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Dr. Vikash Agarwal  - Neurologist, Chennai

Dr. Vikash Agarwal

MBBS, MD, DM - Neurology

Neurologist, Chennai

16 Years Experience  ·  600 at clinic
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Dr. Vikash Agarwal MBBS, MD, DM - Neurology Neurologist, Chennai
16 Years Experience  ·  600 at clinic
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Personal Statement

I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Vikash Agarwal
Dr. Vikash Agarwal is a popular Neurologist in Adyar, Chennai. He has over 16 years of experience as a Neurologist. He is a MBBS, MD, DM - Neurology . You can meet Dr. Vikash Agarwal personally at Dr. Vikash Agarwal@Fortis Malar Hospital in Adyar, Chennai. Don’t wait in a queue, book an instant appointment online with Dr. Vikash Agarwal on Lybrate.com.

Lybrate.com has an excellent community of Neurologists in India. You will find Neurologists with more than 44 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.

Info

Education
MBBS - Gauhati Medical College, Guwahati, Assam, - 2001
MD - JJM Medical College, RGUHS, Karnataka, - 2006
DM - Neurology - Sri Ramachandra Medical College, Chennai, - 2010
Languages spoken
English
Professional Memberships
Indian Academy of Neurology
Indian Epilepsy Association (IEA)
Medical Council of India State Boards of Assam
...more
Karnataka and Tamil Nadu states.

Location

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Fortis Malar Hospital

#52, 1st Main Road, Gandhinagar Landmark : Near Adyar SignalChennai Get Directions
600 at clinic
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Penis stand nhi hota moti nase dikhai deti hai sperm kuch seconds mai hi nikl jata hai.

MBBS, MD - Obstetrtics & Gynaecology, FMAS, DMAS
Gynaecologist, Noida
Penis stand nhi hota moti nase dikhai deti hai sperm kuch seconds mai hi nikl jata hai.
Hello, you are experiencing erectile dysfunction. You may opt for TAB TANTEX FORTE 1 TAB twice a day from Himalaya for 2-4 weeks and see the difference.
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Parkinson s Disease

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Parkinson s Disease

Deep brain stimulation in Parkinson’s disease

Abstract: Deep brain stimulation (DBS) is a widely accepted therapy for medically refractory Parkinson’s disease (PD). Both globus pallidus internus (GPi) and subthalamic nucleus (STN) stimulation are safe and effective in improving the symptoms of PD and reducing dyskinesias. STN DBS is the most commonly performed surgery for PD as compared to GPi DBS. Ventral intermediate nucleus (Vim) DBS is infrequently used as an alternative for tremor predominant PD patients.

Patient selection is critical in achieving good outcomes. Differential diagnosis should be emphasized as well as neurological and nonneurological comorbidities. Good response to a levodopa challenge is an important predictor of favorable long-term outcomes. The DBS surgery is typically performed in an awake patient and involves stereotactic frame application, CT/MRI imaging, anatomical targeting, physiological confirmation, and implantation of the DBS lead and pulse generator. Anatomical targeting consists of direct visualization of the target in MR images, formula-derived coordinates based on the anterior and posterior commissures, and reformatted anatomical stereotactic atlases. Physiological verification is achieved most commonly via microelectrode recording followed by implantation of the DBS lead and intraoperative test stimulation to assess benefits and side effects. The various aspects of DBS surgery will be discussed.

Key words: deep brain stimulation (DBS); Parkinson’s disease(PD),  stereotaxis

Introduction

Parkinson's disease is a slowly progressive, neurodegenerative disease characterized by tremor, rigidity, bradykinesia and postural instability. It is the most common movement disorder in middle or late life with a prevalence of about 0.3% of the general population, rising to 1% in people over 60 years of age. Approximately 130 000 people suffer from it in the UK and it presents an increasing burden in our ageing population. Pathological findings in Parkinson's disease demonstrate greatly diminished neuromelanin pigmented neurons in the substantia nigra of the basal ganglia with associated gliosis, and Lewy bodies present in many remaining neurons.

James Parkinson, in his original 1817 Essay on The Shaking Palsy, gave an account of six patients in which he noted signs of tremor, festinating gait and flexed posture.  Nearly two centuries from Parkinson's observations, and almost four decades after Cotzias' dramatic demonstration of levodopa's efficacy, the limitations and complications of levodopa treatment for Parkinson's disease have become well documented Five years after initiation of therapy, a majority of patients develop medication related motor complications, namely levodopa induced dyskinesias (LID) and motor fluctuations. Deep brain stimulation (DBS) has been developed primarily to address these treatment related motor complications and therapeutic failures.

