Thursday, December 5, 2013
Sunday, March 31, 2013
- What is multiple sclerosis?
- What is the meaning of demyelination or demyelinating illness?
- What are the common symptoms of multiple sclerosis?
- Sudden onset diminished vision in one or both eyes, which may get worse over a few days,
- Numbness of arm or leg on one or both sides of body,
- Weakness of arm or leg on one or both sides of body,
- Imbalance while walking,
- Bladder symptoms,
- How is the diagnosis of multiple sclerosis confirmed?
- What are the important investigations for confirming a diagnosis of multiple sclerosis?
MRI(Magnetic resonance imaging) of brain and spinal cord- this is the most important investigation. MRIshows the involvement of different parts of brain and spinal cord. The white matter of brain and spinal cord are typically affected in multiple sclerosis. The diseased part of brain and spinal cord are also referred to as “lesions” or “plaques”. A new or active lesion shows enhancement on MRIwith contrast dye injection. In addition, there may be swelling around the active lesions. MRIis also able to distinguish new versus old lesions, and is useful to monitor the disease progression or improvement and also the effectiveness of treatment.
- CSF (cerebrospinal fluid) analysis- CSF is removed by lumbar puncture (LP) by inserting a needle in lower back. In multiple sclerosis, the CSF protein is elevated; however, the number of white blood cells (WBCs) is either normal or only slightly elevated. CSF sugar is often normal. CSF is also tested for the presence of oligoclonal bands (OCBs), the presence of which indicates an active disease.
- Evoked potential studies may be ordered to look for involvement of optic nerve (visual evoked potential or VEP) or spinal cord (somatosensory evoked potential).
- Blood tests (such as
ANA, Anti-dsDNA, ANCA, etc) may be ordered to exclude other diseases that can mimic multiple sclerosis.
- What are the current treatment options for multiple sclerosis?
8. Is Multiple sclerosis curable?
As of today, there is no cure for multiple sclerosis. However, with current treatments, the disease can be kept under control and new relapses can be prevented.
9. Is multiple sclerosis always disabling?
Multiple sclerosis does cause disability in a significant number of people. However, more than two-thirds of patients suffering from multiple sclerosis are independent for their activities of daily living and are gainfully employed in a job. The good outcome depends on proper treatment as well as physical & occupational therapies.
10. Is multile sclerosis contagious or genetic?
Multiple sclerosis is not contagious and does not get transmitted from one affected person to another.
There may be genetic predisposition to get multiple sclerosis but it is not a genetic disease in a strict sense, as most patients with multiple sclerosis do not give a positive family history.
11. Is multiple sclerosis fatal or lethal?
In more than 95% of patients with multiple sclerosis, it does not lead to death. However, in a minority (less than 3%) it may lead to death either due to the direct effect of the severe disease or another complication such as pneumonia or deep vein thrombosis.
I hope this article is useful for hundreds of patients with multiple sclerosis as well as their caregivers. In addition, if someone is looking for information on multiple sclerosis (MS), it should be useful.
For any additional information, please email me at firstname.lastname@example.org
DR SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Tuesday, March 12, 2013
- Tremors- shaking of hands and feet,
- Slowness of all activities,
- Stiffness of arms and legs,
- Loss of balance while standing or walking.
- Mask-like facies or expressionless face, (even in situations of happiness, they may fail to express it on the face),
- Stooped posture, with head & trunk bent forwards,
- Slurred and low volume speech (it is often difficult to comprehend what they are saying),
- Slow speed of walking,
- Reduced swinging of arms while walking,
- Very small letters while writing, referred to as Micrographia,
- Reduced blink rate (which makes them give a staring look),
- Short, shuffling steps while walking,
- Loss of balance while turning, leading to falling forwards.
- Giddiness while sitting up or standing- this is because of drop in BP while standing, which is a side effect of levodopa/carbidopa (syndopa/sinemet),
- Behavioural disturbances- agitation, hallucinations (seeing something that is not there or hearing something when no one is speaking, etc), sleep disturbances can occur with syndopa, especially if the last dose is taken late (such as after ).
- Nausea, vomiting, loss of appetite may occur with syndopa.
- Abnormal movements of hands or feet, akin to dancing or rhythmic movements, referred to as dyskinesias.
- There is no cure available for PD,
- Disease continues to progress despite medical treatment, and the severity of disease would worsen over time,
- The disease leads to severe motor disability, hampering the activities of daily living and occupation,
- There is generally no increase in the chances of death, if the patients are looked after well.
- However, it should be noted that a reasonably good quality of life can be maintained with proper medical treatment and physiotherapy for more than 20 years after the onset of PD symptoms.
If you have any additional queries on Parkinson's disease, please send me an email: email@example.com
DR SUDHIR KUMAR MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad, India
Friday, January 11, 2013
Patients with following problems can consult during the camp:
OR Send an email to: firstname.lastname@example.org
Thursday, January 3, 2013
There are two steps involved in ensuring the best outcomes for a patient with migraine:
1. Correct diagnosis, and
2. Correct treatment.
Diagnosis of Migraine Headaches
Migraine is a common condition, affecting about 15% of women and 5% of men. Often, no tests are required for diagnosing migraine. Despite this, there is a significant delay in diagnosis of migraine in many cases. The correct diagnosis depends on the clinical features. Therefore, a good history, as given by the patient, is often sufficient for the diagnosis of migraine. The details can be read on my earlier post in May 2011
Treatment of Migraine Headaches
Starting appropriate treatment is equally important.
Many patients come to me telling that there is no treatment available for migraine or it can not be cured or I have to suffer with these headaches whole life and so on. So, they never take any treatment. Obviously, it is totally incorrect. There are excellent treatments available for treating migraine, and more than 95% of patients get better with proper treatment. You can read about these treatments later on in this post.
There is another group of patients who take only pain-killers, as and when they get headaches. This approach is not correct and may be harmful too, on account of three reasons:
1. Taking a pain-killer may help in reducing one episode of headache, however, it does not prevent the recurrence of headaches in future.
2. Pain-killers may cause side effects such as gastric ulcers, acidity, liver damage and kidney damage, if used for long.
3. Taking more than 15 tablets of pain-killers per month may actually worsen the headaches, a condition called as analgesic-abuse or analgesic-overuse headaches.
On account of the above, it is advised to restrict the use of pain-killers to as low as as possible.
Medical treatment of Migraine
1. If a person has only one or two episodes of headaches per month, then, there is no need of any preventive medications. Use of analgesics may be justified in these cases, as and when they get headaches. Common drugs in this category include-
- Zandu balm or tiger balm (very popular in India)
2. Preventive therapy of migraine-
If a patient gets more than two episodes of headaches per month, then, it is important to start preventive medications (on daily basis) so that the headache frequency and severity can be minimised (or stopped).
Common drugs in this category include:
- Beta blockers such as propranolol,
- Divalproex sodium
Patients, who do not show adequate improvement with above, can be treated with botox injections. More details on this can be read in my previous post (October 2012)
I hope this article provides a little help to those with migraine. If you have any further queries, please mail me.
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad