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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
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Dec 1 • 5 tweets • 3 min read
#Valproate (VPT) is still more efficacious and more cost-effective as compared to #levetiracetam (LEV) for treating generalized #Epilepsy (GE)

1. I see an increasing trend for prescribing LEV in emergency room, ICU & OPD for GE
#MedTwitter #neurotwitter

doi.org/10.1016%2FS014…
2. In a recent study, LEV was found to be inferior for times to treatment failure, 2-year remission from seizures, and first subsequent seizure. In addition, LEV was not found to be a cost-effective alternative.
3. This is despite the fact the LEV is associated with a higher incidence of #psychiatric and #behavioral adverse effects.
This is a major problem in #ICU patients, as it adds to the burden of patients with #psychosis in ICU.
4. In women of child-bearing age, there is an increased risk of teratogenicity with VPT, however, studies indicate that lower dose (upto 600 mg/day) can be safe and effective. In any case, discussion regarding safety and efficacy of VPT vs LEV is needed in this group of patients.
5. Take home message:
VPT is the drug of choice for treating idiopathic generalized epilepsy.
LEV can be offered, if VPT is contraindicated (as in pregnant women) or in medically-refractory epilepsy cases.

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Dec 1
"Retirement" from work as a risk factor for #Dementia: experience of 5 recent patients

1. I saw 5 new cases of dementia last month, which apparently started within 6 to 18 months after retirement from work. All were cognitively normal until retirement.

#MedTwitter #Alzheimer
2. Memory impairment was the most prominent symptom. Over a period of time, other symptoms such as impaired calculation, speech impairment, losing sense of direction, poor judgement and inability to do daily activities without assistance, also started. Symptoms were progressive.
3. A diagnosis of Alzheimer's disease was made on the basis of detailed neuro-psychological assessment, brain scans and other appropriate investigations.
Two patients had comorbid #depression. Three patients had #sleep disorders- two had #insomnia and one had excessive sleep.
Read 10 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Nov 29
#eyes becoming smaller in evenings could be a sign of #neurological illness

1. I was seeing the last patient, on what had been a busy Monday. While counselling the patient's attendant (aged 45), I noticed that her left eye was smaller than the right.

#MedTwitter #neurotwitter
2. On enquiry, she confirmed that her eyes were of equal size in mornings, but left eye became smaller as the day progressed. This was the case for the past 4-5 months. She had no other issues. This had been noted by her family members and friends too. An eye check up was normal.
3. I discussed with her that this could be a sign of #myasthenia gravis (MG) and asked for investigations. Repetitive nerve stimulation was normal. However, acetylcholine receptor antibody was high (8; normal value<0.25). The diagnosis of MG was confirmed. CT chest was normal.
Read 9 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Nov 28
Case of a man who almost stopped eating and drinking, as the act of swallowing caused severe throat pain

1. 45-year old man presented with intense episodes of pain in throat, back of tongue and tonsils on the right side for three months. The pain radiated to ear.
#MedTwitter
2. #pain was excruciating and was triggered by eating, chewing or swallowing food, drinking water, sneezing or even yawning. Pain lasted for 30-45 seconds and occurred 10-15 times every hour. He was so scared to eat or drink that he lost 15 kg weight in those 3 months.
3. He consulted ENT and dental doctors, and detailed examination by them was normal.
He became depressed and also had suicidal thoughts. He consulted psychiatrist and was started on anti-depressant medications.
On his sister's (a medico) advice, he decided to take my opinion.
Read 6 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Nov 28
White coat #hypertension (WCH) can not be left alone

1. Patient: My BP is high only in hospital, at home it is normal. So, I don't want to do anything about it.
Me: High BP (whether in hospital or at home) can lead to adverse outcomes, so, you should aim for a normal BP 24/7.
2. A study showed that in untreated cohorts, WCH was associated with a 38% and 20% increased risk of #Cardiovascular disease (CVD) and total #mortality (death) compared with normotension (normal BP), respectively.
3. However, in the treated patients (who received medications to keep BP normal at office as well as at home), neither the risk of CVD, nor total mortality was increased in WCH.
Read 5 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Nov 27
Calcium supplements increase the risk of dementia inn older people

1. #Calcium tablets are commonly prescribed to older people to lower the risk of #osteoporosis and #fractures. However, calcium tablets may increase the risk of #Dementia.
#neurotwitter #MedTwitter
2. Women (aged 70 or more) taking calcium supplements had a higher risk of all type dementia, vascular and mixed dementia at 5-year follow up.
The risk of dementia was higher in women with previous history of #stroke and those with white matter lesions (WML) on #MRI brain.
3. In another study, higher serum calcium status (even if not hypercalcemia) was associated with increased risk of #Alzheimers disease in elders. Serum calcium is a useful biomarker in predicting clinical progression in nondemented elders.
Read 6 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Nov 27
Regular #exercise effectively reduces #headache days in patients with #migraine

1. Migraine is a disabling disease that causes repeated episodes of headaches.
Exercise is very effective, however, it is uncommonly prescribed in migraine.
#MedTwitter #neurotwitter
2. In a recent research, strength/resistance training reduced monthly migraine days (MMD) by 3.5 days, followed by high-intensity aerobic exercise (3.1 days) and moderate intensity aerobic exercise (2.2 days).
3. All exercise modalities showed higher efficacy compared to placebo.
The reason for strength/resistance training to rank top could be because of targeted muscular strengthening and reconditioning, particularly involving major muscles in the neck, shoulders and upper limbs.
Read 12 tweets

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