Browsing by Author "Jayantee Kalita"

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A randomized controlled trial of high rate rtms versus rtms and amitriptyline in chronic migraine
(American Society of Interventional Pain Physicians, 2021) Jayantee Kalita; Sumit Kumar; Varun K. Singh; Usha K. Misra
Background: The patients with chronic migraine (CM) respond poorly to pharmacological agents including tricyclic antidepressants, β-blockers, anticonvulsants, calcium channel blockers, flunarizine, and melatonin. The combination of 2 or more pharmacological agents has not shown better efficacy but increased side effects. High rate repetitive transcranial magnetic stimulation (rTMS) has been reported effective in episodic migraine and converts CM to episodic migraine. A combination of high rate rTMS with a pharmacological agent may be more effective compared to rTMS alone. Objectives: We evaluate the efficacy and safety of 10 Hz rTMS compared to rTMS and amitriptyline in CM. Study Design: Randomized controlled trial. Setting: Tertiary care teaching institute in India. Methods: Patients with CM as per International Classification of Headache Disorder third edition (ICHD-3) beta criteria were included whose age was between 18 years and 55 years. CM was defined if there were 15 headache days per month and at least 8 of these attacks having migraine characteristics for a period of more than 3 months. Patients with major psychiatric, other neurological or systemic disease, and those on migraine prophylaxis were excluded. The demographic details, frequency of headache attacks and headache days per month, migraine triggers, and associated symptoms were noted. The severity of headache was noted using a 0-10 Visual Analog Scale and the number of abortive drugs per month was noted. CM patients were randomly assigned to rTMS (group I) or rTMS and amitriptyline (group II). 10 Hz rTMS was applied using a figure of eight magnetic stimulation coil. The coil was placed over the left frontal cortex corresponding to the hot spot of the right abductor digiti minimi, which is approximately 7 cm lateral from the midline and 2 cm anterior to interaural line. The motor threshold was measured, and 70% of it was used for rTMS. Ten trains of 10 Hz rTMS, each train comprising of 60 pulses with an inter-train interval of 45 seconds were delivered in one session. Three such sessions were delivered on an alternate day and were repeated every month for 3 months. Amitriptyline was prescribed in a dose of 10mg, increased to 25mg after 2 weeks; thereafter increase in dose to 50 mg was optional. The primary outcome was > 50% reduction in headache days, and secondary outcomes were the reduction in severity of headache, abortive drug, and side effects. Results: Forty-one patients were included in group I and 42 in group II, and their baseline characteristics were comparable. A higher proportion of group II patients had more than 50% reduction in headache days at 3 months (76.2 vs 31.7%; P < 0.001) compared to group I. More than 50% reduction in headache severity was also greater in group II compared to group I at 3 months (47.6% vs 19.5%; P = 0.01). Side effects were comparable, and none had to be withdrawn. Limitations: A higher proportion of patients was shifted from group I to group II. Conclusion: Combination of rTMS and amitriptyline is safe and more effective in CM compared to rTMS alone. © 2021, American Society of Interventional Pain Physicians. All rights reserved.
Cerebral venous sinus thrombosis and pachymeningitis in IgG4 related disease: Report of two cases and review of literature
(Wolters Kluwer Medknow Publications, 2021) Varun Singh; Jayantee Kalita; Usha Misra; Sunil Kumar
[No abstract available]
Corticosteroid-responsive epilepsia partialis continua; [Kortikosteroide yanıtlı epilepsiya parsiyalis kontinua]
(Turkish Neurosurgical Society, 2021) Jayantee Kalita; Prakash Chandra Pandey; Sarvesh Kumar Chaudhary; Varun Kumar Singh; Usha Kant Misra
Epilepsia partialis continua (EPC) is a rare form of status epilepticus and often refractory to antiepileptic drugs (AEDs). Persistent seizure activity may increase pro-inflammatory biomarkers locally, which may respond to adjunctive corticosteroid treatment, especially in central nervous system (CNS) infections. We report four children with refractory EPC and the effect of adjunctive corticosteroid in controlling EPC. The duration of EPC ranged between 3 days and 7 months. One patient had secondary generalized convulsive status epilepticus. Cranial computed tomography/magnetic resonance imaging was abnormal in three out of four patients; revealing old infarction in one, tuberculoma in one, and neurocysticercosis in one. Electroencephalography revealed spike and sharp wave discharges on the corresponding cerebral hemisphere. The EPC was refractory to 2-6 AEDs. Following corticosteroid treatment, EPC remitted in two patients with CNS infection, and those with infarction and cryptogenic EPC converted to discrete seizures. In AED-resistant EPC, a short course of corticosteroid may be helpful. © 2021 by Turkish Neurological Society Turkish Journal of Neurology published by Galenos Publishing House.
