Papers by Pratibha Singhi
Journal of Child Neurology, Jun 1, 2022
Background: Single-lesion neurocysticercosis provides a model of seizure genesis secondary to an ... more Background: Single-lesion neurocysticercosis provides a model of seizure genesis secondary to an acquired lesion. We aimed to study the correlation of seizure semiology with the location of the lesion and interictal electroencephalographic (EEG) abnormalities in children with single-lesion neurocysticercosis. Methods: Prospective, observational study in children with single-lesion neurocysticercosis and seizures. Seizure classification was done after an interview with the parent/onlooker and the child. Localization and lateralization of the lesion were done by neuroimaging. The EEG abnormalities were classified based on their morphology and location. Results: Ninety-two children (7.9 ± 2.4 years) were included. Focal-onset seizures were the commonest (n = 54; 58.6%) seizures. Majority of the lesions were located in the frontal (n = 43; 47%) and parietal cortex (n = 34; 37%). EEG showed focal slowing (n = 15; 53.6%) and epileptiform spikes/spike-wave complexes (n = 13; 46.4%). There was a perfect agreement of clinical semiology with imaging lateralization (K = 1.0) and moderate agreement with imaging localization (K = 0.4). There was no significant agreement of clinical localization with EEG slowing (K = 0.1) or sharps (K = 0). There was moderate agreement (K = 0.6) of EEG slowing and substantial agreement (K = 0.7) of EEG sharps with clinical lateralization. Focal EEG slowing had moderate (K = 0.5) agreement with imaging lateralization. Focal sharps/spikes had substantial (K = 0.7) agreement with imaging lateralization. The positive predictive value (PPV) of seizure semiology for lateralization and localization was 100% and 68%, respectively. PVV of focal sharps for lateralization and localization was 84% and 70%, respectively. PPV of focal slowing for lateralization and localization was 77% and 65%, respectively. Conclusion: Seizure semiology in single-lesion neurocysticercosis correlates very well with lateralization but not so well with localization of lesion on neuroimaging. Focal EEG abnormalities are seen in nearly one-third of children with single-lesion neurocysticercosis. EEG often predicts the side of the lesion but has poor localizing value.
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Indian Journal of Pediatrics, Jan 31, 2017
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Indian Journal of Pediatrics, Oct 8, 2021
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The Annals of Thoracic Surgery, Dec 1, 1996
ABSTRACT Traumatic subarachnoid-pleural fistula is a very uncommon but important condition. Only ... more ABSTRACT Traumatic subarachnoid-pleural fistula is a very uncommon but important condition. Only 21 cases have been reported so far in the world literature. We encountered 2 cases of subarachnoid-pleural fistula, both in pediatric patients presenting without any neurologic deficit. Whereas our first patient presented with recurrent, rapidly filling clear pleural effusions with an obscure cause, posing a diagnostic problem for the pediatricians, the second patient had trauma to the pleura and dura mater by the sharp edge of Kirschner wire, with impending risk of injury to spinal cord and infection. Surgical intervention was undertaken after we had a strong suspicion of subarachnoid-pleural fistula in both cases. A subarachnoid-pleural fistula was found at the level of the eleventh thoracic vertebra in the first patient and at the level of the eighth thoracic vertebra in the second patient. Autogenous tissues (mediastinal pleural flap and hammered intercostal muscle covered with methylcellulose) were used to repair the fistula. The subarachnoid space was decompressed with a lumbar drain in the second patient. The diagnosis of subarachnoid-pleural fistula is difficult when it is not associated with any neurologic deficit. We found that a high degree of suspicion and early surgical intervention to repair the fistula are rewarding.
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Journal of Pediatric Neurosciences, 2018
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Pediatric Neurology, Apr 1, 2017
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Seizure-european Journal of Epilepsy, Dec 1, 2020
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Indian Journal of Pediatrics, Jan 23, 2016
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European Journal of Paediatric Neurology, Jun 1, 2017
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Indian Journal of Pediatrics, Dec 18, 2017
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Journal of Pediatric Neurosciences, 2012
GM1gangliosidosis is a rare autosomal recessive lysosomal storage disorder caused by deficiency o... more GM1gangliosidosis is a rare autosomal recessive lysosomal storage disorder caused by deficiency of enzyme β-galactosidase, resulting in progressive neural and visceral accumulation of GM1gangliosides. Coarse facial features, bilateral cherry red spots, and dysostosis multiplex are important clue to diagnose this condition. We describe a case of GM1gangliosidosis with dysostosis multiplex and characteristic magnetic resonance imaging findings.
