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Dr. Prathap Kumar Pani

MBBS, MS - Neuro Surgery, M.Ch - Neuro Surgery

Neurosurgeon, Bangalore

36 Years Experience  ·  300 at clinic
Dr. Prathap Kumar Pani MBBS, MS - Neuro Surgery, M.Ch - Neuro Surgery Neurosurgeon, Bangalore
36 Years Experience  ·  300 at clinic
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Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences....more
Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences.
More about Dr. Prathap Kumar Pani
Dr. Prathap Kumar Pani is an experienced Neurosurgeon in Jayanagar, Bangalore. He has been a practicing Neurosurgeon for 36 years. He has completed MBBS, MS - Neuro Surgery, M.Ch - Neuro Surgery . He is currently practising at Sagar Hospital in Jayanagar, Bangalore. Book an appointment online with Dr. Prathap Kumar Pani and consult privately on Lybrate.com.

Lybrate.com has a number of highly qualified Neurosurgeons in India. You will find Neurosurgeons with more than 27 years of experience on Lybrate.com. You can find Neurosurgeons online in Bangalore and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

Info

Education
MBBS - SCB Medical College, Cuttack, Orissa, - 1981
MS - Neuro Surgery - SCB Medical College, Cuttack, Orissa, - 1985
M.Ch - Neuro Surgery - SCB Medical College, Cuttack, Orissa, - 1991
Languages spoken
English
Professional Memberships
Neurological Society of India

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No. 44/54, 30th Cross, Tilaknagar,Jayanagar Extension. Landmark:- Near Ocean MallBangalore Get Directions
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Neuro & Ortho Clinic

17/1, HDFC Bank Road, Ambalipura, Sarajapur Road, Karnataka Landmark: Opposite Spring Fields ApartmentsBangalore Get Directions
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I have problem of migraine. From last 7 years. I don't know what to do. Please suggest some medicines.

BHMS
Homeopath, Delhi
Migraine is due to deficient routine stress, sleep disturbances, high altitudes, glaring or fluorescent lights, certain foods, changes in weather conditions, and hormonal fluctuations. Avoid regular coffee, regular tea, regular cola beverages. Other carbonated beverages containing caffeine. Breads, buttermilk, yogurt, and sour cream. Chocolate milk, chocolate ice cream, chocolate. For medicine share your complete history.
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Sir ji. Yeh baat tab ki hai when I was 10 years old, I was playing in ground and I collapsed while playing for few minutes, my friends were saying that it was like fit (mirgi) attack, but due to fear I didn't inform my parents nor I took any medicine or checkup for same now my age is 31. In between these years I never suffered or faced any such problem now I want to know ki kya kbi mere ko future me koi neurological problem ho sakti hai kya ya should I go for some tests or not. Thanks.

MBBS, cc USG
General Physician, Gurgaon
Hello, You need complete neurological examination and investigation like EEG and CT scan may required Many time patient is not aware about seizure may occur while sleeping and if other person not in room, we will not able to come to know about this Kindly consult Neurologist as soon as possible
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Sir I have pain in my shoulder and neck and arm also and arm feels like heavy and I can't do work with it. This symptoms of paralysis? Tell me which specialist I have to go?

D.A.M.S( A. M.), D.AC/B.E.M.S
Acupressurist, Mumbai
You should take Acupressure therapy and take Biochemic Mag phos 200x +Nat mur 200x, 4 tab each thrice a day with warm water and take it 5 days than consult private online.
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I find my hands shivering very frequently. I don't why it happens but it has been happening a lot recently. please help.

BHMS
Homeopath, Faridabad
Hello, take kali phos 6x, 5 tabs twice daily. Ginseng 1x, 1 tab, once daily after lunch. Revert me after 7 days.
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Sir I want to know symptom of brain tumour. As I have pain in center of head. And upper part of the back of the neck.

M.Ch - Neuro Surgery
Neurosurgeon, Panaji
Brain tumour can manifest in many many ways with myriad symptoms like unremitting head ache, persistent vomitting, visual dimunition, fits, double vision, paralysis/weakness of one side of body etc.
2 people found this helpful
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Now Say - GO Migraine

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Gurgaon

Now say - Go Migraine

Migraine headache is usually associated with one sided throbbing headache, with nausea ( the tendency to vomit), vomiting and sensitivity to light. In a migraine there is excessive stimulation (constriction and sudden dilatation) of brain and blood vessels.

