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Dr. Ashok Gandhi

Neurosurgeon, jaipur

200 at clinic
Dr. Ashok Gandhi Neurosurgeon, jaipur
200 at clinic
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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. Ashok Gandhi
Dr. Ashok Gandhi is an experienced Neurosurgeon in Mansarovar, Jaipur. He is currently practising at neuro in Mansarovar, Jaipur. Save your time and book an appointment online with Dr. Ashok Gandhi on Lybrate.com.

Lybrate.com has a number of highly qualified Neurosurgeons in India. You will find Neurosurgeons with more than 37 years of experience on Lybrate.com. Find the best Neurosurgeons online in Jaipur. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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I have migraine problem can you help me. Hello send me your answer. And given your no.

MBBS
General Physician, Cuttack
1.Take Paracetamol 500mg one Tablet sos after food up to a maximum of three tablets daily at the time of attack 2.Drink plenty of water and take rest. 3.Check your BP 4. Avoid stress, anxiety, depression, agitation,exposure to loud noise, bright light since it precipitates migraine attack 5. Go for regular exercise 6. practice yoga, meditation, deep breathing exercise to calm your mind, control your emotion and relieve you from stress 7. If You have chronic migraine, you have to take migraine prophylaxis after consulting neurologist
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I m suffering for tinnitus for one year all reports are positive doctor say ur audiotary nerve become week sir I m now depress any solution

BHMS
Homeopath, Ghaziabad
Start with 1. Acid nit 200 - 2 drops thrice daily 2. Petroleum 200 - 2 drops twice daily See the results in 3 months
1 person found this helpful
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Kya periods ke time sex karne se aids hone ka darr rehta ya fir freely sex kar sakte h ya condom use karna zaroori hai. Kya migrain ki dard me normal painkillers kha sakte hai ya fir kisi doctor ko dikhana must hai. Zada mastubate karne se kya body ka wait kam hone lagta hai aur joints me pain bhi hone lagte hai.Please tell.

MD - Dermatology , Venereology & Leprosy, MBBS
Dermatologist, Delhi
Kya periods ke time sex karne se aids hone ka darr rehta ya fir freely sex kar sakte h ya condom use karna zaroori ha...
Periods ke time aids ka khatra jyada hota hai, condom hamesha use karna chahiye, migraine me normal painkillers kha sakte ho par doctor job dikhana jaruri hai, masturbation once or twice daily will not affect you but if you do more than that then it will affect you.
16 people found this helpful
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I am 47 years old. I have diabetes from last 10 years. From last 1. 5 years I face problem in sensing me feet. What should I do?

Dip. SICOT (Belgium), MNAMS, DNB (Orthopedics), MBBS
Orthopedist, Delhi
Hi thanks for your query and welcome to lybrate. I am Dr. Akshay from fortis hospital, new delhi. It could be due to your long term diabetic status or due to other causes like lower back etc. I would like you to consult an endocrinologist or a neurophysician, probably you will require nerve conduction studies to be done to be sure that it is due to diabetes and then appropriate management can be instituted. Do not hesitate to contact me if you need any further assistance. Thanks & regards Dr. Akshay kumar saxena Consultant orthopaedics fortis hospital, new delhi.
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Hello doctor I have problem of anxiety disorder and hand shaking now these days I have suffering from neck shaking also please suggest me good medication for this that available easiely in medical stores. If I can't improve then I go to see a doctor. Please help me.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Hello doctor I have problem of anxiety disorder and hand shaking now these days I have suffering from neck shaking al...
Dear, instead of going to doctor and having psychiatric medicines for simple anxiety disorder, why don't you use psychotherapy methods which are quite useful? I will help you to manage your anxiety problems with the help of psychotherapy. Don't worry. Let me know the full details. Take care.
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What do you means migration headic problem and iss problem ke bare me koi uppaye btaye ki kaise sahi ho skta h.

PDDM, MHA, MBBS
General Physician, Nashik
Avoid triggers. If certain foods or odors seem to have triggered your migraines in the past, avoid them. Reduce your caffeine and alcohol intake and avoid tobacco. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress. Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraine headaches, and regular exercise can help you maintain a healthy weight or lose weight.
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Sleep Apnea - 7 Ways it Can Be Treated!

MS - ENT, MBBS
ENT Specialist, Delhi
Sleep Apnea - 7 Ways it Can Be Treated!

Sleep apnea is a potentially dangerous sleep disorder in which you stop and start breathing frequently while you are sleeping. Symptoms of sleep apnea often include loud snoring and fatigue even if you sleep uninterrupted through the night. Obesity and age are the common risk factors of sleep apnea.

