Sunday, June 23, 2019

PSYCHOSIS (HALLUCINATIONS AND DELUSIONS) IN PARKINSON'S DISEASE


HALLUCINATIONS IN PARKINSON’S DISEASE

Main symptoms of Parkinson’s disease

Parkinson’s disease (PD) is a slowly progressive degenerative disease of brain. The major symptoms are tremors (shivering), slowness of movements, stiffness and postural imbalance.  These symptoms lead to motor disability and interfere with walking, as well as with other activities of daily living.

Memory impairment in Parkinson’s disease

The mental functions are usually normal in patients with PD, however, 10% of patients can develop dementia (memory impairment along with other cognitive dysfunction), especially in later stages of illness.

What are hallucinations?

Other significant problem in people with PD in later stages is hallucination. Hallucination is often visual. In this condition, patient sees something, which is not there. For example, they may see snakes or lizards in their room (which are not there), and get disturbed with them. They may also see strangers in their house, which are supposedly there to spy on them or harm them. These hallucinations are very upsetting for the patient, making them anxious and depressed. Some patients also have sleep disturbance due to hallucinations.

What are the causes of hallucinations in patients with PD?

1.     Adverse effects of anti-parkinsonian medicines.
2.     Infections such as urinary tract infection or pneumonia,
3.     Side effects of other medications such as pain killers and sleeping pills,
4.     Parkinson’s disease mimic such as Diffuse Lewy body disease (DLBD). In DLBD, patients may have slowness and rigidity (just like PD). However, they have prominent hallucinations and dementia (unlike PD). Moreover, DLBD patients do not respond to levodopa treatment.

Other symptoms of psychosis in patients with PD

1.     Illusions,
2.     Delusions especially paranoid
3.     Confusion,
4.     Sleep disturbance
Delusion refers to a condition where a patient believes in something, even when there is an evidence of the contrary.

How common is psychosis in PD?

About one third of patients with PD suffer from psychosis. So, it is quite common.

How do we manage psychosis in patients with PD?

Management of psychosis can be done in a stepwise fashion as outlined below:

1.     Underlying alternate causes should be looked for and managed. This would include looking for infection and offending drugs.
2.     Comorbid psychiatric conditions, such as anxiety and depression, if present, should be treated.
3.     Minor symptoms such as vivid dreams or minor hallucinations (which are non-disturbing in nature) do not require any treatment.
4.     Anti-parkinsonian drugs should be reduced or stopped. First to eliminate are trihexiphenydyl, amantadine and selegeline/rasagiline. If psychotic symptoms persist, then, the next drugs to be reduced are dopamine agonists (ropinirole and pramipexole), entacapone and levodopa.
5.     In people with cognitive impairment, cholinesterase inhibitors such as rivastigmine or donepezil can be used.
6.     Anti-psychotic medication- quetiapine is the most commonly used.
7.     The first and only FDA approved drug for treating PD psychosis (hallucinations and delusions) is PIMAVANSERIN (Nuplazid). The dose is 34 mg capsules once daily.

DR SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/



Tuesday, February 5, 2019

MIGRAINE IN CHILDREN


MIGRAINE IN CHILDREN

What is migraine?
Migraine refers to a condition where the sufferer gets repeated headaches.

What are the other symptoms of migraine?
People may have nausea or vomiting associated with headaches. They also do not like noise or light during the headache episodes. Some children with migraine may not have headache and they may present with only repeated abdominal pain. 

Do children suffer from migraine?
Yes, children do suffer from migraine. 10-25% of children may suffer from migraines. Before puberty, migraine is more common in boys. After puberty, it becomes more common in girls.

What is the earliest age when migraine can affect children?
Migraine has been reported in children as early as 18 months old. About half of the children with migraine have their first attack before the age of 12 years.

What is the cause of migraine in children?
In most cases, there is a combination of genetic and environmental factors. Children with one parent with migraine has 50% chance of getting it, whereas children whose both parents have migraine have 75% chance of getting migraine. Most children with migraine have at least one close family member suffering from it.

How does migraine affect children’s quality of life?
Migraine in children can be as disabling as in adults. Children with migraine miss school twice as often as compared to those without migraine. They also suffer from anxiety, depression, and mood swings, and may not be able to focus in studies. They may also not enjoy sports and other recreational activities.

How is the diagnosis of migraine confirmed in children?
In most cases, the patient’s history and clinical examination are enough to make a diagnosis of migraine. However, in some cases, a brain scan may be needed to exclude other causes.

