Neurology Procedure

Health conditions triggering epilepsy that you must be aware of

Epilepsy, a central nervous system (neurological) disorder caused by uncontrol or abnormal brain electrical activity that leads to seizures or periods of unusual behaviour, sensations and loss of awareness. Epilepsy affects 5.59 to 10 per 1,000 people in India. What typically makes the condition difficult to treat is the seizure signs and symptoms which may widely vary and may or may not last for long. In some cases, most recover with medications and a few difficult to treat may require lifelong medication and surgery. Most seizures are precipitated by known triggers. Interestingly, there are numerous underlying health problems that may trigger epilepsy and provoke seizures.

 Here is the list of a few underlying health problems that may trigger epilepsy: 

• Head trauma: In case you have suffered from any kind of head trauma due to accidents or any other head injury, it can cause epilepsy. 

• Certain brain conditions: There are numerous brain conditions that may cause severe damage to your brain like brain tumours and strokes that can result in epilepsy. In fact, stroke is considered to be one of the main causes of epilepsy among those who are 35 and above. 

• Infectious diseases: Epilepsy may be caused by certain infectious diseases such as tuberculosis,  meningitis, AIDS and viral encephalitis. In case you have suffered from any of these infections, you must be cautious of epileptic signs. 

• Prenatal injury: The chances of epilepsy may occur even before birth if a baby suffers from any kind of prenatal injury. Babies in the womb are extremely sensitive to brain damage which may happen due to various reasons such as infection in the mother, poor nutrition and oxygen deficiency. Brain injury prior to birth may cause epilepsy and cerebral palsy among children post-birth. 

• Development disorders: Epilepsy may often occur in peoples who are suffering from developmental disorders such as neurofibromatosis and autism. 

• Vascular diseases: A condition related to blood vessels can cause severe brain damage and may increase the risk of epilepsy. Controlling vascular ailments may help in controlling epilepsy well. 

• Dementia: It may increase the risk of epilepsy among older adults. 

• Psychological issues: Peoples with epilepsy are more likely to suffer from psychological problems such as depression, anxiety, suicidal thoughts and behavioural disorders. 

At Sakra World Hospital, our neurologists offer epilepsy treatment in Bangalore with a unique level of specialized care to patients with epilepsy by using advanced technology and an interdisciplinary approach. We bring together the best neurologist for treating epilepsy in Bangalore and experts from multiple disciplines to collaborate on individualized epilepsy treatments for each patient.

When do you reach out for clinical help?

You must seek immediate medical help if 

• The seizure lasts more than five minutes.

• Breathing or consciousness doesn't return even after the seizure stops.

• A second seizure follows immediately.

• You have a high fever.

• You're experiencing heat exhaustion.

• You're pregnant.

• You have diabetes.

• You have injured yourself during the seizure.

Seizure signs and symptoms include temporary confusion, uncontrollable jerking movements of the arms and legs, a staring spell,  loss of consciousness or awareness, psychic symptoms such as fear, anxiety, deja vu and more. 

Diagnosing and treating epilepsy

You may be asked to go for a neurological exam and several blood tests initially. In order to check a kind of brain anomalies, you may be asked to go for Electroencephalogram (EEG), computerised tomography (CT scan), Positron emission tomography (PET), high-density EEG, Magnetic resonance imaging (MRI), Functional MRI (fMRI), and more. 

The treatment generally starts with medication and in case the situation cannot be controlled by drugs, then doctors opt for surgery. Anti-epileptic medication may have certain side effects such as fatigue, dizziness, weight gain, skin rashes, loss of coordination, loss of bone density, speech problems, memory and thinking problems. Depression, suicidal thoughts and behaviour, severe rash and inflammation of certain organs such as the liver are some of the rare and more severe side effects. 

Best seizure control steps

• Take medications as prescribed. Never stop taking them or consult your physician before switching to something else. 

• Consult your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviours.

• Inform your neurosurgeon if you have migraine along with epilepsy

• Get enough sleep and exercise daily

• Know your seizure triggers and avoid them

Sakra is one of the best hospital for epilepsy treatment in Bangalore. The Department of Neurology at Sakra Institute of Neurosciences have one of the most experienced and comprehensive teams of neurologists, neurosurgeons, neuro-anaesthetists, neuro-rehabilitation (physiotherapists), neuro-radiologists, neuro-nurses and epileptologist in Bangalore who are experts in providing patient-focused, world-class medical care for the entire spectrum of neurological diseases.

