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Dr. K.Natarajan

Neurologist, Chennai

500 at clinic
Dr. K.Natarajan Neurologist, Chennai
500 at clinic  ·  ₹ online
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I believe in health care that is based on a personal commitment to meet patient needs with compassion and care....more
I believe in health care that is based on a personal commitment to meet patient needs with compassion and care.
More about Dr. K.Natarajan
Dr. K.Natarajan is a renowned Neurologist in Velachery, Chennai. You can visit him/her at Xcellent Care Multi-Specialty Hospital in Velachery, Chennai. Don’t wait in a queue, book an instant appointment online with Dr. K.Natarajan on Lybrate.com.

Lybrate.com has an excellent community of Neurologists in India. You will find Neurologists with more than 43 years of experience on Lybrate.com. You can find Neurologists online in Chennai and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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No.7,7th Cross Street, Rajalakshmi Nagar, 100 Feet Velachery By-pass Road, Velachery. Landmark: Near Gurunanak College & Lake Behind Univercell Mobile Showroom, ChennaiChennai Get Directions
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I am having burning sensation in both the foot and numbness feeling sometime in left foot fingers. There is tiring feeling while I am standing. I take Riomet duo 1 after lunch and Glyciphage tab after dinner in addition in the night I take pre neuron in 150mg but still no much improvement. Please advise.

BPTh/BPT
Physiotherapist
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I am having burning sensation in both the foot and numbness feeling sometime in left foot fingers. There is tiring fe...
Hi altered sensation is due to nerve irritation or compression. See a physiotherapist for neural mobilization.

I have numbness in both the front part of my sole of the feet - diagnosed as peripheral neuropathy and I now have problem siting in a moving car on d buttocks.

MPTh/MPT
Physiotherapist
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Kindly dip your legs in bucket full of lukewarm water and do some free activity inside lukewarm water for 15 min every day at least for two weeks.

My body shakes when I get nervous or angry?

MBBS, DGO (cal)
General Physician
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What is your age? you need some anger management and personality development course conducted by professionals.

Hi I have recently rejoined gym after a month. What should be pre and post diet for same. I generally take mango shake or banana shake before work out and glucond during work out. And post work out I usually have dinner or lunch depending on time of work out. I want to gain weight.

PGDD, RD, Bachelor of Home Science
Dietitian/Nutritionist
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Hi
I have recently rejoined gym after a month. What should be pre and post diet for same. I generally take mango shak...
Hye. During the first one to two hours after your workout, you should eat a meal rich in carbohydrates and protein. The carbohydrates will help replenish your energy, and the protein will help rebuild muscle that has been broken down during your workout, especially if you are doing resistance training. Examples of post-workout meals include chicken with rice and cooked vegetables or an egg sandwich on whole-grain bread or roti with light chutney and vegetables. Immediately within 15 minutes of workout you can whip up a fruit milk shake to refuel your body. It is important to drink plenty of water to prevent dehydration while working out. If you are exercising for more than an hour at a time, lime juice may be a good idea to replace electrolytes lost during sweating. Glucon d is only sugar which is not ideal. You need to replenish electrolytes.

I am 34 years old I felt so tired and foot feeling numbness. Fingers joints pain early morning cough and it's seems like sticky jelly substance. Legs are getting so tired and feel uneasy. I use to smoke once in a day and alcohol once in a week. Please let me know what check up I have to do.

Dip. SICOT (Belgium), MNAMS, DNB (Orthopedics), MBBS
Orthopedist
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Hi thanks for your query and welcome to lybrate. I am Dr. Akshay from fortis hospital, new delhi. It will be better for you to get a thorough full body work up done and get an evaluation from a general physician. You can again come back to me should you require any information from an orthopaedic point of view. Do not hesitate to contact me if you need any further assistance.

I am suffering from migraine and neck pain and I used 7 months course of tablets but no satisfaction with it. How I can reduce migraine and neck pain. Give any suggestion to reduce it.

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I am suffering from migraine and neck pain and I used 7 months course of tablets but no satisfaction with it. How I c...
Hi migraine headaches are caused due to sinusitis which may not be noticed as you must not be knowing its symptoms. Take following medicines nat suph 30 4pills to be sucked thrice a day for 15 days kali bich 200 4pills to be sucked thrice a day for 15 days take plain water steam once a day avoid eating curd, icecreams, pickles, papad, citrus fruits, watermelon, green skin bananas, pineapple, strawberries, custard apple, guavas. Stop using mosquito repellants. As these are the causes which worsen the headche.

