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Sri Balaji Action Medical Institute

Neurologist Clinic

#FC 34, A-4 Paschim Vihar EAST. Landmark:-Opposite Dda Sports Complex, Delhi Delhi
1 Doctor
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Sri Balaji Action Medical Institute Neurologist Clinic #FC 34, A-4 Paschim Vihar EAST. Landmark:-Opposite Dda Sports Complex, Delhi Delhi
1 Doctor
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Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and fin......more
Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and financial concerns.
More about Sri Balaji Action Medical Institute
Sri Balaji Action Medical Institute is known for housing experienced Neurologists. Dr. Sandhya Koche, a well-reputed Neurologist, practices in Delhi. Visit this medical health centre for Neurologists recommended by 86 patients.

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MON-SAT
09:00 AM - 09:00 PM

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#FC 34, A-4 Paschim Vihar EAST. Landmark:-Opposite Dda Sports Complex, Delhi
Paschim Vihar Delhi, Delhi
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My husband is having migraine from past 1 month he is taking tablets please tell me how many months it will take to cure completely? Or should he take tablet life long for migraine?

MBBS
General Physician, Hyderabad
Migraine headaches do not stay continuously. They come and go. As they can occur any time there is only one thing that you can do is note down the how frequent migraine attacks happen, after what activity does he get these migraines, how long it lasts, which part of your head hurts, does anyone in family have similar trouble, Does bright light/loud sound/ lack of sleep bring headache, what medications help him and does he have an aura before he gets migraine. Aura is basically sensitivity to light ,sound and also nausea. Some people have aura before they get migraine and some do not. Its better to keep note of these above question and follow up with a doctor. If the frequency increases to more than two days in a week you should see a physician. When he has migraine try to sit in a dim light room with no noise. Usually the first treatment option is over the counter pain killers. But if you are having headache very often then I recommend a doctors visit. Hope this helps.
1 person found this helpful
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My husband is having migraine from past 2 months he is under treatment taking tablets from 15 days. He is living in tamilnadu next week we planned to go for Bangalore and settle for 1 month does climatic changes affect his health sir?

MBBS, MD - Internal Medicine, Fellow in Pain Management, DM - Neurology
Neurologist, Delhi
Hello..Yes climate does affect migraine..hot and sunny weather is bad as it can precipitate migraine.. Banglore has an even climate throughout so it won't be a problem.. Migraine treatment usually lasts 6 months to 1 yr..but it depends on the response.. If good response we can stop the medicines but if poor response then it can continue longer..meanwhile avoid stress, caffeine, bright light or bright sound to have good sleep etc.
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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

Dear sir, I had panic attack, but it cured But now I have migraine. I face compilation in loud sound and brighter light like bright bulb, seeing on smartphone, etc Also I guess I have tic disorder/Parkinson's disease. Please suggest me some medications. Thank you.

C.S.C, D.C.H, M.B.B.S
General Physician,
Panic attacks can be cured with psychotherapy and counselling . You have to reduce or avoid use of loud sounds and screens . Parkinson's disease cannot occur in your age
1 person found this helpful
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I hv migraine problem ,diagnosed in 1997. Pls tell cause cure precaution and fast relief from migraine.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Ayurveda
Ayurveda, Sri Ganganagar
You should adopt sattvika life style ie light food, timely take food habit, awakening early in the morning, morning walk etc are will be helpful in reduce the problem.
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Can migraine & varicose be treated by the elrctropathy for permanently. Give address of doctor near karol bagh. Who can treat it with guarantee & charitably.

MBBS
General Physician, Madhubani
There is nothing to be given with guarantee. Even now company are giving warrantee not guarantee. So for migraine you have to change your lifestyle. Prevent urself from going to the area which aggrevate migraine. Start morning walk. Do yoga. Eat less spicy food. Prevent gastritis. For varicose vein surgery is the only treatment or endogenous LASER.
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Every night when I am about to fall sleep, I feel strong electric type of jerking movement in my brain as if I am getting a brain stroke. It happens every night. Currently I am taking tropan xl 5 for frequency of urine.

Homeopath, Hyderabad
Hello Electric Types of jerks or pains are usually neurological based. Consulting a Dr. and investigate will reveal the exact cause Do Confirm whether these started especially after some medication or any injury.
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From past 3 months my hands starts shake automatically, also head is shaking! Is this a vitamin problem? Why this happens? When. I go to doctor they suggest me to take neurobion forte 1 month but this also not working.

MBBS, MD - Internal Medicine, Fellow in Pain Management, DM - Neurology
Neurologist, Delhi
Hello. Would have to see how ur hand shakes and accordingly tell..Most commonly shaking of hands would he due to a tremor but there are other abnormal movements also so actually seeing you is important .. tremor could be due to plain anxiety stress or sometimes thyroid excess, Essential tremor or parkinsonism.. It depends on your Age.. Parkinson and essential tremor usually in older age.. Anxiety can occur in younger age..Also whether ur tremor is at rest or more during stretching out your hands..
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Hello doctor, My mother had been suffered from parkinson disease. She had expired 2 years ago. My maternal grandfather was also suffered from same. One of my mother's sister has also same. I have one brother. I want to ask that is there chances to get same disease to me or my brother?