Causes-

Improper metabolism, suppression of natural urges, anger, jealousy, grief, poor elimination, intake of dry, pungent and salty food, intake of polluted food, mental and physical stress, viewing of tv for long periods, reading with insufficient light, sleeplessness etc.

Origin of a migraine headache
Due to the causative factors, pitta dosha obstructs the flow of Vata dosha in the brain, causing throbbing pain.

If you would like to consult with me privately, please click on consult now.

Management-

  • Sneha nasya - instillation of medicated oils can be carried to the nostrils. Shadbindu tailam or anu tailam yield significant benefits in this condition.
  • Apply a paste of freshly ground clay or freshly ground sandalwood to the forehead, let dry, rub off by hand and wash.
  • Sugar powder 16 parts, vamshalochana 8 parts, pippali (long pepper) 4 parts, ela (cardamom) 2 parts, cinnamon - 1 part. Make fine powder and mix it, keep in tight moisture-free container. Take half teaspoon thrice daily with honey.
  • Mix one-forth teaspoon of clove powder with 1 teaspoon of cinnamon oil. Apply this paste on the affected area for 20-30 minutes.
  • Add chamomile powder to 1 cup of boiling water. Transfer the liquid to a cup. Drink when hot. It gives fast relief from a migraine.
  • Grind 10-12 grains of black pepper and 10-12 grains of rice with water to make it a paste. Apply this paste on the affected area of the head for 15-20 minutes.
  • Take half a glass of carrot juice. Add half a glass of spinach juice. Mix well. Drink this juice to cure the migraine.
  • Practicing meditation is highly recommended.


Diet-

  • Apple, mango, papaya, cheeku, guava.
  • Salad 1hr before lunch, 1hr before dinner.
  • Buttermilk, boiled rice sauted with cinnamon, cumin seeds, and garlic or asafetida are good in the daytime.
  • Have warm and easily digestible foods, boiled and steamed vegetables, soups, vegetable juices, porridge, brown rice and whole-wheat flour.
  • Avoid yogurt especially at night. 
4 people found this helpful

I am feeling numbness on my right hand for 3-4 days. Please help me understanding what could be my problem. Thank you.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me digital x rays of cervical spine. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick matress are harmful use no pillow under the head. Do hot fomantation. Ibuprofen 200mg od & sos x 5days bio d3 max 1tab od x10 do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. Do reply back for detailed treatment plan. Do not ignore. It could be beginning of a serious problem.
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My wife's upper body, stomach, chest, both hands & arms has gone kind of numb since 2 days now. What do we do? Which specialist should we see?

MBBS, MD - General Medicine, DM - Neurology
Neurologist, Hyderabad
You should see a neurologist. After clinical examination, he may ask for mri of spine to confirm the diagnosis. Early treatment would help her recover.
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I am 51 years old from Hyderabad. My daughter is having Brain Tumor. She is having Ecto Dermal Glioma with hydro supholos. My wife does not agree for operation. What I have to do?

M.Ch - Neuro Surgery
Neurosurgeon, Pune
Go ahead with surgery after discussing the risks and prognosis with your doc. Surgery is essentially the first step in treatment, needed to releive brain pressure as well as to diagnose the type of tumor for further treatment. Leaving it as such may be life threatening.
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Hi I'm a 17 years old Female from Mumbai - I have constant migraine and irregular periods after and during my homeopathy treatment for sines (sines is now cured )i also have upper and lower back pain along with with my tailbone. And whenever I masturbate I feel lightheadeD and restless for throughout the week ar month. I had my blood test and it showed I had no thyroid but my level of VITAMIN B12 was low so i've been having dairy products and a B12 syrup. and I suddenly feel very hot and after few min I feel very cold, and my face swells during a very bad migraine I feel drowsy and whenever I wake up after sleeping my feet and back aches (my weight is 73 kg) please help me.

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
At your age migraine is common especially in young females with stress of studies to add. Migraine is a relapsing kind of headache. The treatment of migraine is mainly done for relief from acute headache attacks and later treatments to prevent future relapses. Treatment of factors like anxiety, strata, depression, vitamin deficiencies etc which tend to cause relapses is also important. There is no drug of choice or as such a best medicine for migraine. Treatment has to be individualised after taking into consideration patient factors and the history of migraine in the patient. For long term relief and prevention of relapses, consult a headache specialist an psychiatrist for a complete evaluation and treatment.
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Hello sir, I have problem of migraine and high blood pressure so what I do to control? Please tell me.