Does gender difference matter in cerebral venous thrombosis?
(Churchill Livingstone, 2022) Jayantee Kalita; Usha K. Misra; Varun K. Singh; Sunil Kumar; Neeraj Jain
Female specific risk factors (FSRFs) in cerebral venous thrombosis (CVT) may have difference in clinical, imaging and outcome parameters compared to those females with additional risk factors and males. We compare the clinical, MRI and outcome between male and female patients with CVT. We also compare female patients with and without female specific risk factors. 172 patients were included from a prospectively maintained CVT registry. The diagnosis was confirmed on magnetic resonance venography (MRV). Clinical details, risk factors, MRI and MRV findings were noted. The risk factors in the females were categorized as 1) Isolated FSRF (oral contraceptive, pregnancy, puerperium), 2) FSRF in addition to other risk factor, 3) non FSRF only, and 4) no risk factor groups. Outcome at 6 months was assessed using modified Rankin Scale (mRS) as death, poor (mRS 3–5) and good (mRS ≤ 2). There were 80 (46.5%) females; 24 (30%) had FSRFs and 18 (75%) of whom also had other risk factors leaving only 6(25%) females with isolated FSRF. The frequency of other prothrombotic risk factors, and clinical and imaging findings were similar in males and females except more frequent hyperhomocysteinemia in males (59% vs 41%; P = 0.036) and altered sensorium in females (66% vs 40%; P = 0.001). 17(9.9%) patients died, 12(7%) had poor and 143(83.1%) had good outcome, which were similar in both the gender, and in the females with and without FSRF. Isolated FSRF is rare in CVT, and there is no gender difference in terms of non FSRFs, clinico-radiological severity and outcome. © 2022 Elsevier Ltd
Effect of Exercise on β-Endorphin and Its Receptors in Myasthenia Gravis Patients
(Springer, 2023) Gyanesh M. Tripathi; Usha K. Misra; Jayantee Kalita; Varun K. Singh; Abhilasha Tripathi
This is a prospective observational study evaluating the change in β-endorphin (BE) and its receptors following exercise in patients with myasthenia gravis (MG) and their association with clinical improvement. Fifteen patients with mild to moderate MG, aged 16–70 years, who were able to do 6-Minute Walk Test (6-MWT) and had MG Quality of Life-15 (MGQoL-15) ≤ 45 without any contraindication for exercise were included. The patients walked 30 min daily for 3 months. The primary outcome at 3 months was > 50% improvement in MGQoL-15 from the baseline, and the secondary outcomes were MG Activities of Daily Living (MGADL), Hospital Anxiety and Depression Scale (HADS), number of steps, and distance covered on 6-MWT and adverse events. Plasma BE level, μ-opioid receptor (MOR), and δ-opioid receptor (DOR) were measured on admission and at 1 and 3 months. Twelve age- and gender-matched healthy controls who were not on regular exercise were included for comparison of BE, MOR, and DOR levels. Plasma BE level (P = 0.007) and DOR expression (P = 0.001) were lower in MG patients compared to the healthy controls. After 3 months