Coverage Received in NDTV Doctor - https://doctor.ndtv.com/living-healthy/all-about-epilepsy-risk-factors-diagnosis-treatment-and-more-2352072

Prolonged Exposure to Pesticides May Increase the Risk of Parkinson's Disease: Find out Why?

Post-pandemic life has compelled us to be indoors and has left enough time to catch up with our hobbies. Likewise, several older adults who are nature lovers and are stuck within the four walls in the present times have started devoting more time to gardening and tending their balcony, rooftop and kitchen gardens. Spending time with nature is good for everyone to keep mental health active and engaged, but it can be dangerous for older adults. Nurturing plants and cultivating gardening as a hobby also means prolonged exposure to pesticides which is not good for older people. The latest study reveals disclosure to pesticides for a longer period of time significantly increases the risk of Parkinson's Disease, an age-related disorder of the central nervous system affecting movement, often causing tremors. Along with tremors, slowness in day to day activities (bradykinesia and rigidity) can increase the risk of falls in the elderly. It occurs when the nerve cell damage in the brain results in a drop in the levels of dopamine, a neurotransmitter produced by the body that acts as a chemical messenger and conveys messages between nerve cells. 

Pesticides and Parkinson’s - decoding the link

Several studies conducted earlier have found a correlation between two commonly used pesticides - paraquat and maneb and Parkinson's Disease. Interestingly, it has been now determined that even low-level exposure to these pesticides disrupts cells in a manner that it mimics the impact of mutation that is known to cause Parkinson's Disease. The fact that these chemicals can adversely affect the cells and increase the risk of Parkinson's Disease onset is a matter of deep concern in the context of elderly health. Adding more to the worry, the study has also shown that those exposed to these chemicals are at about a 250% higher risk of getting hit by Parkinson's Disease compared to those who are not exposed. 

Parkinson's Disease affects the dopamine-producing neurons. When such neurons are exposed to paraquat and maneb, the energy-producing mitochondria are found to be barred from moving where they are needed inside the cell, bankrupting the neurons of energy. People having a predisposition of Parkinson's disease are more prone to get affected by low-level exposure to the chemicals and put themselves at a far greater risk of developing the condition. 

Genetic predisposition increases the risk of Parkinson's Disease due to exposure to pesticides

When pesticides enter the body, the enzymatic detoxification systems in our body present in the liver start metabolising them in an attempt to flush them out. Unfortunately, this mechanism does not work for those with a tendency to suffer from Parkinson's Disease as a genetic mutation may alter the enzymes and make them ineffective to cope with the exposure to chemicals. 

Preventing exposure to pesticides: Methods to minimise and avoid exposure

Avoid getting exposed to these chemicals for long to prevent the increased risk of Parkinson's Disease due to them. In order to do that, it is essential to follow certain tips. 

• Ensure that you are using original pesticides with the label attached. Follow the exact directions when applying pesticides. Do not increase or reduce the ratio of the products.   

• Wear protective clothing as described on the label and keep the clothes separated from living spaces. 

• Do not smoke, drink and eat while using pesticides. 

• Mix pesticides in the open or in a well-ventilated area and use only the amount needed for the immediate job. 

• Do not use the measuring cups and spoons used for pesticides to prepare food, even if they are washed.

• Do not let pesticides contaminate food or food preparation surfaces. Ventilate thoroughly after indoor applications.

• Avoid using fogging products. If you do use a fogger, read label directions carefully and don’t use more than required for the size of the space being treated.

• Always close containers correctly, even when only stopping for a break or between mixings.

• Clean up spills promptly according to label directions. Liquid pesticides are usually scattered with sawdust, kitty litter or vermiculite and mobed into a plastic bag for proper disposal.

• Wash your hands and other parts exposed to chemicals and rinse gloves and shoes.

• Change your clothes after applying pesticides and wash soiled clothes separately from other clothes in hot water and detergent.

• Store and dispose of the pesticides in the proper way as mentioned on the label. 

Parkinson’s Disease does not have any treatment as yet. All that can be done is adopting ways to control the condition. Hence, it is wise to adopt smart strategies to stay away from the risk factors of Parkinson’s Disease. Understanding how exposure to pesticides increases risk and taking efficient measures to reduce exposure may extensively help in reducing the chances of developing the neurodegenerative condition.

World Stroke Day

A stroke can happen to anyone, any time and anywhere. Stroke is the leading cause of disability worldwide and the second leading cause of death, but all strokes can be prevented. Research shows that “golden hour” patients showed remarkably more stroke deficits than later arrivals. The patients who arrived at the hospital within one-hour experiencing stroke symptoms received a powerful treatment as often as those who arrived later in the approved time window for treatment. 