MBBS
General Physician, Mumbai
For headache take tablet paracetamol and avoid any triggering factor, take folic acid regularly, eat a healthy diet, always be stress free, exercise regularly.
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Hi Doctor I have half head-ache (Migraine) starts in the evening and last for 4-5 hours every day since a week. Sinus problem too. Please advise.

MD
General Physician, Mumbai
You need to take tab headset stat once and migranil twice a day for 5 days. ping me in private for more detailed prescription.
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How can I get rid off from migraine. I have been facing this problem for long years.

DM - Neurology
Neurologist, Nagpur
Although migraine is a genetic disease and patient experiences symptoms for many years, it can be very well controlled with medications and some non pharmacological methods.

All About Parkison's Disease

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
All About Parkison's Disease

* Should I be afraid of talking to the doctor?
No. Every doctor wants his/her patient to recover as soon as possible. If patients have the right knowledge, they are able to interpret and report their symptoms better. Having this knowledge prevents unnecessary anxiety and greatly facilitates diagnosis and treatment.

It is the duty of every doctor to provide the right information to the patient, and every doctor tries to do this to the best of his/ her ability. Sometimes it is not possible to provide thorough information and answer all questions of a particular patient, because then the doctor will not be able to give adequate time to the next patient. Th is is the main reason behind writing this book. In many cases, patients do not want to talk to their doctor because they are afraid of knowing more about their illness. This is the wrong approach. Knowledge is power. I assure you that having the right knowledge will decrease your anxiety and help you get better.

I do have one suggestion: before going to the doctor, write down all your questions on a piece of paper. Almost all doctors will be very happy to answer your questions if you ask them efficiently.

* Why should I pay attention to my symptoms? just run some tests and you will know what disease I have...
Tests can be helpful, but they cannot diagnose all diseases. Often, no test can detect the small short-circuits in the brain that are responsible for causing seizures. Until very recently, there was absolutely no test that could diagnose parkinson's disease. Tests cannot tell the doctor how you are responding to the medication. For example, in parkinson's the doctor may ask you how you feel in the morning, how long the eff ect of medication lasts, do your arms or shoulders jerk after you take medication, and so on. Each symptom is important for the correct diagnosis and treatment of your condition. You and your immediate family members can provide the doctor with this essential information. If you have difficulty remembering your symptoms, you should note them in a notebook. If you have difficulty describing some of your symptoms, you should make a video recording for 3-5 minutes using a smartphone or digital camera (android, Iphone etc). Such recordings are tremendously helpful for diagnosis and treatment.


* What are the common tests used to diagnose brain diseases?
The three tests most commonly used are:
Mri, ct scan and eeg. Other specific tests have been described in the relevant chapters.
(i) Mri (magnetic resonance imaging) scan:
An mri scan is probably the most important test for diagnosis. It can diagnose many diseases such as a stroke, tumor and inflammation. Mri scanning is done in a big tube shaped machine which is attached to a bed. Th e patient sleeps on the bed for 30-45 minutes. Th e bed slowly moves back and forth through the machine. During this time the machine clicks very detailed pictures of the patient's brain.

Please note that during the scan you may hear some loud whooshing and clicking sounds. Th ese are just the sounds of

Magnets and motors inside the machine, and there is no need to be concerned by these noises. Some people may feel anxious because of the small space within the scanner, and a few people may need medications to decrease this anxiety. Mri scanning is extremely safe; there is usually no health risk. Before the scan, please inform the doctor about any metal inserts or implants (e. G. Heart defi brillator) In your body.

Mri test machines are of various strengths such as 1.5 tesla, 3 tesla and so on. Mri machines with a higher number (for example 3 tesla) take better pictures. This book was written in 2015, at this time the highest resolution mri available in india was 3 tesla.

(ii) Ct (computerized tomography) scan:
The CT Scan machine looks just like the mri machine. It has a bed that moves back and forth slowly while the machine takes a picture of your brain.

CT scan has a few advantages over mri:
(i) It is less expensive. An mri may cost around 5000-7000 rupees, while a ct scan usually costs around 1000 inr (indian rupees).
(ii) It can be done very quickly. An mri may take 1 hour or more, but a ct scan can be completed in 10-15 minutes.

Unfortunately, CT scanning has some significant disadvantages:
- The picture obtained by a ct scan is not as clear as that obtained by an mri. The difference in quality is striking: it is like the diff erence between a black-and-white tv from the 70s and the new lcd televisions available today.

- CT-Scan exposes your body to radiation.
Radiation is bad for your body, and especially a baby's body. Therefore, pregnant women should never have a ct scan. Ct scan is commonly used during emergencies. When a patient comes to the emergency room, a rapid ct scan may be done to look for emergencies which may need immediate surgery such as bleeding inside the brain. An mri is usually done the next day, when the patient is more stable.

If you have already had an mri, then usually you do not need a ct scan. Th ere are a few rare conditions (e. G. Calcification in brain) which are seen better on a ct, but these are very uncommon.

(iii) Eeg (electro-encephalo-graphy):
Our brain functions because of electric currents traveling from one place in the brain to another. An eeg measures this electric current.

To do this test, small pieces of wire are stuck to the head using glue. These wires are then connected to an amplifi er and the electrical activity in the brain is recorded. The machine itself does not send any current to the brain. It only records current. Therefore, there is no pain or discomfort, and this is an extremely safe test. Anyone can have this test, including pregnant women, babies and very sick patients. Th is test is most often used for evaluating seizures. An eeg is also used in cases where the patient is unconscious for a long time, without a clear reason.


1. Doctor, my hand keeps shaking. It stops shaking only at night. Why is this happening?
The shaking of your hands is called a tremor. There are many causes of hand tremor. Th e most common causes are essential tremor and parkinson's disease. If you have essential tremor, your hands will shake more when you try to do something. For example, writing may become very diffi cult or water may fall down when you try to drink form a glass.

If you have parkinson's disease, the tremor is maximum when your hands are resting and doing nothing. For example, when you are sitting on a chair and watching tv comfortably, the hand starts shaking. Besides these common causes, there are other causes. For example, shaking of the hand (s) can begin after a small stroke near an important part of the brain called the red nucleus or in a condition called dystonia which causes contraction of the hand muscles without any clear reason some medications (see list), severe anxiety and very excessive tea/coff ee can cause hand shaking. Finally, there are diseases that have symptoms exactly like parkinson's disease.

Therefore, I need to examine you carefully. Based on observing you so far, I think there is a possibility that you may have parkinson's disease.


2. Parkinson's! I have heard this is an extremely serious illness! is this disease fatal?
No. Parkinson's disease is not fatal. Yes, but it is important to treat parkinson's disease promptly. Th e diagnosis of parkinson's disease is often missed. If not treated on time, patients with parkinson's disease are significantly restricted in their day-to-day activities, practically becoming disabled if treatment is delayed for a long time.

Secondly, if left untreated, patients with parkinson's disease can have frequent falls causing serious injuries including fractures and head injuries. Hence the diagnosis and treatment of parkinson's disease should be done as soon as possible.


3. What causes parkinson's disease?
Our brain runs on electricity and chemicals. If there is too much or too little of a particular chemical in your brain, it causes a disease. Parkinson's disease is caused by the reduction of a chemical called dopamine in our brain.

Dopamine is produced in the back of our brain, in a part called the mid-brain. It is then transported forwards and is widely distributed throughout the entire brain. It fi res up the movement centers of our brain, and helps them communicate better with one another. In parkinson's disease the cells in the midbrain producing dopamine gradually

Die. No one quite understands why this happens. Then effect is that the movement centers of the brain don't Communicate well with one another, and this produces the various symptoms of parkinson's disease.


4. Ok so what are other symptoms of parkinson's?
You already know one symptom shaking of the hands while resting. There are many other symptoms in patients with parkinson's disease and recognizing them is often very easy:
- Their muscles are often stiff and become inflexible, but they often do not complain about it. Th ey may complain that they are not able to do some things such as comb their hair.
- They are very slow in doing everything. They walk very slowly. They often bend forward while walking.
- They have difficulty turning around when they are walking.
- Sometimes they can get stuck in one position. Often this happens while walking, but may happen while doing something else.
- In later stages, they can fall frequently.
- Their friends may notice that their face has become expressionless and they just appear to stare off without blinking into distant space.

All patients do not have all of these symptoms. Some patients experience just the shaking of hands; other people experience just the muscle stiffness and so on. Often as people get older, more and more of the dopamine producing cells are destroyed and patients start developing more symptoms. But it takes years for this to happen and it may not happen in all people. In some patients, parkinson's disease remains restricted to just a few symptoms.