Pathophysiology of PD

The loss of dopaminergic neurons in the substantia nigra, the main functional characteristic of PD, affects the circuit described above and leads to the cardinal motor symptoms of PD. While the exact mechanism of this process is unknown, animal research as well as human recordings have provided functional and biochemical evidence that bradykinesia in PD results from excessive activity in the STN and the GPi. This leads to an exaggerated beta (10-30 Hz) synchronization within and between structures in the basal ganglia circuitry  that could also contribute to rigidity and akinesia.

The pathophysiology of rest tremor in PD is less clear and probably more complicated. This symptom most likely results from a dysfunction of both the striato-pallidal-thalamocortical and the cerebellodentato-thalamocortical circuits, with hyperactivity and hypersynchronization between central oscillators.

Possible mechanism of action of DBS

DBS acts through delivering an electrical current in a specific target area of the brain. This current can be modulated through modification of voltage, frequency and duration of each electrical pulse delivered. The delivered energy creates an electrical field of variable size and shape according to the parameters used for stimulation. Although initially believed to stimulate the target, thus the name of the whole process, it seems that

DBS actually excites the neuronal fibers, but inhibits the neural cells. In fact, GPi DBS decreases the GPi mean firing rate back to a normal range in animal models as well as PD patients, and high frequency DBS has a similar effect as dopamine replacement therapies, and promotes faster (about 70 Hz) nonhypersynchronous activity in the basal ganglia, correlated with clinical improvement. This might be achieved through stimulation of bypassing inhibitory pathways, synaptic inhibition, depolarizing blockade, synaptic depression, and simulation-induced disruption of pathological network activity. Overall, this leads to modifications of the firing rate and pattern of neurons in the basal ganglia, as well as local release of neurotransmitters such as glutamate and adenosine. In addition, it seems that DBS also increases blood flow and stimulates neurogenesis. Over the last few years, functional imaging, specifically functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT), has been used in an attempt to clarify the mechanism of action of DBS. In fMRI, blood-oxygen-level-dependent (BOLD) signals are acquired, and oxygenated blood marks areas of neural stimulation or inhibition. On the other hand, PET and SPECT allow for imaging of multiple activity markers, such as blood flow, glucose and oxygen metabolism. While fMRI is less powerful than nuclear medicine techniques, it provides a much better spatial and temporal resolution. Because of the suspected inhibitory DBS effects in electrophysiological studies, reduced STN blood flow or glucose metabolism would have been expected on functional imaging. However, the opposite has been found to be true in an overwhelming majority of imaging studies to date. In addition, BOLD activation in the area surrounding the electrode has been reported, despite the electrode imaging artifact preventing direct observation of the STN around the electrode. This discrepancy between apparent STN inhibition in single-cell studies and activation in imaging studies might be explained by a few hypotheses. First, electrophysiological recordings identify short neuronal modulation (in the order of milliseconds) while neuroimaging methods may reflect the summed activity changes over seconds to minutes. Second, non-neuronal contributions to the change in blood flow and/or glucose metabolism cannot be excluded, and could confound the results of neuroimaging.

Finally, it is possible that PET and fMRI actually detect the increased activity in the axons, rather than in the cell bodies. Complicating matters further, some imaging studies after STN DBS have showed increased

activity in the GPi while others reported decreased activity in that nucleus. In summary, it is still unclear how exactly DBS affects the firing rate and pattern of neurons and how these changes actually modify the symptoms of Parkinson’s disease. DBS is presently more of an empirically proven treatment in search of physiological explanation.

The effect of DBS on the cardinal symptoms of PD have been established in three randomized controlled clinical trials --- 

TABLE 1

Author, year

 

No of patients

Follow up

Target

Results

Deuschl et al., 2006

156

6 months

BL STN

QOL better with DBS, motor symptom better with DBS

 

Weaver et al., 2009

255

6 months

BL STN or GPi

Dyskinesia free ON time better with DBS

 

Williams et al., 2010

366

12 months

BL STN  or GPi

QOL better with DBS

 

 

PATIENT SELECTION for DBS in PD

Patient selection is a critical first step as poorly chosen candidates may not have optimal benefits and have increased morbidity. Several factors must be considered before determining if a patient is an appropriate candidate for DBS surgery. A multidisciplinary approach involving the neurosurgeon, neurologist, and neuropsychologist is important to determine the appropriate surgical candidate. It is also important that the diagnosis of idiopathic PD be confirmed prior to proceeding with DBS surgery. Key to this assessment is evaluating the surgical candidate in both the on and off medication states with a corroborating levodopa challenge. Perhaps the best prognostic indicator of a patient’s suitability for DBS surgery is their response to levodopa.In general, a levodopa challenge following a 12-hour medication withdrawal should provide at least a 33% improvement in the motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS).

