The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.

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Background Little data are available on the spectrum of movement disorders in inpatients, particularly those admitted in neurology specialty. This may be related to the fact that patients presenting with movement disorders are usually evaluated from outpatient clinics. Objective The aim of this study is to provide data on the pattern of movement disorders in neurology inpatients. Materials and Methods Patients admitted through emergency department or neurology clinic with complaints of movement abnormalities were recruited in this study from October 2019 to September 2020. Cases were subjected to proforma-based detailed history, examination, and appropriate investigations. Statistical Analysis Descriptive statistics using SPSS 20. Results and Conclusion Bradykinesia with or without tremor was the most common movement disorder (28.3%), followed by ataxia and dystonia (24.5% each) and hemifacial spasm and myoclonus (7.5% each). Chorea, tic disorder, and hemiballismus were also reported. Etiologies included Parkinson disease, Wilson’s disease, subacute sclerosing panencephalitis (SSPE), drugs, stroke, spinocerebellar ataxia, Huntington’s disease, neuroacanthocytosis, and others. Dystonia represented the most common disorder in the younger age group (44.4%), whereas bradykinesia and/or tremor represented the most common movement disorder in the older age group (46.4%).This study demonstrates the characteristic distribution of movement disorders in neurology inpatients.

Background: Atrial fibrillation is one of the common indications of oral anticoagulation. Warfarin continues to be the most commonly used oral anticoagulant, particularly in developing countries. However, its use is limited by many factors, the most important of which is monitoring its therapeutic effect. Objective: The objective of our study was to assess the anticoagulation quality in patients with atrial fibrillation receiving warfarin for thromboprophylaxis and the impact of various factors on the anticoagulation quality. Materials and Methods: A total of 79 cases with non-valvular atrial fibrillation with or without a history of ischemic stroke attending the neurology clinic from September 2019 to March 2020 were studied. INR readings were taken from the outpatient record register which was converted to TTR (Time in Therapeutic Range) using the Rosendaal method. Cases that had received warfarin for less than 1 year were excluded. TTR value > 70% was considered as good anticoagulation control, TTR 60-70% as intermediate control and TTR < 60% as poor control. Statistical Analysis: Descriptive statistics and Pearson chi-square analysis using SPSS-20. Results and Conclusion: The mean TTR in our study was 59.72. Only 21.5% of cases in our study achieved a good anticoagulation control (TTR > 70%) while as 55.69% had a poor anticoagulation control (TTR < 60%). Males were reported to have a higher mean TTR value as compared to females (64.24 vs 55.54). High CHA2DS2VASc score and HAS-BLED score proved to have a strong predictive value for TTR less than 60. Individually, alcoholism, diabetes mellitus, hypertension and chronic kidney disease were found to be predictors of poor anticoagulation control i,e. TTR < 60. The presence of Transient ischemic attack or ischemic stroke was found to have a positive correlation with TTR > 70. A high number of adverse events (thromboembolic and bleeding) were reported in patients with TTR less than 60. The observations reflect the poor quality of anticoagulation in non-valvular atrial fibrillation patients on warfarin in the studied population.