The most common type of sleep apnea is obstructive sleep apnea, in which the throat muscles contract and relax while you are asleep. The other type of sleep apnea, called central sleep apnea, usually occurs in people who have been diagnosed with brain tumors, infections or heart failure, or have had a stroke.

Treatment of sleep apnea includes:

  1. CPAP: The Continuous Positive Airway Pressure (CPAP) device is generally recommended in the treatment of sleep apnea. CPAP is a breathing machine that stops your airways from getting blocked when you are sleeping. The CPAP device is normally the size of a tissue box. It comes with a mask that you put over your mouth and nose. The machine attached to the mask pumps a continuous flow of air that keeps your airways clear as you sleep.
  2. BPAP: The Bilevel Positive Airway Pressure (BPAP) device is used as an alternative to the CPAP device, if you find it hard to adjust to the CPAP. If you have a weak pattern of breathing, the BPAP can be helpful.
  3. ASV: The Adaptive Servo-ventilation (ASV) device is used to treat both central and obstructive sleep apnea.
  4. Treatment for other medical conditions: Sometimes sleep apnea can be caused by underlying health conditions. Problems such as rhinitis (nasal passage inflammation) and hypothyroidism (underactive thyroid gland) can cause sleep apnea. In such cases, your doctor needs to diagnose these conditions first before treating your sleep apnea.
  5. Lifestyle changes: Excessive weight sometimes can cause sleep apnea; so losing excessive weight should be a priority. Also, alcohol and tobacco can contribute to your symptoms, so try avoiding those.
  6. Medication: Usually, doctors do not prescribe any medicine, since sedatives and sleeping pills actually worsen sleep apnea. But, in case of sleep apnea in children, doctors typically suggest intra nasal corticosteroid medicine to treat the symptoms.
  7. Surgery: Surgeries to increase the size of your airway or to remove your adenoids, tonsils or extra tissues in the rear of your throat or your nose can prove helpful. If you wish to discuss about any specific problem, you can consult a doctor.
3881 people found this helpful

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

I am 43 year old I am working as clerk in jnv. Doctor, my right leg feeling senseless. Feeling like no leg and always some inside feeling with I am unable to express. Kindly help me.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
I am 43 year old I am working as clerk in jnv. Doctor, my right leg feeling senseless. Feeling like no leg and always...
Do keep mobilising the limbs by simple stretching and Strengthening exercises from physiotherapist Best wishes.
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Dear Dr. l am suffering from hand tremors and weakness in hand. When l face some challenging tasks these symptoms increases, Also let Android break down. Or lam getting restless and Angry, lf someone is not listening me l start getting violent. Sometimes l feel danger from my wife and son .l want to go away from them. They are reason for my disease they always do not listen to me, THEY are doubting me. I feel they are spying on me. They are spying on me. I feel as if l have done some thing wrong, Not always but during peak of nervousness l start listening some mild sounds/ musics when l follow these sounds l find no one talking or l was listening a fake ringtone of my phone, there was actually no calls on my phone. These are some examples. Also these days not before from last 2,3 days l am getting confused like did l locked my door or not, where did l kept my mobile, what is the date today. Thanks.

M.PHIL - CLINICAL PSYCHOLOGY, MA - CLINICAL PSYCHOLOGY
Psychologist, Delhi
Dear Dr. l am suffering from hand tremors and weakness in hand. When l face some challenging tasks these symptoms inc...
Dear, some of the behaviors you have described fall into the category of psychotic symptoms. This means your suspiciousness towards your wife and son, the sounds/music that you hear, and other similar behaviors where you doubt intentions of other people - these behaviors indicate that you are displaying symptoms of schizophrenia. However, you also mentioned feelings of worry, anxiety, anger and guilt. These emotional symptoms are making your condition worse and they are also maintaining psychotic symptoms because during these peaks of nervousness, your voice hearing increases. This is leading to a never ending chain of severity. Generally these symptoms of suspiciousness and doubt develop due to lack of social skills and poor reasoning ability. You may be facing difficulties in knowing intentions of others towards you. You do not trust others in general. You are not able to develop attachment with others easily. This may have been present since your childhood. You feel left out and believe nobody cares for you. Feelings of guilt and rejection are some of the signs why you have got these symptoms. You also mention some poor concentration at work and day to day life. This is also common in schizophrenia. You need to consult a psychiatrist or a clinical psychologist to relieve these symptoms. Please consult some specialist as soon as possible to prevent your condition from getting worse.
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Dr. hume migrain hai so ye bataye ki kya iska koi ilaj hai india mai aur kuch suggest kriye kaise ye thik hoga please Dr. bcz bahut dard hota hai body mai.

