Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts

Wednesday, January 29, 2014

MYASTHENIA GRAVIS

MYASTHENIA GRAVIS

Introduction

Myasthenia gravis is an uncommon auto-immune disease, characterised by muscle weakness.

Common symptoms of Myasthenia Gravis

Myasthenia gravis presents with symptoms due to weakness of various muscles. 

Common presentations of this include:

1. Drooping of one or both eyelids (usually, there is a difference in the degree of eyelid drooping). Drooping of eyelid is also called as ptosis. 

2. Double vision, on looking up, down, left, right or sideways.

3. Slurring of speech or nasal twang in voice,

4. Difficulty in chewing food,

5. Difficulty in swallowing food, or nasal regurgitation of liquids, 

6. Weakness of arms or legs,

7. Breathing difficulty,

8. Difficulty in holding neck straight (tends to droop forwards)

Please note

The sensations are normal in the affected parts of body.

Urinary and bowel control is preserved. 

Please also note

1. Symptoms may vary at different times of day, most often they are worse in evenings,

2. There is fatiguability, symptoms get worse on repeating the same movements,

3. There may be periods (days to weeks) of remission, when all symptoms seem to disappear, only to return back later. 

The following factors may trigger or worsen exacerbations:
  • Bright sunlight
  • Surgery
  • Immunization
  • Emotional stress
  • Menstruation
  • Intercurrent illness (eg, viral infection)
  • Medication (eg, aminoglycosides, ciprofloxacin, chloroquine, lithium, phenytoin, beta-blockers, statins)
How do we confirm the diagnosis of myasthenia gravis?

1. Clinical symptoms, as described above make us suspect a diagnosis of MG, 

2. Tensilon test- where tensilon (edrophonium) injection is given, after which there is temporary improvement of symptoms such as ptosis,

3. Repetitive nerve stimulation- This test in done in the electrophysiology laboratory, where the muscle fatigue is shown (by seeing reduced amplitude with repeated stimulation of muscles),

4. Anti-Acetylcholine receptor antibody levels are elevated in about 80% of people. These antibodies are supposed to be released from thymus gland (located behind the upper chest wall in the centre). These antibodies prevent the action of acetylcholine on the muscles, making them weak. 

5. CT scan of chest is done to look for enlargement or tumor in thymus gland. 

6. Other less common antibodies seen in some patients with MG are anti-straited muscle antibody, anti-MuSK antibody, and anti-striational antibody.

What is the medical management of Myasthenia Gravis?

The medical management is classified into two categories:

1. Symptomatic treatment- to improve the symptoms. Pyridostigmine is commonly used.

We usually start a dose of 60 mg two times daily, and the maximum dose can be unto 720 mg per day.

Common side effects include increased salivation, abdominal pain and cramps, diarrhoea, muscle twitchings, etc.

2. Definitive treatment- is used to suppress the antibodies.

Steroids are commonly used. 

Other agents used are azathioprine, mycophenolate, cyclosporine, methotrexate, and cyclophosphamide.

3. In patients with myasthenic crisis (severe disease requiring feeding tube due to swallowing problem), or requiring mechanical ventilation (due to respiratory distress), PLASMAPHERESIS (blood is purified, and antibodies are removed, something similar to dialysis) or IV IMMUNOGLOBULINS (injections are given by drip over five days) are required.

4. THYMECTOMY- the best and permanent treatment for MG is thymectomy operation. In this, the thymus gland located behind the sternum bone (chest wall) is removed by operation. This removes the source of antibodies and the disease gets cured in most people.

What is the outcome of myasthenia gravis after treatment?

Earlier, the disease had a high morbidity and mortality, as treatments were not available. However, now, with good treatments available, more than 95% people do well and are fully cured.


I hope this articles helps people with myasthenia gravis as well as their caregivers. I would be pleased to answer any further queries. 