5. Ok doctor, thankfully I seem to be having just the hand shaking at this time. But other than the symptoms you just described, I am having other symptoms. I am always constipated, I cannot sleep well, and my saliva keeps dribbling from my mouth. Is it possible that these symptoms are also related to parkinson's disease?
Yes. It is not just possible but very likely that all these symptoms are due to parkinson's disease. Parkinson's disease is recognized by all doctors as a disease affecting movement. But in addition to movement problems, patients can have many other problems.

These are frequently not recognized, even by physicians, and therefore left untreated. If recognized and treated (and simple treatments are available for many of these symptoms), their resolution can significantly improve the patient's quality of life. It is important that your doctor should think about other diseases too. For example

If you have back pain, it is important that the doctor should think about arthritis of the back, if you have impotence your doctor should think about diabetes etc. But in many cases, no other cause can be found - these problems are due to parkinson's disease. About 10-20 years ago, even doctors did not know about these complications of parkinson's disease. It is a matter of great pride for me that I had the opportunity to receive training from the world-famous indian professor who is at the forefront of research regarding these symptoms: Dr. Kallol ray chaudhuri at king's college hospital in london.


6. How can you be sure that I have parkinson's disease?
A better patient history and examination will help me to confirm my diagnosis. We need to rule out other problems which look like parkinson's disease. Certain drugs may produce symptoms that are very similar to parkinson's disease (see list). Make sure you are not taking these medications, and avoid these medications in the future.

There are a few other diseases which have almost the same symptoms at parkinson's disease. Their names are complicated! these include diseases such as progressive supranuclear palsy (psp), multiple systems atrophy (msa) and cortico- basal degeneration (cbd)! th names are not very important the important thing is that there are other diseases that look just like parkinson's disease. Some of these diseases are identified by your doctor by looking for small clues on your exam: such as your blood pressure and the way your eyes move. Now let me tell you something very frankly even after a very detailed history and meticulous examination, the diagnosis may not be clear in some patients, even to the best of doctors in the best of institutions.


7. So isn't there a test for parkinson's disease?
Unfortunately, there is no test for parkinson's disease which can prove it with 100% accuracy. An mri (see information for everyone section) can be helpful to rule out some other diseases e. G. Multiple strokes, and 
Therefore many doctors get an mri in patients with parkinson's disease. There is one test that can be helpful. It

Is called the dat scan. The dat scan is abnormal in parkinson's disease, but it is also abnormal in some other diseases that look like parkinson's disease! therefore it is helpful only in certain cases. There are a few other tests like a cardiac scan (mibg scan), but these are only available at a few research centers, and again, do not help to completely rule out other diseases.


8. But. That is very concerning. What you are saying is that in some patients the diagnosis remains unclear?
You are correct. In most cases, the diagnosis of parkinson's disease can be made with certainty. But about 10% of patients have an uncommon mixture of symptoms so that no doctor, no blood test, no investigation can confidently determine if the patient has parkinson's disease or if he/she has another, similar disease. In such cases, most doctors explain the situation to the patients, and give them anti- parkinson's medications such as levodopa. Usually, a dramatic improvement is seen if the patient has parkinson's disease. If a patient takes an adequate quantity of Levodopa for 4-6 weeks and there is no clinical improvement, it is very unlikely that he has parkinson's disease.

These medications cause clinical improvement in about 1/3rd of all patients with the other diseases such as msa, psp etc. However, this improvement is not as dramatic as the improvement seen in parkinson's disease and frequently does not last as long. As the years go by, other symptoms develop (such as urinary problems, eye movement problems and falling) and a more definite diagnosis can be made on the basis of repeat examination.

9. Hmm. Doctor, there must be several medicines for parkinson's. If the parkinson's is caused by a lack of dopamine, shouldn't consuming dopamine help to reduce the symptoms of the parkinson's?
Yes, there are many medications and yes you are correct providing extra dopamine to the brain is one of the best ways to make the symptoms better. I have provided a list of these medications, but it is worth highlighting two of them: levodopa is the oral form of dopamine. It is converted into dopamine when it goes inside the brain. Th is is usually the fi rst medication that is started. It is available in standard, dispersible and extended-release

Preparations. Young patients with very mild symptoms of parkinson's disease are given a diff erent kind of medication initially. These medications are called dopamine agonists. Th ere are 3 dopamine agonist medications: pramipexole, ropirinole, and rotigotine. Th ey are available in standard and extended release preparations.