of exercise, 6 patients improved. Plasma BE, MOR, and DOR levels increased in the first and decreased in the third month. MGQoL-15 (P < 0.001), HADS (P < 0.0001), number of steps (P < 0.007), distance (P = 0.030), and MGADL (P < 0.001) significantly improved compared to baseline. At 3 months, MGQoL-15 was associated with HADS score (P = 0.001), reduced depression (P = 0.013), MGADL (P = 0.035), and distance travelled on the 6-WMW test (P = 0.050). The improvement in depression was associated with higher BE level. Graphical Abstract: [Figure not available: see fulltext.] © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Effect of Intravenous Immunoglobulin or Plasmapheresis in Myasthenic Crisis and Worsening Myasthenia Gravis Compared to Without Rescue Treatment
(Elsevier Inc., 2025) Jayantee Kalita; Nagendra Babu Gutti; Faim Ahamed; Roopali Mahajan; Varun Kumar Singh
Purpose: There is a paucity of studies on intravenous immunoglobulin (IVIg)/plasmapheresis (PLEX) compared with no rescue treatment (NRT) in myasthenic crisis (MC) and worsening myasthenia gravis (WMG). We report the efficacy of RTs (IVIg and PLEX) compared with NRT in MC/WMG. Methods: Patients with MC and those having worsening in the MG Foundation of America classification by ≥2 grades were included. Their clinical findings, precipitating causes, and MG Activity of Daily Living (MGADL) and MG Quality of Life (MGQoL)-15 scores were noted. Patients were either treated with IVIg (400 mg/kg/d for 5 days) or PLEX (20–25 mL/kg × 5 sessions), and nonaffording patients received only standard care. The primary outcome was improvement in MG Foundation of America classification by ≥2 grades, and the secondary outcomes included MG Activity of Daily Living score, MG Quality of Life-15 score, Myasthenia Muscle Score, and days of mechanical ventilation (MV), hospital stay, and reaching pre-worsening status at 1 month. Findings: Forty-four patients were included; 19 had MC and 25 had WMG. They were treated for MG for 2 to 19 years. Forty-one (93.2%) patients achieved the primary end point; 22 (95.7%) in RT and 19 (90.5%) in NRT (P = 0.60). The overall odds ratio of RT for the primary outcome was 1.20 (95% CI, 0.70–23.50; P = 0.13). The RT group had an overall hazard ratio of 0.93 (95% CI, 0.37–2.40; P = 0.96) for duration of MV, had hospital stay of 0.78 days (95% CI, 0.34–1.94; P = 0.80), and achieved pre-worsening MG status in 0.99 days (95% CI, 0.40–2.40; P = 0.72) compared with NRT after adjusting for age, triggers, dose of acetylcholine esterase inhibitors (AChEIs), and azathioprine at baseline. PLEX had an edge over IVIg in reducing the duration of MV and hospital stay, but overall hazard ratio was not significant. The RT group, however, required a lower dose of AChEIs (P = 0.04). Ten patients had mild adverse effects. Implications: All the patients with MC and WMG improved irrespective of RT or NRT, and the RT group required a lower dose of AChEIs at 1 month. A multicenter randomized controlled trial may confirm these observations. © 2025 Elsevier Inc.
Inclusion of mechanical ventilation in severity staging of tuberculous meningitis improves outcome prediction
(American Society of Tropical Medicine and Hygiene, 2020) Jayantee Kalita; Usha K. Misra; Varun K. Singh; Prakash C. Pandey; Justin Thomas
Patients with tuberculous meningitis (TBM) in any stage of the British Medical Research Council (BMRC) scale, if requiring mechanical ventilation (MV), are likely to have a poor outcome. We report the usefulness of BMRC, BMRC-MV, and BMRC-hydrocephalus (BMRC-HC) staging, and Haydarpasa Meningitis Severity Index (HAMSI) scoring in predicting the outcome of TBM. One hundred ninety-seven TBM patients were analyzed from a prospectively maintained TBM registry. The severity of meningitis was categorized using BMRC (stages I-III), BMRC-MV (I-IV [MV patients were grouped as stage IV]), and BMRC-HC (I-IV [BMRC stage III patients with hydrocephalus were grouped as stage IV]). Haydarpasa Meningitis Severity Index scoring was categorized as < 6 and 3 6. The outcome was defined at 6 months using the modified Rankin Scale (mRS) as death, poor (mRS score > 2), or good (mRS score £ 2). Forty-nine (25%) patients died. BMRC-mechanical ventilation stage IV had the highest predictive value for defining death, with a sensitivity of 88% and a specificity of 86%. About 81.7% of surviving patients had a good outcome at 6 months. BMRC-mechanical ventilation stages I-III had the highest predictive value for defining good outcome, with a sensitivity of 93% and a specificity of 61%. In TBM, BMRC-MV staging has the best predictive value for defining death and disability. Copyright © 2020 by The American Society of Tropical Medicine and Hygiene
Myositis in H1N1 Infection Compounds to Myasthenic Crisis
(Wolters Kluwer Medknow Publications, 2024) Jayantee Kalita; Sarvesh K. Chaudhary; Prakash C. Pandey; Varun K. Singh; Usha K. Misra
Infection is an important trigger of myasthenic crisis (MC), and those infections manifest with pneumonia and muscle involvement may result in more frequent MC. We report two myasthenia gravis (MG) patients with H1N1 infection, and highlight the reasons for deterioration. Two patients with MG had H1N1 infection. The diagnosis of MG was confirmed by neostigmine, repetitive nerve stimulation, and anti‑acetylcholine receptor antibody tests. H1N1 was confirmed by nucleic acid detection study, and myositis by creatinine kinase. The patient with pneumonia and myositis had MC needing mechanical ventilation for 10 days, and the other patient without myositis did not have MC. They were treated with oseltamivir 75 mg twice daily for 5 days, and the patients with MC received ceftriaxone intravenously. Both the patients were on prednisolone and azathioprine, and none received prior H1N1 vaccination. The lady with MC with myositis was discharged on day 27 in wheelchair bound state, and the other one patient without myositis or MC was discharged on 6th day with full recovery. These patients highlight the need for evaluation for myositis along with pneumonia in the MG patients with H1N1 infection. Vaccination in MG patients on immunosuppression may be useful. © 2024 Neurology India, Neurological Society of India.
Outcome of Cerebral Venous Thrombosis Requiring Mechanical Ventilation
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Jayantee Kalita; Prakash Chandra Pandey; Nagendra Babu Gutti; Kuntal Kanti Das; S. P.V. Kumar; Varun Kumar Singh
Background: Patients with cerebral venous thrombosis (CVT) requiring mechanical ventilation (MV) may have a severe procoagulant state, extensive venous sinus thrombosis, and a worse outcome, but there is a paucity of studies on this topic. We compare the clinical risk factors, radiological findings, and outcomes between CVT patients requiring MV and the non-MV group. Methods: Consecutive CVT patients admitted to our service were included. Their clinical details, prothrombotic states and MRI and MRV findings were noted. The patients were admitted to the intensive care unit (ICU) if the Glasgow Coma Scale (GCS) score was below 14 and intubated if arterial blood gas analysis was abnormal. All the patients received heparin followed by an oral anticoagulant. In-hospital death was noted, and functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS). Results: Ninety-eight patients with CVT were admitted during the study period; 45 (45.9%) required ICU care, and 18 of them required MV for a median of 6.5 (1–15) days. The MV patients had a shorter duration of illness, a lower GCS score, and protein C deficiency. Twelve (12.2%) patients died: five (27.8%) in the MV, four (14.8%) in the non-MV ICU, and three (5.7%) in the non-MV non-ICU groups. Poor outcomes were 5.5%, 14.8%, and 5.7%, respectively. On Cox regression analysis, the MV had an association with death [adjusted hazard ratio (AHR) 0.40, 95% confidence interval 0.21–0.77; p = 0.007] and poor outcome at 3 months (AHR 0.45, 95% CI 0.27–0.76; p = 0.003). Conclusions: About 18.4% of CVT patients require MV with a mortality of 27.8%. Amongst the survivors, 90.7% of patients have a good outcome at 3 months. © 2025 by the authors.
