ARTICLES ON Neurology

As you’re snarled in traffic or in the middle of a meeting, your phone alerts you with a calendar reminder for your next dose. If you or a loved one has epilepsy, this little daily balancing act probably sounds familiar.  The good news is that this condition is much simpler to manage than it first appears if you have the correct information about the law, your rights at work, and your medications. Let’s find out more about what living with epilepsy looks like and its related aspects in this guide.  What is Epilepsy and What Are Its Symptoms? Epilepsy is a disorder of the nervous system in which the normal electrical activity of the brain is disturbed, causing repeated seizures. It’s not one disease. It’s an umbrella term for lots of different types of seizure disorders, each with its own triggers and patterns.  Epilepsy is one of the most common neurological conditions in India, affecting an estimated 1 crore people. Its common symptoms are:  Uncontrolled movements of the arms or legs. A brief spell of confusion or a blank stare. Loss of consciousness or awareness, sometimes with falling. Tonic seizures (stiffening of the body). A peculiar feeling before an episode, such as a smell or a feeling of “butterflies” in the stomach (known as an aura). Doing things over and over again, like smacking lips, blinking, or walking in circles.  Brief periods of memory loss or a dazed feeling afterward (called the postictal state). Seizure Type What It Looks Like Focal (partial) seizure. Affects one area of the brain. The person may stay aware or briefly lose awareness. Generalized tonic-clonic. Full-body stiffening followed by jerking. The most recognizable seizure type. Absence seizure. Brief staring spells, common in children, lasting 5–10 seconds. Myoclonic seizure. Sudden, brief muscle jerks, often in the arms. Atonic seizure. Sudden loss of muscle tone, causing a fall or drop. If you notice these patterns in yourself or a family member, don’t wait it out. A timely visit to a neurologist can prevent complications and start you on the right treatment path early. Epilepsy Treatment: What Actually Works Epilepsy treatment today is far more effective than most people realize. About 7 out of 10 people with epilepsy can have their seizures controlled with the right antiepileptic drug (AED). Let’s check out some of the most common approaches for epilepsy treatment:  Anti-Seizure Medications (ASMs): This line of treatment usually begins with one drug at a low dose that can be increased if needed. Monotherapy First: Doctors try this medication before combining drugs to reduce side effects and simplify dosing. Regular Monitoring: Blood tests and visits with your neurologist to monitor levels of medication and adjust doses. Surgery or Devices: If epilepsy is drug-resistant, resective surgery or neurostimulation devices may be alternatives. Lifestyle Management: Adequate sleep, stress reduction, and avoiding known triggers (like flashing lights or alcohol). One detail that’s often missed is that after an initial unprovoked seizure, doctors don’t always start you on medication right away. This will depend on your risk of recurrence, such as abnormal EEG results, brain imaging results, or a family history of epilepsy.  This is precisely the kind of complex decision that requires expert judgment as opposed to a one-size-fits-all strategy. Why Medication Timing Matters More Than You Think This is one of the most frequently asked questions on the internet and one of the most underappreciated aspects of managing a seizure disorder. The most frequent cause of breakthrough seizures in people with well-controlled epilepsy is taking medication at irregular times or missing doses. Now here is why timing is so important: Anti-seizure medicines work by maintaining a constant amount of the drug in your blood. With irregular dosing, this level drops, allowing a window for seizures to occur. Missing even one dose can cause a seizure disorder, especially if you are taking a short-acting medicine. Taking doses at the same time each day (e.g., 8 AM and 8 PM, instead of loosely “morning and night”) keeps drug levels steady. Your body’s ability to process ASMs may be hampered by alcohol, some over-the-counter medications, and even some herbal supplements. Always consult your neurologist before taking anything new. Hospitals follow time-sensitive treatment protocols for suspected prolonged seizures or status epilepticus (a medical emergency). The first medication is usually administered within 5 to 10 minutes of the onset of the seizure, with escalation to additional treatment if the seizure disorder persists for more than 20 to 40 minutes. Simple Habits That Help With Medication Timing Rather than using ambiguous morning/evening reminders, set two fixed daily alarms. Track missed doses with a weekly pill organizer. For days when you’re not at home, keep a small backup dose in your car, office drawer, or bag. Keep a seizure and medication diary. Note the exact time you took the dose, any missed doses, and how you felt that day. If you’ve been seizure-free for months, don’t stop or change medication doses without your neurologist’s advice. What Are the Driving License Rules for Epilepsy in India? For those with epilepsy in India, this is one of the most sought-after and misinterpreted subjects. So here’s the reality, plain and simple. Under the Central Motor Vehicles Rules, 1989 (Rule 5), every applicant has to declare their medical fitness for getting a driving license.They also have strict restrictions for applicants with epilepsy: Aspect Current Rule in India Legal basis Motor Vehicles Act, 1988 and Central Motor Vehicles Rules, 1989. Declaration required. All applicants must fill Form 1 (physical fitness declaration). If epilepsy is declared. Medical examination becomes mandatory. license outcome Even with a positive medical opinion, there is currently no legal provision to issue a license to a person who has declared epilepsy. Applies to Both transport (commercial) and non-transport (private) vehicle licenses. Differentiation by seizure type/frequency None. The restriction applies uniformly, regardless of how long someone has been seizure-free. In practical terms, this means that once epilepsy is diagnosed, both people with frequent, uncontrollable seizures and those who had

Are your Parkinson’s disease symptoms starting to run your day, instead of the other way around? If so, you may wonder if deep brain stimulation (DBS) can help.  DBS may help some people whose movement symptoms are troublesome and no longer consistently controlled by medicines.  But it is not the next step for everyone with Parkinson’s disease. The right patient needs the right diagnosis, symptoms, expectations, and overall health profile. This guide explains who may be eligible for deep brain stimulation, what doctors look for before DBS surgery, and what to expect at your pre-surgery assessment. What is Deep Brain Stimulation? Deep brain stimulation is a surgery in which a small neurostimulator is placed to send controlled electrical pulses to targeted areas of the brain that control movement. The aim is to alter abnormal brain signals and ameliorate certain symptoms. DBS is most commonly used to treat Parkinson’s disease and a few other movement disorders, depending on the case. But DBS surgery is not a cure for Parkinson’s disease. It is a treatment intended to control some symptoms and possibly improve daily functioning and quality of life. Who May Qualify for Deep Brain Stimulation? No checklist automatically makes someone eligible. A specialist team reviews the full clinical picture and determines whether deep brain stimulation may be appropriate. People with Parkinson’s disease might be candidates for DBS surgery when they: Have problematic motor fluctuations (e.g., return of symptoms before the next medication dose)  Dyskinesia or involuntary movements that affect daily life. Tremor that persists as disabling despite adequate medication therapy. A good response to levodopa or other dopaminergic treatments, even when the medication has become difficult to tolerate. Symptoms that continue to interfere with work, mobility, independence, or quality of life despite optimized medical treatment.  There is no single test that can confirm whether DBS is right for you. Doctors look at the big picture, i.e., how symptoms will affect your routine and how your body responds to medication. This thorough evaluation helps the medical team determine whether DBS is the appropriate next step for you. A Simple Way to Understand It Situation Could DBS Evaluation Be Considered? Parkinson’s symptoms are well controlled with medicines. Usually, DBS surgery may not be needed at this stage. Medicines work, but symptoms wear off unpredictably. Yes, an evaluation for deep brain stimulation for parkinson’s, may be appropriate. Severe dyskinesia affects daily activities Yes. Tremor remains disabling despite appropriate treatment Yes. Diagnosis is uncertain or may be atypical Parkinsonism. Further specialist assessment is needed. Significant untreated psychiatric or cognitive concerns. These may need to be addressed before deep brain stimulation surgery. The decision should always be individualized by a qualified neurological and neurosurgical team. Is There a Specific Age or Disease-Duration Cut-Off? This is one of the most frequently asked questions about deep brain stimulation for Parkinson’s disease. The answer is not as simple as it seems. Many people assume you must be a certain age, or have had Parkinson’s for a set number of years,  but it isn’t that simple. Recent expert recommendations suggest that age, disease duration, disease stage, or one motor-score measurement should not be the only determinants of deep brain stimulation candidacy. Instead, doctors look at the diagnosis, symptom pattern, response to medication, cognitive and psychiatric health, general medical fitness, and what the person wants. Longer disease duration historically has been used during patient selection as it can help to differentiate typical Parkinson’s disease from conditions that can appear similar.  