Sushil Razdan

Prevalence and Pattern of Epilepsy (Lath/Mirgi/Laran) in Rural Kashmir, India

Summary: The rural population of 63,645 living in the mountainous Kuthar Valley of South Kashmir, Northwest India was surveyed to determine the prevalence of major neurologic disorders, including epilepsy (called Lath/Mirgi/Laran in the local language). The survey was done according to a World Health Organization protocol (1981). House‐to‐house screening was done by Angan‐wadi workers to identify people with possible epilepsy. The screening questionnaire was translated into local vernacular. Persons who had some indication of a history of seizures or other neurologic disease were subsequently examined by a neurologic team. The diagnostic criteria of Hauser and Kurland (1975) were used to define cases of active epilepsy and seizure classification (ILAE, 1981) was done only with clinical data. One hundred fifty‐seven cases of active epilepsy were detected, giving a crude prevalence rate of 2.47/1,000 general population. In those aged <14 years, prevalence was 3.18/1,000. Ninety‐five (60.5%) of all cases were male; 91% of active epilepsy cases had onset of seizures before age 30 years. Mean age of onset in males was 5.3 years, and in females it was 7.1 years. Mean duration of seizures was 6 years; 78.9% cases had generalized seizures, 74.5% cases were receiving no specific treatment, 99.4% cases were born of home delivery, and 8.9% cases had a positive family history of seizures. Mental retardation was the most common associated abnormality in 22.9% of cases.

Prevalence and Pattern of Major Neurological Disorders in Rural Kashmir (India) in 1986

In 1986 in the Kuthar Valley in the Anantnag District of south Kashmir (northwestern India), we studied the population to ascertain the prevalence and pattern of various neurological diseases. A house-to-house survey was done in a rural population of 63,645 (according to a World Health Organization protocol, 1981). 616 cases of major neurological disorders were detected, yielding a prevalence of ratio of 9.67/1,000 as of prevalence day November 1, 1986. The prevalence ratios for various common neurological disorders were: epilepsy 2.47/1,000; stroke 1.43/1,000; paralytic poliomyelitis 2.18/1,000; mental retardation 2.09/1,000; deaf mutism 1.63/1,000, and cerebral palsy 1.24/1,000. Persons with these conditions constituted 92% of all neurological cases. Patients with motor neuron disease, Alzheimers dementia or multiple sclerosis were not found.

Cerebrovascular disease in rural Kashmir, India.

We studied the Kuthar Valley in the Anantnag District of south Kashmir (northwestern India) during the year 1986 to ascertain the prevalence and pattern of completed stroke. We detected 91 cases, giving a crude prevalence rate of 143/100,000. However, age-specific prevalence was 41/100,000 in the group aged 15-39 years and 630/100,000 in the group aged greater than or equal to 40 years; 69.23% of the cases were in men. Hypertension was present in 58.24% of the cases, while strokes due to valvular heart disease and puerperium-related strokes were most common in the young. Our study is first of its kind in this part of India.

Incidence of dementia in a Kashmiri migrant population

Background: Mishriwala is one of five exclusive clusters of Kashmiri migrants established in 1990 to accommodate Kashmiri Pandit families who left Kashmir valley in the wake of militancy. Mishriwala migrant camp has seen minimal immigration and out-migration since its establishment. In an earlier study we reported on the prevalence of dementia amongst a Kashmiri migrant population. That study was conducted in the migrant camp at Mishriwala, 12 km west of Jammu city, the winter capital of Jammu and Kashmir State. We have developed standardized study methods and instruments for use in the Kashmiri-speaking population, which we used for screening for dementia during the prevalence study. We now report the results of a 1-year prospective study carried out to find out the incidence of dementia in the same population. Aim: To ascertain the incidence of dementiain the Kashmiri Pandit population aged 60 years and above. Materials and Methods: A 1-year, prospective, epidemiological study of 186 subjects aged 60 years and above, using cognitive and functional ability screening and clinical evaluation. Results: The incidence of dementia in this population was 5.34 cases per 1000 person-years.

Prevalence of dementia among Kashmiri migrants

Background: Neurological diseases are common disorders resulting in the loss of productive life and disability. Dementia is becoming a major public health problem in the developing world also. Aim: To ascertain the prevalence of dementia among Kashmiri Pandit population aged 60 years and above. Materials and Methods: A cross-sectional survey was conducted among the elderly population of the Kashmiris living in a migrant camp. We developed and used a Kashmiri version of the Mini-Mental State Examination as the test instrument, and a score below 24 was considered indicative of dementia. A functional ability questionnaire was also administered to the subjects. A neurologist carried out the examinations. Results: A sample comprising 200 subjects (95 males and 105 females) were evaluated. The prevalence of dementia is 6.5% among the Kashmiri Pandit population aged 60 years and above, which is higher than that reported from other parts of India.