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Aims West Syndrome is an age dependent epileptic encephalopathy with variable therapeutic respons... more Aims West Syndrome is an age dependent epileptic encephalopathy with variable therapeutic response. Worldwide, there is scarce data on magnitude and effect of treatment lag on therapeutic response with adrenocorticotrophic hormone (ACTH) or steroid therapy in West Syndrome. There is conflicting evidence regarding impact of treatment lag in West Syndrome. The present study aimed to elucidate magnitude of diagnostic and treatment lag, potential determinants of treatment lag and its impact on short-term therapeutic response with ACTH or oral steroids therapy. Methods We conducted a prospective study in a tertiary care hospital in northern India between January-December 2014. A total of 82 consecutive children with West Syndrome were enrolled. Magnitude and determinants of treatment lag were determined in all the children. Parents were interviewed and medical records of the child were reviewed. The treatment lag was calculated as the time delay between onset of spasms and initiation of ACTH/oral steroids treatment. Short term therapeutic response was taken as cessation of spasms within 14 days of therapy and sustained for a period of 28 days from the last witnessed spasm. We analysed following potential predictors: age of onset of spasms, aetiology, treatment lag and gender for their association with short-term therapeutic response. Results The median treatment lag duration was 90 days (95% CI: 110–198 days). The significant determinants of treatment lag in our study were: the pre-existing delay of children, educational status of the parents and qualification of the first practitioner visited. Our study showed shorter treatment lag (<1 month) was associated with a better spasms cessation rate (85% vs 15%; p=0.011). Conclusion We observed a significant treatment lag in our children with West Syndrome. The lead time to treatment emerged as a potential modifiable risk factor for therapeutic response with ACTH/steroid therapy.
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Indian Journal of Pediatrics, Jun 20, 2014
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Indian Journal of Pediatrics, Jan 3, 2017
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Pediatric Neurology, 2018
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Indian Journal of Pediatrics, 2022
This study evaluated 32 children (mean age: 8.5 y) with autism spectrum disorder (ASD) and 23 hea... more This study evaluated 32 children (mean age: 8.5 y) with autism spectrum disorder (ASD) and 23 healthy controls (similar age, sex, and Tanner stage) for hyperandrogenism. These children underwent sexual maturity rating (Tanner staging), ASD severity assessment (Childhood Autism Rating Scale), and quantitative estimation for plasma testosterone, dehydroepiandrosterone sulfate (DHEAS), and androstenedione. There was no significant difference in androgen levels in the two groups. Elevated (> 95 centiles) testosterone, DHEAS, and androstenedione levels were seen in 12.3%, 6.2%, and 9% children with ASD, and 7/9 of these children (78%) with hyperandrogenism had severe ASD. However, there was no significant correlation between ASD severity and androgen levels.
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Seizure, 2021
OBJECTIVE To determine whether high-dose, oral pyridoxine in combination with standard adrenocort... more OBJECTIVE To determine whether high-dose, oral pyridoxine in combination with standard adrenocorticotropic hormone (ACTH) therapy has superior effectiveness than ACTH therapy alone in increasing cessation of epileptic spasms for children with West syndrome. METHODS This study was an open-label, randomized controlled trial with masked endpoint assessments. Eligible children with West syndrome, age ranged 3-18 months, were randomized into the intervention (n = 43) and the standard arm (n = 37) of therapy. The intervention group received oral pyridoxine at 100-300 mg/kg/day in addition to standard therapy of intramuscular ACTH at 150 IU/m2/day. Primary effectiveness outcome was a complete cessation of spasms at two weeks and sustained till six weeks. RESULTS Comparison of effectiveness measures between intervention and standard groups were : complete cessation of epileptic spasms (48.8% vs 58.3%; group difference -9.6%; 95% confidence interval [CI] -30% to 12.3%; p = 0.4), median EEG scores (Q1-Q3) by Jeavons Score at six weeks [3 (1-5) vs 3 (1-5); p = 0.6], median motor scores (Q1-Q3) by DASII (Development Assessment Scales for Indian Infants) at 12 weeks [35 (29-49) vs 42 (34.3-63.8), p = 0.04], and median mental scores (Q1-Q3) by DASII at 12 weeks [35 (29.5-46) vs 41.5 (31.3-60), p = 0.02]. Adverse events were comparable in both arms. CONCLUSIONS There was no evidence to suggest the superiority of high-dose pyridoxine in combination with ACTH versus ACTH alone for the treatment of West syndrome, considering the limitations of the study design.
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Journal of Pediatric Neurosciences, 2021
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Papers by Pratibha Singhi