Is ambient air pollution a risk factor for Parkinson's disease? A meta-analysis of epidemiological evidence.

Current evidence shows inconsistencies about ambient air pollution (AAP) exposure as a risk factor for Parkinson's disease (PD). We performed meta-analyses to estimate the pooled risk of PD due to AAP exposure. We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of PD due to exposure to PM2.5, PM10, O3, CO, NO2, NOX and SO2; from the beginning until October 2021. The pooled odds ratio (OR) for the effect of NO2 (per 1 µg/m3) and O3 (per 1 ppb) on PD was 1.01[95% CI: 1.00,1.02; I2 = 69% (p = .01)] and 1.01 [95% CI: 1.00,1.02; I2 = 66% (p = .03)], respectively. The ORs for the effects of PM2.5 (per 1 µg/m3) and CO (per 1 ppm) on PD were 1.01 [95% CI: .99,1.03; I2 = 40%] and 1.64 [95% CI: .96,2.78; I2 = 75% (p = .01)], respectively. The study showed the adverse roles of NO2, O3, PM2.5, and CO in increasing the risk for PD.

Bryophyllum pinnatum leaf extract mediated ZnO nanoparticles with prodigious potential for solar driven photocatalytic degradation of industrial contaminants.

In an era of environment-friendly development plant extract-based biological techniques for synthesizing nanoparticles have gained a lot of attention over traditionally famous chemical and physical synthesis techniques. In the present study we have synthesized biogenic zinc oxide nanoparticles (BPLE-ZnO NPs) using Bryophyllum pinnatum leaf extract, compared its native properties and solar-driven photocatalytic activity with chemically prepared ZnO nanoparticles (Chem-ZnO NPs). In order to characterize and compare the Chem-ZnO and BPLE-ZnO, various techniques were used, including UV-visible spectroscopy, x-ray diffractrometry, photoluminescence spectroscopy, field emission scanning electron microscopy, electron dispersive x-ray spectroscopy, fourier transform infrared spectroscopy, and zeta potential analyzer. The results revealed the formation of hexagonal wurtzite ZnO, with no significant difference between the two methods; however, the use of Bryophyllum pinnatum leaf extract in ZnO NPs synthesis resulted in reduced size, presence of biomolecules on its surface and better monodispersity than purely chemical synthesis. Further, the BPLE-ZnO NPs showed better efficiency in the solar-driven photocatalytic degradation of methylene blue (MB) dye compared to Chem-ZnO NPs. Under solar exposure at a dose of 0.50 mg/mL BPLE-ZnO, resulted in 97.31% photodegradation with a rate constant of 0.06 min-1 of 20 mg/L MB solution within just 60 min which was 9.51% higher compared to the Chem-ZnO NPs. The BPLE-ZnO NPs were also employed to investigate their solar-driven photocatalytic performance for degrading the pharmaceutical (Metronidazole and Amoxycillin) and textile pollutants (Methyl orange dye) under sunlight. The results show that Bryophyllum pinnatum leaf extract-mediated ZnO NPs have an excellent potential in solar-based photocatalytic applications.

A systematic review and meta-analysis of prevalence of seven psychiatric disorders in India.