Please send email at drsudhirkumar@yahoo.com 

If anyone prefers ONLINE CONSULTATION, please visit http://bit.ly/Dr-Sudhir-kumar

DR SUDHIR KUMAR MD (INTERNAL MEDICINE) DM (NEUROLOGY)
SENIOR CONSULTANT NEUROLOGIST
APOLLO HEALTH CITY
Phone (for appointment): 0091-40-23607777 (extension 6634/3011)
Email: drsudhirkumar@yahoo.com 
Online consultation: http://members.tripod.com/sudhirkumar_5/neurologist/id6.html








Sunday, March 31, 2013

MULTIPLE SCLEROSIS

DIAGNOSIS AND TREATMENT OF MULTIPLE SCLEROSIS

  1. What is multiple sclerosis?
Multiple sclerosis is a demyelinating disease of central nervous system-CNS (brain and spinal cord), which is characterized by involvement of “multiple” parts of CNS.
The disease is also characterized by remissions (improvement of symptoms) and relapses (occurrence of new symptoms) over a period of time, causing “multiple” episodes of symptoms.  
Multiple sclerosis is an autoimmune disease, which means the antibodies produced in the body attacks own healthy tissues.

  1. What is the meaning of demyelination or demyelinating illness?
Nerves in central nervous system are like “electric wires”, that is, they have a central core surrounded by an insulation or covering. This covering of the nerves is called “myelin sheath”.
A disease, where the myelin sheath is affected or damaged is called a demyelinating disease or illness, and the process is called as demyelination. Multiple sclerosis is one of the most common demyelinating diseases of the CNS.

3. Who are the common people affected by multiple sclerosis?

·        Multiple sclerosis is commonly seen between the ages of 10 and 60 years, which means, it is uncommon in children below 10 years and those adults who are above 60 years of age.
·        Multiple sclerosis is typically more common in young women (between the ages of 18-36 years),
·        Multiple sclerosis is seen all over the world, probably more common in the West, as compared to Asian countries.
·        Also, the severity of multiple sclerosis seems to be lesser in Asians, leading to lesser degrees of disability, which has led some people to label Asian multiple sclerosis as relatively “benign form” of multiple sclerosis.

  1. What are the common symptoms of multiple sclerosis?
Common symptoms of multiple sclerosis include:
    • 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,
Less common symptoms of multiple sclerosis include
·        Memory disturbances,
·        Seizures or fits,
·        Depression
It is important to note that a patient with multiple sclerosis may have only one or more than one symptom described above at one point of time, or different symptoms may occur during multiple episodes of the disease.

  1. How is the diagnosis of multiple sclerosis confirmed?
A person who has one or more symptoms suspicious of multiple sclerosis should consult a neurologist. A neurologist would take history and do a clinical examination to ascertain the number of episodes of illness, and also to identify the affected the parts of central nervous system.
After that he would order for investigations to confirm the diagnosis of multiple sclerosis.

  1. 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. MRI shows 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 MRI with contrast dye injection. In addition, there may be swelling around the active lesions. MRI is 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.

  1. What are the current treatment options for multiple sclerosis?
Treatment of multiple sclerosis can be divided into two categories- treatment of acute episodes and treatment to prevent future relapses of disease.
Treatment for acute episodes:
Steroid injections are the preferred treatment options. The drug of choice is methylprednisolone given as injections in the veins over 3-5 days. Then, steroid tablets are given for 15-20 days.
Treatment to prevent relapses of disease:
The most preferred treatment is interferon injections (such as avonex, relibeta and rebif in India). Avonex and relibeta are given as injections in the muscles, once a week, whereas rebif is given as injections underneath the skin three times a week.
Other FDA-approved treatment options to prevent relapses of disease in multiple sclerosis are:
1. Glatiramer acetate (copaxone)- given as injection underneath the skin, once a day.
2. Fingolimod- oral capsule (0.5 mg) once daily
3. Mitoxantrone- given as infusion in the vein, every three months (maximum 8-12 doses over two-three years),
4. Natalizumab (tysabri)- given as infusion in the vein, once every four weeks.
5. Dimethyl fumerate (tecfidera)- twice a day oral capsules.
6. Teriflunomide (Aubagio)- once daily tablets. 


 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 drsudhirkumar@yahoo.com

DR SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066

Tuesday, March 12, 2013

PARKINSON'S DISEASE

PARKINSON’S DISEASE (PD)

What is Parkinson’s disease (PD)?
Parkinson’s disease is a disease of the brain, which is caused by selective degeneration of nerves in the basal ganglia, leading to deficiency of dopamine in brain.

