Neurological-Science

It is a disease that causes memory loss and approximately 10% of the patients above 70 years who have memory loss is due to Alzheimer’s disease. Loss of episodic memory is observed which is then followed by progressive dementia. The brain atrophies that is become smaller in size in advanced ages and this may contribute to memory loss. Genetic research has identified one of the genes responsible for the development of this disease. The cognitive changes, that is the changes that are associated with the process of acquiring knowledge and understanding through thought, experience and the senses, follow a characteristic pattern  beginning with memory impairment and progressing to language and deficits related to the spatial relationship of objects. The last loss in function is the executive dysfunction. The management of Alzheimer’s disease is challenging and gratifying despite the absence of a cure or a robust pharmacologic treatment. The primary focus is on long-term amelioration of associated behavioral and neurologic problems, as well as providing caregiver support. Medication and other conservative therapies are the mainstay for the treatment. 

The size of the posterior part of the brain decreases in Alzheimer’s disease. The main reasons for the pathology are the formation of amyloid plaques (abnormal deposits of protein) that damage and destroy brain cells. The other thing is the formation of neurofibrillary tangles of the normal protein tau that also leads to the death of brain cells. The risk factors for this disease are :

• Advanced age
• Family history and genetics
• Down syndrome
• Head injuries and past head trauma
• Mild cognitive impairment

Medications and other conservative neurological treatments in India are the mainstay treatment options for the management of Alzheimer’s disease. The drugs usually used are donepezil, rivastigmine, galantamine and memantine Use of nose to brain delivery system has also improved the drug delivery to the targeted site and achieve the desired effect.

It is a chronic and progressive movement disorder caused due to the loss of dopaminergic neurons in the substantia nigra located in the brain. It is a hypokinetic disorder that affects the basal ganglia in the brain. Basal ganglia are a group of neurons that are responsible for motor control and other functions like motor learning, executive functions and behaviors, and emotions. Therefore the symptoms of the disease include resting tremor also called pill-rolling tremor as it resembles pill rolling action, diminished facial expression termed as masked facies, stooped posture, slowing of voluntary movement or difficulty in initiating a movement (bradykinesia), festinating gait (progressively shortened, accelerated steps) and rigidity. 

Parkinson’s disease is caused due to the loss of dopaminergic neurons in the substantia nigra located in the brain but how these neurons get damaged is still unknown. 85-90% of the cases do not have any specific cause. Gene mutations have been implicated in many of the cases. MPTP (1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine), which is a by-product of the illicit manufacture of heroin like drug, causes Parkinson Disease like symptoms and have been used in animal models to simulate the features of the disease and then study and research them. Exposure to toxic chemicals like pesticides can also cause symptoms related to the disease but these can be reversed.

Dementia means loss of memory. This can occur due to various reasons. Diseases like Alzheimer’s disease is a very common reason dementia to develop. Other reasons may include degeneration in the neurons of the frontotemporal lobe of the brain, vascular reasons where cerebrovascular diseases are severe enough to cause significant deficits in occupational, social and functional abilities. Dementia is very common in the elderly and almost 10 million cases per year are registered in India. Medications and other conservative neurological treatments in India are the mainstay treatment options.

This is a common phenomenon and falls under the disorder called Obsessive-Compulsive disorder. The patient has the obsession of doing and feels the compulsion of doing that and hence the name. The most common forms are constantly cleaning and washing, checking locks repeatedly, etc. The disease may increase to an extent that even if the person is unable to do the things that he/she feels compelled to do, they keep on trying or else they cannot be satisfied and remain irritable. For the correct treatment, it is very necessary that the physician or the psychiatrist is able to differentially diagnose the disease. The common medication that is used to treat this disorder is fluoxetine. The other conservative ways are to make the patient understand the pathology and give them warmth and support rather than constantly nagging about their behavior.

Parkinson’s disease can be managed by the replacement of the neurotransmitter dopamine as it is caused by the destruction of dopaminergic neurons in the substantia nigra located in the brain. L-Dopa along with carbidopa are administered. This can only alleviate the symptoms but cannot cure the disease. As the disease progresses, these drugs become less effective. Deep brain stimulation has been a new promising treatment option in the management of the motor deficits associated with Parkinson’s disease. In this technique, electrodes are placed in the affected regions of the brain and the control of these electrodes is with the patients. The exact mechanism is unknown but it does provide relief from the severe symptoms of the disease.

Brain tumors are the neoplasms that form due to uncontrollable growth of the cells that confer protection to the functional neurons. The tumors are named based on the type of cell involved. 