However, more recent expert recommendations focus on timely referral instead of waiting for very advanced symptoms. Note: If symptoms of Parkinson’s are becoming difficult to manage with appropriate medicines, it may be worth talking to a movement-disorder specialist about deep brain stimulation instead of waiting until daily life is severely impacted. What Does the Pre-Surgery Assessment for DBS Involve? Prior to deep brain stimulation, your doctor will perform a comprehensive evaluation to learn about your symptoms, your response to medication, your overall health, and your treatment goals. The team can now decide if DBS surgery is the right choice and safely plan the procedure. Evaluation for deep brain stimulation for Parkinson’s disease includes: Neurological Examination: A neurologist will examine your Parkinson’s symptoms, movement problems, tremor, stiffness, balance, and motor fluctuations. They also check how these symptoms affect your day-to-day functions. Medication and Levodopa Assessment: Your doctor will review the medications you take, including their benefits and side effects. They may also check how your symptoms change when the medicine is working and when its effect wears off. Brain Imaging: Your doctor may recommend an MRI or other scans to examine the structure of your brain for anything that could influence surgical planning or treatment. Cognitive and Psychological Assessment: Memory, attention, thinking abilities, mood, and mental health can be tested. So doctors can determine if any issues need to be addressed before DBS surgery. General Health Assessment: You may need blood tests, a heart check, an anesthetic assessment, and other investigations depending on age, medical history, and existing health conditions. Neurosurgical Consultation: The neurosurgeon describes how the procedure works, possible benefits and risks, recovery, device programming, and long-term follow-up. You can also talk about your expectations and concerns about deep brain stimulation. The DBS Pre-Surgery Assessment at a Glance Assessment What Doctors Want to Understand Neurological examination Diagnosis and movement symptoms Medication review Which medicines help and what side effects occur Levodopa response Which symptoms are medication-responsive Brain MRI/imaging Structural assessment and surgical planning Cognitive testing Memory, attention, thinking, and executive function Psychiatric assessment Mood, behavior, and emotional stability Neurosurgical consultation Surgical suitability, risks, and expectations General health assessment Fitness for surgery Family discussion Support system and realistic expectations A Useful Question to Ask: Which Symptoms Will DBS Actually Help? Before deciding on DBS surgery, ask your doctor to separate your symptoms into three categories: Symptoms Probable to Improve These may include tremor responsive to medication, rigidity, bradykinesia, and some motor fluctuations. Symptoms that May Improve in Less Predictable Ways Some

Most people equate the word stroke with an abrupt event, such as a sudden collapse, an event that occurs without any prior signs. However, that is not usually the case.  Most often, your body allows you some time, whether that be a few minutes or even a bit more, and what you choose to do during this short period will make all the difference.  Watching for stroke symptoms as they occur, instead of waiting to see if they pass, can be the difference between walking out of the hospital and years spent relearning basic things. What Exactly Is a Stroke? A stroke occurs because of reduced or interrupted flow of blood to any part of the brain. This is very serious since brain cells cannot survive long without oxygen and nutrients.  There are two main types worth knowing, since that explains how treatment approaches vary between patients: Ischemic Stroke: It happens when a blockage in an artery reduces blood flow to the brain. Hemorrhagic stroke: It is caused when a blood vessel bursts or starts bleeding in the brain or the adjacent tissues. Transient Ischemic Attack (TIA): It is also known as a mini-stroke. Symptoms of stroke in a TIA appear for a brief period of time and usually fade within an hour. It could signal a future stroke. What Are the Common Warning Signs of a Stroke? Recognizing brain stroke symptoms fast is really what the rest of this article hinges on. And here is the thing about most stroke symptoms: they appear suddenly and commonly affect one side of the body.   