Neurol India. 2001 Jun;49(2):128-33.

Split cord malformation (scm) in paediatric patients: outcome of 19 cases.

Kumar R, Bansal KK, Chhabra DK.

Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow, 226014, India.

There had been considerable debate regarding the surgical outcome of
neuro-orthopaedic syndromes (NOS) and neurological syndromes in cases of split
cord malformation (SCM). On retrospective analysis of 19 cases of SCM, thirteen
were grouped under (Pang) type I and 6 in type II. Their age ranged from 1 month
to 9 years (mean 3.5 years). 14 of these were male children. The NOS without
neurological signs was detected in 6 cases where as pure neurological signs
without NOS were seen in 8 patients. However, the rest 5 had mixed picture of NOS
and neurological dysfunction. Nine of 19 cases presented with cutaneous stigmata,
mainly in the form of hairy patch. 18 cases had other associated craniospinal
anomalies i.e. hydrocephalus, meningomyelocoele, syrinx, dermoid, teratoma etc.
Detethering of cord was done in all cases by removal of fibrous/bony septum.
Associated anomalies were also treated accordingly. Follow up of these cases
ranged from 6 months to 6 years. Six cases of NOS group neither showed
deterioration nor improvement, and remained static on follow up. However, four of
8 children with neurological signs showed improvement in their motor weakness,
and 1 in saddle hypoaesthesia as well as bladder/bowel function. In 5 cases of
mixed group, two had improvement in their weakness and one in hypoaesthesia, but
no change was noticed in NOS of this group as well. Hence surgery seemed to be
effective, particularly in patients with neurological dysfunction.

Indian J Pediatr. 2005 Feb;72(2):109-15.

Comparative study of complex spina bifida and split cord malformation.

Kumar R, Singh SN, Bansal KK, Singh V.

Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical
Sciences & King Georges Medical University, Lucknow, India.

OBJECTIVE: To see the difference in clinical profiles, radiological findings and
surgical outcome of the group 1 split cord malformation and meningomyelocele (SCM
with MMC) from group 2 (SCM without MMC). METHODS: 46 patients of SCM were
selected from a total of 138 cases of spinal dysraphism. They were divided into
two groups, based on presence or absence of MMC. Group I (SCM with MMC) n =19
patients and Group II (SCM without MMC) n=27 patients. A detail clinical
evaluation and MR screening of whole spine of all cases was performed. All
patients underwent surgical detethering of cord. After an average follow-up of
1.7 years, the operative results were clinically assessed and statistical
significance was calculated. RESULTS: Male to female ratio was 1:09. Mean age of
presentation was 3.6 years. Cutaneous markers like tuft of hair, cutaneous
haemangioma, etc, had a higher incidence in group II in comparison to group I
(50% vs 10.5%). The incidence of motor deficits was significant in group I in
comparison to group II (63% vs 40%). The incidences of sensory loss, trophic
ulcers, sphincteric dysfunction and muscle atrophy were relatively more common in
group I patients, while neuro-orthopedic deformities such as congenital telepes
equinovarus (CTEV), scoliosis and limb shortening were more frequent (67%) in
group II children as compared to group I (53%). Type I SCM has higher incidence
in group I children. Low lying conus were found in 47% patient of group I, while
in group II it was noticed in 69%. The associated cranial anomalies like
hydrocephalus, ACM and syrinx, were slightly higher in group I patients. At
surgery, dysgenetic nerve roots, neural placode, arachnoid bands and atrophic
cord were seen mainly in group I. Postoperative complications like, CSF leak,
pseudomeningocele and meningitis were more commonly encountered in group I
patients. The patients of group II showed better operative outcome compared to
group I cases. CONCLUSION: Incidence of SCM with MMC amount to 41% of total SCM
cases. Progressive neurological deficit was higher in this group (SCM with MMC)
in comparison to the group harboring SCM without MMC. In view of a significant
association of SCM in MMC cases, associated with other craniospinal anomalies, a
thorough screening of neuraxis (by MRI) is recommended to treat all treatable
anomalies simultaneously for desired outcome.

1: Neurol India. 2008 Apr-Jun;56(2):151-5.

Sleep seizures versus wake seizures: A comparative hospital study on clinical,
electroencephalographic and radiological profile.

Goel D, Mittal M, Bansal KK, Srivastav RK, Singhal A.

Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun,
India.

Background: Epileptic seizures, predominantly or exclusively during sleep had
been the focus of attention for many electroencephalographers. Though few
epileptic syndromes are associated with sleep seizures (SS) its frequencies in
Indian patients is still unknown. Aim: To find out the patterns of epilepsies in
patients having SS and compare them with patients having wake seizures (WS).
Setting and Design : Open label hospital based study. Materials and Methods: One
hundred and forty-four (13%) patients having predominantly SS were compared with
976 (87%) patients of WS by various clinical, electrophysiological and
radiological factors. Statistical Analysis: Chi square test and student T test,
using software SPSS (version 10, 1999) was applied to compare various parameters.
Relative risk was calculated by 2 x 2 contingency table. Results: The seizure
semiology was better defined in patients with WS and GTCS was more common in SS (
P = 0.001). Wake-electroencephalogram (EEG) was abnormal in significantly ( P =
0.001) higher number of patients with WS. Symptomatic etiologies were found in
more than half patients. Left lobe involvement was more common in patients having
SS ( P = 0.000). After symptomatic, idiopathic generalized and frontal lobe
epilepsy were most frequent with SS. Undetermined epilepsy was found in 37
(25.7%) patients with SS. Conclusion: Epilepsies associated with SS were less
frequent and had symptomatic cause in most cases. Left hemispherical and frontal
lobe lesion were more commonly associated with SS. Frontal lobe and idiopathic
generalized epilepsy was most frequent in patients of SS. Sleep EEG should always
be done in patients with sleep seizures.