Neurology India最新文献

Background: The outcome after severe traumatic brain injury (STBI) is a multifactorial process. We assessed the correlation of serum IL-6 levels and IL-6-174 G/C polymorphisms with long-term functional outcome after STBI.

Methods: Serum IL-6 was measured by ELISA technique. IL-6-174 G/C gene polymorphisms were assessed using PCR-RFLP in STBI patients between 18 and 65 years. The functional outcome (Glasgow Outcome Scale, GOS and Functional Independence Measure, FIM) was evaluated at 1, 6, and 12 months after injury.

Results: 62 consecutive patients (mean age 33.8 ± 11.6 years) with STBI were recruited for the study. There was a statistically significant reduction of serum IL-6 levels after 1 week of injury in both wild (GG) and variant (GC and CC) genotypes (p=<0.0001 and P = 0.001, respectively); however, there was no significant variation of serum IL-6 levels among the two genotypes at any time point (P = 0.97 and P = 0.84 at admission and day 7, respectively). Intragenotype analysis demonstrated a statistically significant improvement in outcome parameters (GOS and FIM) till 6 months after injury in both the wild (P = 0.0001 and p=<0.0001) and variant (P = 0.0002 and P = 0.0005) genotypes. While a significant improvement of FIM was evident between 6 and 12 months (P = 0.003 and P = 0.02 for wild and variant types respectively), the recovery pattern plateaued for the GOS with no significant improvement over the next 6 months (P = 0.08 for wild type and P = 0.16 for variant type, respectively, for 6-month and 12-month time intervals). Inter-genotype analysis demonstrated no significant difference in outcome (GOS and FIM) between wild and variant types at any time point (1-month, 6-month, and 12-month time periods; P > 0.05). Multivariate logistic regression model failed to identify IL-6 genetic polymorphism (P = 0.81 and P = 0.99) and serum IL-6 levels (P = 0.54 and P = 0.69) as independent risk factors for outcome (GOS and FIM) at 1 year. Admission GCS was the only significant (P = 0.04) independent risk factor for FIM outcome after 1 year of injury in the present cohort.

Conclusion: We could not find any significant association of IL-6-174 G/C polymorphism and serum IL-6 levels with long-term outcome after STBI. Besides, contrary to our expectations, there was no difference in serum IL-6 levels among the two genotypic groups. The underlying mechanisms behind the observed findings are unclear and need to be further studied.

To investigate the clinical features of tuberous sclerosis complex (TSC) and to improve the understanding of TSC. Analysis of clinical and image data of a patient diagnosed as TSC. The symptoms of TSC are epilepsy, intelligent reduction, facial angiofibroma, renal hamartoma, and so on, and it may be associated with hypothyroidism. At present, TSC has no specific treatment. TSC is rarely in clinical practice. It is necessary to improve the understanding of it. Early detection, early diagnosis, and early intervention should be done.

Introduction: Glioblastoma multiforme (GBM) continues to have a poor prognosis despite advances in therapeutic modalities. Given the rising costs of treatment, it is unclear how cost-effective treating the condition is in a middle-income country.

Objective: To compare the cost-effectiveness (CE) of different strategies for treating GBMs in India.

Methods: Seventy adult patients with GBMs were included in this analysis. Direct and indirect costs were calculated from a societal perspective. Effectiveness was calculated in terms of quality-adjusted life years (QALYs). A decision-tree model compared different real-world strategies: surgery (maximal safe resection) alone, surgery with radiotherapy (RT) and concurrent temozolomide (RT-TMZ), and surgery with RT-TMZ and adjuvant TMZ (Stupp protocol). These were compared with a hypothetical "no active treatment" group. Incremental CE ratios (ICERs) were calculated, and a one-way sensitivity analysis was performed.

Results: Using a CE threshold of 1 per-capita gross domestic product (INR 2,28,007)/QALY, surgery alone was found to be cost-effective (ICER of INR 61,790/QALY compared to "no active treatment"), while the Stupp protocol was not (ICER of INR 12,06,595/QALY compared to surgery). Sensitivity analysis revealed that the ICERs were most sensitive to the duration and utility of progression-free survival (PFS), loss of productivity, and cost of intervention.

Conclusions: Surgery without adjuvant therapy is currently the only cost-effective treatment strategy for GBMs in India. In order to provide a cost-effective Stupp protocol, health policymakers should address the high costs of adjuvant RT, invest in methods for screening and early diagnosis to improve PFS, and develop policies to improve disease-related QOL and productivity.