Active Epilepsy as Indicator of Neurocysticercosis in Rural Northwest India

Objective. To determine the contribution of neurocysticercosis as a cause for active epilepsy and to establish Neurocysticercosis as major definable risk of epilepsy in our setup. Methods. We conducted a door-to-door survey of 2,209 individuals of Bhore Pind and Bhore Kullian villages in Chattah zone of district Jammu (Jumma and Kashmir, Northwest India) to identify patients with symptomatic epilepsy. Patients with active epilepsy were investigated with neuroimaging techniques to establish diagnosis of NCC (neurocysticercosis). Results. Among 25 patients with epilepsy 10(40%) had CT/MR evidence of past or recent NCC infection. This gave us the point prevalence of 4.5/1000 for Neurocysticercosis in our study population. Interpretation. The study shows a high prevalence of NCC accounting for symptomatic epilepsy in our part of India.

Prevalence of cerebral palsy in children < 10 years of age in R.S. Pura town of Jammu and Kashmir.

OBJECTIVE To determine the prevalence of cerebral palsy in children aged <10 years. METHODS The study was conducted in the framework of a population-based, single-centre, cross-sectional surveillance at R.S. Pura town, 22 km south-west of Jammu city. RESULTS A total of 11 cases of cerebral palsy were ascertained yielding a crude prevalence rate of 2.27/1000 in the age group of <10 years. The proportion of cerebral palsy occurring in males was higher than that in females. INTERPRETATION The prevalence rates of cerebral palsy among children <10 years of age in R.S. town compare favorably with studies from developed countries.

Whole Exome Screening Identifies Novel and Recurrent WISP3 Mutations Causing Progressive Pseudorheumatoid Dysplasia in Jammu and Kashmir-India

We report identification and genetic characterization of a rare skeletal disorder that remained unidentified for decades in a village of Jammu and Kashmir, India. The population residing in this region is highly consanguineous and a lack of understanding of the disorder has hindered clinical management and genetic counseling for the many affected individuals in the region. We collected familial information and identified two large extended multiplex pedigrees displaying apparent autosomal recessive inheritance of an uncharacterized skeletal dysplasia. Whole exome sequencing (WES) in members of one pedigree revealed a rare mutation in WISP3:c.156C > A (NP_003871.1:p.Cys52Ter), that perfectly segregated with the disease in the family. To our surprise, Sanger sequencing the WISP3 gene in the second family identified a distinct, novel splice site mutation c.643 + 1G > A, that perfectly segregated with the disease. Combining our next generation sequencing data with careful clinical documentation (familial histories, genetic data, clinical and radiological findings), we have diagnosed the families with Progressive Pseudorheumatoid Dysplasia (PPD). Our results underscore the utility of WES in arriving at definitive diagnoses for rare skeletal dysplasias. This genetic characterization will aid in genetic counseling and management, critically required to curb this rare disorder in the families.

Triggering Risk Factors for Stroke: A Case Crossover Study from a Tertiary Care Hospital in Northwest India

Introduction: The role of traditional risk factors in the pathophysiology of stroke (IS) has been established and is well know. It has recently been shown that 10 risk factors are associated with 90% of the risk of stroke. Material and methods: A case-crossover study design was used for the purpose of study. 2-hour hazard period immediately before the onset of stroke was compared with the 2-hour control period at the same time on the day before the onset of stroke. Results: The study assessed the role of seven potential triggers for stroke. Forty four patients (73%) reported exposure to at least one potential triggering factor during the 2 hours hazard period before onset of stroke symptoms. Twenty nine patients (66%) reported exposure to at least one of three (Anger, sudden change in posture, negative emotions) potential triggers during the 2-hour hazard period. Discussion: The current study examined possible association between exposure to potential triggers during a defined hazard period and triggering of the acute onset of stroke. There have been previously reported observations on the potential effect of emotions as a trigger for MI. Conclusion: The period of study and the study sample may not be large enough for extrapolation but nevertheless does open up a new area for research in our setup.

Prevalence of neurological disorders in children less than 10 years of age in RS Pura town of Jammu and Kashmir

Objective: To determine the prevalence of major neurological disorders in children less than 10 years of age. Materials and Methods: The study was conducted in the framework of a population based, single centre, cross-sectional study at Ranbir Singh Pura town, 22 km south-west of Jammu city. Results: Eight cases of active epilepsy with a crude prevalence rate of 202 (95% confidence interval [CI] 180-220), five cases of Febrile seizures with a crude prevalence of 126 (95% CI 110-140) and eleven cases of cerebral palsy with a crude prevalence rate of 277 (95% CI 245-309) per 100,000 were found. Very few cases of other major neurological disorders were found. The prevalence rate of these disorders is estimated at same level as for other disorders such as - Post-meningitic sequelae, Infantile hemiparesis, Spinal deformity and Tic disorder is at 25 (95% CI 15-34) per 100,000. Interpretation: On the basis of the data obtained, the present study provides some valuable data on common neurological diseases among children in RS Pura town of Jammu district of Jammu and Kashmir.