                     In our institute, we follow a simple chart(below) for screening of patients for DBS in PD.

 

 

  1.  

Age<75 years

 

  •  

No

  1.  

Idiopathic PD ( No PSP/MSA/NSD etc)

 

  •  

No

  1.  

Levodopa responsive  

                      

  •  

No

  1.  

Poor/adverse response to drug          

 

  1.  Increased off period                                                              

 

  1. Disabling dyskinesia                                                              

 

 

  1. Disabling motor fluctuations                 

 

 

Yes

 

Yes

 

 

Yes

 

 

No

 

No

 

 

No

  1.  

Degree of disability(UPDRS part III score)>25

 

  •  

No

  1.  

Neuropsychology, MMSE>24

 

  •  

No

  1.  

LEVODOPA CHALLENGE RESPONSE POSITIVE                                                   

 

(30% improvement in UPDRS after 12-hours off medication)

 

  •  

No

  1.  

Advanced  co-morbidity

 

Yes

  •  
  1.  

long term anticoagulation

 

Yes

  •  
  1.  

Willing for surgery and programming

 

  •  

No

 

 

PREOPERATIVE MANAGEMENT

A full medical assessment is a necessary part of the preoperative evaluation, as advanced PD patients tend to be elderly with significant comorbidities. Major issues are---

 

Anticoagulation/antiplatelets--- The risk of discontinuing medications that affect anticoagulation and

platelet aggregation should be weighed against the potential benefits in the quality of life offered by DBS surgery. However, timely discontinuation of these latter medications is mandatory for stereotactic surgery since intracerebral hematomas are the most serious of all potential complications from DBS. Any anticlotting medications, including aspirin, ticlopidine, clopidogrel, and all nonsteroidal anti-inflammatory drugs should be discontinued at least 7 to 10 days preoperatively to ensure the return of normal blood clotting function.

Arterial hypertension can also increase the risk of intracranial bleeding during stereotactic procedures and must be controlled in the weeks prior to surgery.

A prolonged discussion on the short- and long-term effects of DBS on Parkinson’s disease should be carried out with the patient, family, and caregivers.

The night prior to DBS surgery, the antiparkinsonian medications are typically held to pronounce the Parkinson’s symptoms at the time of surgery to see the clinical effects on symptoms during surgery and the families must be counselled regarding their role in facilitating the patient.

Target selection

The two main targets considered for DBS in PD are the STN and the GPi. current tendency is to prefer targeting the STN because of a greater improvement in the OFF phase motor symptoms as well as a higher chance to decrease the medication dosage and a lower battery consumption linked to the use of lower voltage in the STN compared to the GPi DBS. GPi can be the preferred target if LID is the main complaint. GPi DBS might be preferred for patients with mild cognitive impairment and psychiatric symptoms. Because STN DBS might have a higher rate of cognitive decline and/or depression and worsening of verbal fluency in some studies.

Surgical technique

The basic components of DBS implantation surgery involve frame placement, anatomical targeting, physiological mapping, evaluation of macrostimulation thresholds for improvement in motor symptoms or induction of side effects, implantation of the DBS electrode and implantable pulse generator (IPG).

Head-frame placement

The CRW frame is the most commonly used followed by the Leksell frame. Placement of the frame is done under local anesthesia unless anxiety or uncontrollable movements necessitate the use of sedation or general anesthesia.

Leksell stereotactic frame  placed over the head of a patient showing the correct method for placement of the Leksell head-frame. The frame should be placed parallel to orbito-meatal line in order to approximate the AC-PC plane. It is attached to the patient’s head using four pins under local anesthesia.

Imaging and anatomic targeting

Computerized Tomography (CT) scans and MRI are the two main imaging modalities used for targeting when performing DBS implantations. A thin cut stereotactic CT (_2 mm slices with no gap and no gantry tilt) is obtained after frame placement and is then fused with the stereotactic MRI on a planning station (Stealth station). The advantage of fusing the CT with MRI is the ability to avoid image-distortions inherent to MR imaging adding to the stereotactic accuracy. To better define the STN, T2-weighted images (TR 2800, TE 90, flip angle 90˚, slice thickness 2.0 mm) were obtained.

The AC and the PC were marked and the centre of the AC–PC line determined. The next step is planning the entry point and trajectory. The strategy here is to avoid surface and sub-cortical vessels. After trajectory planning, the patient is placed supine on the operating table and the frame attached to the table using an adaptor. Prophylactic antibiotics are given at least 30 min prior to incision. The head is prepped and draped in a sterile fashion. Under local anesthesia, a burr-hole is placed on the calculated entry point marked on the skull. The entry point is determined by the calculated arc and ring angles. Hemostasis is achieved with bone wax and bipolar cautery.

