Study of the brain has fascinated specialists all over the globe since time immemorial. The brain being the most vital organ for survival and coordination is perhaps the most complex of them all too. This has led to a limited understanding of its working in spite of the available advanced technology. However, with the advent of techniques for diagnosis and treatment, therapeutic strategies are evolving. This is a major step towards rendering Neurosurgery safer than ever in the history of mankind.

Neurosurgery through the 20th Century-

During the beginning of the 20th century, Neurosurgery was considered as a specialty. The clinical-neurologist would draw conclusions related to lesions in the brain through neurological examination and clinical history. It enabled diagnosis of vascular lesions, spinal disorders, and brain tumors. During the second and third decades of the 20th century, vascular pathologies and brain tumors could be diagnosed indirectly through techniques like angiography, ventriculography, and pneumoencephalography. But since the operative techniques were too crude and the lack of skilled professionals were rampant, there were high rates of morbidity and mortality due to neurological conditions. Generally, after diagnosing the nature of brain lesion and its site, surgery was performed with inadequate maintenance and control of intracranial pressure and through not too sophisticated surgical instruments.

During the fifth and sixth decades of the 20th century, chemotherapy and radiation treatment came into the picture for treating malignant brain tumors, thereby reducing mortality to a good extent.

During the seventh decade of the 20th century, Computed Tomography (CT) scan provided a better understanding of the location of lesions in the brain which slightly substantiated the earlier techniques. Then, the procedures for cerebrospinal fluid diversion significantly improved management of intracranial pressure during surgery.

It was only during the last decade of the 20th century that the Neurology saw a giant progressive leap through the introduction of Magnetic Resonance Imaging (MRI) and powerful high magnification microscopes. Combined with Neuroanesthesia and Intracranial Pressure Management, this aided surgeons to work on a relaxed brain. This promoted safe removal of the brain tumor and better management of vascular lesions. Moreover, the understanding of micro-surgical anatomy improved drastically, leading to a boost in confidence levels of the micro-neurosurgeons performing the operation.

Neurosurgery in the 21st Century-

The 21st century is actually a revolutionary era that uses powerful computers in almost all the fields possible. Computer-based applications such as Neuro-imaging, Neuronavigation, Intra-operative Neuro-monitoring, and Neuro-modulation are now used in standard neurosurgical practice as a part of the routine. Extremely powerful CT scans and MRIs are used for diagnosis before surgery. The advent of nanotechnology and its application in Neurosurgery is doing great and has a promising future ahead based on the current study of scenarios. Moreover, there is a possibility of most of the Neurosurgical procedures becoming minimally invasive. Frameless Stereotaxy is another technique that helps in locating the exact position of the tumor, which further helps the neurosurgeon in navigating with great precision the very sensitive, high-risk areas of the brain. Such techniques, to a great extent, have lowered mortality and morbidity, lessened the rate of recovery, and chances of infection related to Neurosurgery.

Take Away-

A number of techniques for diagnosis and precise location of the tumor in the brain have made Neurosurgery much safer today, due to advancement in science and technology, than it ever had been in the history of mankind.

Advancements In Neurosurgery - Know How Safe It Is!

A neurological disorder characterized by sudden recurrent episodes of sensory disturbance, loss of consciousness, and convulsions associated with abnormal electrical activity in the brain.

Role of physiotherapy in epilepsy

It helps improve strength, mobility, and increases the range of motion and sphere of movement.

It helps improve sensory awareness, response, balance, and coordination.

It helps to improve quality of movement and physical performance.

The goals of physiotherapy

To develop strength enough to support one s head upright

To have balance and motor control to maintain their trunk at midline

To use many different muscle groups

To assist necessary motion in their trunk and extremities

The physiotherapists write short-term goals for each of the items on the problem list that need to be covered to help the patient achieve the long-term goals

To understand what the patient is good at and does well

To focus on what he or she capable of doing rather than on what they can t do

To educate and provide awareness with a view to prevent injuries

For example, advice on special swimming equipment to prevent drowning if he/she gets seizures in the pool

Padding out sharp corners in the house to prevent damage if fallen on

Physiotherapy treatment for a healed fracture consists of strengthening muscles that have got weak from being immobilized and stretching muscles that are stiff owing to being in the cast for a long period of time.

How can physical exercise help with seizures?

Physical exercise improves fitness, energy, and mood and even relieves stress. Improving overall health and well-being in this way can help reduce seizures. 

It can also help people feel more in control of their health. 
It also helps release  feel good  hormones into the brain, keeps muscles active, reduces fat levels in the body, and increases oxygen flow to the brain. 
It can also increase the bone density. 
A research showed that regular sessions of aerobic exercise (for example running, walking, swimming, cycling) for 60 minutes, twice a week, for 15 weeks can result in a significant reduction in the number of seizures they had.
Drink water, diluted fruit juice, or squash while exercising to help replace the fluids and body. Do not exercise straight after a meal.
Team sports or group activities such as walking or gardening groups can also be a good way of increasing self-confidence. 
Making new friends may help with any feelings of isolation. 
Most sports, including contact sports like football, hockey, basketball and rugby, have not shown to increase the chance of someone having a seizure, but contact sports come with an increased risk of head injuries, which could affect people with a history of epilepsy. Protective sports headgear helps to reduce this risk.


