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Dr. Mona Thakur

Neurologist, Pune

600 at clinic
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Dr. Mona Thakur Neurologist, Pune
600 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. Mona Thakur
Dr. Mona Thakur is a renowned Neurologist in Thergaon, Pune. You can consult Dr. Mona Thakur at Aditya Birla Memorial Hospital in Thergaon, Pune. You can book an instant appointment online with Dr. Mona Thakur on Lybrate.com.

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Aditya Birla Memorial Hospital

Sr. No. 31, Aditya Birla Hospital Marg, Thergaon, Chinchwad, Landmark: NR Morya Mangal Karyalaya, PunePune Get Directions
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Sleep is as Important as Food

MD - Psychiatry
Psychiatrist, Chennai
Sleep is as Important as Food

"With advent of gadgets and night life, many have become sleep deprived off late. There is also a fallacy you need to sleep early and wake up early, whcih is medically untrue. The duration of sleep is of paramount importance for a healthy life. An average of 8 hours of sleep prevents stress, obesity, cardiac illness, immune related disorders, and many more. Minimum one needs 6 hours of sleep, maximum 10 hours. The benefits of dieting, workouts are all negated in the absence of adequate sleep leading to higher morbidity and mortality. Sleep well and be healthy." - Dr. Jagadeesan. (Psychiatrist)

3 people found this helpful

There is numbness in my both feet. Used injections and tabs methley cobala predominantly. Little effect for some days but again complete numbness. Please. Solve.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Normally numbness occurs if there is any nerve deficit or impingement etc, so kindly rule out the cause by clinical examination by neuro musculoskelotal physiotherapist or orthopaedician or neuro physcian asap tens physiothearpy treatment may help to solve this issue of course of 14 days regularly with neuro specialised physiotherapist guidance regards
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I am 88 years for quite a longtime I have numbness on the bottom feet. Taking neurobion regularly no d. M advice.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Any way rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. It is because of diabetic/senile neuropathy. Any way take caldikind plus (mankind) 1tab odx10days epineuron sr 150mg 1 tab odx 10 days. Cntact me again for follow up.
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I am 23 year old male. My hands get shivered holding any object or performing any activity. I have a habit of masturbation. I have numbness in hands and legs.

DHB
Homeopath, Sagar
I am 23 year old male. My hands get shivered holding any object or performing any activity. I have a habit of masturb...
Dear What you are suffering are effects due to your mastrbation habit, stop it immediately all the symptoms will subsidie naturally. I understand that you will need help for leaving this habit for this Homoeopathic treatment can help you consult a Homoeopathic doctor nearby or you can consult me privately
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Having headiac from 5 years consult doctor said migraine and advised to take tab. Naxdom 500 mg but not having permanent solution.

MBBS, cc USG
General Physician, Gurgaon
I am giving some health tips for Migraine headache •1.You can turn off light for some time •2.Apply hot or cold compresses to your head or neck. •Ice packs have a numbing effect, which may dull the sensation of pain. •Hot packs and heating pads can relax tense muscles. •3.Warm showers or baths may have a similar effect. •4.You can take Tea or coffee( but not excess) 5.Sleep well Here are some tips to encourage sound sleep. Establish regular sleep hours. •Minimize distractions. •Your eating habits can influence your migraines. •Be consistent. Eat at about the same time every day. Don't skip meals. Fasting increases the risk of migraines Avoid foods that trigger migraines Meditation This problem can be solved by Meditation, i can give you address of rajyoga meditation center near your house Consult Physician/me for further management
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Numbness, burning sensation and pain which keep shifting in the soles of foot. I seek homeopathic remedy. I am type 2 diabetic.

MD - Psychiatry, MBBS
Psychiatrist, Patna
These are features of peripheral neuropathy. It is more common in diabetics. You should have strict control of blood sugar through diet restriction, exercise and antidiabetic medicines. Apart from this you should take multivitamins containing Vit B12, Folic acid, Niacin, pyridoxine etc.
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I have a child. She is suffering from generalized seizure since last six years. Now she takes 5ml valparin twice a day and clonazepam 0.25 once a day and cereflo four ml twice a day. Seizure stopped last one year. But language problem can not develop.