Being confused and unable to comprehend what someone is saying. Sudden numbness or weakness, radiating towards one side of the body, arms, legs, and face. Slurred speech or difficulty speaking. Visual disturbances may include blurred vision, darkened vision, or black spots in one or both eyes. A sudden, severe headache that people say later was the worst of their life. There is a simple way to hold onto these brain stroke symptoms when panic sets in, and your brain refuses to think straight. It is called FAST, the same test used by emergency responders across the globe, including the CDC and the American Stroke Association.  F for Face. Ask them to smile. Check if one side is drooping. A for Arms. Ask them to lift both arms together, and see if one arm sinks back down without them noticing. S for Speech. Get them to repeat a short sentence after you. Does it come out strange, slurred, off? T for Time. Even one of these on its own is reason enough to call emergency services immediately. Not after breakfast. Now, this minute. Does a Stroke Affect Differently in Women and Younger People? Yes, on top of everything mentioned above, women having a stroke can also experience: Fatigue or heaviness in the body that has no obvious explanation Nausea or vomiting that comes on out of the blue Hiccups that won’t stop, causing a strange discomfort in the chest A sudden change in mental state, confusion, or simply not responding the way the brain normally does One more thing worth knowing: stroke symptoms are not limited to older people only; more cases keep turning up in people under 45, a lot of it tied back to high BP or blood sugar that went unmanaged for years.  So no matter your age, don’t dismiss a FAST sign as stress or a bad night’s sleep.  Why Does Every Minute Matter? Here is a number that tends to stop people mid-sentence. According to a published research journal on stroke from the AHA, during an untreated ischemic stroke, roughly 1.9 million neurons die every single minute.  “Time is brain.”You’ll hear doctors say this a lot, and it’s not an exaggeration for effect; it’s just true. In India especially, reaching a hospital quickly can be a real challenge.  Traffic, distance, gaps in emergency access – any of these can eat into the minutes that actually matter. The longer you delay treatment, the higher the risk of permanent disability.  The early identification of the signs and prompt arrival at the doctor is, actually, the key to success. What Are The Risk Factors Involved? A short list of conditions accounts for most strokes, and here is the good part: a lot of them can be managed once you know they exist.  Regular testing of blood pressure, sugar, and cholesterol is one of the easiest ways to diagnose the problem even before it becomes serious. High blood pressure, being one of the key risk factors in strokes. Atrial fibrillation or other arrhythmias, which create small blood clots in the bloodstream that can travel up to the brain. High cholesterol, causing plaques in the arteries. Diabetes, silently damaging blood vessels. Excessive smoking and alcohol abuse, causing high BP and blood sugar, which in turn damage blood vessels in the process. Over-sitting, being overweight, and physical inactivity. Family history of stroke, due to genetic reasons or heart diseases that might have occurred in the family. How Is a Stroke Diagnosed? The physician conducts various tests to identify the category of the stroke and the area of the brain where it occurred. Brain Scan (CT or MRI) to detect the nature and location of the stroke. Blood tests to measure blood sugar and coagulation properties and to exclude other diseases that might have similar symptoms. ECG is performed within an hour to assess any arrhythmia of the heart, such as atrial fibrillation. Most of this is done within the first hour because each result points to a decision that can’t be put off. How Is a Stroke Treated? What comes next depends a lot on the type of stroke and, once again, on how quickly the person reached the hospital. A clot-dissolving medicine, called thrombolysis, works best when it’s given within four and a half hours of the first sign.  There’s also mechanical thrombectomy, where the clot is physically pulled out, and this can still help some people