Background: After the National Mental Health Survey in 2016, multiple individual studies showed inconsistencies in the prevalence rates of psychiatric disorders in India. We performed a meta-analysis to estimate an up-to-date pooled estimate of the prevalence of depression, alcohol use disorder (AUD), anxiety disorder (AD), intellectual disability, suicidal attempt/death, autism, and bipolar disorder (BD) in India. Materials and Methods: We performed a systematic bibliographic search in Pub Med, Global Health Data Exchange (GHDx), and Google Scholar, along with a manual search for peer-reviewed epidemiological studies reporting the prevalence of depression, AUD, AD, MR, suicidal attempt/death, autism, and BD in India from January 1980 till March 2022. Adopting a random-effects model, we performed the meta-analysis using "MetaXL" software. Results: A total of 79 studies were included: depression (n = 28), AUD (n = 14), AD (n = 12), intellectual disability (n = 8), suicidal attempt/death (n = 7), autism (n = 6) and BD (n = 4). The pooled prevalence of depression and AUD was 12.4% (95% CI 9.4-15.9) (P < 0.001, I2 = 100%) and 21.5% (95% CI 14.1-30.0) (P < 0.001, I2 = 100%), respectively. AD, intellectual disability and suicidal attempt/death showed a prevalence of 11.6% (95% CI 8.1-15.7) (P < 0.001, I2 = 99%), 1% (95% CI 0.5-1.6) (P < 0.001, I2 = 98%) and 0.5% (95% CI 0.3-0.8) (P < 0.001, I2 = 100%), respectively. The meta-analysis in autism and BD showed pooled prevalence of 0.3% (95% CI 0.1-0.6) (P < 0.001, I2 = 96%) and 0.3% (95% CI 0.2-0.4) (P < 0.001, I2 = 78%), respectively. Subgroup analysis showed an increased prevalence of AD in the urban [24.3% (95% CI 3.7-52.9)] and younger [16.7% (95% CI 5.1-32.7)] population. The prevalence of depression and AD increased during the last two decades on decadal prevalence analysis. Discussion: The findings could be used for appropriate policy measures and guiding subsequent national mental health surveys.

Is Air Pollution Associated with Increased Risk of Dementia? A Meta-Analysis of Epidemiological Research.

Background: There are prevailing inconsistencies in epidemiological research about air pollution being a risk factor for dementia. Objective: We performed meta-analyses to calculate the pooled estimates of the risk of developing dementia due to air pollution exposure. Methods and Materials: We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of developing all-cause dementia, cognitive decline, Alzheimer's disease (AD), and vascular dementia (VaD) due to exposure to particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) and less than 10 µm (PM10), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxides (NOX) and sulfur dioxide (SO2) from the beginning until December 2020. Meta-analysis was performed by adopting the random-effects model using Meta-XL. Results: In all-cause dementia, the pooled hazard ratio (HR) for PM2.5 and NO2 exposure was 1.03 [(95%CI: 1.01-1.06; I2 = 99% (P < 0.001)] and 1.00 [(95%CI: 1.00-1.01; I2 = 96% (P < 0.001)], respectively. The pooled HR for NOX was 1.00 [(95%CI: 1.00-1.01; I2 = 61% (P = 0.05)]. In AD, the pooled HRs for PM2.5 and O3 was 1.08 (95%CI: 1.01-1.15; I2 = 99% (P < 0.001)]) and 1.02 (95%CI: 0.96-1.08; I2 = 100% (P < 0.001)], respectively. In VaD, the pooled HR for PM2.5 exposure was 1.03 (95%CI: 1.01-1.06; I2 = 91% (P < 0.001)]. In NO2/NOX, the results were found to be equivocal. Meta-analysis could not be performed in cognitive decline because of wide variations in assessments methods. Conclusions: The present study showed exposure to PM2.5 as a risk factor for all-cause dementia, AD, and VaD and exposure to O3 as a possible risk factor for AD. These findings can be used for policy measures and further research.

Environmental monitoring and health assessment in an industrial town in central India: A cross-sectional study protocol.

BACKGROUND: Textile industry has been widely implicated in environmental pollution. The health effects of residing near manufacturing industries are not well documented in India, especially in central India. Hence, a cross-sectional environmental monitoring and health assessment study was initiated as per directions of the local authorities. METHODS: Comprehensive exposure data about the concentrations of relevant pollutants in the ambient air and ground water samples in the study area will be collected over one year. Using stratified random sampling, 3003 apparently healthy adults will be selected from the study area. Sociodemographic and anthropometric information, relevant medical and family history, and investigations including spirometry, electrocardiogram, neurobehavioral tests, and laboratory investigations (complete blood count, lipid profile and random blood glucose) will be conducted. Finally Iodine azide test and heavy metal level detection in urine and blood samples respectively will be conducted in a subset of selected participants to assess individual pollution exposure. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/IEC-7-II/1027, dated 07/01/2021). DISCUSSION: This manuscript describes the protocol for a multi-disciplinary study that aims to conduct environmental monitoring and health assessment in residential areas near viscose rayon and associated chemical manufacturing industries. Although India is the second largest manufacturer of rayon, next only to China, and viscose rayon manufacturing has been documented to be a source of multiple toxic pollutants, there is a lack of comprehensive information about the health effects of residing near such manufacturing units in India. Therefore implementing this study protocol will aid in filling in this knowledge gap.

Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence.

OBJECTIVES: Ambient air pollution (AAP) is an important risk factor for increased mental health morbidity. Studies have highlighted the effect of AAP on psychological stress and anxiety disorder. However, existing evidence regarding this is largely equivocal. This systematic review with meta-analysis aims to synthesize published evidence to calculate the pooled estimate of the effect of AAP on psychological stress and anxiety disorder. CONTENT: A systematic bibliographic search was undertaken using PubMed, JGateplus, Google Scholar, and Cochrane Library for observational human studies published in English till 31st March 2020 reporting the effect of AAP on psychological stress and anxiety disorder. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analysis was performed adopting a random-effects model using Meta-XL. Of 412 articles retrieved, a total of 30 articles [AAP and anxiety disorders, (n=17, 57%); AAP and psychological stress, (n=9, 30%) and AAP and both psychological stress and anxiety disorders, (n=4, 13%)] fulfilled the inclusion criteria covering a total population of 973,725 individuals. The pooled estimate (OR) of the effects of PM10 on psychological stress was 1.03 [(95% CI: 1.00, 1.05) (p=0.17, I 2=41%)]. The pooled estimate of the effects of NO2 and PM10 on anxiety disorder was 0.93 [(95% CI: 0.89, 0.97) (p=0.91, I 2=0%)] and 0.88 [(95% CI: 0.78, 0.98) (p=0.01, I 2=59%)] respectively. The pooled estimate of the effects of PM2.5 on anxiety Disorder was 0.88 [(95% CI: 0.72, 1.06) (p=0.00, I 2=80%)]. SUMMARY AND OUTLOOK: The present study provides the most updated pooled estimate of the effect of AAP on psychological stress and anxiety disorder. Future studies should focus on longitudinal studies conducted in LIC and LMIC countries using uniform and standardized criteria for exposure and outcome assessment as well as robust adjustment for confounders to minimize methodological heterogeneity resulting in reliable and comparable estimation of environmental mental health burden.

A Systematic Review and Meta-analysis of Prevalence of Epilepsy, Dementia, Headache, and Parkinson Disease in India.

BACKGROUND: There are wide variations reported in the prevalence rates of common neurological disorders in India leading to huge treatment gap. There is no comprehensive systematic review reporting prevalence of common neurological conditions affecting Indians which is essential for developing and aligning health services to meet patient care. OBJECTIVES: The aim of this study was to perform a systematic review and meta-analysis of prevalence of epilepsy, dementia, headache, and Parkinson's disease (PD) in India from 1980 to 2019. METHODS AND MATERIALS: We performed a bibliographic systematic search in PubMed and Google Scholar along with manual search for peer-reviewed cross-sectional studies and community-based surveys reporting prevalence of epilepsy, dementia, headache, and PD in India from January 1980 to July 2019. Meta-analysis was performed adopting a random-effects model using "Metafor" package in R. RESULTS: The systematic review and meta-analysis included 50 studies [epilepsy (n = 22), dementia (n = 19), headache (n = 6), and PD (n = 3)] including a total of 179,1541 participants of which 5,890 were diagnosed with epilepsy, 1,843 with dementia, 914 with headache, and 121 were diagnosed with PD. The pooled prevalence of epilepsy was 4.7 per 1,000 population (95% CI: 3.8-5.6) with high heterogeneity (P < 0.01, I2 = 98%). The prevalence of dementia was found to be 33.7 per 1,000 population (95% CI: 19.4-49.8) (P = 0, I2 = 100%). The pooled prevalence of headache and PD were found to be 438.8 per 1,000 population (95% CI: 287.6-602.3) (P < 0.0001, I2 = 97.99%), and 0.8 per 1,000 population (95%CI: 0.4-1.3) (P < 0.01, I2 = 95%), respectively. CONCLUSIONS: The findings could be used for appropriate policy measures and targeted treatments for addressing these conditions.