I am having body ache and some time I shiver also. My body gets cold. What is it?

cc USG, MBBS
General Physician
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I am having body ache and some time I shiver also. My body gets cold. What is it?
Hello, Body pain may be due to 1. fever 2. abrupt start or stop of exercise 3. Any other medical disease like Anaemia/ Hypoproteinemia/ Thyroid problem 4. Vit D deficiency 5. Multi mineral and vitamin Deficiency 6.Stress/ anxiety 7. Over exertion (physical and mental) kindly follow advises given below: 1. Take adequate rest 2. Proper diet 3. Measure your temperature and tell me reading 4. Bathing may also reduce body pain 5. Avoid stress Kindly consult Physician for further management

Actually I have a major migraine problem plus foot fading colour nd after my body starts swell. It cause me ultimately extreme pain. What should I do for this.

CCEBDM, PG Diploma In Clinical cardiology, MBBS
Cardiologist
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Get BP and eye sight checked, x ray PNS, thyroid hormones T3 T4 Tsh 1.Sleep.Go to bed and get up about the same times every day, 3. Eat regular meals. 4. Drink plenty of water to avoid dehydration 5. Relax – listen soothing music. Walk for 5 mts 6.avoid .stress, 7. .avoid strong stimuli like loud noises, and smell of food 8. Keep your routine fixed and regular for medicine contact on private consultation.

Hi, I am 32 years old and pregnant by 14 weeks. I am the patient of migraine and suffering from severe migraine for last 2 months. It gets over for a day or half after every 10-15 days but then again come back on the very next day. My gynecologist has only suggested me to have crocin advance in this condition. Can someone help me to get the medicine which can be taken while pregnancy in migraine. Also I have the case if low lying placenta and have allergic to BRUFEN salts.

MBBS, MD - Anaesthesiology, FIPM
Pain Management Specialist
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Hi, I am 32 years old and pregnant by 14 weeks. I am the patient of migraine and suffering from severe migraine for l...
In pregnancy you should take as little medicine as possible. Only painkiller safe in pregnancy is paracetamol (crocin). Don't take any other painkillers as they harm the baby. You should try simple tips to avoid headache and start preventive medicine for migraine after baby is delivered. Follow these lifestyle changes to avoid headache 1. Maintain regular sleep wake cycle, even on holiday's. 2. Don't skip meals. Take regular healthy diet with adequate fluids 3. Do not consume excess caffeine / carbohydrates / alcohol or smoke. 4. Exercise daily (aerobics and cardiovascular) 5. Identify your headache trigger and try to avoid it. 6. Perform pranayam every morning.

I have migraine and I do not have courage to feel more pain how can I relief so fastly.

BAMS, MD Ayurveda
Ayurveda
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1. Add chamomile powder to 1 cup of boiling water 2. Transfer the liquid to a cup 3. Drink when hot 4. It gives fast relief from migraine.

I am a 27 years old female. I have back pain (sit area) since last 2 years. Pain increase even sit on chair for half an hour. It is not tolerable. Yes. I suffering by neurological symptoms like numbness, paresthesia, weakness in limbs.

MBBS, MS - Orthopaedics
Orthopedist
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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. Any way take bio d3 max 1tab odx10days ibuprofen 200mg od & sos x 5days do back (spine) exercises contact me again if need be. Make sure you are not allergic to any of the medicines you are going to take.

I have a migraine problem. I am having a headache frequently about 2 times in a week. What is the solution for this?

MBBS, MBA (Healthcare)
General Physician
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I have a migraine problem. I am having a headache frequently about 2 times in a week. What is the solution for this?
take crocin pain relief one sos, check your BP. check your eye sight. take good sleep and rest. take healthy diet. consult again if not ok.

All About Parkison's Disease

MBBS, Master In Health Science
Neurologist
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* 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.
1. 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.


2. 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. Th ese 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. 2. 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.


180. 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 (lt 2%).


190. Can the doctor guarantee a signifi cant 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:
https://static.lybrate.com/imgs/ps/cl/8b479eb55d75e060499901855481ea38/ebooks/NPE_BKL_002_Parkinson_COLOR_V05.pdf
All About Parkison's Disease

1. I have a pain in neck, low back ache and joints. 2. Pain, numbness in arms & limbs. 3. Burning sensation in feet and eyes. 4. Ear nerve pain. My age is 58 and I am male.PLease do help

Hand Surgery, M.S. (Orthopaedics
Orthopedist
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Dear well I think you need a detailed work up and a diagnosis. Then we can offer you various means of treatment.

My dad is suffering from high blood pressure from past 12years. After his fast attack of bell's palsy. Ever since, he is dealing with high blood pressure. And from past few days, his pulse rate is going over 100. Can you tell us what could be the problem? His last ECG report was OK, which was done a month ago.