Ph.D psychology, M.phil clinical psychology (RCI reg.)
Psychologist, Alwar
Hello doctor,
My mother had been suffered from parkinson disease. She had expired 2 years ago. My maternal grandfathe...
This problem may be genetic. But do not think negative. Do not feel fear aisa kuch hua nahi uske liye aap present khrab kar rahe ho apke sochne se kuch nahi ho sakta. Aap apne nearest Dr. Se consult kare.
1 person found this helpful
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How to know if you have migraine? Is there any confirmation test or something which confirms it?

MBBS
General Physician, Cuttack
Symptoms of Migraine 1.Unilateral Headache, eye pain 2.Throbbing and pulsating pain 3.Nausea and Vomiting 4.Increased sensitivity to light and sound 5.Feeling of Dizzy or Faint Cause Unknown.May be due to decrease in brain chemical-serotonin which regulates pain in the nervous system,genetic,environmental factor Triggering factors a)Hunger(missedmeal) ,drinking alcohol(redwine),/coffee,tea) b)Inadequatesleep, stress,anxiety,depression,agitation, bright light/sun glare c)environmental factors like glaring light, Loud noise,strong smell/prfume/passive smoking d)weather changes,high altitude, e)use of oral contraceptive,hormonal changes like oestrogen fluctuation during pregnancy, menopause, hormonal replacement therapy f)continuous use of cell phone g) salted food,aged cheese, processed food
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My father had epilepsy stroke 2 years back so he is consuming eptoin from 2 years now he is not going for regular consultancy but is consuming eptoin as a regular medicine till death is it right that for epilepsy patient eptoin is compulsory till his her death?

MBBS, DPM
Psychiatrist, Agartala
It's so nice dear that you are t aking care of your father. If your father did not have epilepsy for last 2 years consecutively and it CT brain, sodium,potassium, thyroid,calcium level is normal than your physician may start lowering the dose under his supervision. You can give folic acid supplementation. Thanks.
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I am feeling uneasy in my left hand finger. I am not getting pain but its like its getting numb. Finger is working but still feel like numb on it.

Neurologist,
I am feeling uneasy in my left hand finger. I am not getting pain but its like its getting numb. Finger is working bu...
If your symptoms had been in the The first three digits of a hand, it could be carpal tunnel syndrome- a pinched nerve in your wrist. If the symptoms are in last 2 digits of the hand, it could a different type of pinched nerve. If numbness and tingling is in whole hand- it could be neuropathy. If numbness in fingers is associated with neck pain and radiating pain in arm- it could be a pinched nerve in your cervical spine. So based on the information you share, it is hard to draw any conclusions about what you have.
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My hemoglobin is 8 and I feel really week I feel numbness in my legs sometimes. Guide to recover from this ad do on as possible.

BHMS, M.D.
Homeopath, Chandrapur
My hemoglobin is 8 and I feel really week I feel numbness in my legs sometimes. Guide to recover from this ad do on a...
hello maimuna, there are verious causes of low heamoglobin (anemia) like, anemia due to excessive menstrual flow, or anemia due to previous chronic illness like malaria, typhoid etc. or simply due to nutrition deficiany. underlying cause is need to rule out and treated accordingly. to increase heamoglobin, have more protein and iron rich diet. like spinach, beans, jagary n peanuts, milk, egg etc. avoid excessive physical exersion. well selected homeopathic medicine (selected on the basis of thorough details and history of patient) helps to assimilate the nutrition properly and also cures the underlying cause. for consultation, message back. take care.
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My age 21. Sometimes when I was nervous my body and hand is shaking and have never stopped. Body also weak. Give some advice.

Neurologist,
Hello. Don't worry lybrate-user. It is okay to have mild tremors if your nervous/ or experiencing any strong emotion/ fatigue or with consumption of excess caffeine. Sometimes problems of thyroid gland could be causing this as well. But a proper neurological examination can rule out more serious types of tremors.
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My mother is suffering from tingling in her feet since a month She is diabetic None of the medicines working on it Pls suggest me if there is any alternative treatment.

Neurologist,
It's of foremost and utmost importance to control the diabetes as aggressively as able, because if not taken care of, it will not only lead to the worsening of these symptoms- but also place her at risk for stroke, heart attack, chronic kidney disease, vision loss, etc If medications for diabetic neuropathy are not functioning, you may try massages with certain pain relieving creams, acupuncture and other alternative options.
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Hi sir I am suffering from migraine and taking medicine every night from past one month. Can I donate blood?

BHMS, MD - Alternate Medicine
Homeopath, Nagpur
Migraine headache occurs due to stress many times but is triggered by external factor like shiny object, sunlight etc .So you have to avoid these triggering causes.
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Hello doctor I am feeling full right arm numbness and pain (mild) from last one month. Both Numbness and pain are not continue kindly suggest what to do.

