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Dr. Siddharth Kharkar - Neurologist, Borivali (west)

Dr. Siddharth Kharkar

87 (68 ratings)
MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment ...

Neurologist, Borivali (west)

15 Years Experience  ·  750 - 800 at clinic
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Dr. Siddharth Kharkar 87% (68 ratings) MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, ... Neurologist, Borivali (west)
15 Years Experience  ·  750 - 800 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. Siddharth Kharkar
Dr. Siddharth Kharkar graduated with his MBBS from Seth G.S. Medical College and K.E.M. Hospital in the year 2002 scoring first class in all subjects including distinctions. He then obtained his Master in Health Sciences degree from Johns Hopkins University in Baltimore, Maryland, USA. Dr. Kharkar then pursued post graduate training in Internal Medicine at Washington Hospital Center / Georgetown University, Washington DC, USA. Next, he completed a residency in neurology at Drexel University in Philadelphia, USA. After finishing his residency, he pursued a 2 year fellowship in Epilepsy at University of California at San Francisco (UCSF), one of the most renowned centers for epilepsy treatment in the world. Recently, he completed a clinical attachment in movement disorders and Parkinson’s disease at King’s college in London, again a world-renowned center for movement disorders. Dr. Kharkar was part of the epilepsy faculty at University of Alabama at Birmingham and was in-charge of the epilepsy division at the Veterans Affairs (Ex-Army) hospital at Birmingham. He has published numerous research papers in international journals, and has been on the review board of multiple internationally renowned journals including “Annals of Neurology” and “Neurosurgery”. Dr. Kharkar returned back to India after a successful career abroad with the strong desire of serving his fellow countrymen, and an intense motivation to contribute in advancing neurological care and research in India.

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Education
MBBS - Seth G.S. Medical College & KEM Hospital - 2002
MHS - Johns Hopkins Bloomberg School of Public Health -Baltimore, Maryland - US - 2005
MD - Neurology (USA) - Drexel College of Medicine, Philadelphia, PA - 2011
...more
Fellowship in Epilepsy - UCSF, USA (University of California at San Francisco) - 2013
Clinical Attachment in Movement disorders - Kings College, London - 2015
Past Experience
Division of Epilepsy Department of Neurology, University of Alabama at Birmingham Birmingham Alabama USA Number of Unique Resective Epilepsy Surgeries Per Year: 40-60 at 2014 - 2015 Assistant Professor
University of California at San Francisco San Francisco California USA Mentor (s): Dr. Daniel Lowenstein Dr. Paul Garcia Number of Unique Resective Epilepsy Surgeries Per Year: 50-60 at 2011 - 2013 Epilepsy Fellow / Instructor
Resident - Neurology at 2008 - 2011 Drexel University Philadelphia Pennsylvania USA
...more
Resident - Internal Medicine at 2007 - 2008 Washington Hospital Center / Georgetown University Washington District of Columbia USA
2006 - 2007 Research Coordinator at Department of Neurosurgery Johns & Hopkins Hospital Mentor: Dr. Daniele Rigamonti - Vice - Chairman Department of Neurosurgery
2004 - 2005 Research Assistant at Department of Neurology & Kennedy Krieger Institute for Children Mentor: Dr. Hugo Moser Professor & Ex-President Kennedy Krieger Institute
2008 - Present at Ongoing Research Activity As Listed in The Publications Section
Awards and Recognitions
Selected for the national “Neurology Residents Scholar Program
Best resident research project Award
Humanitarian Resident of the Year award
Professional Memberships
American Academy Of Neurology
American Epilepsy Society
Indian Association of Neurology
...more
Maharastra Association of Neurology

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Wockhardt Clinic

Lancelot Building, SV RoadBorivali (west) Get Directions
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Wockhardt Hospital

Naya Nagar RoadMumbai Get Directions
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Dr. Kharkar's Dispensary

2nd Floor, Thakur ArcadeVirar (west) Get Directions
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Wockhardt clinic

Jan Seva hospital, behind Dattani mallVasai Get Directions
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Parkinson's Disease - Know Its Causes and Symptoms!

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Parkinson's Disease - Know Its Causes and Symptoms!

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 fires 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. The net 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.

What are the symptoms of Parkinson's?