BHMS
Homeopath, Chennai
Seizures are a condition wherein the nerves are very excitable. Triggered by certain factors. Medication include those that decrease excitability. But in the process general neural function is also suppressed, leading to dullness, memory weakness, and social behavioral changes. Consider homeopathy to correct the underlying cause of seizure in the child - as you can be tapered and stopped of seizure medicines and return to normal functioning.
1 person found this helpful
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Sometimes when I'm sleeping, if I want to wake up, I feel like I don't have control over my body and I can't move even my hands and legs like I'm paralyzed. This is happening frequently. Why does this happen. Is this common for anyone or do I have to take any treatment for this problem (pls tell the reason why does this happen)

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
Sometimes when I'm sleeping, if I want to wake up, I feel like I don't have control over my body and I can't move eve...
This is called as "sleep paralysis". It usually occurs during REM sleep and is a type of sleep-wake disorder, when your brain is awakened from form sleep but body is not yet. So u tend to have a feeling of inability to move. Usually if it occurs once in a while it is physiological. But if it occurs more often then I would suggest you go for a Sleep study and complete evaluation with EEG
1 person found this helpful
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Hello Doctor, I have Migraine headache for more than 20 years, onside headache, it sustains more than 6 hours, painkiller I am taking is Headset, grenil ,i will vomit after the headache starts, it will be yellowish, headache will be severe on onside right side above eyebrow. Can somebody suggest medicine or treatment to cure.

B.A.M.S, Diploma in Nutrition and Health Education (DNHE, PG Diploma in Hospital Managment
Ayurveda, Delhi
Hello Doctor, I have Migraine headache for more than 20 years, onside headache, it sustains more than 6 hours, painki...
Use turmeric medicine 4 that which cure it completely ,we prepare it ,for more query feel free to talj.
1 person found this helpful
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Due to certain incident in may 2015 though it was protected sex, I had done my hiv test on 7th day, 135th day and 174th day from that incident. All report was negative. Do I need further test as I am scared and for last 6 month I am facing many health issues like hip pain, fissure, mouth sores, itching in lower part of legs or below knee.

MS - General Surgery
General Surgeon, Kanpur
Due to certain incident in may 2015 though it was protected sex, I had done my hiv test on 7th day, 135th day and 174...
Your symptoms probably have nothing to do with hiv. It doesn't develop so quickly. Also since your tests have been negative I think there is nothing much to worry about. But it would be better to know the hiv status of your partner.
2 people found this helpful
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Nerves Pulling reason for that. Is Dates advisable for all ages / sugar patients? I understand dates contain Iron. So its good for all. Explain me.

MBBS
General Physician, Cuttack
Nerves Pulling reason for that. Is Dates advisable for all ages / sugar patients? I understand dates contain Iron. So...
Dates can be used in diabetes as it has low glycemic index. it is a rich source of iron.it can be taken by all age groups
2 people found this helpful
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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

Headache is one of the most frequently encountered problem

MD - General Medicine, MBBS
General Physician, Kolkata
Headache is one of the most frequently encountered problem
Headache

Headache is one of the most frequently encountered problem at a clinic. Even questions at lybrate are mostly studded with this symptom.
More often than not, headaches are self limiting and without a serious medical problem. But any chronic headache needs proper evaluation for definitive therapy.
Grossly, headaches can be divided into primary (no definite structural lesion in brain) or secondary (associated with changes).
Any headache, if associated with vomiting without nausea, visual disturbance or nerve deficit (new onset squint, double vision, loss of sensation anywhere, facial deviation amongst many) may indicate secondary headache, but exceptions are there. These require immediate attention to rule out life threatening disease.
Commonest primary headache is tension type headache all of us have felt at certain times. Often it is like a band pressing around forehead. Common analgesics manage them well but for recurrent problem, we might prescribe prophylactic drug.
Migraine is something very common presenting as pain in one half of head with vomiting, nausea, visual or auditory aura. They require immediate analgesic like acetaminophen and prophylaxis with propranolol or amitriptyline.
Cluster headache, as the name suggests, comes in cluster for few days and more common in male. Oxygen has been proven as effective treatment.
Trigeminal neuralgia is more sharp, lanceolating pain, but responds satisfactorily to carbamazepine.
Sinusitis, in frontal bone presents as headache more around 10am in the morning that requires therapy with antihistamines and antibiotics occasionally.
Therefore' headache' carries little value unless it is described in detail to ensure proper therapy.
103 people found this helpful

Sir, I feel depression, tension and negativity always. I am unable to get rid of my past incidents. And have some symptoms of insomnia. Sometimes want to commit suicide. There are so many problems in married life. please help.