Binding of Cu+ and Cu2+ with peptides: Peptides = oxytocin, Arg8 -vasopressin, bradykinin, angiotensin-I, substance-P, somatostatin, and neurotensin.

The intrinsic binding ability of 7 natural peptides (oxytocin, arg8 -vasopressin, bradykinin, angiotensin-I, substance-P, somatostatin, and neurotensin) with copper in 2 different oxidation states (CuI/II ) derived from different Cu+/2+ precursor sources have been investigated for their charge-dependent binding characteristics. The peptide-CuI/II complexes, [M - (n-1)H + nCuI ] and [M - (2n-1)H + nCuII ], are prepared/generated by the reaction of peptides with CuI solution/Cu-target and CuSO4 solution and are analyzed by using matrix-assisted laser desorption/ionization (MALDI) time-of-flight mass spectrometry. The MALDI mass spectra of both [M - (n-1)H + nCuI ] and [M - (2n-1)H + nCuII ] complexes show no mass shift due to the loss of ─H atoms in the main chain ─NH of these peptides by Cu+ and Cu2+ deprotonation. The measured m/z value indicates the reduction of CuI/II oxidation state into Cu0 during MALDI processes. The number and relative abundance of Cu+ bound to the peptides are greater compared with the Cu2+ bound peptides. Oxytocin, arg8 -vasopressin, bradykinin, substance-P, and somatostatin show the binding of 5Cu+ , and angiotensin-I and neurotensin show the binding of 7Cu+ from both CuI and Cu targets, while bradykinin shows the binding of 2Cu2+ , oxytocin, arg8 -vasopressin, angiotensin-I, and substance-P; somatostatin shows the binding of 3Cu2+ ; and neurotensin shows 4Cu2+ binding. The binding of more Cu+ with these small peptides signifies that the bonding characteristics of both Cu+ and Cu2+ are different. The amino acid residues responsible for the binding of both Cu+ and Cu2+ in these peptides have been identified based on the density functional theory computed binding energy values of Cu+ and the fragment transformation method predicted binding preference of Cu2+ for individual amino acids.

Learning Compositional Sparse Bimodal Models.

Various perceptual domains have underlying compositional semantics that are rarely captured in current models. We suspect this is because directly learning the compositional structure has evaded these models. Yet, the compositional structure of a given domain can be grounded in a separate domain thereby simplifying its learning. To that end, we propose a new approach to modeling bimodal perceptual domains that explicitly relates distinct projections across each modality and then jointly learns a bimodal sparse representation. The resulting model enables compositionality across these distinct projections and hence can generalize to unobserved percepts spanned by this compositional basis. For example, our model can be trained on red triangles and blue squares; yet, implicitly will also have learned red squares and blue triangles. The structure of the projections and hence the compositional basis is learned automatically; no assumption is made on the ordering of the compositional elements in either modality. Although our modeling paradigm is general, we explicitly focus on a tabletop building-blocks setting. To test our model, we have acquired a new bimodal dataset comprising images and spoken utterances of colored shapes (blocks) in the tabletop setting. Our experiments demonstrate the benefits of explicitly leveraging compositionality in both quantitative and human evaluation studies.

Molecular Genetics of Epilepsy: A Clinician's Perspective.