Epilepsy - Understanding The Role Of Physiotherapy In It!

Cerebral Palsy (CG) is a neurological disorder caused by an injury to the brain or a brain malformation that occurs while the child s brain is still developing   in the mother s womb before birth, during birth, or immediately after birth.

This disorder affects the child s movement and muscle coordination and control. It also affects his:

Reflexes
Balance
Posture
Motor skills and
Oral motor functions
In easy to understand language, CG can impact the child s ability to walk, talk, sit, do simple tasks like eating, combing hair, talking, and other activities we take for granted. The physical impairment caused by cerebral palsy can affect all limbs, the face and head, or it may just affect one limb. Since CG affects muscles and a child s ability to control them, common symptoms include muscles that contract too much, too little, or all at the same time, leading to limbs that are stiff and forced into awkward positions. Other complications also arise such as intellectual impairment, seizures, or vision/ hearing and speech impairment.

How does Speech Therapy help?
Speech problems affect more than half of all children with cerebral palsy as they have difficulty controlling the muscles in their face, throat, neck and head. Apart from speaking, this also affects chewing and swallowing. It can also cause drooling and the ability to learn, difficulty hearing and understanding spoken language.

This is where speech and language therapy comes in. Speech therapy improves a child s speech and communication by strengthening the muscles used for speech. It also improves understanding of speech and language as well as help with swallowing disorders, like dysphagia.

Speech therapy helps exponentially as when children improve their speech and communication, they are able to express their needs, share their thoughts and interact with others, leading to an overall improvement in their overall quality of life.

Speech therapy can help with the following:

Listening
Articulation of words
Pronunciation
Fluency
Sound and word formation
Language and vocabulary development
Breath control
Chewing
Swallowing
Speech muscle coordination
Apart from this, the other primary benefits are boosting self esteem, socialization, independence and reducing shyness. 

Exercises used in Speech Therapy
Speech therapy treatment usually consists of exercises tailored to a child s specific needs. Different exercises are used in speech therapy like:

Articulation therapy: The therapist uses language cards to help focus attention on specific sounds to encourage the child to make sounds while looking in the mirror to help him understand how his mouth moves.
Blowing exercises: The therapist encourages the child to blow bubbles or a whistle to train the mouth muscles to produce sounds.
Breathing exercises: Work is exclusively on inhalation and exhalation to strengthen the diaphragm.
Jaw exercises: The child is encouraged to eat foods that require extra chewing to strengthen jaw muscles.
Language and word association: The therapist uses flashcards with different words and sounds written on them.

Cerebral Palsy (CP) - How Speech Therapy Can Help You?

Brain cancer is a disease of the brain in which cancer cells (malignant cells) arise in the brain tissue. Cancer cells grow to form a mass of cancer tissue (tumor) that interferes with brain functions such as muscle control, sensation, memory, and other normal body functions. Tumors composed of cancer cells are called malignant tumors, and those composed of mainly non-cancerous cells are called benign tumors. Cancer cells that develop from brain tissue are called primary brain tumors while tumors that spread from other body sites to the brain are termed metastatic or secondary brain tumors.

Prologue:

Brain cancer is actually the abnormal growth and uncontrolled growth of the cancer cells in the brain,that forms a tumor in the brain.Tumours can be either benign or malignant.

Benign brain tumours are abnormal collections of cells that reproduce slowly and usually remain separate from the surrounding normal brain.

Malignant tumours reproduce and grow quickly. Their borders are hard to distinguish from the normal brain around them.

Symptoms:

There are few early symptoms of brain cancer, but as the tumour grows within the confines of the skull, it causes increased intracranial pressure and exerts pressure on the brain, causing signs to develop.

Brain cancer symptoms and signs are varied and depend on the area of the brain involved, but can include:

Headaches.

Seizures.

Nausea and vomiting, which, CANSA reports, may be worse in the morning or after a sudden position change.

Difficulty walking or clumsiness.

Vision changes.

Changes in alertness.

Behavioural impairment.

Causes:

Brain cancer occurs when there is an uncontrolled growth of cancer cells in the brain that form a malignant brain tumor. The underlying cause of primary brain cancer, cancer that begins in the brain, is not known. Secondary brain cancer is caused by a cancer of another organ in the body, such as the breast, prostate, kidney, skin, or bone, that has spread to the brain.

What are the risk factors for brain cancer?

Certain inherited conditions, including neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome

Personal history of cancer or family history of brain cancer

Impaired immune system

Radiation therapy of the head

Treatments Options:

Treatment

Surgery is the main form of treatment for brain tumors that lie within the membranes covering the brain or in parts of the brain that can be removed without damaging critical neurological functions. The goal is to remove the entire tumor, whenever possible, as a tumor may recur if any tumor cells are left behind. Radiation therapy and chemotherapy are generally used as secondary treatment for tumors that cannot be cured through surgery alone.