MD - Psychiatry
Psychiatrist, Chennai
Sir, I feel depression, tension and negativity always. I am unable to get rid of my past incidents. And have some sym...
Suicidal thoughts are indicative of severe depression, kindly consult a psychiatrist immediately .The word depressed is a common everyday word. People might say" i'm depressed" when in fact they mean" i'm fed up because i've had a row, or failed an exam, or lost my job" etc. These ups and downs of life are common and normal. Most people recover quite quickly. With true depression, you have a low mood and other symptoms each day for at least two weeks The common symptoms are (few might be present in a person with depression) Feelings of sadness, tearfulness, emptiness or hopelessness Angry outbursts, irritability or frustration, even over small matters Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports Sleep disturbances, including insomnia or sleeping too much Tiredness and lack of energy, so even small tasks take extra effort Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people Anxiety, agitation or restlessness Slowed thinking, speaking or body movements Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility Trouble thinking, concentrating, making decisions and remembering things Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide Unexplained physical problems, such as back pain or headaches General medical conditions and substances causing depression also needs to be ruled out. Consult a psychiatrist and get evaluated.
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Severe Epilepsy - How Surgery Can Help?

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Severe Epilepsy - How Surgery Can Help?

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

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

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

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

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

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

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When lie down on bed, a couple of fingers in my leg get numb. If get up and keep my legs down then it will slowly become normal. Some times my left leg heel will give me pain while walking. How to get rid of it ?

M.P.T. (Neuro), BPTh/BPT
Physiotherapist, Lucknow
First you should reduce your weight if obase and use soft footwear for heel pain. Then start lumbar spine extensor stretching exercise or goto physioclinic for ultrasound and swd
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Some times I feel swelling in the upper side of my right thigh, it's not painful but uncomfortable, usually when I can feel it I feel stiffness in my thigh muscles and sometimes a little sensation of numbness in my leg, when it goes away everything gets back to normal, what could this be and could it be something serious?, thank you.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Hyderabad
Some times I feel swelling in the upper side of my right thigh, it's not painful but uncomfortable, usually when I ca...
U have not mentioned your age I feel you should consult a gp or take sufficient of potassium rich foods like fruits like banana some times due to exhaustionleads to cramps may be d vitamin defficiancy presumably one of the reasons.
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Please enlist/name the foods and activities that can trigger a migraine attack. Also please tell if there is any treatment for chronic migraines. I am suffering from migraine for about 17 years.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Bangalore
Peanuts, soya, walnuts, deep fried food, reused oil, mustard oil, sour and spicy food, fermented food are some of the common triggers for migraine. Sun exposure, looking at bright light, irregular food habits are some of the activities that cause migraine yes ayurveda has treatment for chronic migraine. We initially reduce the frequency and the intensity of attacks and then finally cure it. This requires co operation from your side too in terms of following the prescribed diet and lifestyle modifications internal medications will be prescribed in addition to a therapy called nasya - where a few drops of medicated oil is instilled through the nostrils.
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I have migraine. How can I get rid of this? What medicine do you prefer for this? It's being so long I'm suffering from migraine.

MD Hom., Certificate in Food and Nutrition, BHMS, Diploma In Yoga
Homeopath, Indore
Empty stomach cause gases and bloating which is causing migraine headache. Do eat something in every 2 to 3 hours, avoid oily and spicey food so that there will be less chance of gastric problem, and less will be headache. Also be hydrated. Till then take BELLADONNA 200, 4 pills twice a day for 4 days, and then report thereafter for further homeopathic treatment.
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