Some of the more common types of primary brain tumors include:

• Astrocytoma: Astrocytes are star shaped cells that protect the functional neurons. Neoplasms arising out of these cells comprise the most of the observed brain tumors.
• Meningioma: Meninges are protective lining that forms a boundary protecting the brain and the spinal cord. The cancers of these form the most common type of non-cancerous brain tumor. Its presence is almost 33% in the number of brain tumors diagnosed. Only in rare cases, they are converted into cancerous tumors.
• Oligodendroglioma: Oligodendrocytes are cells that confer protection to the brain and the spinal cord by secreting myelin. The tumors of these cells are called oligodendroglioma and are usually cancerous. 

Astrocytomas are common in children, as they are in adults. But they are less likely to be cancer. These are other common primary brain tumors in children:

• Medulloblastoma: This tumor forms in the back part of the brain in the cerebellum, near the spinal cord and is usually cancerous. It can spread to the spinal cord and cause a condition called hydrocephalus by causing the spinal fluid to back up into the brain.
• Ependymoma: Ependymal cells form the lining of the ventricles of the brain and the vertebral canal that contains cerebrospinal fluid. The tumors of these cells are usually found in children and young adults and ranges from being cancerous to non-cancerous.

India is home to some of the best neurology hospitals. The neurologists and neurosurgeons in India have a vast experience in their fields and employ some of the best techniques available with utmost professionalism. The doctor will consider several things in deciding how to treat a brain tumor, including:

• Location of the tumor
• Size of the tumor
• Type of tumor
• Whether the tumor has spread
• overall health
• Potential complications

Deep brain stimulation has been a new promising neurological treatment in India in management of a number of neurological diseases. In this technique, electrodes are placed in the affected regions of the brain and the control of these electrodes is with the patients. The exact mechanism is unknown but it does provide relief from the severe symptoms of the disease. The major diseases that can be treated by this method are Parkinson’s disease and Tourette syndrome. Motor deficits of other neurological diseases can also be managed to some extent by this method.

Epilepsy is a neurological disease characterized by the occurrence of recurrent seizures. A seizure is defined as a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The clinical manifestations may range from excessive convulsive activity to something that is hardly distinguished by an observer depending on the distribution of charges. The main types of epilepsy are focal onset or generalized onset. The management depends on the type of epilepsy. Usually used drugs include:

• Phenytoin
• Benzodiazepine class of drugs like diazepam
• Phenobarbital
• Primidone
• Carbamazepine
• Eslicarbazepine acetate
• Ethosuximide
• Acetazolamide
• Ezogabine
• Felbamate
• Gabapentin and pregabalin. These two drugs are also used in a number of conditions where tingling is a chief complaint.
• Lacosamide
• Lamotrigine
• Levetiracetam and bivaracetam
• Perampanel
• Rufinamide
• Stiripentol
• Tiagabine
• Topiramate
• Valproate
• Vigabatrin
• Zonisamide

In febrile seizures that occur in children, diazepam administered rectally is the treatment of choice. Vigabatrin has the orphan drug status to treat infantile spasms in children. Lamotrigine and topiramate are effective in the severe form of epilepsy caused by Lennox-Gastaut syndrome. Valproate in the form of a syrup is the drug of choice in most of the seizure disorders in children.

ADHD refers to Attention Deficit Hyperactivity Disorder. It is the most studied and diagnosed mental disorder in children and adolescents but the causes are still unknown. The symptoms are inattention, or excessive activity and impulsivity, which is inappropriate at the person’s age. There may also be other symptoms like difficulty in controlling emotions or problems with executive function. Inattention may cause poor performance in schools and such people are more vulnerable to substance misuse. The diagnosis usually involves the presence of symptoms before a person is 12 years old and is present for more than 6 months and also that it causes problems in at least 2 settings e.g. school, home or recreational activities. Although it causes impairment, such patients have displayed sustained attention in tasks they find interesting or rewarding. This is referred to as hyperfocus. ADHD can be managed by a multi-pronged approach. These include behavioral therapy, medication and diet. Behavioral therapies include psychoeducational input, cognitive behavior therapy, interpersonal psychotherapy, family therapy, school-based interventions, social skills training, behavioral peer intervention, organization training, parent management training and neurofeedback. The drugs that are used include clonidine, guanfacine, dextroamphetamine, methylphenidate, dexmethylphenidate, pemoline and lisdexamphetamine. 