A Medronic Stim-Loc anchoring device (Medtronic, Minneapolis, MN) burr-hole base ring is then placed on the burr-hole and secured with two screws which are used at the end of the procedure to anchor the DBS electrode.

The dura is then cauterized and opened exposing the underlying surface of the brain. The microdrive is then assembled and cannulae inserted 10 mm above the target to avoid lenticulostriate vessels found deeper. Gel- foam and fibrin glue is applied on dural hole to minimize cerebrospinal fluid (CSF) loss and air entry into the skull. Subsequently, microelectrode recording and stimulation is undertaken.

Microelectrode recording/ Mapping

Microelectrode mapping is used to precisely define the target STN and its boundaries as well as nearby critical structures. We believe microelectrode mapping is crucial in order to give one the best chance for optimal placement of the DBS lead given anatomical inaccuracies due to image distortion and intraoperative brain shifts secondary to CSF loss, and pneumocephalus that can lead to inaccuracies in defining the initial target coordinates and shifts in the target itself once the skull is opened. Microelectrode mapping is performed using platinum-iridium glass coated microelectrodes dipped in platinum black with an impedance of around 0.3–0.5 Mo. These platinum-iridium microelectrodes are capable of recording single unit activity and can also be used for micro-stimulation up to 100 mAwithout significant breakdown in their recording qualities.

As the recording electrode was advanced, entry into the STN was identified by a sudden increase in the density of cellular discharge, with the characteristic irregular pattern of discharge—spikes of different sizes, occurring at random intervals. On coming out of the STN a quiet period (background noise) was seen followed by recording from the substantia nigra if the recording was continued far enough, described as high frequency (50–60 spikes/s) discharge pattern.11 Characteristic STN recordings (visual and audio) were identified and the depth of the STN activity was noted. Identification of STN activity was only based on the visual identification. The centre of the point of best electrical activity was selected as the final target. The microelectrode was replaced with a permanent quadripolar macroelectrode (Medtronic electrode no. 3389) to target the centre of the STN electrical activity. The proximal part of this electrode consists of four nickel conductor wires insulated with a polytetrafluoroethylene jacket tubing. The distal part has four metallic noninsulated contacts of 1.5 mm spaced at 0.5 mm intervals. The diameter of the distal electrode is 1.27 mm. Based on the clinical response any of the four contacts can be used for stimulation. Macrostimulation using the DBS electrode itself is then used to determine benefits and side effects. In most cases lateral skull x rays were obtained at this point with image intensifier carefully positioned to locate the target point in the centre of the Leksell-G frame rings.

Initial programming is always refined by using intra-operative macrostimulation data and a mono-polar review to identify the thresholds of stimulation for improvement in parkinsonian motor signs as well as the thresholds for inducing side effects at the level of each contact. The four variables that are used in programming are choice of contacts (0, 1, 2 or 3 used either as the cathode or anode), frequency of stimulation (hertz), pulse-width (ms) and amplitude (voltage).

POSTOPERATIVE MANAGEMENT

In the immediate hours after surgery, it is important to keep arterial blood pressure in the normal range. In addition, the patient’s preoperative drug regimen should be restarted immediately after surgery to avoid problems with dopaminergic withdrawal. Patients should undergo postoperative CT scans and/or MRI scans to assess the electrode location and intracranial status. In addition, plain X-rays are obtained to assess the location and geometry of the leads and hardware. Parkinson’s medications may need to be adjusted depending on the patient’s status. Cognitive and behavioral changes may occur in the postoperative period, particularly in older patients. Patients can be discharged as early as 24 hours after surgery, depending on their neurological and cognitive status.

Conclusion

For the last 50 years, levodopa has been the cornerstone of PD management. However, a majority of patients develop motor fluctuations and/or LID about 5 years after the initiation of therapy. DBS of the STN or the GPI grant to patients with PD improved quality of life and decreased motor complications, and has been approved as such by the Food and Drug Administration in the US in 2002. We reviewed the experience and available literature on DBS for Parkinson’s disease over the last decade and arrive at the following understandings.

The success of DBS surgery depends on the accurate placement of the leads and meticulous programming of the stimulation. Therefore, it is best accomplished by an experienced team of neurosurgeon, neurologist, and support staff dedicated to the treatment.

Reports of surgical complication rates and long-term side-effects of DBS are very variable, so benefits and potential adverse results should not be under- or over-emphasized.