10. So, what you are saying is that the dose of parkinson's medications does not stay constant throughout life?
You are correct. Parkinson's disease often progresses as patients grow older. Some symptoms change and become less prominent but on the whole the symptoms become more severe. Th is progression is probably caused by gradual death of more and more cells producing dopamine. Very few people have side eff ects due to these based on the symptoms that develop, the medications. Often, parkinson's disease dose of parkinson's medication may need progresses as patients grow older and new to be changed, or new medications may be given. For example, if you have trouble sleeping at night, then the doctor can ask you to take an extra levodopa pill at night or an extended release ropnirole pill. If the benefi cial effect of levodopa is not lasting for as long as it used to, the doctor may ask you to take entacapone with the levodopa. If you have constipation the doctor will prescribe a laxative and so on. Sometimes it may take a few trials of different medications over 1-2 weeks to find the right combination that works for you. Parkinson's is not a deadly disease. Th ere are many medications for parkinson's. Th e doctor needs to have precise information about the patient's symptoms in order to prescribe the right medications. In parkinson's disease, the doctor needs help from his/her patient. It is essential to record your symptoms accurately and visit your doctor regularly, every 3 to 6 months.


11. Doctor, you are saying that frequently the dose of levodopa needs to be increased. But what happens if too much levodopa gets into the person's brain?
Yes, this can happen but it is not life-threatening. When there is excessive dopamine in the brain, the body starts moving too much. Often there are small jerks in the neck, shoulders and sometimes in the leg. If you are a fan of michael jackson, you have seen break-dancing. Th ese excessive movements look like break-dancing. Th e medical term

For these excessive movements is dys-kinesias. It is very important for you to be aware of them and remember the word: dys-kinesias. Often, dys-kinesias are at their maximum 1-2 hours after you take levodopa. If you have trouble recognizing these movements, you should take a video of any suspicious movements on your smartphone and show it to your doctor. In the early stages of parkinson's disease, dys-kinesias are only seen when the

Levodopa dose is very high. But in more advanced stages, they may be seen at lower doses and giving the patient an adequate dose of levodopa without producing dyskinesias may become diffi cult. At this stage, some dyskinesias may need to be tolerated. If you are suff ering from dyskinesias, you can reduce the dose of levodopa that you are

Taking. But this may result in some of the symptoms of parkinson's disease (slowness, rigidity, freezing etc) to reappear. Another way in which dyskinesias may be reduced is by giving you amantadine.


12. I am getting it now, doctor. This is like a weighing scale isn't it? too little levodopa causes the parkinson's disease symptoms to come back, and too much levodopa action causes dyskinesias.
Yes! th at is absolutely right. In the initial stages, balancing this weighing scale is very easy. But after 10, 15 or in some cases 20 years, balancing this scale becomes diffi cult. After taking levodopa, many patients improve but also get dyskinesias. It becomes impossible to fi nd a levodopa dose that causes improvement without producing dyskinesias. Th erefore, at this stage, some dyskinesias may need to be tolerated as long as you are able to function satisfactorily.


13. So doctor, you told me what happens when there is too much dopamine action in the brain. What if the there is too little dopamine action in the brain? What if levodopa just stops working?
Levodopa never stops working. But it may become less effective, and its effect may become short-lived. Th ere could be many reasons for levodopa to become less eff ective. These are listed separately the most important reason is that the patient may not be taking the levodopa on an empty stomach. As parkinson's disease advances, the eff ect of levodopa lasts for a shorter duration of time. Here is a somewhat typical story from such a patient. Remember, this happens only in few cases:
Taking the tablet helps me only for a short time. When I wake up in the morning, my feet contract, twist and become painful.


14. I understand. It must be difficult at that stage to find the right combination of medications. What if the situation worsens further?
Yes. And I think it is vital for patients to understand this. Frequently, with the right combination of medications the patient can get better. But it can take some time to find the right combination; sometimes even 3-4 trials of diff erent combinations may be required. If a patient gives up hope and gives up in the middle of these trials, the only possible outcome is progressive deterioration of the patient's health.