Epilepsy is a common neurological problem, and there is a genetic basis in almost 50% of people with epilepsy. The diagnosis of genetic epilepsies makes the patient assured of the reasons of his/her seizures and avoids unnecessary, expensive, and invasive investigations. Last decade has shown tremendous growth in gene sequencing technologies, which have made genetic tests available at the bedside. Whole exome sequencing is now being routinely used in the clinical setting for making a genetic diagnosis. Genetic testing not only makes the diagnosis but also has an effect on the management of the patients, for example, the role of sodium channels blockers in SCN1A+ Dravet syndrome patients and usefulness of ketogenic diet therapy in SLC2A1+ generalized epilepsy patients. Many clinicians in our country have no or limited knowledge about the molecular genetics of epilepsies, types of genetic tests available, how to access them and how to interpret the results. The purpose of this review is to give an overview in this direction and encourage the clinicians to start considering genetic testing as an important investigation along with electroencephalogram and magnetic resonance imaging for better understanding and management of epilepsy in their patients.

Analysis of argentinated peptide complexes using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: Peptide = oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, neurotensin.

RATIONALE: The increased use of silver nanoparticles (AgNPs) for various biological applications, and over-expression of various peptide receptors in different tumors/cancer cells, necessitate the need for dedicated investigations on the intrinsic binding ability of Ag with various biologically important peptides for better understanding of AgNPs-peptide interactions and for the future development of contrasting agents as well as drugs for imaging/biomedical applications. METHODS: The [M+(Ag)n ](+) complexes are prepared and characterized using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). RESULTS: Silver complexes of the peptides [M+(Ag)n ](+) , where M = oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, and neurotensin, have been investigated for their intrinsic Ag(+) -binding ability. Unusual binding of up to seven Ag(+) with these small peptides is observed. The mass spectra show n = 1-5 for bombesin and somatostatin, n = 1-6 for bradykinin and arg(8) -vasopressin, and n = 1-7 for oxytocin and neurotensin. In addition, oxytocin and arg(8) -vasopressin show the formation of dimers and their complexes [M2 +(Ag)n ](+) with n = 1-8 and n = 1-5, respectively. The possible amino acid residues responsible for Ag(+) binding in each peptide have been identified on the basis of density functional theory (DFT)-calculated binding energy values of Ag(+) towards individual amino acids. CONCLUSIONS: Mass spectrometric evidence indicates that the peptides, viz., oxytocin, arg(8) -vasopressin, bradykinin, bombesin, somatostatin, and neurotensin, show greater affinity for Ag(+) . Hence, they may be used as carriers for AgNPs in targeted drug delivery as well as an alternative for iodinated contrasting agents in dual energy X-ray imaging techniques. Radio-labeled Ag with these peptides can also be used in radio-pharmaceuticals for diagnostic and therapeutic applications. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of spontaneous transient seizure remission in patients of medically refractory epilepsy due to mesial temporal sclerosis (MTS).

PURPOSE: To analyze the predictors of spontaneous transient seizure remission for ≥1 year in patients with drug-resistant epilepsy (DRE) due to mesial temporal sclerosis (MTS). METHODS: This analysis included 38 patients with DRE (M:F = 20:18, age: 31.7 ± 10.9 years) diagnosed with unilateral MTS (right:left = 16:22). Group I ('remission' group) comprised of patients with seizure remission (M:F = 10:8, age: 32.8 ± 12.3 years, mean seizure free period: 2.2 ± 1.1 years; median: 2.1 years). Group II ('non-remission' group) comprised of age and gender matched 20 patients (M:F = 10:10, age: 30.7 ± 9.7 years) with unilateral MTS who never had seizure remission and subsequently underwent epilepsy surgery. Groups I and II were compared to find the predictors associated with transient seizure remission. RESULTS: The age at onset of seizures in group I was 13.2 ± 11.8 years and in group II was 12.0 ± 7.6 years. The duration of seizure was: group I - 19.7 ± 12.5 years and group II - 19.3 ± 7.7 years. Past history of seizure remissions (p < 0.001), frequent periods of remissions (p < 0.001), first remission within a year of onset of seizures (p = 0.04) and normal EEG (p = 0.04) were the important clinical predictors associated with seizure remission in this cohort. Fifteen patients in group I (83.3%) experienced remission following either change in AED (p ≤ 0.001) or increase in AED dosages (p < 0.001). There was no difference between the two groups regarding the type of semiology (partial vs. secondarily generalized) (p = 0.50), family history of seizures (p = 1.0), side of the lesion (p = 0.34), history of febrile seizures (p = 1.0) and the number of AEDs used (p = 0.53). CONCLUSION: The present study unfolds, some of the clinically relevant predictors associated with transient seizure remission in patients with DRE and MTS. Future molecular and network studies are required to understand its mechanism.