How is migraine treated in children?
Migraine can be effectively treated in children with medications.

For acute severe headaches, helpful medicines include paracetamol, ibuprofen and triptans (such as sumatriptan, zolmitriptan and rizatriptan).

To prevent headache episodes in future (migraine prophylaxis), propranolol, Flunarizine, topiramate or valproic acid may be used.

What measures can the children take to reduce the headache episodes?

1. Sleep adequately,
2. Eat food on time,
3. Avoid stress,
4. Certain triggers such as cakes, chocolates, Chinese food, too much TV/phone use, can be avoided/reduced. 

DR SUDHIR KUMAR MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist



Monday, December 31, 2018

HEMIFACIAL SPASM


HEMIFACIAL SPASM

What is hemifacial spasm?
Hemifacial spasm (HFS) refers to sudden episodic involuntary contractions of muscles on one side of the face.
                                                                                   (Swedish)
Who suffer from hemifacial spasm?
Hemifacial spasm occurs in people all over the world. It occurs more commonly in people aged 40-60 years. It affects both men and women, however, slightly more common in women.

What causes hemifacial spasm?
1.     In most people, there is no specific cause for hemifacial spasm, when it is referred to as idiopathic.
2.     In some people, there is compression of facial nerve (that supplies facial muscles) by a blood vessel.
3.     In some others, the compression could be due to tumors, aneurysms (abnormal balloon-like dilatation of the vessel wall), etc.
4.     Medical problems of brain such as infarct (blood clot in brain) or multiple sclerosis can also cause HFS.

What investigations are usually needed?
A detailed clinical examination needs to be performed by neurologist. This would confirm the diagnosis. The diagnosis is based on clinical examination and no test is needed for that. However, MRI with MR Angiogram brain is needed to exclude secondary causes (as listed in points 2-4 above).

How is hemifacial spasm treated?
1.     Botulinum toxin (botox) is the treatment of choice. Botox injections are given in the affected muscles. The benefit is seen within a few days and the effect may last upto 6 months.
2.     Those who refuse botox or cannot afford it can be treated with medications such as carbamazepine, clonazepam or baclofen tablets.
3.     Those who do not respond to botox or medicines can be treated with microvascular decompression (MVD) surgery.

Can there be a serious complication due to hemifacial spasm?
If all secondary causes have been excluded with MRI of brain, we do not expect any serious complications. However, frequent closure of eyes can be a hindrance for safe driving. Moreover, it may lead to awkward situations, especially in front of people of opposite gender.

What is the long-term outcome of hemifacial spasm?
Both botox and MVD surgery are effective and safe treatments, leading to excellent long-term outcome.

DR SUDHIR KUMAR MD DM
CONSULTANT NEUROLOGIST
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/
04023607777


Sunday, December 30, 2018

ACADEMIC MEETINGS, CONFERENCES, CME- DR SUDHIR KUMAR

PARTICIPATION IN ACADEMIC MEETINGS, CONFERENCES, CMEs 

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com

Participation in academic meetings is an important method of learning from experts and imparting knowledge to colleagues and peers. These meetings provide platforms to meet colleagues, learn and share from each other.

2019

January 12th 2019: CASE-BASED APPROACH TO VERTIGO MANAGEMENT

Panelist, along with guest speak Prof Michael Strupp (Germany)


January 16th, 2019: Brighter outcomes; Advancing epilepsy management (Guest speaker: Prof Pavel Klein, Washington DC)

Moderator for a panel discussion on "Balancing seizure control with better quality of life" 



2018

1. Obstetric Medicine update 2018 (Hyderabad): Delivered a lecture "When stroke strikes pregnancy"








2. Neuro Critical Care Update 2018 (Hyderabad): Organised the second Neuro critical Care update 2018 on 16th December 2018 at Apollo Hospitals, Hyderabad. There were ten lectures taken by experts and it was attended by about 70 doctors. I spoke on the topic "Current management of cerebral venous sinus thrombosis)". 



3. EPILEPSY EXPERT GROUP MEETING (13th December 2018, Hyderabad). In this meeting, I spoke on the topic "Zonisamide as a monotherapy in partial onset seizures."




4. STROKE ACADEMY MASTERCLASS (8th-9th December, 2018, Mumbai)

I was a faculty in this meeting, where I spoke on the topic "Quality monitoring in stroke care".