While essentially equal in improving the motor symptoms of PD, STN and GPi might have their own benefits and risks, and the choice of the target should be individualized and adapted to the patient’s situation.

Knowledge to further improve DBS treatment for Parkinson’s disease, such as a more scientific and reliable protocol on programming, strategies to minimize cognitive and psychiatric complications, and the better

long-term maintenance of the implanted device, are still lacking.

Data on the impact of DBS on non-motor symptoms affecting the quality of life of PD patients, such as pain, speech or gastro-intestinal complaints, are still scarce. Further research in these areas will help make this useful treatment even more beneficial.

3 people found this helpful

How Homeopathy Helps Prevent Epilepsy?

Diploma in Diet and Nutrition, PG HOM (London), CCH, CGO, BHMS
Homeopath, Mumbai
How Homeopathy Helps Prevent Epilepsy?

Epilepsy is a disease that affects the brain's nerve cells and triggers the release of abnormal electrical signals. This can cause temporary malfunctioning of the other brain cells and result in sudden loss of consciousness. Epilepsy can affect both children and adults.

Epilepsy can be treated in a number of ways. One of the most preferred forms of treatment is Homeopathy. Homoeopathy not only controls these episodes but can also cure it. A few homeopathic remedies that can be used to treat epilepsy are:

  • Cicuta: Cicuta is very effective when used to treat cases of epilepsy where convulsions are marked by violent, body distortions. This can include the horrific backward bending of the spine. These convulsions also make the person's face turn blue and trigger a locked jaw. This can also be used to effectively treat epilepsy cases triggered by head injuries and worms.

  • Artemisia Vulgaris: This is used to often treat cases of Petit Mal Epilepsy which are characterized by staring into space, leaning forwards or backwards and stopping a sentence abruptly. It also addresses fear that triggers epileptic attacks.

  • Stramonium: Convulsions triggered by exposure to bright lights or shiny objects can be treated with this homeopathic remedy. In such cases, the patient may not lose consciousness but experiences jerks in the muscles of the upper body.

  • Cuprum Met: This homeopathic remedy is used to treat seizures that are preceded by experiencing an aura in the knees. Other symptoms that characterize this sort of an epileptic attack are spasms that begin in the fingers and toes and gradually spread to the rest of the body and jerking of muscles. This can also be used to treat convulsions that accompany menstruation and follow the delivery of a baby.

  • Bufo Rana: Not all epileptic attacks occur you are awake. Attacks that occur in your sleep can be treated with bufo rana. Such epileptic attacks are accompanied by experiencing an aura in the genital regions. This is especially helpful for women who experience seizures during menstruation.

  • Hyoscyamus: Some epileptic fits are followed by a deep sleep. This type of epileptic attacks can be treated with Hyoscyamus. Other symptoms addresses by this homeopathic medicine are fidgeting with bed clothes, fidgeting with fingers and muscular twitching.

Always remember for proper treatment consult a Homoeopathic doctor. We can take homoeopathic treatment with other medicines, and then can slowly reduce its doses.

3 people found this helpful

I am taking medicine for Epilepsy for almost 18 Years. Fitz occur once in 8-12 months subject to my lapse of medicine. I am 24 Years aged now. Doctors say as per EEG that there is very minor problem. I want to know is there any way out that i do not have to take medicine further. Is there any permanent cure of Epilepsy ??

MD - Psychiatry, MBBS
Psychiatrist, Patna
Do not stop medicine, as it is the mainstay of treatment. epileptic attack is potentially fatal, suppose you get epilepsy while standing at the gate of moving train, or in a swimming pool or in front of gas burner while cooking.
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Peripheral Neuropathy - How Ayurveda Can Help You Treat it?

BAMS
Ayurveda,
Peripheral Neuropathy - How Ayurveda Can Help You Treat it?

Neuropathy, popularly called us peripheral neuropathy, is a condition where the nerves that are responsible for carrying information from spinal cord to brain is damaged. It is always good to consult your Ayurvedic doctor to treat neuropathy. The affected patients are treated naturally with Bhumyamalaki Chura 3g on a dosage of two times per day. It is always good to go by

Symptoms
Peripheral neuropathy condition results in numbness and pain in feet and hands. The usual symptoms of the disease include infections, metabolic disorders, exposure to toxins and injuries. Sometimes tingling or pain of toes, legs, feet, arms, hand, fingers etc. may happen.

Causes
In spite of reducing the body’s toxicity, it is very important to identify the root cause for the disease. Here the essential cause for the disease includes viruses, inflammation and oxidation.