Many people confuse headaches with migraine, stating it as a “bad headache”, but both are quite different and come with their own set of symptoms and treatments. When you know the correct difference between a migraine and a headache, it helps you find the signs that need urgent care and choose the right relief option. Difference Between Migraine and Headache A headache is just a normal pain in the head, which is quite dull and feels like a tight pressure band on your head. It goes away with rest or a simple painkiller. A migraine is a neurological condition that starts as a throbbing pain on one side and is followed by nausea and sensitivity to light and sound. They last longer and disrupt daily life far more than headaches. Difference Between Migraine and Headache A headache is just a normal pain in the head, which is quite dull and feels like a tight pressure band on your head. It goes away with rest or a simple painkiller. A migraine is a neurological condition that starts as a throbbing pain on one side and is followed by nausea and sensitivity to light and sound. They last longer and disrupt daily life far more than headaches. Common Types of Headaches ● Tension Headache: They are dull, steady, and create a band-like pressure on the head. They are the most frequent types of headaches. ● Sinus Headache: This usually comes up with pain and pressure in the forehead, cheeks, and nose. They also sometimes can cause a cold or sinus infection. ● Cluster Headache: They are centered near one eye and cause a sharp stinging pain near that area. ● Medication-overuse Headache: It is also known as a rebound headache, as they come back due to excess use of painkillers. What Is a Migraine and What Does It Feel Like? A migraine is a neurological disorder where a person feels intense, throbbing headaches. It often happens on one side of the head and can get worse with movement or when the person walks around or climbs stairs. You may also experience nausea or vomiting, with a strong sensitivity to bright light, loud sounds, and strong smells. Many people lie down in dark, quiet rooms to feel calmer. An untreated migraine attack can last anywhere from a few hours to about three days, which is why it can force you to miss work or school. Sometimes just before the migraine attack, some people feel temporary changes in vision or the senses. This is a migraine warning sign and is commonly known as an aura and can show up as flashing lights, zig-zag lines, or fading blind spots. It usually lasts between five minutes and an hour and then fades. Not everyone with a migraine experiences this. Migraine is a serious condition, and even the World Health Organization believes it to be a leading cause of disability worldwide in young and middle-aged adults. So if you have migraines, it is important to look for proper care and manage them to avoid any future complications. Four Phases Every Person With a Migraine Goes Through A migraine attack includes four stages. However, not everyone experiences these exact stages, as the early ones can be quite hard to notice. 1.Prodrome (warning phase): This occurs hours before the actual headache, and you may feel your mood change, have food cravings, and have a stiff neck, followed by frequent urination and attention issues. 2.Aura: In the second stage, you might get vision or sensory changes which may last roughly 5 to 60 minutes. 3.Headache (migraine attack): Here’s where migraine actually begins. This can be followed by nausea and sensitivity to light or sound, which can last from 4 to 72 hours. 4.Postdrome: There is almost no pain but the individual keeps getting some after effects like feeling drained or foggy. Where Is Migraine Pain Felt? Migraine pain is normally felt on either side of the head, and sometimes around the temple or forehead. Migraine vs Headache: Side-by-Side Comparison Feature Tension Headache Migraine Type of pain Dull, tight, pressing Throbbing, pounding Location Both sides, band-like Usually one side Severity Mild to moderate Moderate to severe Effect of movement Little change Gets worse Nausea or vomiting Rare Common Light and sound sensitivity Mild or none Strong Aura (vision changes) No Sometimes Typical duration 30 minutes to a few hours 4 to 72 hours Effect on daily life Can usually carry on Often forced to stop and rest Cluster Headache vs Migraine Another type of headache people confuse with migraines is cluster headaches. In a cluster headache, a person feels sharp, piercing pain around or behind one eye. The eye here can start to water and go red, with the nostril feeling blocked or runny. The person can even feel restless throughout the day. They are also short, usually 15 minutes to 3 hours, and happen in clusters, and can come and go several times a day for weeks, at a fixed time. If we compare a migraine to this, they last longer and show up with nausea and light/sound sensitivity. The treatment for both is different and needs medical care. It is advised to consult a neurologist to differentiate between what you are experiencing