When does a stroke occur?
A stroke occurs when the blood supply to the part of the brain is cut off resulting in oxygen starvation, brain damage and loss of function. Usually, it is caused by a clot in an artery supplying blood to the brain, known as ischemia. Stroke can cause permanent damage which includes partial paralysis and impairment in speech, comprehension and memory.
During a stroke, 32,000 brain cells die every second, but if a patient receives treatment in time, the damage can be minimized. 

The warning signs of a stroke include:

• Numbness of the leg, arm or face

• Confusion or trouble understanding

• Trouble seeing in both eyes

• Trouble walking

• Dizziness

• Loss of balance and coordination

Severe headache with no known cause

From the time you feel symptoms, there is only a 3 to 4 and a half-hour window (called golden hour) to use clot-busting drugs to try to restore blood supply to the affected part of the brain.

Remember FAST  whenever someone is having a stroke:
Face drooping
Arm weakness
Speech difficulty
Time to call emergency

What causes a stroke?
One of the main diseases that lead to stroke is atherosclerosis. Other risk factors include:

• Tobacco

• Physical inactivity

• Unhealthy diet

• Harmful use of alcohol

• Hypertension

• Atrial fibrillation

• Raised blood lipid levels

• Obesity

Types of Stroke

There are three types of stroke:

Ischemic Stroke: They occur as a result of an obstruction in a blood vessel supplying blood to the brain which can cause a blood clot to form, called cerebral thrombosis.
Hemorrhagic stroke: It occurs when a weakened blood vessel damages and bleed into the brain. Bleed can be caused by an aneurysm or an arteriovenous malformation (AVM).
Transient Ischemic Attack (TIA or mini-stroke): TIA occurs due to the temporary disruption in the blood supply in the brain. It causes symptoms similar to a stroke, but TIA symptoms pass quickly and usually resolve within 24 hours.
In the early stages of a TIA, it is impossible to tell whether it is a stroke or not, so it is important to call emergency services.

Diagnosis of a Stroke

The doctor will perform several tests to check your heart and blood pressure. Several tests may include blood tests and sugar tests.
Imaging tests: CT scan, MRI to create a detailed image of the brain. 
Echocardiogram: It uses sound waves to create detailed images of the heart.
Carotid angiogram: In this test, sound waves create detailed images of the carotid arteries in the neck. 

Treatment of a Stroke

Prompt treatment is important for recovering from a stroke. According to the American Heart Association, “Time lost is brain lost”.  Call emergency services immediately if you realize you may be having a stroke, or if you suspect a loved one.

Treatment of a stroke depends on the type of stroke a person is having:

Ischemic stroke and TIA: These type of strokes are treated with:
Anticoagulants and antiplatelet: These drugs should be taken within 24 to 48 hours after stroke symptoms begin.
Clot-breaking drugs: Thrombolytic drugs can break up blood clots in the brain arteries which will stop the stroke and reduce damage to the brain.

Mechanical thrombectomy: In this procedure, the doctor inserts a catheter into a large blood vessel inside your head. The surgery is most successful if performed within 6 to 24 hours after the stroke begins.

Hemorrhagic stroke: Treatment for hemorrhagic stroke includes:

Medications: In hemorrhagic stroke, the treatment goal is to make your blood clot. The doctors will give medication to counteract any blood thinners you take.
Clamping: During MRI, the doctor may find out an aneurysm that hasn’t started bleeding yet or has stopped. To prevent bleeding, a surgeon may place a clamp at the base of the aneurysm.
Surgery: If an aneurysm burst, then the doctor will clip the aneurysm and may perform a craniotomy to relieve the pressure on the brain.

Recovery from a Stroke
According to the National Stroke Association reports, 10 per cent of stroke survivors make an almost-complete recovery, while another 25 per cent recover with only minor impairments.

Stroke recovery focuses on four main areas:

Speech therapy: Stroke can lead to speech and language impairment which can be improved with the help of a language therapist. The therapist will work with you to relearn how to speak. 

Cognitive therapy: After a stroke, many survivors have changes to their thinking and reasoning skills which can lead to behavioural and mood changes. An occupational therapist can help you work to regain thinking and reasoning skills and to control emotional responses.

Physical Therapy: After the stroke, you may find that you are unable to move your body as well as you could before. A physical therapist will help you to regain your strength and balance.