Co-morbidities and outcome of childhood psychogenic non-epileptic seizures--an observational study.

PURPOSE: To assess the psychiatric diagnoses and outcome in children with psychogenic non-epileptic seizures (PNES). METHODOLOGY: This hospital based observational study was performed on 44 children aged <16 years, who suspected to have psychogenic non-epileptic seizures based on video-EEG, from August 2005 to August 2012. The parameters noted were the psychiatric diagnosis, co-morbidities, management assessment and interventions (pharmacological and psychosocial), number and duration of follow-up visits, symptoms at follow-up, functioning as reflected by involvement in the social and scholastic work. RESULTS: All forty four children completed the evaluation. Thirty four children were diagnosed as having PNES and the underlying psychiatric diagnosis was conversion disorder (n=34, 77.3%). Co-morbid psychiatric disorders were present in 17 children (50%). The common co-morbidities were intellectual disability (n=8, 23.5%), specific learning disorder (n=5, 14.7%), and depression (n=5, 14.7%). Co-morbid epilepsy was present in 8 (23.5%) children and family history of epilepsy was present in 10 (29.4%) cases. About 17 of 34 (50.0%) patients had a minimum follow-up of 6 months (13.9 ± 4.8 months). Twenty six children (76.5%) remained symptom free at the follow-up of 9.8 ± 7 months. The remaining 10 children (22.7%) had non-epileptic seizures with underlying diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), gratification disorder and other physiological conditions. CONCLUSIONS: Conversion disorder is a common diagnosis underlying psychogenic non-epileptic seizures. Outcome was good in 76.5% children with PNES. A multidisciplinary approach is needed in the diagnosis and management of PNES.

Children with psychogenic non-epileptic seizures (PNES): a detailed semiologic analysis and modified new classification.

PURPOSE: To analyze children with psychogenic non epileptic seizures and propose a modified new classification. METHODS: This retrospective analysis included 56 children aged <18 years (M:F=26:30; mean age: 12.3±4.0 years) diagnosed PNES on video-EEG monitoring. The semiological characteristics like pattern of bodily movements, emotional signs, stereotypy, ictal vocalization, responsiveness, delay in diagnosis etc. were recorded. We analyzed our data as per previous adult classifications and proposed a modified classification. RESULTS: There were 190 recorded attacks (range: 1-9, median: 3) recorded. The age at onset of PNES was 8.9±4.1 years (range: 0.4-15.8 years; median: 9 years), age at diagnosis: 11.9±4.1 years (range: 2-17; median: 12.0 years), delay in diagnosis: 3.2±3.7 years (range: 0-15; median: 2.0 years). Anxiety disorder was seen in 9 (16.1%), stress in 6 (10.7%) children. Flexion/extension bodily movements were seen in 40 (70.1%), negative emotional signs in 17 (30.4%) and tremors in 14 (25%) cases. Thirty-three (58.9%) patients diagnosed as having true seizures initially and were on anti-epileptic drugs (AEDs), 14 patients (25.0%) initially diagnosed of PNES which remained unchanged after VEEG, nine patients (16.1%) had both PNES and true seizures. Twenty-six (46.4%) of our patients into the existing classifications. We then classified our patients into categories of a modified new classification: Hypermotor: 13 (23.2%), partial motor: 8 (14.3%), affective/emotional behaviour phenomena: 2 (3.6%), dialeptic: 8 (14.3%), 'aura': 3 (5.4%), mixed: 22 (39.3%). CONCLUSION: Incorrect diagnosis of epilepsy leads to unnecessary drug treatment. A detailed analysis of semiology and classification helps in early diagnosis of PNES. A modified systematic classification of PNES is proposed which would help in better standardization of PNES.