AUTLS, CCEDM, MD - Internal Medicine, MBBS
General Physician
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My dad is suffering from high blood pressure from past 12years. After his fast attack of bell's palsy. Ever since, he...
Why suffer when u can easily control it with medication s..there are plenty of medicines available.. Get ur bp checked by doctor first

I have one question whenever my hed having pain like a migraine and my hand or body some where pulse is pumping why its so. Please help me.

MBBS
General Physician
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Your headache could be a tension headache due to stress and anxiety.Check your Bp and consult doctor

How to Deal with Severe Epilepsy

FRCS - Neurosurgery(UK), M.Ch - Neuro Surgery, MS - General Surgery, MBBS
Neurosurgeon
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The word epilepsy brings to mind visions of people frothing at the mouth and rolling on the ground. However, epilepsy affects each patient in a different way. This can make it hard to recognize at times. In the more serious cases of epilepsy, an epileptic attack can make a patient injure himself or develop other life threatening conditions. In rare cases, epilepsy can even cause death. Thus it becomes imperative to understand how to deal with epilepsy.

Treatment options for epilepsy can be categorized as medication, surgical procedures and dietary changes.

Medication
Medication for epilepsy is prescribed on the basis of the symptoms presented and the type of epilepsy the patient is suffering from. In most cases, seizures can be controlled with a single type of medication, but in others, the doctor may need to prescribe a combination of medicines to control epilepsy. These forms of medication do have side effects and hence any reactions to the medication must be immediately brought to the doctor's notice. The dosage for epilepsy medication may need to be varied with time. An epileptic patient should never discontinue medication on their own.

Surgery
Depending on the type of seizures and the area of the brain affected, a doctor may advise surgery in cases of severe epilepsy. Surgery can help reduce the number of seizures experienced or completely stop them. Surgery to treat epilepsy is of many types. Some of the common procedures are:

1. Surgery to remove tumor of any such conditions that may be triggering the epileptic attacks
2. Surgery to remove a small section of the brain from where a seizure originates. This may also be referred to as a lobectomy.
3. Multiple subpial transaction or a surgery that involves making a series of cuts in the brain to prevent the seizures from spreading to other parts of the brain.
4. Surgery to sever the neural connections between the right and left hemispheres of the brain.
5. Surgery to remove half the brain's cortex or outer layer

Dietary changes
A diet rich in fats and low in carbohydrates can help reduce seizures. This is known as a ketogenic diet and aims at making the body break down fats instead of carbohydrates. It can cause a buildup of uric acid in the body and thus should be practiced only under the guidance of a dietician. In cases where epileptic attacks are triggered by malnutrition and birth defects, taking vitamin supplements can help lower the frequency of seizures.
How to Deal with Severe Epilepsy

March 21st 2016 I was attacked by bell's palsy I consult to the neurologist and take treatment he said me to have medicines for 1 month and physiotherapy. The course had completed. But there is still 10 %of problem is there. Now what I have to do and what types of foods I have to take and which ones are not to take and if any exercises plzz tell to me. Thanking you sir.

DNB (Neurosurgery)
Neurosurgeon
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The complete recovery may take up to 1 year sometimes. Some have permanent residual deficits which are usually minor. Just continue physio for face.

I am a 50 year old male. Diagnosed with type 2 diabetes for the last three years. Recently the toes and fingers of my left foot have become numb. Doctors have prescribed vitamin injections. However I am not feeling improvement. Will this be a permanent disability or be cured. My sugar levels are in the range of 170 after food and 150 fasting.

Critical Care Training, MD - Internal Medicine, MBBS
General Physician
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Hello, get done ncv to confirm neuropathy. And check serum creatinine, urine albumin, ecg, fundus examination by ophthalmologist, lipid profile - to rule out effect of diabetes on other vital organs and body functions. Tell me your last 2 fbs, pp2bs values and hba1c values and medicines you r taking. I will be glad to help you to improve quality. Of life and control diabetes.

1 month back I got some swelling in my eyelid and had taken eye drops and medicines of anti bacteria consulting doctor. It was got normal after 5 days, but now from past a week that eye was blinking (not visible to others) blinking I can feel. Is any problem of nerves its disturbing me soo from inside (fear of nerve weakness) Only my left eye is like this, right eye is food. My vision from both eyes also good, even from individual the vision is clear for me. Suggest me what to do.

DNB Ophtalmology, MS - Ophthalmology, MBBS
Ophthalmologist
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1 month back I got some swelling in my eyelid and had taken eye drops and medicines of anti bacteria consulting docto...
Nothing. ..This is twitching of eyelids...technically myokimia. ..In most cases it is self limiting and resolves in weeks...Sometimes in months. Simply ignore for time being.
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