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Common Neurological Disorders

Often dreaded, neurological conditions are no more untreatable in today’s modern era. In fact, more than 40 percent of all the neurological conditions are curable, and a lot other are treatable. The common ones in Indian subcontinent include Migraine, Stroke, Epilepsy, Parkinson’s disease, etc. These constitute a major chunk of neurological conditions prevalent in India apart from polio, encephalitis, spondylotic disc disorders and peripheral neuropathies. 

Migraine is the most common illness and the most common type of all headaches, that present to a neurology clinic. It has various pathogenic mechanisms proposed ranging from increased vascularity in the brain, to hyperexcitable brain cortex, and to an over sensitized brain. None of these theories though is proven till date. Nonetheless it is totally curable if treated by an expert. There are no diagnostic tests to confirm it and it’s a clinical diagnosis. It often gets complicated and transformed into a different headache if mismanaged and then gets difficult to treat. There is a host of medications used to treat migraine, and failure of one drug is an indication to switch to other. However, treatment failure is called so, only after at least a month of therapy because these medications take time to work. If medications aren’t helping, steroids in a short course of low doses and various nerve blocks help well. A refractory migraine often responds well to local botox therapy. A debilitating continuous migrainous headache lasting more than 72 hours becomes a Status Migrainosus and requires hospitalisation.  

Stroke is defined as death of a neurological tissue and can happen because of less blood reaching the brain causing oxygen deprivation, called as an Ischemic stroke or because of excessive bleeding inside brain tissue called as an Hemorrhagic stroke. Ischemic stroke is far more common amongst these two. Common modifiable risk factors include obesity, smoking, sedentary life style and non-modifiable ones include certain genetic conditions. Diabetes and Hypertension are now being called as modifiable risk factors because if kept in tight control, the risk of stroke drops dramatically. Common tests used to diagnose a stroke include MRI and a CT scan of head. It can be treated completely if the patient is brought on time. Each minute of oxygen deprivation leads to millions of neurons dying, and beyond 4.5 hours, the thrombolytic therapy isn’t useful. However, a mechanical removal of clot can be attempted upto 12 hours as well in selected cases. So, an immediate transfer to a dedicated neurocentre is most important at the outset. Hemorrhagic stroke is often managed conservatively by controlling the blood pressure and reducing brain swelling. Selected cases are treated surgically. 

Epilepsy is a paroxysm due to abnormal excessive electrical discharge from an aggregate of neurons in the brain. It presents with abnormal limb movements with or without loss of consciousness. There are various types of epilepsies, common ones including generalised and focal. It can be due to a secondary cause or can happen due to no apparent cause, the so-called idiopathic epilepsy. Other genetic forms exist as well. Diagnosis is usually done by brain imaging and an EEG. One must not attempt to feed the patient during such episodes and turning the patient to either side while waiting for medical attention is prudent. There are a number of antiepileptic medications used to treat epilepsy in different combinations and refractory cases are managed surgically. 

Parkinson’s disease is named after James Parkinson who identified first such case and wrote an essay called the shaking palsy. As the name implies, there is involuntary tremor in one or more limbs with progressive slowing in all activities, some patients have a postural instability and develop frequent falls. It results due to loss of dopamine in our brain. The diagnosis is usually clinical and imaging is used to rule out other mimics or the plus syndromes which carry a poor prognosis. It is treated with a combination of dopaminergic medications and the disease does not affect the life span of the individual. Selected patients who respond well but develop abnormal limb movements, called as dyskinesias are managed with deep brain stimulation where in electrodes are implanted into the brain and are stimulated by an external battery implanted under the skin.

The global community is today, more than ever before, opening up and trying to come together to tackle neurological disorders and mental affectations. New studies reveal that neurological disorders feature among the leading causes of death owing to non-communicable diseases. Globally neurological disorders claim second highest number of lives per year and this problem doesn’t seem to be abating any time soon. As populations across the world age and grow: so, will disabilities along with them. These are trying times, for people and those responsible for them, the efforts have to be doubled up and greater care and understanding afforded to those affected by neurological diseases. 

Dr. Madhukar Bhardwaj
Senior Consultant
Neurology

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