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Neurology

Neurosciences is designed to provide the highest levels of professional expertise and leadership in all major disciplines of neurosciences/neurosurgery through an integrated team of neurologists dedicated towards providing total patient care. Indian Spinal Injuries Centre boasts of high-end technology and renowned doctors.

Amongst the various nervous system diseases dealt with at the Department of Neurosciences, ISIC, a few of the common ones are:

HEADACHE:

Headache in one of the most common presenting symptoms encountered in neurosciences. Common causes of headache are tension type headache, migraine, trigeminal autonomic cephalgias, sub arachnoid hemorrhage, meningitis, brain tumors, and raised intra cranial pressure. Any individual suffering from sudden severe headache or long standing episodic /chronic headache should consult neurologist for clinical evaluation & further investigations, if required, like CT scan/ MRI Brain/ MR Angiography / venography for proper diagnosis & treatment.

Epilepsy

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions and loss of consciousness. Epilepsy causes. Anything that disturbs the normal pattern of neuron activity – from illness to brain damage to abnormal brain development – can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring; an imbalance of nerve signaling chemicals called neurotransmitters. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. Both children and adults can be afflicted with epilepsy or seizure. Investigations like Electroencephalogram( EEGs) and MRI brain scans are common diagnostic tests for epilepsy.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques..

Movement disorders

What is Parkinson’s disease?

Parkinson’s disease (PD) belongs to a group of conditions  which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

Is there any treatment?

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, patients are given levodopa combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain.  Nerve cells can use levodopa to make dopamine and replenish the brain’s dwindling supply.  Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  An antiviral drug, amantadine, also appears to reduce symptoms.

In some cases, surgery may be appropriate if the disease doesn’t respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.

Stroke

What is Stroke?

A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke: ischemic – blockage of a blood vessel supplying the brain, and hemorrhagic – bleeding into or around the brain.

Is there any treatment?

Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual’s underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.

MULTIPLE SCLEROSIS:

What is Multiple Sclerosis?

An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted.  Many investigators believe MS to be an autoimmune disease — one in which the body, through its immune system, launches a defensive attack against its own tissues. In the case of MS, it is the nerve-insulating myelin that comes under assault. Such assaults may be linked to an unknown environmental trigger, perhaps a virus.

Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye.  Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance.  These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis.  Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or “pins and needles” sensations.  Some may also experience pain.  Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss. Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.  Depression is another common feature of MS.

Is there any treatment?

There is as yet no cure for MS. Many patients do well with no therapy at all, especially since many medications have serious side effects and some carry significant risks.  However, three forms of beta interferon (Avonex, Betaseron, and Rebif) have now been approved by the Food and Drug Administration for treatment of relapsing-remitting MS. Beta interferon has been shown to reduce the number of exacerbations and may slow the progression of physical disability. When attacks do occur, they tend to be shorter and less severe.  The FDA also has approved a synthetic form of myelin basic protein, called copolymer I (Copaxone), for the treatment of relapsing-remitting MS. Copolymer I has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one third. An immunosuppressant treatment, mitoxantrone is approved by the FDA for the treatment of advanced or chronic MS.  The FDA has also approved dalfampridine (Ampyra) to improve walking in individuals with MS.

One monoclonal antibody, natalizumab (Tysabri), was shown in clinical trials to significantly reduce the frequency of attacks in people with relapsing forms of MS and was approved for marketing by the U.S. Food and Drug Administration (FDA) in 2004.  However, in 2005 the drug’s manufacturer voluntarily suspended marketing of the drug after several reports of significant adverse events.  In 2006, the FDA again approved sale of the drug for MS but under strict treatment guidelines involving infusion centers where patients can be monitored by specially trained physicians.

While steroids do not affect the course of MS over time, they can reduce the duration and severity of attacks in some patients.  Spasticity, which can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, is usually treated with muscle relaxants and tranquilizers such as baclofen, tizanidine, diazepam, clonazepam, and dantrolene. Physical therapy and exercise can help preserve remaining function, and patients may find that various aids — such as foot braces, canes, and walkers — can help them remain independent and mobile.  Avoiding excessive activity and avoiding heat are probably the most important measures patients can take to counter physiological fatigue.  If psychological symptoms of fatigue such as depression or apathy are evident, antidepressant medications may help. Although improvement of optic symptoms usually occurs even without treatment, a short course of treatment with intravenous methylprednisolone followed by treatment with oral steroids is sometimes used.

Infection of nervous system (Meningitis/ encephalitis/ myelitis/neuritis): Viral, bacterial, tubercular, fungal & parasitic infections like neurcysticercosis (tape worm infection of brain) of the nervous system can manifest in the form of fever, headache, vomiting, altered consciousness, convulsion, paralytic problems at times life threatening illness. Good clinical judgment, investigations like CT / MRI brain, EEG and prompt medical interventions can aid in the recovery of these patients.

NEUROMUSCULAR DISORDERS:

Neuromuscular disorders comprise of a vast group of diseases, the diagnosis & treatment of which need a multidisciplinary dedicated approach. Realizing the unique nature of these disorders & understanding the requirement of a dedicated multidisciplinary team for addressing the multifaceted issues related to these disorders, ISIC has structured an exclusive neuromuscular unit.