What are the symptoms of Parkinson’s disease?
The most typical symptoms of this disease include:
  1. Tremors- shaking of hands and feet,
  2. Slowness of all activities,
  3. Stiffness of arms and legs,
  4. Loss of balance while standing or walking.
A patient may have only one or some or all of these at onset. However, as the disease progresses, all of them would eventually develop all these symptoms.

What are some of the other symptoms of Parkinson’s disease?
Other symptoms that may occur in a patient with Parkinson’s disease are:
  1. Mask-like facies or expressionless face, (even in situations of happiness, they may fail to express it on the face),
  2. Stooped posture, with head & trunk bent forwards,
  3. Slurred and low volume speech (it is often difficult to comprehend what they are saying),
  4. Slow speed of walking,
  5. Reduced swinging of arms while walking,
  6. Very small letters while writing, referred to as Micrographia,
  7. Reduced blink rate (which makes them give a staring look),
  8. Short, shuffling steps while walking,
  9. Loss of balance while turning, leading to falling forwards.
Why this disease is called Parkinson’s disease?
This is because the very first description of this disease was given by a doctor named Dr James Parkinson, a neurologist from UK. In his honour, the disease was given his name.

Which age group is commonly affected with Parkinson’s disease?
This disease typically affects people above 40 years of age, and the incidence increases with advancing age.
Occasionally, this can occur in people younger than 40, when it is called young onset Parkinson’s disease (YOPD).

How is Parkinson’s disease diagnosed?
Like many other neurological problem, Parkinson’s disease too is diagnosed on the basis of typical symptoms (as described above).
It may be difficult to diagnose PD in very early stages, as the affected person may have only minor symptoms such as mild tremors of hands, and perfectly well otherwise. However, careful examination by a Neurologist would help confirm its diagnosis in this stage too.

Is there a very specific test for diagnosing Parkinson’s disease, especially in early stage?
In doubtful cases, or in very early stages, PET scan (positron emission tomography) can help in accurate diagnosis of PD. This facility is available in our hospital, and I do use it in some cases.

Can Parkinson's disease be transmitted genetically to the children of patients suffering from this disease?

In about 10% of cases, PD can be genetic in origin. But about 90% of cases of PD are sporadic (they have no family history of Parkinson's disease).

What are the treatment options available for Parkinson’s disease?
The mainstay of treatment of PD is medications. Various medications are available. These include levodopa/carbidopa combination (which provide direct dopamine to the brain); ropinirole & pramipexole (which increase the action of dopamine); trihexiphenidyl, amantadine, entacapone, etc.
The choice of drug depends on the patient’s symptoms as well as the severity & duration of PD.
Your neurologist is the best person to decide the most appropriate medications and their doses.

What are the common side effects with medications used for treating PD?
Though these medications are generally safe, some side effects may occur:
  1. 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),
  2. 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 8 pm). 
  3. Nausea, vomiting, loss of appetite may occur with syndopa.
  4. Abnormal movements of hands or feet, akin to dancing or rhythmic movements, referred to as dyskinesias.
What are the common precautions while taking medications for PD?
1. Medications for PD should be taken on empty stomach, as presence of food may interfere with their absorption,
2. They should be taken on exact time, as advised by the doctor,
3. Any change in the dosage or timing of the medications should be done only after consulting the neurologist.

How long are the medications required in Parkinson’s disease?
Medications are usually required for lifelong. However, the dose would change as per the severity of disease.

Are botulinum toxin injections (Botox) helpful in treating PD?
In selected cases, where there is increased rigidity or dystonia, botox may be useful. The decision can be made by the neurologist after clinical examination.

Are there any surgeries available for treating Parkinson’s disease?
Deep brain stimulation (DBS) surgery is the standard surgery performed in some cases of PD. This surgery can be compared to pacemaker (of heart); wherein an electrode is placed in the brain.
It should be noted that not all cases of PD require surgery, nor would all cases of PD benefit from DBS surgery.
Patients with predominant tremors of hands may be the best candidates for DBS surgery.
Another group of patients who may benefit are those with inadequate response to levodopa, or those with levodopa-induced dyskinesias (see above under side effects).
The decision regarding the need or usefulness of surgery can be made by the neurologist after detailed clinical evaluation.

Is DBS surgery available in India?
Yes, many centers in India (Mumbai, Bangalore, New Delhi, Hyderabad, Trivandrum, etc) have the facilities for doing DBS surgery in India.
We perform DBS surgery in our institute too.