BHMS
Homeopath, Mumbai
Hello doctor
I am feeling full right arm numbness and pain (mild) from last one month. Both Numbness and pain are not...
It may b due to b12 deficiency or any nerve compression. In my opninion consult a gp n rule out the cause.
1 person found this helpful
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Mere mummy ko Parkinson h 15 saal se unki recoport normal aaye h CT scan or MRI (brain) Dr. ne symptoms Dekh Kar Parkinson bataya h unki age 59 year h par unko bham ki bhi problem ho rahi h sycraterest se bhi treatment Chal raha h par dabai asar nahi ho rahi h bahut koshis karte h samjhane ki Kuch nahi h unko lagta h bahar koi Unka naam Le Kar Kuch bol raha h.

DM - Neurology
Neurologist,
Mere mummy ko Parkinson h 15 saal se unki recoport normal aaye h CT scan or MRI (brain) Dr. ne symptoms Dekh Kar Park...
Jisko aap vaham kah rahe hain, usse medical bhaasha mein auditory hallucination kehte hain, aur uski vajah psychosis hoti hai; sambhav hai aapki maataji ko schizophrenia - jaisi koi bimari bhi ho, ya toh dawaiyon ke side-effects se auditory hallucinations ho rahe hon. Par samajh ne wali baat ye hai ki unke liye jo aawazein sunaiy de rahin hain, woh utni hi vastavik hain jitni hamare liye hoti hain jab koi sach mein baat kar rahaa ho - unko chahe aap kitna bhi samjhayen, woh is baat ko samajh nahin paayengi. Psychiatrist isska sahi nidaan karke sahi ilaaj kar sakte hain - dawaon ka asar bhi seemit hotaa hai. Agar Parkinson Disease ko lekar koi samsya ho to mujhe bataiye, shaayad main koi sevaa kar sakun.
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Autism Spectrum - How Homeopathy Can Help?

BHMS
Homeopath, Delhi
Autism Spectrum - How Homeopathy Can Help?

One of the best pleasures of life is to watch a child grow up and begin to learn and explore new things in the surroundings. However, children affected by autism spectrum disorder (ASD) or autism may not be able to do this at the same pace as other kids. They are a little slow to respond and may not socialise very easily.

ASD is a collective term used for a range of symptoms, including poor verbal and nonverbal communication, poor social skills, repetitive behaviour, and impaired learning abilities. The onset and severity of symptoms also vary across children. While some show symptoms in preschool, others would be completely normal and start showing symptoms after a couple of years of schooling. The following are some symptoms that indicate the child could have autism.

  1. Lack of babbling by 9 months of age
  2. No response when called by their name even after 12 months of age
  3. Not uttering single words by the age of 16 months, two words by 24 months
  4. Lack of social skills including resistance to cuddling, not mingling with other kids
  5. Self-injurious behaviour like banging head on the wall, hurting a toy, etc.

Homeopathy offers safe, effective remedy for children with autism. Treatment regime is highly customised based on underlying and accompanying symptoms of each patient. The following are commonly used ingredients; however, self-medication is best avoided.

  1. Agaricus: The child talks and sings but does not respond. There is indifference, fearlessness, shouting, constant jerking of the head, difficulty reading, possible double vision and feels awkward physically and mentally.
  2. Carcinosin: The child is obstinate and has compulsive obsessive tendencies. It is hyperactive, does not sleep, has addictive tendencies, and likes to drink milk which worsens the symptoms.
  3. Androctonus: The child is destructive, suspicious, mischievous, but very quick to respond. The child behaves very well at times and can be very naughty at other times.
  4. Helleborus: The child is generally weak, slow to respond, appears thoughtless, often stares into air, and looks depressed with involuntary sighing and habit of lip biting. Sight, hearing, and taste could be affected.
  5. Cuprum Metallicum: The child is extremely tense, irritable, rigid, malicious, and very difficult to handle. Does not like to be touched or spoken to or played with. Can be aggressive with the parents, driving them to despair.

May have tics infestation on the scalp.
Another recent approach is the CEASE (Complete Elimination Autism Spectrum Expression) Therapy. This combines homoeopathy with orthomolecular medicines that provide the required nutrition for brain development (vitamins, minerals, omega-3 fatty acids, etc.) This helps in overall brain development and restoring function in affected children. As noted, the right potency of these products will determine the response to treatment. If you wish to discuss about any specific problem, you can consult a homeopath.

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Daily between 10: 00 am to 10: 45 am there is a urge of hunger with shivering of my whole body specially face, hand and I got stuck I can not even think anything with my brain, I take breakfast at 7: 00 am daily, my sugar level is under 100. please help me what to do, why it isbhappening.

M.Sc - Dietitics / Nutrition, B.Sc. - Dietitics / Nutrition, PG Diploma in Dietetics & Nutrition Management
Dietitian/Nutritionist, Visakhapatnam
The stomach needs to be refuelled every 90 minutes. Veggie or fruit salad, or oats or whole wheat biscuits are some of the good sources. After your breakfast time, there is a time gap of 3 hrs. Due to this, you feel weak and dizzy; thus, brain does not function properly.
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