           MOTOR Symptoms

      NON-MOTOR Symptoms
1. Shaking of the hands while resting. Difficulty in thinking
2. Stiff & inflexible muscle DepressionFatigue
3. Bending forward while walking  Pain in one part of the body especially legs or throughout the body
4. Difficulty turning around while walking Ribbling of saliva from the mouth
5. Getting stuck in one position while walking Tingling and restlessness of the legs in the evening or at night
6. In later stages, they can fall frequently. They get slow in doing things Difficulty sleeping at night, Feeling sleepy during the day
7. Expressionless Face Vivid and fearful dreams
  Violent movements of hands and legs while sleeping
  Problems controlling your bladder, having to rush to the bathroom
  Constipation Difficulty in seeing things, especially on waking up

​​​

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.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3248 people found this helpful

Surgery For Parkinson's Disease - Deep Brain Stimulation (DBS)

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Surgery For Parkinson's Disease - Deep Brain Stimulation (DBS)

Brain Surgery for treating Parkinson's diease is called Deep Brain Stimulation, or 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 is pushed into a very particular part of the 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  kept in the skin below the chest. No part 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 not the same for every patient. On an average, patients get 5 extra hours of good functioning during which time they can walk, talk, go around and – in general – have a better life. The 5 “good” hours may not seem like much. But when you consider the fact that these patients frequently don’t even have 4 hours of good functioning before the surgery, it represents a major improvement in their quality of life.

DBS SURGICAL PROCEDURE - 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 brain called the “sub-thalamic nucleus”.

The 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 of this device can be seen from the outside, and any scars on the head are usually covered by hair in a few weeks.The device is usually turned on 4 weeks after the surgery. On an average, most batteries last about 5 years, and can be replaced when required. Consult an Expert & get answers to your questions!

3312 people found this helpful

Male 26, Unmarried. Weight 50 kg. Height 164 cms. No Alcohol/smoking. I'm a Epilepsy patient before when I had the 1st seizure on feb 2010. After that I had almost 30 seizures completely. Last seizure occurred 20/06/2011. After that No recurrence of seizures. I had modification for 3 years daily under Neurologist Doctor. CT scan and EEG reports are normal. Everything now fine. Sometimes I get headache like migraine: I will take Naxdom 500 mg, it gives relief. But Sometimes I feel something disturbed that it makes me i'm going to have a seizure now .something brain functioning will become dull and changes. Please assist me whether after complete recover also Are there any chances for fits/seizures again in my life? Can I take the medication when I feel?

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Male 26, Unmarried. Weight 50 kg. Height 164 cms. No Alcohol/smoking.
I'm a Epilepsy patient before when I had the 1s...
Take your medications regularly. If you are getting auras or small seizures, these need to be controlled as well. You may need a change in medications or slightly higher doses. You should followup with your neurologist regularly and tell him about all your symptoms, including the periods when your brain feels "dull" - if that sensation lasts only for 1-2 minutes it could be a seizure. Wish you the best.
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I have migration problems. Heavy headache. Am working any time see in systems. How can handle this problem, I have tonsil operate in 6 th std.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
I have migration problems. Heavy headache. Am working any time see in systems. How can handle this problem, I have to...
See a good neurologist. There are many treatments for migraine and not all of them involve medications. Prevention is the best cure.
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Suffering From Parkinson's Disease - How You Can Maximise The Effect Of Levodopa?

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Suffering From Parkinson's Disease - How You Can Maximise The Effect Of Levodopa?

If you are being treated for Parkinson's disease. How can you maximize the effect of Levodopa? The effect of levodopa can be maximized by increasing its absorption from the digestive system. In particular, taking levodopa on an empty stomach is very important. 

  1. Take on an empty stomach: Do not eat anything 1 hour before taking levodopa. Do not eat anything for at least 30 minutes and if possible 1 hour after taking it. Take the pill with 2 glasses of water so that it can dissolve. If taking the levodopa on an empty stomach makes you nauseous, confirm that your medication has the right amount of carbidopa in relation to the levodopa (25%). If you continue to feel nauseous, you can eat a piece of white bread around the time that you take levodopa. Do not apply any butter, yogurt, cheese or similar high protein spreads. Protein can drastically decrease the absorption of levodopa. 
  2. Get your constipation treated: This is critically important too. Being constipated can slow down the passage of levodopa through the digestive system. In most patients, drinking adequate water and taking stool softeners is helpful. 
  3. Get your ulcer treated: It can be difficult to recognize that you have a gastric ulcer. However, if you have a burning sensation in your stomach at any time, or belch frequently, you may have a gastric ulcer. If you think you have an ulcer you should get tested (there is a simple breath test now) and treated with antibiotics (not antacids!) 
  4. Do not take levodopa with iron tablets: The iron binds to levodopa and prevents its absorption. Keep a gap of at least two hours between these two medications. 
  5. Try taking levodopa with orange juice and carbonated water (soda): Mix equal quantities of orange juice and carbonated water (soda). Take your regular levodopa with a glass of this preparation instead of water. The carbonated water hastens disintegration of the tablet, and the acidity of both things helps in levodopa absorption. There are special tablets of levodopa (dispersible levodopa, Madopar) which can be dissolved in this preparation. If you wish to discuss about any specific problem, you can consult a Neurologist.
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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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My wife is taking tegrital (Carbamazepine) 200 mg daily, earlier she was taking 600 mg daily but gradually reduced to 200. This medicine she is taking since the age of 12 due to seizures, and now she is 46 years old. The last attach had happened almost 15 years ago, hence my question is that she will continue the medicine or should stop it.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
You should talk to an epilepsy specialist before stopping it. The chances of seizure recurrence after stopping medications is about 50-50. Studying earlier Mris and repeating the eeg might help in predicting if she needs to continue taking medications.
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I am suffering from migraine procedure for the last two years and I have headache. Can you suggest what should be done?