Ways to Prevent a stroke

Here are some steps you can take to prevent stroke:

• Monitor your blood pressure

• Control your cholesterol

• Keep your blood sugar down

• Get active

• Eat better

• Don’t smoke

• Lose weight if required

• Get regular check-ups and stay in communication with the doctor

Conclusion

If you feel that you are experiencing symptoms of a stroke then immediately seek emergency medical care. The first few hours after the stroke are very vital and the clot-busting medication can only be provided within the first hours after the signs of a stroke begin.

Early treatment is the most effective way to reduce the risk of long-term complications and disability. You can prevent a stroke, whether you are preventing a first stroke or trying to prevent a second. Consult a cardiologist near you to find ways of preventing a stroke.

Knowledge Is Power. Learn About Stroke to Fight It Now.

What is a Stroke?

Stroke is also known as “Brain Attack”. It is similar to a heart attack in nature. It has the potential to affect people of all age groups. The stroke happens when the blood supply directed toward the brain is cut off abruptly. Without blood, the brain cells are deprived of oxygen and other nutrients and hence the brain cell begins to die. The damaged caused by it is relational to the area of the brain it affects. Stroke affects people’s most basic functional aspects such as speech, mobility and their ability to think, feel or respond. Consequences of a stroke on a person depend on where it occurs in the brain and the amount of damage caused by it.

Is a Stroke treatable?

Though Stroke is a complex medical issue, there are effective ways to minimize its effects. Identifying early signs of stroke and seeking emergency medical care in the dedicated “stroke unit” minimizes the effects of it. 
Stroke can be treated effectively if one seeks emergency stroke treatment in the initial 3-4.5 hrs. Also, an early access to the best professional care can significantly improve results.

What are the warning signs of a Stroke?

Symptoms of a stroke are sudden and unexpected. Here are the warning signs of a stroke: 

1. Sudden, severe headache 
2. Sudden trouble seeing in one or both eyes
3. Sudden weakness of the face, arm or leg, particularly on one side of the body
4. Sudden trouble speaking or understanding
5. Sudden trouble in walking, coordination and a significant loss of balance or dizziness

 If you notice one or more of these signs, don’t worry or panic.
Call your emergency medical services and get to a hospital immediately. 

6 Key facts about Stroke Treatment

1.  You can make a positive difference by recognizing the signs of Stroke
Recognizing the signs of Stroke and getting the treatment on time saves lives and accounts for a speedy recovery. 
If you think someone may have had a stroke, check for these signs quickly:
1. Face – Is one side drooping? 
2. Arms – Raise both arms. Is one side weak?
3. Speech – Is the person able to speak? Are words jumbled or slurred?
4. Time – Act quickly. Seek emergency medical attention immediately.

2. When cared for in a specialized stroke unit, around 1 in 10 diagnosed people make fast recovery 
All the patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team. This team includes a Neurologist, Neurosurgeon, Neurointerventionist, Neuroradiologist and a Stroke rehabilitation specialist. 

3. Provide the patient with clot-busting drugs (tPA or thrombolysis) and enhance his or her chances of recovery by 30%
Clot-busting drugs break up blood clots. This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. The earlier it is given, the greater the effect.

4. Provide the patient with clot retrieval treatment and enhance his or her chances of recovery by 50%
Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot from the large arteries by Neurointerventionists in the cath lab. Clot retrieval can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.

5. The most critical step in the treatment process is rehabilitation 
Rehabilitation starts in the hospital by neurosurgeons as soon as possible post a stroke. It can improve the patient’s functionality and assist him or her in regaining maximum independence with time.

6. One in four survivors will have another stroke.
Stroke risk can be reduced by treating risk factors for stroke. Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing.

“Right  Stroke Care Makes a Difference”

Join the fight against stroke.

Stroke affects all of us. So let’s take an action, a drive awareness and push for a better access to stroke treatments.
Learn how to contribute in spreading awareness and access with regard to a stroke. 

Individuals

1. Be aware. Learn the signs of stroke and know to take immediate action.
2. Share this information with family and friends.

Learn How To Prevent A Stroke 

Here are six steps anyone can take to reduce the risk and danger of a stroke:

1. Know your personal risk factors: High blood pressure, diabetes, and high blood cholesterol.
2. Be physically active and exercise regularly.
3. Maintain a healthy diet-  High in fruits and vegetables and low in salt to keep the blood pressure low.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6. Learn to recognize the warning signs of a stroke.