What kind of outcome can be expected in patients with PD after treatment?
  1. There is no cure available for PD,
  2. Disease continues to progress despite medical treatment, and the severity of disease would worsen over time,
  3. The disease leads to severe motor disability, hampering the activities of daily living and occupation,
  4. There is generally no increase in the chances of death, if the patients are looked after well.
  5. 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.
Is there a specific diet to be followed by patients suffering from Parkinson’s disease?
Protein content should be reduced by 50%, and protein-rich foods (such as pulses, meat, etc) should be shifted to dinner time (after the last dose of syndopa has been taken). This is to ensure proper absorption of syndopa, as presence of high protein food may interfere with the absorption of levodopa.

Is there any limitation on physical activities?
No, there is none. In fact, it is better for a patient with PD to indulge in regular physical activities, including outdoor games, to maintain good physical fitness & mobility.

If you have any additional queries on Parkinson's disease, please send me an email: drsudhirkumar@yahoo.com

DR SUDHIR KUMAR MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad, India
Phone: 0091-40-23607777


Thursday, January 3, 2013

MANAGEMENT OF MIGRAINE HEADACHES

Management of Migraine Headaches

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

http://bestneurodoctor.blogspot.in/2011/05/how-to-diagnose-migraine.html

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-
  • Paracetamol,
  • Disprin,
  • Zandu balm or tiger balm (very popular in India)
  • Ibuprofen,
  • Diclofenac,
  • Vasograin,
  • Rizatriptan,
  • Sumatriptan
Any of the above can be used at the time of severe headaches. Some people also have vomiting, then ondansetron or domperidone tablets may be used.

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:
  • Flunarizine
  • Beta blockers such as propranolol,
  • Topiramate,
  • Divalproex sodium
In some cases, a combination of two medicines may be required.

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)

http://bestneurodoctor.blogspot.in/2012/10/botox-treatment-for-migraine.html

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
Phone: 0091-40-23607777/60601066
email: drsudhirkumar@yahoo.com

Friday, October 19, 2012

BOTOX TREATMENT FOR MIGRAINE

Botox Therapy for Chronic Migraine

What is migraine?
  • Migraine is a condition, characterized by repeated episodes of headache.
  • Headache can be on one side or both sides of head.
  • Headache typically lasts for more than four hours, but usually resolves in less than 72 hours.
  • Nausea (a sensation to vomit) or vomiting may be present during headache episodes.
  • There may be photophobia (headache becomes more in bright light or sunlight) or phonophobia (headache becomes more in noise).
 What is chronic migraine?
A person, who has been suffering from migraine, for a period of more than six months, is said to be suffering from chronic migraine.

What is the impact of chronic migraine on the sufferer?
Chronic migraine leads to a number of problems in the sufferer:
  • Recurrent headache interferes with job or studies, leading to poor performance at work or in studies.
  • It leads to frequent absenteeism at workplace or in college.
  • People suffering from chronic migraine can not enjoy social functions, as slight triggers such as music can trigger the headaches.
  • They need to avoid road travel, as it can trigger headaches.
  • Patients are frequently forced to take multiple analgesics (pain-killers) every month, leading to significant adverse effects.
What are the treatment options for patients with chronic migraine?
Patients with chronic migraine, who get three or more than three episodes of headache in a month, require preventive therapy (medications to prevent repeated episodes of headache).

What are the commonly used medications to prevent headaches in a migraine patient?
Following medicines (with their brand names) are available for use in chronic migraine:
Tablets
·        Amitryptiline (Tryptomer)
·        Flunarizine (Sibelium)
·        Propranolol (Betacap TR, Ciplar LA)
·        Divalproex (Divaa OD, Dicorate ER)
·        Topiramate (Topamac)
Injections
·        Botulinum toxin (Botox) injections

What are the disadvantages of oral medications?
1.      Lack of efficacy- many people do not adequately respond to these medications. They continue to get recurrent headaches despite taking them for long periods.
2.      Adverse effects- Significant adverse effects are noted with oral medications.
·        Amitryptiline- drowsiness
·        Flunarizine- drowsiness, weight gain
·        Propranolol- aggravation of asthma, depression
·        Divalproex- weight gain, tremors of hands, hair loss, pregnancy-related complications,
·        Topiramate- tingling of feet, weight loss, glaucoma in rare cases, renal stones in rare cases.
 3.      Need to take them on a daily basis

What are the advantages of Botox injections over oral medications in migraine treatment?
1.      Efficacy of botox in migraine has been proven in research and clinical practice.
2.      Botox is fairly safe and the side effects are negligible.
3.      Botox injections need to be repeated once in 3-6 months, so, the patient compliance is better and they can get rid of daily tablets.

