CORRELATION BETWEEN PHYSICAL ACTIVITY AND BODY MASS INDEX AMONG CHILDREN

Background: The prevalence of childhood obesity increasing steadily in India. Obesity may results from a complex interaction of endogenous and exogenous causes. Most of them having exogenous causes and physical inactivity is one of them. Increased hours of inactivity due to increasing academic pressure, use of electronics gazettes have all replaced outdoor games and activities which promotes sedentary life. There are very few studies describing the pattern of physical activity of children in India.Aim: The present study aimed to find out correlation between physical activity, BMI and time spend in front of screen among children.Methodology: Study was approved by review board of ethics committee. 312 school going children of various income groups with the age 6-12 years were recruited by purposive sampling method. Informed consent was provided by teachers or parents. Height and weight of children was taken to calculate BMI. Physical Activity Questionnaire for children (PAQ-C) was filled up to assess the physical activity by children. Self-reported hours of time spent in front of the screen was noted.Results: Distribution of obesity and overweight in the sample was 9% and 16%, respectively. There were statistically significant negative correlation between physical activity and BMI (r = -0.619); and Time Spend in front of Screen and physical activity (r = -0.554). There was positive correlation between BMI and Time Spend in front of Screen (r= 0.556).Conclusion: Increasing prevalence of overweight and obesity in school going children relate to decreasing physical activity level and increasing time spend if front of TV, video games and computers

Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review

Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient\u27s profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute\u27s DBS paradigm to ensure that patients receive the optimal therapy

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS). Objectives: To describe the long-term, real-world management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy. Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted. Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively. Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control

From medications to surgery: advances in the treatment of motor complications in Parkinson\u27s disease

Motor complications are responsible for the large burden of disability and poor quality of life in Parkinson\u27s disease (PD). The pulsatile nature of stimulation with oral dopaminergic therapies due to relatively short pharmacokinetic profiles and dysfunctional gastrointestinal absorption have been attributed to the development of PD motor complications. In this review, we will provide an overview of the pharmacologic and surgical therapies currently available and under investigation for the treatment of motor fluctuations and dyskinesia

Substance abuse in cervical dystonia

Objective: To assess the prevalence of substance abuse (SA) in cervical dystonia (CD) patients and correlation with psychiatric symptoms. Background: CD patients have a higher frequency of psychiatric disorders compared to healthy controls. Medications such as benzodiazepines, muscle relaxants and opiates, often used in the management of CD, are habit-forming and may lead to SA. Methods: Data collected from 10 sites participating in the Dystonia Coalition (htts://clinicaltrials.gov/show/NCT01373424) included individual responses to Hospital Anxiety and Depression Scale (HADS), Beck Depression Index II (BID-II) and Patient Health Questionaire-9 (PHQ9). These responses were correlated with clinical assessments of CD using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Structured Clinical Interview for DSM (SCID). Patients were divided into two groups based on the presence of SA, utilizing SCID criteria. Wilcoxon Rank-Sum test was used to analyze the difference in median scores on the questionnaires between the groups. A two-tailed p-value of \u3c0.05 was considered significant. Results: Of 208 CD patients enrolled, 23 (11%) were identified with SA. Of the male CD patients, 23% were identified with SA compared to 6.58% among female CD patients (p5 0.0007). The median age was 55 years in the SA group versus 61 in the other (p5 0.0315). Compared to those without SA, SA patients scored higher on PHQ9 (Median score 5 vs 3, P50.0437), BDI-II score (Median score 11 vs 7, P50.005), HADS total score (Median score 13 vs 9, P50.0035) and TWSTRS total psych (Median score 5 vs 3, P50.0335). Conclusions: Potential risk factors for SA in CD include younger age and male gender. The SA CD patients are more likely to appear to have co-morbid anxiety and depression. Patients with CD, particularly young males with associated psychiatric disorders, should be carefully monitored for potential SA

Immunotherapy-responsive chorea in a patient with antiphospholipid antibody syndrome and refractory Crohn\u27s disease: A case report

Objective: To describe a case of immunotherapy-responsive chorea in a 68-year-old woman with antiphospholipid antibody syndrome (APS) and refractory Crohn\u27s disease treated with Vedolizumab Background: Chorea is a rare manifestation of anti-phospholipid syndrome (APS), occurring in 1.3 % of patients. The median age of onset is approximately 20 years of age. There have been rare reports of APS in patients with Crohn\u27s disease and treatment is challenging. Design/Methods: Case report Results: A 68-year-old woman with history of refractory Crohn\u27s disease (CD) on vedolizumab presented with an acute onset of confusion, chorea and falls. MRI demonstrated multiple small cortical parieto-occipital infarcts. Chorea resolved spontaneously with no treatment. Three months later she presented with generalized chorea, cognitive impairment and imbalance. Repeat MRI demonstrated no new or acute infarcts. Autoimmune workup revealed positive ANA (1:160), DNA antibody, anti-cardiolipin (aCL) IgM (10.8) and IgG (139.4) antibodies and beta-2 glycoprotein IgG antibodies. CSF analysis demonstrated mild lymphocytic pleocytosis (7 WBCs, 100 % lymphocytes). She received 5 day course of IV methylprednisolone followed by IVIG treatment for 5 days with marked improvement of chorea and cognition. She was discharged on prednisone taper and warfarin therapy. Patient failed long term immunotherapy with hydroxychloriquine and azathioprine due to side effects. Conclusions: Thromboembolic events are frequently associated with inflammatory bowel disease. Prevalence of aCL is high in patients with Ulcerative colitis (18.1%) and CD (15.6%). To our knowledge APS related Chorea in patients with refractory CD on vedolizumab has not been previously described. Literature supports that high titers of cardiolipin are associated with increased risk for neuropsychiatric manifestations. Steroids and IVIG remain the treatment of choice in immune mediated movement disorders

Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management

Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2A receptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics

Pseudobulbar Affect Correlates With Mood Symptoms in Parkinsonian Disorders but Not Amyotrophic Lateral Sclerosis

Pseudobulbar affect (PBA) is a syndrome of affective disturbance associated with inappropriate laughter and crying, independent of mood. PBA is common in amyotrophic lateral sclerosis (ALS) and increasingly recognized in Parkinson\u27s disease (PD) and atypical parkinsonism (aP). Correlates of PBA have not been systematically studied. The purpose of this study was to determine whether cognitive and psychiatric comorbidities correlated with patient-reported symptoms of PBA by using the Center for Neurological Study-Lability Scale among patients with ALS, PD, and aP. A total of 108 patients (PD, N=53; aP, N=29; ALS, N=26) completed a cognitive screener and self-reported measures of lability, depression, anxiety, apathy, and quality of life. Statistical analyses included one- and two-way analyses of covariance to evaluate group differences, Pearson\u27s correlations to determine relationships between PBA symptoms and comorbidities, multiple regression for predicting PBA symptom severity in clinical correlates, and chi-square t tests for predicting demographic variables. PBA symptom severity did not vary between the three groups. Younger age and worse anxiety correlated with PBA symptom severity in all three groups, whereas depression and poor mental health/quality of life only correlated with PBA symptom severity in the PD and aP groups. PD and aP patients may be more likely to benefit from treatment with antidepressants. Increased PBA symptoms were associated with declines in cognitive functioning in the aP group, but sufficient numbers of PD and ALS patients with cognitive dysfunction may not have been recruited. The results suggest the possibility of an alternate pathophysiologic mechanism for PBA, which may vary between neurological disorders and disease progression. Mood and cognition are of particular relevance and should be evaluated when symptoms of PBA are suspected