and get an accurate diagnosis. What Are Common Causes of Migraines? Migraines have always been linked to changes in brain activity, which in turn affect the nerves and blood vessels. They also tend to run in families, so genes play a big part here. Many people who are prone to migraines can trigger one if a particular event happens. Some common ones include: ●Stress, whether it’s emotional or physical. ●Fasting or skipping meals during the day can trigger it. ●Not drinking enough water. ●Irregular sleep. ●Foods and drinks like aged cheese, processed meats, or even alcohol. To avoid a migraine, you can maintain a headache diary to note down everything you do throughout the day and what triggers a headache. Is a Migraine Dangerous? When a

Parkinson’s disease (PD), the second most common neurodegenerative disorder after Alzheimer’s, is often misinterpreted as a natural part of aging. Affecting nearly 1% of individuals over 60, PD frequently goes undiagnosed in its early stages, leading to unnecessary suffering. Dr. Manish Baldia, Functional Neurosurgeon at Wockhardt Hospitals, Mumbai, sheds light on the critical need for early detection and intervention. A retired school principal in his early 70s, exemplifies the challenges of misdiagnosed Parkinson’s disease. For years, he attributed his tremors, slowed movements, and fatigue to aging. His family, though concerned, also dismissed the symptoms as part of the natural aging process. This misconception led to a decline in his quality of life, causing emotional distress and social withdrawal. The turning point came when a visiting relative, a medical professional, urged him to seek specialized care. A neurologist confirmed the diagnosis of Parkinson’s disease, bringing both relief and apprehension. With timely intervention, He was introduced to advanced treatments, including Deep Brain Stimulation (DBS), medication adjustments, and rehabilitation therapy under the expertise of Dr. Baldia. After undergoing DBS, a cutting-edge procedure that regulates abnormal brain activity through electrical impulses, He experienced a dramatic improvement in his motor functions. His tremors reduced, his voice regained strength through speech therapy, and he even resumed hobbies like gardening—activities he once believed were lost forever. A Message of Hope and Awareness Now thriving with his condition, He has become an advocate for Parkinson’s awareness, urging others to recognize early symptoms and seek timely medical attention. “The biggest lesson I’ve learned is not to ignore your body’s signals. Growing older doesn’t mean suffering in silence. Parkinson’s is not the end—it’s a new beginning with the right guidance,” he passionately shares. Dr. Manish Baldia emphasizes, “Early diagnosis and access to advanced treatments can dramatically improve the quality of life for Parkinson’s patients. Our goal is to ensure that no one else has to endure years of unnecessary suffering due to a lack of awareness.” He adds, “With advancements like Deep Brain Stimulation and personalized treatment plans, we can offer hope and a renewed quality of life to those battling Parkinson’s.” Wockhardt Hospitals remains at the forefront of neurological advancements, offering state-of-the-art treatments and compassionate care for Parkinson’s patients. As awareness grows, more individuals can regain control over their lives. _______ Dr. Manish Baldia, Functional Neurosurgeon at Wockhardt Hospitals, Mumbai Central, Shares Insights on “A Parkinson’s Journey from Neglect to Hope” – Exclusive Interview on Zee 24 Taas

Movement disorders during sleep are numerous with varied aetiology. Aetiology presents range from neurological, psychiatry, medical, or sleep disorders. Hence, a detailed and smart evaluation by a Neurologist helps an individual to get the correct diagnosis and appropriate treatment related to aetiology. The importance of evaluation of such conditions lies behind the fact that many such movement disorders disrupt regular sleep which leads to multiple psychological issues like fatigue, anxiety, depression, and medical conditions like uncontrolled hypertension, increased risk of cardiovascular events, etc. Commonly Witnessed Movement Disorders Encountered in Day-To-Day Neurological Practice 1. Restless leg syndrome (RLS) RLS is a movement disorder known to have a fluctuating course with remission rarely seen. It is an irresistible urge to move legs that usually occur during inactivity or at rest and becomes worse in the evening and night 2. Periodic limb movements of sleep (PLMS) PLMS is defined as periodic episodes of repetitive and highly stereotyped limb movements that occur during sleep. 3. Sleep related Bruxism (SLB) SLB is defined as repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible during sleep.  