Outcome of lesionectomy in medically refractory epilepsy due to non-mesial temporal sclerosis (non-MTS) lesions.

OBJECTIVES: To analyze the seizure outcome of lesionectomy for refractory epilepsy secondary to non-mesial temporal sclerosis (non-MTS) lesions. METHODS: Sixty-eight patients with non-MTS lesions (M:F=42:26; age at onset: 11.7±9.6 years; age at surgery: 21.1±9.4 years), who underwent lesionectomy for refractory epilepsy were analyzed. The age at onset, frequency/type of seizure, MRI findings, video-EEG, histopathology and Engel's grading at 1 year/last follow up were recorded. RESULTS: The duration of epilepsy at surgery was 9.9±6.9 years. The location of lesions were: temporal: 41 (60.3%); frontal: 21 (30.9%); parietal: 6 (8.8%). The type of lesionectomies performed were temporal 41 (60.3%), extra-temporal: 25 (36.8%), temporo-frontal and temporo-parietal: 1 (1.5%) patient each. The histopathological diagnosis were neoplastic: 32 (47.1%), cortical dysplasia: 19 (27.9%), other focal lesions: 17 (25%). At mean follow up of 2.9±2.1 years (median: 2.6 years), outcome was - Engel's class I: 43 (63.2%), IIa: 14 (20.6%), III: 7 (10.3%), IV: 4 (5.9%). Good seizure control (Engel's class I/IIa) was achieved in 57 (83.8%) patients. The good prognostic markers included temporal seizures, extended lesionectomy and AEDs after surgery while poor prognostic marker was gliotic lesion on histopathology. CONCLUSION: Following lesionectomy due to non-MTS lesions, seizure freedom (Engel I) was noted in about 63.2% of patients, which is comparable to other series and reiterates the effectiveness of lesionectomy for seizure control.

Semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs): an attempt towards a new classification.

This study was carried out to analyze the semiological characteristics of adults with psychogenic nonepileptic seizures (PNESs) and to propose a modified new classification of PNESs. This retrospective analysis included 82 patients (M:F=38:44; mean age: 33.4 ± 12.0 years) diagnosed to have PNESs based on video-EEG recording. Detailed semiological characteristics including pattern of limb movements, body movements, psychological/emotional manifestations, "aura", level of consciousness, age at onset of PNESs, age at diagnosis, and history of AED intake were recorded. We classified our cohort of patients as per available classifications and proposed a modified new classification. Age at onset of PNESs was 21.8 ± 14.1 years (range: 2-64; median: 18.5 years), age at diagnosis was 29.3 ± 12.7 years (range: 2-67; median: 26.0 years), and delay in diagnosis was 7.4 ± 7.3 years (range: 0-28; median: 5.0 years). There were 369 recorded attacks (range: 1-10; median: 4). Prior to VEEG, 47 (57.3%) patients were incorrectly diagnosed as having true epileptic seizures initially and were on antiepileptic drugs (AEDs), 15 (18.3%) patients had an initial diagnosis of PNESs which remained unchanged after VEEG analysis, and 20 (24.4%) patients had both PNESs and epileptic seizures. We could not classify 40-66% of our patients into any of the available classification proposed by previous authors. We categorized all our patients into the following categories of a modified new classification: abnormal hypermotor response: 23 (28%), abnormal partial motor response: 18 (22%), affective/emotional behavior phenomena: 4 (4.9%), dialeptic type: 5 (6.1%), nonepileptic aura: 5 (6.1%), and mixed pattern: 27 (32.9%). Incorrect diagnosis of PNESs leads to unnecessary prescription of AEDs, with side effects and cost implications. A modified systematic classification of PNESs is proposed which would help in the better characterization of PNESs.