To know more visit our best neurologists in Bangalore at our hospital

Pituitary Adenoma

A pituitary adenoma is a slow-growing and typically benign tumor arising from cells in the pituitary gland. Because they originate from cells in the pituitary gland, they often cause problems related to hormonal dysfunction. A large proportion of these tumors grow to a size where they cause symptoms because they compress surrounding structures. For these reasons, larger pituitary tumors (called macroadenomas) often present with headache, visual loss and pituitary gland dysfunction. Changes in energy level, sexual function and libido, and many other symptoms may be a result of a dysfunctional pituitary gland (called hypopituitarism).

Other types of tumors and cysts are also often seen in the pituitary area, and some require surgical management. These include craniopharyngiomas, Rathke’s cleft cysts, meningiomas, and other less common neoplasms and inflammatory processes.

Causes of pituitary adenomas
The specific cause of pituitary adenoma development is unknown, although they are likely to be caused in part by random mutations in cells of the pituitary gland. Congenital syndromes known to be associated with some pituitary adenomas make up only a minority of patients with these tumors.

Treatment for pituitary tumors involves various options, including removing the tumor, controlling its growth and managing your hormone levels with medications.

Signs and symptoms of pressure from a pituitary tumor may include:

• Headache

• Vision loss, particularly loss of peripheral vision

• Nausea and vomiting

• Symptoms of pituitary hormone deficiency

• Weakness

• Less frequent or no menstrual periods

• Body hair loss

• Sexual dysfunction

• Increased frequency and amount of urination

• Unintended weight loss or gain

Risk factors:

Although pituitary tumors can occur at any age, they're most likely to occur in older adults. People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type I (MEN I), have an increased risk of pituitary tumors. In MEN I, multiple tumors occur in various glands of the endocrine system. Genetic testing is available for this disorder.

COMPLICATIONS

Vision loss, permanent hormone deficiency and diabetes insipidus.

A rare but potentially serious complication of a pituitary tumor is pituitary apoplexy, when sudden bleeding into the tumor occurs. Pituitary apoplexy requires emergency treatment, usually with corticosteroids and possibly surgery.

• Tests and diagnosis: Blood and urine tests to determine whether there is any over production or deficiency of hormones.

• Brain imaging: CT and MRI to judge the location and size of pituitary tumor.

• Vision testing: Such tests can determine if growth of a pituitary tumor has impaired your sight or peripheral vision.

Treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a nervous system specialist (neurologist). Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

• Surgery include: Endoscopic transnasal transsphenoidal and Transcranial approach (craniotomy).

• Radiation therapy include: External beam radiation and Gamma Knife stereotactic radiosurgery.

Craniosynostosis

Craniosynostosis is derived from the terms cranio, syn and ostosis that relates to the bone. It is a birth defect in which one or more of the joints between the bones on an infant's skull close prematurely, before the infant's brain is fully formed. Craniosynostosis transpire in one in 2000 births. An infant’s skull has seven bones. In general, these bones don’t fuse until the age of 2, giving enough time for the infant’s brain to develop. These bones are held together with a joint called cranial sutures, made of strong fibrous tissue.

Symptoms of Craniosynostosis

• Increase of pressure inside the skull such as intracranial pressure

• A distorted skull having the shape that depend upon which of the cranial sutures are affected

• Development of a hard or raised ridge near the affected sutures

• No or slow growth of the head as the baby grows

• Abnormal disappearing or feeling of a soft spot on the skull of the baby

Craniosynostosis can be categorized into many types. Some of the most commonly found types are:

Sagittal synostosis (scaphocephaly)
Premature fusion of the sew up at the top of the head forces the head to grow long and thin, rather than wide. Scaphocephaly is the most common type of craniosynostosis.

Coronal synostosis (anterior plagiocephaly)
The premature fusion of a coronal suture may force the infant’s forehead to flatten on the affected side. It can as well cause a deviated nose and slanted skull.

Bicoronal synostosis (brachycephaly)
In this stage, the baby may have a flat, elevated forehead and brow. This happens when both of the coronal sutures fuse prematurely.

Treatment of Craniosynostosis
The overall health and medical history of the child has to be taken into priority. The only treatment for craniosynostosis is an intervention of surgery. An open surgery is performed for reshaping the skull of the child. This is made at the top of the head by an incision. Followed by the affected suture is removed by a neurosurgeon, giving a more normal shape to the skull bones by a craniofacial plastic surgeon. Screws and plates are used for holding the new shape till the time bone heals. The screws and plates are made up of special material that absolutely dissolves in 1-2 years. Only one surgery is required if a baby has single suture craniosynostosis. More than one surgery is required if a child has craniosynostosis caused by craniofacial syndromes.