Sometimes, inspite of repeated adjustments, a good combination of medications cannot be found. But remember this situation arises 10-20 years after the parkinson's symptoms have been detected. Many parkinson's

Patients do not have to face this situation. If the right combination of medicines could not be found even after many trials, then still there is one solution. Brain surgery. Th en I take my morning dose of levodopa

And feel good. Sometimes I get some dyskinesias, but I don't complain about them because I am feeling good. But only an hour or 1.5 hours later, the symptoms of parkinson's disease start coming back. I become slower and slower, and then freeze. I get better again when I take levodopa, but I can't keep taking levodopa every hour!

I understand. It must be difficult at that stage to fi nd the right combination of medications. What if the situation worsens further?

Yes. And I think it is vital for patients to understand this. Frequently, with the right combination of medications the patient can get better. But it can take some time to fi nd the right combination; sometimes

Even 3-4 trials of different combinations may be required. If a patient gives up hope and gives up in the middle of these trials, the only possible outcome is progressive deterioration of the patient's health. Sometimes, inspite of repeated adjustments, a good combination of medications cannot be found. But remember this situation arises 10-20 years after the parkinson's symptoms have been detected. Many parkinson's patients do not have to face this situation. If the right combination of medicines could not be found even after many trials, then still there is one solution. Brain surgery. A proper mixture of medications may help this situation as well. I had given you an
Example of this earlier: entacapone can prolong the eff ect of levodopa.


15. Doctor. Brain surgery? are you kidding me? this is a big deal. By the way, what is this surgery called?
I know brain surgery is a big deal. This surgery is called deep brain stimulation, or this is a brain surgery, but a relatively dbs

If your symptoms are well controlled with medications, no doctor in their right mind would recommend you to have surgery. But in a few patients, medications no longer produce adequate improvement. Either the improvement lasts for a very short time, or the medication produces such dramatic dyskinesias that giving an adequate dose is impossible.

Approximately, 70% of such patients benefit from this surgery. The improvement is very significant, but dbs does not make all symptoms of parkinson's disease magically disappear. It is very important to have realistic expectations from the surgery. The improvement seen after surgery is batteries last for about 5 years, and can be Replaced when required.


16. Well. How is this surgery done?
This is a brain surgery, but a relatively minor one. A metal frame is usually attached to the patient's head. A very small hole (approximately 1 cm in diameter) is made in the head, and a thin (1 to 1.5 mm thick) wire is inserted through it. The wire is pushed into a very particular part of the brain called the sub-thalamic nucleus. Th e same process is repeated on the other side and another small wire is inserted. These wires are then connected to a small battery (a square of approx. 3 inch) that is kept in the skin below the chest. No part of this device can be seen from the outside, and any scars on the head are usually covered by hair in a few weeks. Th e device is usually turned on 4 weeks after the surgery. On an average, most.


17. I see. Doctor, does DBS cure all symptoms of parkinson's disease?
No. DBS surgery improves only those symptoms which improve after levodopa.

- Dbs surgery prolongs the eff ect of levodopa, decreases dyskinesias, improves slowness of movement, hand shaking, muscle stiff ness and in general makes the patient much more functional. However, symptoms that do not get better after levodopa such as freezing and falling usually do not get better after dbs.

- Approximately 5% of patients can have serious complications such as stroke, seizure and infection. But most of these problems are cured with medications. Only 1% of these patients have permanent problems from these complications, such as permanent weakness of one side of the body. Other symptoms that we talked about e. G. Sleep problems may get better after dbs. I conducted an audit of sleep symptoms after dbs during my time in london at king's college hospital, and found that there is

Significant, but non-dramatic, improvement in many patients.

Two problems can become worse after DBS:
(i) Severe psychiatric problems such as severe depression and hallucinations and
(ii) Severe diffi culties of thinking and memory. If any of these problems are severe, dbs is usually not off ered to the patient. If a patient has severe psychiatric problems and is under treatment, dbs may be considered in the future if they completely resolve.


18. Okay doctor, what are the risks of this surgery?
Th ere is a small amount of risk involved in any surgery. Since dbs surgery is relatively minor, the risk is low but is not non- existent.
- The risk of death is less than 1%
- Approximately 5% of patients can have serious complications such as stroke, seizure and infection. But most of these problems are cured with medications. Only 1% of these patients have permanent problems from these complications, such as permanent weakness of one side of the body.
- A few patients have minor problems such as problems in wire connections or a non-functioning battery. Th ese are easily corrected. In short, about almost 90-95% of patient do not have any complications during or after the surgery, and the risk of death or permanent problems is very small (lts 2%).