4. Sleep related hyper motor seizures (SHE) SHE has clinical manifestations which consist of rapid, hyperkinetic movements as well as tonic/dystonic posturing of the limbs usually brief duration with abrupt onset and offset.   5. Sleep related leg cramps (SRLC) SRLC represents painful contractions of the legs during sleep. It is characterized by suddenly occurring, episodic, persistently painful, involuntary contractions of the calf, hamstrings or foot muscles at night.  6. Benign Sleep Myoclonus of Infancy (BSMI)  (BSMI) is a benign condition can occur anywhere between Day 1 of life to 3 years of life it is characterized by twitches or jerks that occur when an infant is drowsy or asleep.  7. Propriospinal Myoclonus at Sleep Onset (PSM) PSM is defined as a movement disorder characterized by a person experiencing sudden jerks of the neck and abdomen both during drowsiness or trying to fall asleep.  8. Sleep-Related Rhythmic Movement Disorder (SRRMD) SRRMD is characterized by repeated rocking, rolling, and banging rhythmic movement disorder, and may also make rhythmic noises such as loud humming. Such rhythmic movements are commonly seen during infancy, and by 5 years old, only 5% of children are still affected. Risk factors include positive family history, infancy, intellectual disability, and associated other sleep disorders. Normal Variants Sleep starts (hypnic jerks): These are present at all ages and characterized by abrupt, startle-like movements that occur as one is drifting off to sleep, sometimes accompanied by a sensation of falling, a dream-like feeling, or a flashing sensation.  Excessive fragmentary myoclonus (EFM)- EFM is considered a benign, nonprogressive condition characterized by the movement of the fingers, toes, or mouth during sleep, with or without corresponding small visible movements(sometimes only evident by electromyography).  Hypnagogic foot tremor – Hypnagogic foot tremor is a rhythmic movement of the feet or toes lasting several minutes and tends to resolve spontaneously over time. It is seen in both adults and children. It occurs around the time of sleep onset with a periodicity of once every one to two seconds involving one or both feet. The patient may perceive a sensation of movement of the feet.  Management for various types of movement disorders related to sleep can be divided into – proper evaluation and correct diagnosis of the type of disorder the individual is suffering from. Though sleep-related movement disorders are clinically diagnosed, investigations required are blood investigations to rule out secondary causes supplemented by EEG, polysomnography, and nerve conduction study as and when required. The establishment of diagnosis is followed by medications for the management of symptoms and treatment of secondary causes leading to such symptoms. When required, the medication should be complemented with non-pharmacological measures as well. Conclusion Movement disorders related to sleep are numerous. More than one movement disorder during sleep can co-exist in the same individual. As these disorders can lead to sleep disturbances followed by psychological consequences, Sleep-related movement disorders need to be properly diagnosed and treated.  For further enquiry please contact  Dr . Sheetal GoyalSr. Consultant NeurologistWockhardt Hospitals, Mumbai Central

Subarachnoid haemorrhage (SAH) or ‘brain haemorrhage ” is a very serious life-threatening neuro-surgical emergency condition requiring immediate diagnosis, transfer to a specialised neuro-care centre and intensive (ICU) management. This condition is often seen in both male and female patients, particularly in middle-aged groups. The patient usually experiences a sudden severe headache (worst ever headache in life) followed by loss of consciousness or seizures. The cause of haemorrhage is usually due to the rupture of an aneurysm in the brain. What is an Aneurysm? In some individuals, there is a defect in the walls of the blood vessels of the brain. This balloon-like outpouching from the wall is the weakest point of rupture. It is like a bomb in the brain which on explosion throws a significant amount of blood under pressure causing haemorrhage within the brain. This leads to a sudden increase in pressure in the brain (ICP) and can cause brain death. 