Neuromuscular unit of ISIC delivers classified specialized services for clinical evaluation, investigation & management of diseases of anterior horn cell, peripheral nerves, neuro-muscular junction & muscles. The unit evaluates clinical phenotype, pathology, genotype for accurate diagnosis & planning treatment of these disorders. Neuromuscular unit of ISIC  comprises of neurophysicians, neuropathologist, orthopedicians, spine surgeons, neurosurgeons, physiotherapist, occupational therapist, ortho/prostheticians  to manage neuromuscular cases.

Common Diseases covered under Neuromuscular unit ISIC:

  • Duchene Muscular dystrophy
  • Becker’s muscular dystrophy
  • Limb girdle muscular dystrophy
  • Facio scapulo humeral dystrophy
  • Congenital muscular dystrophy
  • Distal myopathy
  • Myotonic  dystrophy
  • Congenital  myopathy
  • Metaboblic  myopahy
  • Myasthenia gravis
  • Congenital myasthenic  syndromes
  • Channelopathies
    • Periodic palsy
    • myotonia
  • Inflammatory muscle diseases
    • Polymyositis/dermatomyositis/IBM
  • Neuropathies
    • AIDP/CIDP/DNP/Hansen’s neuropathy/vasculitic neuropahy/CMT
  • Motor neuron disease
  • Spinal muscular atrophy
  • PPRP
  • Nerve injuries
  • Plexopathies

Facilities:

  • Clinical evaluation
  • Neuro-electrophysiological study: NCV, EMG, RNST
  • Muscle & nerve biopsy
  • Muscle enzyme, biochemical assay & metabolic profile
  • Corrective surgeries for deformities & contracture
  • Physiotherapy
  • Occupational therapy
  • Orthotic & prosthetic devices
  • Counseling
  • Disorders of memory (dementia clinic):

What is Dementia?

Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions – such as memory and language skills — are significantly impaired without loss of consciousness.  Some of the diseases that can cause symptoms of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington’s disease, and Creutzfeldt-Jakob disease.  Although it is common in very elderly individuals, dementia is not a normal part of the aging process.

Drugs to specifically treat Alzheimer’s disease and some other progressive dementias are now available.  Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow the progression of the disease. This may improve an individual’s quality of life, ease the burden on caregivers, or delay admission to a nursing home.

Chronic Pain: Patients with cancer, diabetes, injuries, neuropathy, radiculopathy etc., suffer from incessant, continuous, unbearable pain to different parts of their body. Pain management is a science, which includes various forms of therapy including medications, TENS, neuro-stimulations, anesthetics and surgical relief.

Brain and spine tumors: Brain tumor patients have good chances of survival depending on the tumor pathology. Benign growths of the brain and spine, once removed by minimally invasive surgery, may not recur and patient recovers completely. Cancerous growths will require complete surgical excision followed by chemotherapy or radiotherapy. Neuroimaging like CT and MRI scans with sophisticated neurosurgical techniques help in brain tumor patient care.

Neurovascular pathologies: Any abnormalities of the blood vessels supplying the brain or spine can lead to damage. Diagnosis will require angiography and further management includes coiling/embolization, surgical excisions/clipping, stenting etc.

Backache and neck pain: Majority of the population, more than 30 yrs of age, face back and neck problem due to bad posture, obesity, injury etc. Management of slip disc or canal stenosis will require relevant MRI with medical, surgical or physiotherapy intervention. Spine surgery is quick and safe, thanks to modern techniques.

Facilities available:

Emergency Unit and Intensive care: Life threatening conditions are dealt with sophisticated monitoring equipments, ventilators and good intensivists. Highly trained specialists are on duty 24×7 at ISIC.

Neuroradiology center: Easy access to Magnetic Resonance Imaging (MRI) & Computed Tomography scans (CT) day and night, trained staff and immediate reporting is ensured at ISIC.

Neurology and Neurosurgery Unit: A well-qualified team of specialists trained both nationally and internationally at premier institutes are dedicated to deliver high quality care.  The following services are made available to the public:

Neurology Clinics:

  • Stroke clinic & Stroke unit
  • Epilepsy clinic
  • Headache clinic
  • Parksinson Disease Clinic
  • Neuromuscular clinic & Neuromuscular unit
  • Multiple sclerosis clinic
  • Sleep Disorder clinic
  • Dementia clinic
  • Botox clinic.
  • Pain clinic

NEUROELECTROPHYSIOLOGY UNIT:

Tests like nerve conduction study, electromyography (EMG), electroencephalogram (EEG), evoked potential (SSEP, VEP, BAER, MEP), RNST, Blink reflex etc. are regularly conducted in a dedicated Neuro-electro-physiology Laboratory at ISIC neurosciences department with most sophisticated machines by well trained technicians.

Neurosurgery Unit:

  • Minimally invasive neurosurgery unit – Microscopic & Endoscopic surgeries for
    • brain and spine tumors,
    • brain and spine injuries,
    • pediatric neurosurgery,
    • Neurovascular anomalies.
  • Spine surgery unit – spine fixation.

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