Facts regarding Botox injections in a patient with migraine
·        There are fixed points over the scalp, where the injections are given (irrespective of the site of head pain).
·        These locations include front of head, over eyebrows, temple region, back of head and neck muscles.
·        Injections are given by a neurologist, who is trained in the botox procedure.
·        It is given by insulin syringe and needle, and is given in the superficial tissues (scalp muscles, which are hardly a few mm beneath the skin).
·        Topical (surface anesthetic) creams are used, so, the injection does not hurt much and is almost painless.
·        The whole procedure can be completed in an office (Outpatient) set up and is completed in 15-20 minutes.
·        Patient can leave for office or home immediately after the botox procedure.
·        A total dose of 155 units of botox is used in chronic migraine.
Are there any side effects of botox injections?
·        This is the same botox that is used in cosmetic procedures and several million patients have received botox for neurological problems as well (such as writer’s cramp, dystonia, blepharospasm, post-stroke spasticity, hyperhidrosis, etc).
·        It is among the safest injections, and has no serious side effects.
·        Mild pain at the injection site may be felt (just as is felt with any injections).
·        Mild bruising (and redness) and swelling may occur at the injection site.
·        Mild eyelid droop may occur, which improves in a few days on its own.

My experience with Botox in migraine
  • I see about 15-20 new cases of migraine per month, and have seen thousands of patients in the past 18 years of my medical practice.
  • About 20-30% of them either do not improve with oral preventive tablets or they have side effects with them. Some people find it difficult to take tablets on a daily basis for a long period of time.
  • For this group of patients, botox injection therapy is the most ideal. I see 2-3 patients per month, who are eligible to receive botox therapy in chronic migraine. About 1-2 per month receive them. In the past two years, I have given botox to about 40 patients with chronic migraine.
  • About 95% patients report benefit after botox therapy and in most cases, oral tablets are not required after botox.
  • None of them reported any adverse or side effects with botox.
I would like to share an interesting experience with one of the patients. Mrs Nazia (name changed) from Dubai came in June 2012 for botox therapy in migraine. I gave her the injections on OP basis on the usual sites, including forehead. She had no side effects with botox. She came back for review three months later and reported that she was totally headache-free. However, she wanted a repeat botox injection. I was surprised. I asked her if she has no headache, then why does she want botox! She said, after botox, her husband has started to give her more attention and love, as her face has also improved (then, I realized that she wanted it for cosmetic effects). She also told me that three of her colleagues at her office want the botox to be given by me (but only for cosmetic reasons). I had a tough time, referring them to a cosmetic surgeon for the same.

If you want any further information regarding botox therapy in migraine, please email me at drsudhirkumar@yahoo.com

Dr Sudhir Kumar MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Phone-0091-40-23607777/60601066

Wednesday, June 1, 2011

Homocysteine in heart and brain disease

IMPORTANCE OF HOMOCYSTEINE

Myocardial infarction (heart attacks) and brain strokes (paralysis) are the two most common causes of death and disability in the world. They occur in all regions of the world, and the prevalence increases with advancing age.

There are a number of known risk factors for causing heart attacks and brain strokes, which include high BP, diabetes, high cholesterol, smoking, positive family history and so on.

Role of homocysteine in heart attacks and brain strokes
  • Homocysteine is a normal amino acid in our blood.
  • However, elevated levels of homocysteine in the blood is an additional risk factor for causing atherosclerosis (narrowing of blood vessels for heart and brain).
  • Elevated levels of homocysteine causes injury to the inside of blood vessel.
Though there are no definite reasons for elevated homocysteine levels, they tend to occur more in smokers and pure vegetarians.

It is easy to identify high homocysteine, by doing a simple blood test in fasting state.

Treatment of elevated homocysteine is also easy. One needs to use certain vitamins (folic acid, and other B group vitamins).
Please consult your neurologist for any further information.

Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Hyderabad
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com