Treatment

  1. Intake of 600 mg lipoic acid per day would reduce the symptoms of peripheral neuropathy. In case of diabetes patients, it is good to monitor the blood glucose level, as the intake of lipoic acid on a regular basis might reduce blood glucose level.
  2. Another effective medicine to control the symptom of Peripheral neuropathy is CoQ10. This is very good at treating heart and brain.
  3. Omega-3 fatty acid is also good at treating this disease. Salmon fish and flax seeds acids are the natural source of fatty acids that helps in reducing the inflammation I the body.
  4. An herb known as St.John’s wort is good at treating all types of nerve injuries, especially to the toes and fingers. It helps in reducing the burning and shooting pain. The herb is very powerful in treating mild depression and is anti-viral herb.
  5. The numbness and weakness in the limb can be cured by the regular usage of oat seed. It is an herb that is rich in minerals. It is a safe natural medicine free from any side effect.
  6. Another herb called passion flower is useful in curing from agitation, spasms, muscle twitching and restlessness.
  7. Nettle and Ginko Bilba are other useful herbs that help in treating peripheral neuropathy. If you wish to discuss about any specific problem, you can consult an Ayurveda.
3553 people found this helpful

Hello Doctor, I am 32 years old female, working in a pvt company. I have a history of migraine which got better and also low blood pressure and acidity. From the past 10 days I'm having constant headache especially when I get up in the morning. I am taking migranil from past 1 week twice which is relieving the pain. But this headache is daily. I have no stress as such of work or personal. Also it's been 1-2 months I I have this weird pain in my right feet. It's like I feel a hot thing running inside. Its a pinching Sensation. please guide.

CCEBDM, PG Diploma In Clinical cardiology, MBBS
General Physician, Ghaziabad
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 chat.
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I am 60 years old i have painin left upper hand left back side head occasionally for ten years mri diagonisis an aranachoid sists in left temporal lobe. Eeg report normal. What should I do ?

MBBS
General Physician, Ahmedabad
Arachnoiditis genrally causes symptoms of limbs. But arachnoiditis temporal lobe can not cause upper limb problem. Temporal lobe related to mainly ear /speech problems. Hence you need to consult good senior neurophysician. Or send detailed report on private question.
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I am suffering from insomnia for the last 10 days. Normally I sleep 6 to 7 hours a day. But due to some unknown reasons I am facing this disorder.

COMT, MPTh/MPT
Physiotherapist, Surat
I can understand how disturbing an interuppted, inappropriate or disturbed sleep can affect your day to day life. In india it has been found 55% of patients are suffering from insomnia just because of stress, distractions and anxiety. So the best way to get rid from insomnia is to reduce the stress level. A physiotherapist can help you to give you the ways to relax your mind and give you comfort and stress full sleep. Consult some neurologist/neuropyschiatric and start taking medicine if it is due to some neurological discorder. And consult nearby physio who can make a perfect routine and daily life styl chart to make you relax so that you get an appropriate sleep. Please follow some points that will help you in such condition along with medical treatment: 1) use of ice packs over your eyes or frontal area for some time to give relaxation. 2) massage your head especially forehead area using levander oil or clove oil as it removes toxins from body 3) regular intake of healthy dietry food rich in proteins and vitamins. 4) avoid fasting - eat breakfast, lunch and dinner at fixed timings 5) make yourself busy by fulfilling your hobby as it will give you freshness and your mind will be diverted from normal life which help in pain reduction. 6) before sleeping time do some relaxation exercises. - sit on chair with both the hands placed on the pillow placed over thighs. - deep inhale from your nose, mouth should be closed. - hold your breath for the count of 5. - exhale completely from mouth making a loud sound. Continue to do this exercise for 10 times. Before going to bed make a habit of doing this daily. Modified technique of same exercise is while inhaling extend your arms, hold for 5 count and then exhale making your arms back in the rest position. 7) room modification while sleep - make sure room should be dark with no noise. Avoid sleeping immediately after dinner or food. Take a walk for 15 min and then come back, bed should be not too soft not too hard. 8) it is recommended to drink at least 8 to 10 glasses of water per day. It is also a very good habit to start and finish your day by drinking a good glass of purifying water. 9) exerices like aerobics (running) can be done to make your muscles active. Many other ways are there in order to maintain your life stress free and active so that you can continue to sleep on time and it does affect your life. Good luck and get well soon.

I am suffering from cerebellar ataxia caused by genetic disorder now I cannot walk please help me.

MCh Neurosurgery, MS - General Surgery, MBBS
Neurosurgeon, Guwahati
Physiotherapy with electrotherapy suggested. May evaluate with a brain scan if rapidly progressing symptoms esp new.
8 people found this helpful
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I am suffering from migraine since one year. Some times I feel vomiting also. Please suggest what should I do to.

