Paresh Zanzmera

Bio: Paresh Zanzmera is an academic researcher from All India Institute of Medical Sciences. The author has contributed to research in topics: Obstructive sleep apnea & Epilepsy. The author has an hindex of 2, co-authored 3 publications receiving 82 citations.

Markedly disturbed sleep in medically refractory compared to controlled epilepsy – A clinical and polysomnography study

Abstract: Purpose To evaluate sleep disturbances or sleep related events and their characteristics among patients with medically refractory epilepsy, compared to those with controlled epilepsy. Methods In a prospective case-controlled study, patients of medically refractory and controlled epilepsy were recruited and history pertaining to epilepsy and sleep related events and Epworth sleepiness scores were recorded and all patients underwent over night polysomnography. Results Among 40 patients, 20 with medically refractory (Group 1) and 20 with controlled epilepsy (Group 2) (median age 18, range 10–35 years), the self reported sleep parameters in Group 1 patients were found to be significantly different as compared to Group 2, in terms of the duration of night time sleep, day time sleep, day time nap frequency, total sleep hours per day, excessive daytime sleepiness (EDS)(45% vs. 15%) and average sleep hours over the week prior to polysomnography. On PSG, Group 1 patients showed significantly less total sleep time [340.4min (147–673) vs. 450.3min (330–570)] with delayed sleep latency and REM latency, poor sleep efficiency [80.45 (40.5–98.0) vs. 95.45 (88.4–99.7)] and frequent arousals and wake after sleep onset (WASO) compared to Group 2 patients. Four patients (20%) in Group 1 compared to none in Group 2 were found to have mild obstructive sleep apnea. Conclusions Our results indicate that medically refractory epilepsy patients believe that they spend more time sleeping, in contrast to the documented shorter sleep duration on polysomnography. This difference between perceived and actual sleep seems, by their data, to arise mainly from sleep fragmentation, disturbed architecture and the interesting finding of associated sleep apnea among the medically refractory epilepsy patients.

Myofibrosis in a pentazocine addict

Abstract: Pentazocine, a synthetic narcotic analgesic, is commonly used for the relief of moderate to severe pain, but has been rarely abused also. It is usually well tolerated; however, adverse effects are not uncommon, when higher doses are used, especially in a dependent fashion. There are reports of various complications associated with its use, including skin fibrosis, skin ulceration, abnormal skin pigmentation and symmetrical myopathy with fibrous myopathy. Fibrosis has usually been reported in the muscles at the site of injection of the drug. Being opioid in nature, it has a high abuse potential. We report a case of pentazocine-induced myofibrosis in a 33-year-old man involving muscles which were not injected with pentazocine. This case highlights the care that needs to be taken when prescribing opioid analgesics, such as pentazocine, as routine painkillers. Rare consequences such as myofibrosis are devastating and can cause significant lifelong disability.

Study Protocol: IMPETUS: Implementing a Uniform Stroke Care Pathway in Medical Colleges of India: IMPETUS Stroke

Abstract: Introduction: In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India. Methods and Analysis: This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases. Discussion: Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.

Effects of epilepsy treatments on sleep architecture and daytime sleepiness: An evidence‐based review of objective sleep metrics

Abstract: SummaryObjective Sleep is considered restorative, and good quantity and quality sleep is required for memory consolidation and synaptic plasticity. Sleep disorders are common in patients with epilepsy. Poor sleep quality or quantity may worsen seizure control. On the other end, seizures and epilepsy may worsen the sleep quality and set a vicious cycle. In addition, antiepileptic drugs have an effect on sleep architecture. We performed a systemic literature review with a goal to evaluate the effect of antiepileptic drugs and nondrug treatments for epilepsy on sleep architecture to help better understand treatment effects, especially in patients with epilepsy and sleep problems. Methods We searched PubMed and identified studies that evaluated objective sleep outcomes for an antiepileptic drug. We also searched for studies with objective sleep outcomes that evaluated other epilepsy treatments such as epilepsy surgery, vagus nerve stimulation, and ketogenic diet. Results The studies were categorized based on evidence class and study population for an individual antiepileptic drug or treatment. We identified that most antiepileptic drugs and nondrug treatments for epilepsy affect sleep architecture. Significance We identified that gabapentin, tiagabine, pregabalin, clobazam, and carbamazepine reduce sleep latency and/or improve sleep efficiency. Phenobarbital, valproic acid, and higher-dose levetiracetam aggravate daytime sleepiness, whereas topiramate and zonisamide do not. Vagus nerve stimulation reduces daytime sleepiness, and ketogenic diet improves slow-wave sleep. Epilepsy surgery may improve nocturnal sleep only in a subgroup of patients with improved seizure frequency. Further studies are needed to evaluate the dose-dependent sleep effects of antiepileptic drugs and nondrug treatments independent of the improvement of epilepsy, and to identify if these changes are clinically significant.

Obstructive sleep apnoea in patients with epilepsy: a meta-analysis

Abstract: The aim of this study was to accurately determine the prevalence of obstructive sleep apnoea (OSA) in patients with epilepsy (PWE) and to evaluate the efficacy of seizure control after treating OSA. Articles were identified through a search of both MEDLINE and Embase. The articles were collected and data were extracted independently by two authors. OSA was described using the following terms: Apnoea/hypopnoea index (AHI) and respiratory disturbance index (RDI). The variables were calculated using DerSimonian and Laird’s random-effects model and odds ratio (OR). The prevalence of mild-to-severe OSA in PWE was determined to be 33.4 % (95 % CI 20.8–46.1 %), and PWE are more susceptible to OSA as compared to healthy controls (OR 2.36; 95 % CI 1.33–4.18). Males were shown to be more susceptible to OSA than females (OR 3.00; 95 % CI 2.25–3.99). The results also indicated that the prevalence of OSA in patients with refractory epilepsy is not higher than the prevalence of OSA in PWE overall (17.5 vs 33.4 %). The prevalence of OSA was not found to be significantly different for different seizure types or in the number of antiepileptic drugs (AEDs). Patients that had been treated with continuous positive airway pressure (CPAP) were shown to have better seizure control than those untreated (OR 5.26; 95 % CI 2.04–13.5). The prevalence of OSA in PWE is higher than in the general population. Additionally, the results of our study suggest that CPAP treatment results in a reduction of seizures.