Prolonged coma in scrub typhus: Consider non-convulsive status epilepticus
(Oxford University Press, 2021) Jayantee Kalita; Mahesh S. Jadhav; Varun K. Singh; Usha K. Misra
Background: Scrub typhus is prevalent in the Tsutsugamushi belt and may manifest with meningoencephalitis and seizures. We report a patient with scrub typhus who had non-convulsive status epilepticus (NCSE). Methods: A 50-y-old female with fever and altered sensorium for 5 d was diagnosed as scrub typhus based on serum IgM ELISA. She was on mechanical ventilation and received doxycycline and ceftriaxone, but did not improve until the third day of admission. Results: An EEG revealed >2.5 Hz generalised epileptiform discharges, which were suppressed by intravenous lorazepam suggesting NCSE. Following valproate and levetiracetam, she became conscious and had a full recovery. Conclusion: A scrub typhus patient recovers even after prolonged NCSE. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial
(S. Karger AG, 2021) Usha K. Misra; Jayantee Kalita; Varun K. Singh; Aditya Kapoor; Abhilasha Tripathi; Prabhakar Mishra
Introduction: There is a lack of evidence about the usefulness of exercise or rest in myasthenia gravis (MG). This study is aimed to evaluate the efficacy and safety of exercise or rest in MG. Methods: In a single-center open-labeled randomized controlled trial, the patients with mild to moderate MG were randomized to 30-min walk or rest in addition to the standard treatment. The primary endpoint was 50% improvement in the MG Quality of Life (MG-QOL15), and secondary endpoints were change in the Myasthenic Muscle Score (MMS), MG Activities of Daily Living (MGADL), grip strength, dose of acetylcholine esterase inhibitor and prednisone, 6-min walk test (6MWT), decrement in trapezius on the low-rate repetitive nerve stimulation test, and adverse events. The outcomes were defined at 3 months, by >50% improvement in these outcome parameters. Results: Forty patients with MG were randomized to the exercise or rest arm. The 2 arms were matched for demographic and clinical parameters. The patients in the exercise arm had significantly better QOL evidenced by MG-QOL15 (p = 0.02). The secondary endpoints, distance covered in 6MWT (p = 0.007), were also better in the exercise arm without any adverse event. Conclusion: Regular exercise for 30 min in mild and moderate MG improves quality of life and walking distance compared to rest and is safe. Clinical Trial Registration: The clinical trial registration number is CTRI/2019/11/021869. © 2021 S. Karger AG, Basel. Copyright: All rights reserved.
Significance of recanalization of sinuses and resolution of parenchymal lesion in cerebral venous sinus thrombosis
(Churchill Livingstone, 2020) Varun K Singh; Neeraj Jain; Jayantee Kalita; Usha K Misra; Sunil Kumar
In cerebral venous sinus thrombosis (CVST), the degree of recanalization may determine resolution of parenchymal lesion and clinical outcome. The aim of our study was to evaluate the relationship of recanalization with resolution of MRI lesion and clinical outcome. The patients with CVST diagnosed on the basis of magnetic resonance venography (MRV) were included prospectively. Risk factors, clinical features, and MRI and MRV findings were noted. MRI and MRV were repeated at 6 months and the change in parenchymal lesion and grade of recanalization (I, II, III) were noted. Patients were evaluated clinically at three and six months. Complete recovery was considered if modified Rankin Scale (mRS) score was 0. Thirty-three CVST patients were included, 12 (36.4%) of whom were females. Recanalization occurred in 29 (87.9%), which was complete (grade III) in 6 (21%). Sigmoid sinus (52%) recanalized more frequently. Resolution of parenchymal lesion on repeat MRI occurred in 13.3% (4/30) patients, and they had no sequelae. Degree of recanalization was not related to resolution of neurological sequelae, MRI lesion at follow up and burden of thrombosis at baseline. Varying degree of recanalization occurred in 87.9% patients with CVST, and resolution of parenchymal lesion occurred in 13.3%. Clinical outcome however was not related to recanalization. © 2020 Elsevier Ltd
Vitamin B12 deficiency presenting as acute febrile encephalopathy and retinopathy
(BMJ Publishing Group, 2021) Nikhil Dongre; Varun Kumar Singh; Jayantee Kalita; Usha Kant Misra
[No abstract available]