MBBS
General Physician, Hyderabad
hi nargis, Lifestyle habits can go a long way to help reduce the number and severity of migraines. A consistent sleep pattern and regular exerciseand meals are important. Here are some lifestyle changes that may help: Sleep. Setting a consistent sleep schedule may help reduce migraines. Go to bed and get up about the same time every day, including weekends and holidays. Disruptions to your sleep schedule, getting too much or too little sleep, can trigger a headache. Exercise regularly. You may be tempted to avoid exercise, afraid it might trigger a migraine. And, although overexertion may trigger a headache in some people, research suggests regular, moderate aerobic exercise may reduce the severity, duration, and number of migraines in many people. Regular exercise also helps control stress, another migraine trigger. Eat regular meals. Regular meals are important to maintain level blood sugar. A drop in blood sugar can trigger a migraine. Also drink plenty of water to avoid dehydration, which can trigger migraine. Limit stress. For many migraine sufferers, stress is a common trigger. Take time each day for a relaxation break. Find something that you enjoy that helps you relax. For example: • Listen to calming music • Take a short walk • Meditate • Do yoga Try complementary therapies. Along with your prescribed treatment, consider using complementary therapy to help prevent migraines. For example, you may be able to manage stress and prevent migraines through: • Acupuncture • Massage • Cognitive behavioral therapy tc.if problem still persists revert me back ill help you best.
2 people found this helpful
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Is penile nerve tingling is from any nerve damage. Also nerve do not tingle but pain happens. Already taken antidepressants like ibrufen and amritipilline both at same time for two months. But now 8 months gone but same happens. Kindly suggest I am very depressed about my life.

BHMS
Homeopath, Thane
Is penile nerve tingling is from any nerve damage. Also nerve do not tingle but pain happens. Already taken antidepre...
Hi, this may be due to nerve compression.Stop any of medicines you are taking. Start with this Tabaccum 1M 4pills to be sucked thrice a day for 15days .and revert ack for further treatment
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My husband is 34 years now and was operated for brain tumor (right side) on dec 2013. He was disabled on left arm and left leg. Now has regained shoulder movement and left leg movement partially. Left arm fingers can be closed but he is unable to open them or use for any activity. He continues his physio and ergo therapy. How far will his healing take and how much of his movement be regained. Thanks in advance for your response.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), PG Dip Panchakarma, PG Dip Ksharsutra for piles,pilonidal sinus and fistula management , Post Graduate Diploma In Hospital Administration (PGDHA), Certificate in Diabetes update
Ayurveda, Navi Mumbai
My husband is 34 years now and was operated for brain tumor (right side) on dec 2013. He was disabled on left arm and...
Thanks for expecting Healthier fitness solutions with Ayurved, trust self n have faith on ur Dr, its great u dealt powerfully. Continue physiotherapy n share ur concern with surgeon who operated. Simple things like pichu, abhyanham, Nasyam Therapy sos Basti therapy will add pace to ur recovery
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I get Migraine attack, like when I think over and over ill suffer like anything it will continues 3 to 4 days.

PhD, Human Energy Fields, Diploma in PIP, EFI, Aura scanning for Health evaluation; Energy field assessment, Fellowship Cardiac Rehabilitation, Cardiac Rehabilitation, MD (Ayur - Mind Body Med), Mind Body Medicine
Non-Invasive Conservative Cardiac Care Specialist, Pune
Dear When you know you are in a negative mind set, drink 2 glasses of hot water, walk for 30 mins at fast pace. The proper blood circulation will help you overcome the pain and discomfort. Make it a habit to exercise, eat the right foods for your body constitution and begin to do mindful meditation. Regards.
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I have migraine for past 5 years. Now I suffer erratic blood pressure. Sometime low sometime high. Fatigue and have spotted some facial hair growth. Please suggest.

Clinical Cardiology, MD - Consultant Physician
Cardiologist, Surat
I have migraine for past 5 years. Now I suffer erratic blood pressure. Sometime low sometime high. Fatigue and have s...
Hi. As you said, your bp is fluctuating, and you also notice some facial hair growth. You should consult a gynaecologist in you town and let her judge weather you need any further investigation for these things. Heart doctors have less role to play in your case. Take care.
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Hie, my mom is 40 years old. She feels vibration under her pelvic area since a month. It doesn't pain her but annoys her a lot. After many tests result is still unclear some reports conclude that there is some infection and she has deficiency of vitamin d. She continues to feel that vibration even after medications. What can be the cause? and what should be done for this?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Numbness in bottom area could be due to pressure on the nerve. This could be due to lumbar spondylosis with nerve root compression. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Use no pillow under the head. Any way take paracetamol 250mg od & sos you will need other supportive medicines also. Do back (spine) exercises make sure you are not allergic to any of the medicines you are going to take you may have to use lumbosacral support for some time. Don't ignore.
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I am a 42 years old male and have a problem with my hands they go to sleep often and sometimes I wake up with scratching palms. I read online it may be carpel tunnel syndrome. Please suggest.