30% of such patients with severe haemorrhage die before reaching a hospital. Almost 50% may lose their life after reaching the hospital in the first 24 hours. Diagnosis of SAH CT scan of the brain gives a prompt diagnosis. Details of the aneurysm like its size, location etc can be obtained further by doing a CT angiogram or a Digital subtraction angiography (DSA). Management of an Aneurysmal SAH Essentially involves management of the initial bleed, its complications and sequelae and also preventing further re-bleed. The haemorrhagic blood may disturb the circulation of brain fluid (CSF) causing the ventricles (waterbags) in the brain to increase in size – a condition called hydrocephalus. This often requires a CSF diversion procedure (EVD)involving the placement of a small tube into the ventricle by drilling a burr hole in the skull and draining the CSF externally. Aneurysmal blood can also cause irritation to blood vessels which can contract in size (vasospasm) and reduce the blood supply to the brain. After initial stabilisation, the aneurysm should be secured to prevent a re-bleed. The aneurysm can be closed by either of the two procedures The clipping procedure involves opening of the skull (craniotomy) and direct visualisation, dissection of the aneurysm under a microscope and occluding its neck by applying a titanium clip while coiling is an endovascular procedure and does not involve a craniotomy. Management of an aneurysmal haemorrhage is very complex and challenging. Results depend on the severity or grade of haemorrhage, age, other comorbidities and the neurological condition of the patient at the time of arrival at the hospital. Prompt shifting of such patients to hospitals with neuro-care facilities may result in saving life and better prognosis. Dr Ashwin BorkarConsultant NeurosurgeonWockhardt Hospital

A revolution in malignant and benign tumors treatment “The first goal of a neurosurgeon is to restore or maintain my patients’ quality of life. Efforts are at the global forefront of advancing these minimally invasive approaches for a wide range of common and uncommon brain and skull base tumors, various vascular conditions such as aneurysms and craniofacial pain syndromes. Keyhole surgery is the concept of safely removing brain & skull base tumors through smaller, more precise openings that minimize collateral damage to the surrounding scalp, brain, blood vessels & nerves. Fortunately, given advances over the last two decades in technology and instrumentation as well improved brain and skull base anatomical understanding, a majority of brain and skull base tumors can now be removed through this surgical approach (Keyhole). Notably, this approach technically demanding, require specialized instrumentation, significant surgical expertise, and are not appropriate for all tumors. Consequently, there remains a role for conventional larger craniotomies. Approaches to perform Keyhole surgeries: Advantages:

Neuroendocrine Tumour: Know about its symptoms and treatment | PINKVILLA Prof. (Dr.) Mallika Tewari, Senior Consultant & Program Lead Surgical Oncology, Wockhardt Hospital, Mira Road shared in detail about Neuroendocrine Tumour aka NET. Read on to know. Actor Irrfan Khan passed away in Mumbai after battling colon infection. He was diagnosed with a neuroendocrine tumour, 2 years back. Here, we brief you about the neuroendocrine tumour. Read on to know more about this. Neuroendocrine tumours (NETs) are thought to arise from cells throughout the diffuse endocrine system of the human body. They comprise a broad family of tumours that are in the gastrointestinal (GI) tract (i.e. in stomach small intestine, appendix and rectum), lungs and bronchi, thymus, and pancreas.  Less common sites include adrenals, thyroid, parathyroid the pitutary gland (latter in the brain).NETs are uncommon and account for about 0.5% of all newly diagnosed malignancies. Some grow slowly while some tend to grow quickly. Did you know? Some NETs may produce excess hormones (functional NETs). While others do not release hormones or may not release enough to cause symptoms (those are nonfunctional NETs). Symptoms of neuroendocrine tumour One may exhibit symptoms of NETs depending on the location of the tumour and whether it produces excess hormones. The common symptoms are feeling fatigued, unintentional weight loss, and pain owing to a growing tumour. Due to excess hormones (functional tumours), one may also notice signs such as intermittent flushing & diarrhoea, hypertension, hypoglycemia, frequent urination, dizziness, and skin rash. Thus, immediately visit the doctor, in case you exhibit these symptoms. Causes Still, the exact cause of NETs is not known. Most NETs are sporadic and few are hereditary and a part of inherited genetic syndromes e.g. MEN-1; MEN-2 etc. Risk factors  People of all the age groups may suffer from these tumours. Though, it is rarely seen in children. Are you aware? Gastrointestinal conditions like atrophic gastritis can be the culprits.  Treatment The line of treatment will depend on the stage, size and location of the tumour. The treatment may vary from person to person. Your doctor may ask you to go for surgery to get rid of the tumour. Chemotherapy, radiation therapy, hormone therapy, or targeted therapy can also be given.