This disorder has under its ambit a range of neurodevelopmental conditions including autism and Asperger’s syndrome. The patients that suffer from these usually have very less social interactions and find it very difficult to make even eye contact. These defects are usually observed in child at around 1-2 years of age but usually it gets diagnosed in older children or adolescents. These patients do not share interests with same age children, have stereotyped behaviors, are oversensitive, resist any changes, self-injury behavior, unusual speech such as not able to gauge the situation and speak e.g. speaking loudly in theatres or libraries. The disease is referred to as spectrum as the patients have the symptoms in varying nature; some may exhibit one symptom more than the other. 

Some of the defects are present since birth and lead to impairment in the growth and development of the brain or the central nervous system. These can affect emotion, learning ability, self-control and memory which can be observed as the individual develops and grows. Some of these disorders are:

• Intellectual disability (ID) or intellectual and developmental disability (IDD), formerly known as mental retardation
• Learning  disorders like dyslexia or dyscalculia
• Autistic spectrum disorders
• Tourette’s syndrome
• Motor disorders
• Traumatic brain injury including congenital injuries like cerebral palsy
• Genetic disorders like Turner syndrome, fragile-X syndrome, Down syndrome
• Hypogonadal syndromes, schizophrenia and other mental disorders

Brain stroke is a condition where brain cells die due to poor flow of blood. This may be due to lack of blood flow called ischemia and the stroke referred to as ischemic stroke and the other type is due to hemorrhagic bleeding. The result is the same irrespective of the cause; part of the brain that doesn’t receive blood stops functioning or performs poorly. The signs and symptoms may vary depending on the location of cell death and may include paralysis that is inability to feel or move part of the body, dizziness, vision problems, difficulty in understanding speech or speaking, etc. If the symptoms resolve within 1-2 hours, then the attack is called transient ischemic attack (TIA). If stroke is not transient, then the symptoms may remain for the remainder of life.

Many tests ranging from the basic physical tests to advanced ones that involve the use of latest instruments are used to evaluate neurological function in babies. Some of these include:

• Physical tests like Babinski sign test
• Imaging tests like CT scan, MRI scan, PET scan
• Electrodiagnostic tests like electromyography and nerve conduction velocity
• Arteriogram
• Myelogram
• EEG (electroencephalogram), one of the most common done tests
• Cerebrospinal fluid analysis
• Evoked potentials
• Neurosonography
• Ultrasound 

Many tests ranging from the basic physical tests to advanced ones that involve the use of latest instruments are used to evaluate neurological function. Some of these include:

• Physical tests like Babinski sign test
• Imaging tests like CT scan, MRI scan, PET scan
• Electrodiagnostic tests like electromyography and nerve conduction velocity
• Arteriogram
• Myelogram
• EEG (electroencephalogram), one of the most common done tests
• Cerebrospinal fluid analysis
• Evoked potentials
• Neurosonography
• Ultrasound 

India is home to some of the best neurological hospitals and neurosurgeons having a vast amount of experience in their fields. Some of the best hospitals include:

1. Medanta The Medicity
2. Artemis Hospital
3. Indraprastha Apollo Hospitals
4. BLK Super Speciality Hospital
5. Max Super Specialty Hospital Saket
6. Fortis Memorial Research Institute
7. Apollo Hospital Chennai
8. SevenHills Hospital
9. Aster Medcity
10. Dharamshila Narayana Superspeciality Hospital
11. Zydus hospital

Headache is one of the most common complaint of a number of patients. The cause and the severity may vary. Also sometimes the underlying pathology might require urgent medical attention. The different types of headaches which are usually present are:

• Migraine
• Tension type headache
• Trigeminal autonomic cephalalgias
• Cluster headache
• Primary cough headache
• Headache due to sinusitis

Migraine is a disease that causes headache and is the second most common cause of headache in the world. It affects women more than men. It is usually episodic and is associated with certain features like sensitivity to light, sound or movement, nausea and vomiting and may be accompanied with an aura. The basic pathology is usually dysfunction of the monoaminergic sensory control systems located in the brainstem and the hypothalamus that are a part of the central nervous system. It is a very disturbing manifestation and causes a lot of pain trouble to the patient. It can be managed by medications and the main class of drugs that are used are triptans including sumatriptan, almotriptan, zolmitriptan, rizatriptan, eletriptan, etc.

Brain haemorrhage refers to bleeding inside the brain and formation of clots. It may be caused due to trauma or other reasons like aneurysm, high blood pressure, blood vessel abnormalities, blood or bleeding disorders, brain tumors, liver disease, etc. The symptoms vary depending on the location, severity of bleeding and the amount of brain tissue affected.