MD - Homeopathy, BHMS
Homeopath, Ghaziabad
I am a 42 years old male and have a problem with my hands they go to sleep often and sometimes I wake up with scratch...
Have milk regularly for few days with some vitamn B-complex supplements if possible. Leave the job of diagnosis for doctors they are skilled for that... Feel free to ask any doubts you have..
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Dear Sir, I am suffering from neck and shoulder pain also migraine, what kind of treatment wants to take and also some home remedies for the same.

Dip. SICOT (Belgium), MNAMS, DNB (Orthopedics), MBBS
Orthopedist, Delhi
Dear Sir,
I am suffering from neck and shoulder pain also migraine, what kind of treatment wants to take and also som...
Hi thanks for your query and welcome to lybrate. If you have have localized neck pain with no other symptoms like radiating upper limb pain, neurological symptoms like numbness, weakness, paresthesias etc and with no other associated constitutional symptoms like evening rise in temperature, loss of weight, excessive sweating at night etc, then you can start with following recommendations for initial period of 2-3 weeks: - to maintain proper posture of your neck while working and sleeping - if pain is more then you can take a short course of an anti-inflammatory medication like tab etoshine or paracetamol or one which suits you - physical therapy initially under supervision of a trained physiotherapist and then to continue at home - adequate calcium & vitamin d intake if levels are low in body - ice packs can applied if your pain is acute, then hot fomentation can be done at home - analgesic spray for local application can be used and is easily available. We will observe you for next 2-3 weeks how you respond to this conservative management protocol. If you are not feeling better, then we will have to get some investigations like, dynamic x rays of neck and few blood tests for evaluation. Do not hesitate to contact me if you need any further assistance. You can also discuss your case and treatment plans with me in a greater detail in a private consultation.
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How to Treat Brain Tumor With Ayurvedic Remedies

Skin Diseases Cancer Heart Diseases Musculoskeletal Disorders Male Sexual Disorders AIDS, Hypertension Diabetes Mellitus Blood Disorders Respiratory Disorders, Gastrointestinal Disorders Endocrine Disorders ENT Disorders, Gynecological Disorders Opthalmic Disorders Psychiatric Disorders Urological Disorders
Ayurveda, Indore
How to Treat Brain Tumor With Ayurvedic Remedies

Absolutely indispensable to your existence is the proper functioning of your brain. Not only does your brain ensure a normal functioning of your body, but also it controls all your vital organs. Yet, brain disorders are among the most common diseases the modern populace has to confront. Tumorous growth in the brain affects the health of the brain in the most significant of manners. Be it benign or malignant, anomalous growth of the brain tissues leads to brain tumor. Some of the most evident causes of brain tumor are genetic dysfunctions, exposure to harmful radiations and immune-suppressants. You may detect the incidence of brain tumors through some of the more obvious symptoms like acute headaches, seizures, projectile vomiting as well as some fairly subtle conditions like a feeling of numbness, coordination problems, etc. The immediate recourse to brain surgeries and expensive treatments often do not yield the desired results. As a consequence, many seek an alternative therapy which can potentially soothe the trauma and fight the disease.

Replete with the benefits of ancient medicinal knowledge, Ayurveda offers remedies, which heal the diseases without causing any side-effects. The natural, herbal therapies improve your immunity from within; enhance your bodily strength and your will to live. It also aborts abnormal cell growth and helps in normal regeneration. Some of the most reliable Ayurvedic remedies have been enumerated below.

  1. Aswagandha: Aswagandha herb has fascinating healing properties. They play a major role in restoring strength and immunity in your body. It is endowed with anti-inflammatory properties and is beneficial anti-oxidant. It supplements the essential nutrients, which improve the functions of the brain and minimize the adverse effects caused by harmful radiation.
  2. Curcumin: Curcumin has been known to disintegrate malignant cells from your body. It not only is a great anti-oxidant, but also improves immunity. It has gained popularity as a cure for brain tumors as well.
  3. Guggul: Guggul is known to revitalize the damaged cells and impart good health. It enhances oxidation potentials of the body and speeds up recovery from brain tumors.
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