin as a Biomarker in Acute Ischaemic Stroke

Background and Purpose: Stroke is one of the leading causes of mortality and long-term disability. Prompt diagnosis and treatment of stroke are crucial for a better outcome. A blood test, which serves as a biomarker in rural areas will help in immediately transferring patients to a hospital for thrombolytic therapy. The aim of the present study was to examine the role of ischemia modified albumin (IMA) as a screening biomarker in acute ischaemic stroke. Materials and Methods: Serum samples were collected from 50 patients with acute ischaemic stroke within one, 24, 48, 72 and 144 h of time of admission for IMA. We compared patients’ 1st-hour value with age- and sex-matched controls by independent sample t test. p value < 0.05 was considered significant. Results: The serum IMA levels of patients 1st hour (108 ± 8.9) were significantly higher than those of the controls (79 ± 6.3) p < 0.05. The IMA levels showed a steady decline at 1 h (108 ± 8.9), 24 h (94 ± 4.2), 48 h (82 ± 6.1), 72 h (77 ± 5.6) and 144 h (76 ± 3.8) of admission in patients. Conclusion: We observed that serum IMA was significantly higher in stroke patients as compared to controls. IMA was elevated in the acute phase of stroke and had a gradual graded decline over 1 week. We concluded that IMA may be a sensitive and rapid biomarker for screening of early ischaemic stroke in rural settings.

Female caregivers and stroke severity determines caregiver stress in stroke patients

Background: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. Materials and Methods: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] <75) and B (BI >75) according to patients BI, according to gender (male and female CG) and relation; spouses (wife, husband), daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws). Data were analyzed using SPSS software version–21. Data were analyzed to determine which variables of the patient effects the CG stress. Results: Majority of the CGs (74.62%) were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patients bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patients bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002) than males (χ2 = 11.931, P = 0.018); wives and daughters than other relations (χ2 = 32.184, P = 0.000), (χ2 = 35.162, P = 0.019). Conclusion: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in patients with severe stroke.