Diploma in Naturopathy & Yogic Science (DNYS), bachelor Of Science in Nursing
Yoga & Naturopathy Specialist, Gandhinagar
Take proper rest and sleep. Take your meal on time and don't skip meal. Cure Constipation, gas and acidity first if you have. Take plenty of water and juices. You can also do some Pranayam of better results like Anulom vilom, kapal Bharti and Bhramri. Your feedback will be expected.
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My right eye was flinching and the very next day my rightface got swollen. And it has become numb. I couldn't eat or open my mouth flexibly right side. I want to know what is the cause for this. This from 2 days.

DHMS (Hons.)
Homeopath, Patna
My right eye was flinching and the very next day my rightface got swollen. And it has become numb. I couldn't eat or ...
Hello, it might b due to cold exposure. Take homoeo-medicine** @ rhus tox-6 pills, thrice a day. @ lyco-30-6 pills, thrice a day. Reprot, your progress, wkly.
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RISK FACTORS OF DEMENTIA

MBBS, DPM (Psychiatry)
Psychiatrist, Thrissur
RISK FACTORS OF DEMENTIA

RISK FACTORS OF DEMENTIA

Risk factors
Dementia usually affects older people. While it is possible to develop dementia early in life, the chances of doing so increase dramatically with age. One in 50 people between the ages of 65 and 70 have a form of dementia, compared to one in five people over the age of 80.
Mind your head There is no fail-safe way to prevent dementia, no magic medicines or vitamins that do this, but there is now good evidence that a healthy lifestyle and diet could reduce your risk. 
Causes of Alzheimer’s diseaseIt is unlikely that there is a single cause of Alzheimer's disease. Researchers believe that many factors, including age, genetic background and lifestyle, work together and lead to the onset of the disease. Information sheet Am I at risk of developing Alzheimer's disease? Information sheet Aluminium and Alzheimer's disease.
Causes of vascular dementia Many factors can affect whether a person develops vascular disease or vascular dementia, including lifestyle, diet, and drinking and smoking habits. Some types of vascular disease are hereditary. People with high blood pressure, a high level of fats in their blood or diabetes are at an increased risk of developing vascular disease.
Learning disabilities and dementia The prevalence of dementia in people with other forms of learning disability is also higher than in the general population. People with Down’s syndrome are at particular risk of developing dementia.Information sheet Learning disabilities and dementia

Dear doctors what are the symptoms of brain hemorrhage and what precaution should we take to avoid such disease and what we eat.

PG Diploma in Emergency Medicine Services (PGDEMS), Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine
Ayurveda, Ghaziabad
sudden weakness, tingling, or paralysis in the face, arm, or leg, especially if it occurs on only one side of the body. sudden onset of severe headache. trouble swallowing. trouble with vision in one or both eyes. loss of balance and coordination, dizziness.
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My body is feeling like like shaky/tremor and after eating food I am pooping. What may be the reason?

MBBS
General Physician, Jalgaon
Please Wake up early go for morning walk in greenery daily Do yogasanas and pranayam daily Do meditation regularly Avoid oily spicy and fast food Avoid rice, non veg food Take Cap wokride 15 1 on empty stomach Tab gasex by Himalaya 2..2 for 15 days Re Consult me on Lybrate after 15 days.
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Which one is the best pain killer tablet for migraine or adhasishi headache pain?

MBBS
General Physician,
Which one is the best pain killer tablet for migraine or adhasishi headache pain?
It is very difficult to say which one is the best because different pain killer acts differently in each individual normally it can be paracetamol calpol, brofen ibubrufen or combiflam main reason of aggravating factor is stress and strain anxiety neurosis, one has to avoid that even one has to change his or her lifestyle.

I have heard that ketogenic diet helps patients suffering from epilepsy. Please suggest me a good healthy ketogenic diet?

MBBS, cc USG
General Physician, Gurgaon
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet few example of ketogenic diet Butter Ghee coconut oil olive oil Lime/ olive/ strawberry legume Yogurts Cashews/ Walnut
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I have migraine since 15 years I have done many treatment but there is no good result please suggest me medicine which have no size effect.

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
Migraine is a relapsing headache disorder. It causes episodic one sided headache associated with nausea and/ vomiting, relieved by medicines and rest and aggravated by factors like impaired sleep, stress, allergies, loud noise, sun exposure etc. In addition to taking medicines for acute headache attacks you also have to take treatment foe prevention of further episodes. This can be decided according to the type, duration, severity of headaches, medicines taken so far and associated symptoms like stress, anxiety, depression, sleep problems etc.
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