19. Can the doctor guarantee a significant benefi t after DBS surgery?
No. No doctor in the world can guarantee Improvement after dbs. Th at being said, improvement happens in most patients as long as they are carefully selected. Before off ering you option of surgery, the doctor will give you a large dose of levodopa and make sure that your symptoms improve significantly. He/she will tell you that this is the maximum benefit that you may get after dbs, and try to set realistic expectations so that you are not disappointed after the surgery. Often the surgery is followed by a period of temporary improvement, even before the battery is switched on. This improvement Goes away in a few weeks. Th is is expected and you should not be disappointed - this is a good sign. After the battery is switched on, it may take between 3-6 months to achieve the optimal balance between your dbs and medications. During this time, your symptoms will improve gradually. But you should be patient if your symptoms

Have not improved within 1-2 months there is a good chance they will improve with further dbs adjustments. Most patients improve after dbs surgery, but a few people do not improve. Th e reason why these people do not benefit from dbs surgery is unknown, and this is being vigorously researched in the us, uk and other countries. Read more here

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DEAR SIR, after acupuncture treatment vide wwwacu5solution since 12-09-15, pains, sprains, tightness, numbness all over body, tried Dr. ortho for 45 days, oils, balms, gels, home etc no relief, what to do? I am 66, male on insulin, lantus, amyral-m and madhu sanjeevani-02-0-02, bph on urimax d, regards---narasanna n.

MBBS
General Physician, Mumbai
In a known case of diabetic we need to control sugar levels with medication, aerobic exercise and following a diabetic diet and for pain take tablet paracetamol 650 mg and also take physiotherapy treatment till recovery.
2 people found this helpful
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My mother is suffering from brain tumour. It was diagnosed in 2008 and it was operated in 2009. So now my mother in not so conscious about the surroundings, keep on asking few things whole day like asking to give her biscuits whole day and so on. Her hairs are not grown till now and sometime she fall also while walking not because of any fits or seizures but due to walking imbalance. So our main concern is can we improve her position to previous state before the operation by some technology and we have heard a term neuro physiotherapy. Is that beneficial?

MBBS, MD - MD- Skin & VD
Dermatologist, Ahmedabad
Hello, in my knowledge it can really help her, enhance and/or maximise the functional ability. Nothing is hundred percent guaranteed but rather than letting her be, it is better to get treatment done. Will be good for you and your family. Consult a neurologist before going ahead, there are other ways too, so it would be good to show her reports, history etc. To a neurologist and go ahead.
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Sir/Madam, There is a continuous numbness in my left hand and also sometimes I get pain in foot. And also I started loosing body weight what are the causes for this problem? Some say these are the symptoms of diabetes. Is that true?

Diploma in Diabetology, Pregnancy & Diabetes, Hypertension, Cardiovascular Prevention in Diabetes ,Thyroid
General Physician, Sri Ganganagar
It may be due to hight blood pressure and high cholesterol. Donot worry at all. Discuss with neuro-physician. Get your sugar also tested.
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I am 20 and I am suffering backache and high migraine problem. This problem has caused many problems to me. I had cured alot but it was not helpful. I jst want some good and healthy cure.

M.D. (Ayurveda )
Ayurveda, Patiala
kindly take pathyakshdhatraydi kshayam and and adreesahacharadi kshayam, 2 tsf each in half a glass of warm water twice a day before meals. Take panchamruta loha guggal, 2 tabs (chew the tabs for best results) with dashmoolajeerakadyarishta, 2 tsf in half a glass of warm water after meals, twice a day. Avoid cold water or cold eatables in your routine. Take liquid diet like daliya, khichdi, moong daal and veggie soup in your diet regularly. Avoid AC and direct exposure to cooler air. Do massage with prabhanjanavimardan oil over the whole body. Continue the regime for 1 month. stay in touch. Good luck.
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My mom have been suffering from migraine from her childhood. How could it be cured?

MBBS
General Physician, Mumbai
Migrane- It is characterised by one sided headache which is pulsatile in nature and with a throbbing pain usually with an aura and we can start with tablet propranolol after personal examination
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Altamash has autistic disease. Doctor said that growth of his brain is very slow. So can you any other treatment for him.

PDDM, MHA, MBBS
General Physician, Nashik
There is no cure for autism; however, with appropriate treatment and education, many children with autism spectrum disorders can learn and develop. Early intervention often can reduce challenges associated with autism, lessen disruptive behavior, and provide some degree of independence.
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