Stereotactic radiosurgery

Stereotactic radiosurgery is a treatment option that delivers a high concentration of radiation directly to the tumor in order to stop its growth, while delivering only a minimal dose of radiation to the surrounding tissue. Unlike conventional surgery, stereotactic radiosurgery does not require making an incision to remove the tumor. It can be especially effective in patients with many small metastatic brain tumors.

Brain Cancer

A neurological disorder is characterized by sudden recurrent episodes of sensory disturbance, loss of consciousness, and convulsions associated with abnormal electrical activity in the brain.

Role of Physiotherapy in Epilepsy

It helps improve strength, mobility, and increases the range of motion and sphere of movement.
It helps improve sensory awareness, response, balance, and coordination.
It helps to improve quality of movement and physical performance.
The Goals of Physiotherapy

To develop strength enough to support one s head upright
To have balance and motor control to maintain their trunk at midline
To use many different muscle groups
To assist necessary motion in their trunk and extremities
The physiotherapists write short-term goals for each of the items on the problem list that need to be covered to help the patient achieve the long-term goals
To understand what the patient is good at and does well
To focus on what he or she capable of doing rather than on what they can t do
To educate and provide awareness with a view to prevent injury. For example, advice on special swimming equipment to prevent drowning if he/she gets seizures in the pool
Physiotherapy treatment for a healed fracture consists of strengthening muscles that have got weak from being immobilized and stretching muscles that are stiff owing to being in the cast for a long period of time.

Physical exercise improves fitness, energy, and mood and even relieves stress. Improving overall health and wellbeing in this way can help reduce seizures. It can also help people feel more in control of their health. It also helps release  feel good  hormones into the brain, helps keep the muscles active, reduces fat levels in the body, and increases oxygen flow to the brain. It can also increase the bone density. A research showed that regular sessions of aerobic exercise (for example running, walking, swimming, cycling) for 60 minutes, twice a week, for 15 weeks resulted in a significant reduction in the number of seizures they had.

Drink water, diluted fruit juice, or squash while exercising to help replace the fluids and body. Do not exercise straight after a meal.

Team sports or group activities such as walking or gardening groups can also be a good way of increasing self-confidence. Making new friends may help with any feelings of isolation. Most sports, including contact sports like football, hockey, basketball and rugby, have not shown to increase the chance of someone having a seizure, but contact sports come with an increased risk of head injuries, which could affect people with a history of epilepsy. Protective sports headgear helps to reduce this risk. 

Role Of Physiotherapy In Treating Epilepsy!

A migraine often causes throbbing pain at one side of the head accompanied by sensitivity to sound and light, nausea and vomiting. The pain can last from a few hours to few days. Some warning signs of the pain take over include tingling of the leg or face, flashes of light and blind spots. Medication can help in avoiding the pain or manage it considerably.

Diagnosis:
Detection of a migraine is fairly easy for a medical professional. If a patient has a family history of a migraine, a doctor can prescribe the following to lock in on the diagnosis:

Blood tests: Through blood tests, a doctor tries to understand any possible problems in the blood vessels, spinal cord or presence of other toxins in the system
Magnetic Resonance Imaging: Better known as MRI, this is a process of capturing the detailed image of the blood vessels and the brain. It readily detects any possible problems related to a migraine.
Computerized tomography: More commonly known as CT scan, this is a process of capturing an image through a line of x-rays to detect any possible problems related to a migraine.
Lumbar puncture: This test is prescribed in extreme cases when a doctor suspects that there is a possible chance of bleeding in the brain.
What are the treatment options available?
There are two kinds of medications available- preventive medication and pain relieving medication. The treatment strategy is decided based on the frequency of the headaches and other health factors.



Some pain reliever medication includes triptan, ergots, opioid, glucocorticoids, anti-nausea medications etc. These medicines constrict the blood vessels and block the pathways of the pain in the brain cells. While some medicines are required to be consumed immediately after the symptoms starts, some should be taken regularly to avoid the pain in the first place. These pain relievers have side effects and should be consumed after prior discussion with a doctor.



Preventive medication, on the other hand, is only suggested by a doctor when a patient suffers from a migraine twice or more in a month, the pain lasts for more than 12 hours and the pain relievers do not work. Some of the common group of medicines that are suggested for these set of patients include cardiovascular drugs, anti-seizure drugs, anti-depressants etc.

Alternative medicine approach:
Alternative medicines are often witnessed to fetch positive results for migraine patients:

Acupuncture: this form of treatment involves inserting thin needles into the skin at various points to give relief from pain
Cognitive behavioral therapy: This is a form of treatment which focuses on perceiving pain with behavioral changes.
Biofeedback: This is a relaxation technique that teaches to control physical responses such as pain, stress, muscle contraction etc.
In case you have a concern or query you can always consult an expert & get answers to your questions!

Migraine - Treatment Options Available!

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