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
First the diagnosis of migraine needs to be confirmed, other serious causes for a headache need to be ruled out. If it is really migraine - Lifestyle changes can be very effective in migraine. Some people do need prophylactic medications to prevent migraine. Prevention e.g. 8 hrs of sleep, avoiding hunger, avoiding stress, keeping a diary and avoiding triggers is better than medications.
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Since last 3 years my mother is suffering from numbness in hands during nights. Recently, it has started occurring in her legs also. Why is it happening and how to solve this problem at its best? please help.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Since last 3 years my mother is suffering from numbness in hands during nights. Recently, it has started occurring in...
Numbness in hands especially numbness that is relieved by shaking hands vigorously or wringing hands can suggest carpal tunnel syndrome. If, in addition, she really has tingling in the legs then other conditions including thyroid problems, b12 deficiency, and paraneoplastic problems etc need to be ruled out. In my experience usually these turn out to be two different problems (carpal tunnel + back arthritis, neck + back arthritis etc)
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My husband is 42 year .he has a problem of migraine headache not frequently but sometimes. His blood pressure is 145/100 though he doesn't have history of high blood pressure but since few days his bp is fluctuating between 140 /100 to 130/90. Right now he's staying in Australia. And we all are in India .he has a history of allergy rhinitis. When ever he has headache he's taking naprosyn tab 250 mg.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
High blood pressure does Not cause headaches unless it's very very high. Migraines are different as compared to other headaches. If he has allergic rhinitis saline nasal spray or steroid nasal sprays are very effective. Lack of sleep due to nasal blockage can exacerbate headaches. Many interrelated issues. I have written a small book on the subject for the benefit of patients.
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My husband is suffering from skin infection 'herper zoster'.He has epilepsy. Can he use his epilepsy medicines along with skin infection medicines? He is using oxmazetol 300 mg in the mornings and 500 mg in the night.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
My husband is suffering from skin infection 'herper zoster'.He has epilepsy. Can he use his epilepsy medicines along ...
Seek the help of a neurologist. Most medications used for post herpetic neuralgia help to prevent seizures rather than precipitate them. I have written a small book on the subject of epilepsy for the benefit of patients.
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Is Sleep Paralysis a Symptom of a Serious Problem? Yesterday left side full not sense (top to bottom like head, hand and leg) this is 1st time happening to me.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Usually sleep paralysis affects the entire body and is part of narcolepsy which includes cataplexy (neck quickly losing power e.f. While Laughing) and excessive daytime sleepiness. Since your episode was so asymmetric you should be very intensively evaluated to rule out a transient loss of blood supply to one part of your brain (a transient ischaemic attack or TIA)
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Dear Doctor, Since last one week frequently my right hand and small and ring fingers are also getting numbed slightly but not completely and I am feeling that for long time. One more thing is this happens to me after the very next day of night shift I usually attend at office (but I sleep at least 4 hrs though). And 'm really getting afraid so much. Is it any kind of serious? please help me out by suggesting something to cure it.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Dear Doctor,
Since last one week frequently my right hand and small and ring fingers are also getting numbed slightly...
Probably is caused by compression of the c8 nerve in your neck. Usually this is caused by mild arthritis of the neck. Make sure you are not placing your body in a odd position in work e.g. Sleeping in a chair and make sure you are following proper ergonomic precautions. If your symptoms don't resolve then see a neurologist in person.
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Good evening, my father is diabetic and hypertensive and had present history of insomnia. He is suffering from burning sensation on tongue and feet. He is taking clonazepam and pregeb M regularly. What should we do.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
Good evening, my father is diabetic and hypertensive and had present history of insomnia. He is suffering from burnin...
See a good neurologist. First thing would be to rule out other causes for the pain especially the tongue pain. Second, There are other medications for a small fiber neuropathy which is what your father seems to have. Some of them e.g. Duloxetine may help your father.
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I have pain n right side Testicle & getting Numbness in my right side of leg toe.

MBBS, MHS, MD - Neurology (USA), Fellowship in Epilepsy, Clinical Attachment in Movement disorders
Neurologist,
I have pain n right side Testicle & getting Numbness in my right side of leg toe.
Probably non neurological. If at all neurological, it may be due to pinched nerves in your back (t10 and L1)
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