Alzheimer’s Disease..its risk factors and stages

alzIt is the type of dementia which is irreversible and progressive disease that slowly destroy memory and thinking skills of a person and eventually the ability to carry out the simple task. Although, this disease has been described at every stage of adult life, but majority are in 60’s or older. Prevalence of this disease is higher in females. The survival of patients with this disease is reduced to half of the expected rate  because of CV and respiratory causes.

HISTORY— Alzheimer disease is named after DR. alois Alzheimer.  In the year 1906 Dr alois noticed certain changes in the brain tissues of a woman who died of some unusual mental illness. Her main symptoms are memory loss, language problem and unpredictable behavior  After she died he examined her brain and found some abnormal clumps called as amyloid plaques and tangled bundles of fibers called as neuro fibillary tangles. In the brain these are the main feature of disease and third is loss of connection between neurons in the brain.  

RISK FACTORS— The important risk factors are–

a) AGE- Increase in age is the greatest known risk factor for Alzheimer disease. This disease is not a part of normal ageing, but risk increases after age of 65 years and risk reaches up to 50% after age of 85 years.

b) FAMILY HISTORY- Another strong risk factor is family history. This disease is somewhat higher if first degree relative like parents or siblings. Sometime rare changes called mutations in three genes virtually generate person with Alzheimer disease.

c) SEX- Women are more likely to develop Alzheimer disease than men.

d) PAST HEAD TRAUMA- People who had severe head trauma appear to have greater risk of Alzheimer disease.

e) LIFESTYLE- some factors of heart disease increase the chance of Alzheimer disease like lack of exercise, smoking, high BP, poor diabetes.

STAGES OF ALZHEIMER’S DISEASE There are different stages of this disease ..

1)  STAGE I    NORMAL– In this stage the person is free of any symptoms of cognition and functional decline. we call this stage as normal.

2)  STAGE II     NORMAL AGED FORGETFULNESS– Half people over 65 years of age experience some complaints of cognition and functional problem . With these symptoms people believe they can no longer recall names as they could be 5 or 6 years previously. They can no longer recall when they placed things. Some experienced difficulties in concentration.

3) STAGE III       MILD COGNITIVE IMPAIRMENT– during this stage  deficits are mainly noted by person who are closely associated with the subjective. These person repeat questions. Their capacity to perform executive function become compromised. They are unable to master new computer skills.

4) STAGE IV       MILD ALZHEIMER DISEASE– The most important deficit in these patient is their decreased ability to manage instrumental or complex activities of  daily living. The main duration of this stage is 2 years . Impairment symptoms become evident during this stage.

5) STAGE V          MODERATE ALZHEIMER DISEASE–      In this stage the functional deficits are so evident that their survival is little bit  dependent. The mean duration of this stage is 1.5 years.

6) STAGE VI      MODERATE SEVERE ALZHEIMER DISEASE– During this stage patient is not able to do daily activities.

alz 7) STAGE VII      SEVERE ALZHEIMER DISEASE– In this stage patient needs assistance while doing daily activity.

Article publié pour la première fois le 25/02/2013

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Multiple Sclerosis

Multiple Sclerosis

Multiple Sclerosis

Multiple Sclerosis

Also abbreviated as MS, disseminated Sclerosis or encephalomyelitis disseminated. It is an inflammatory(a protective response by the organism to the stimuli that causes injury and thus initiate the healing process) disease in which myelin sheath (usually layer around the neuron that is essential for the proper functioning of CNS) around the brain and spinal cord get damaged leading to demyelination (removal of myelin sheath) and scarring occurs.

MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other. Nerve cells communicate by sending the electrical signals through long fibres called as axons which are wrapped in an insulating substance called myelin. In MS , body’s own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer conducts signals.

MS refers to scars(commonly called plaques or lesions)particularly in the white matter (one of two components of CNS) of brain and spinal cord



Causes of multiple sclerosis.

Most commonly MS  are result of some combination of  Genetic

Environmental and possibly vascular factors .


Genetic factors

It is not a hereditary (cannot pass from parents to their offspring’s) disease. However, a number of genetic variations have been shown to increase the risk factors of developing this disease. Apart from this specific genes have been linked with MS. Difference in human leukocyte antigen(HLA system) , a group of genes in the chromosome 6 that serves major Histo compatibility complex. (i.e. a large gene family found in vertebrates, that encodes MHC molecule. MHC molecule plays an important role in immune system and auto immunity.) , in humans that increase the probability of suffering MS.


Environmental factors

MS is common in people live farther from equator, although exceptions exist. Decreased sunlight exposure and decreased vitamin-D production is also linked with high risk of MS. Stress, smoking, occupational exposure and toxins mainly solvents has been evaluated for the cause of MS. Vaccinations may be the casual factor for MS.

Gout may be expected in people with MS to some extent.



Signs and Symptoms of multiple sclerosis

A person with MS can suffer any neurological symptom or sign, including changes in sensations, such as loss of sensitivity, pricking and numbness, hypoesthesia( reduced sense of touch) , paraesthesia( feeling of pricking needle of a limb  when falling asleep), weakness of the muscles, difficulty in moving and there is problem in maintaining balance and coordination., difficulty in speech(dysarthria) and swallowing(dysphagia).  visual problems including nystagmus(involuntary eye movements), optic neuritis(inflammation of optic nerve that may cause partial or complete loss of vision.), diplopia( double vision means perception of two images),

Fatigue, bladder and bowel difficulties. Depression and change in mood is commonly seen. Uhthoff’s phenomena is common  which means  an increase in symptoms occurs due to exposure to slight increase in temperature. Lhermitte’s sign(  bending of the neck leads to pain in the back) is commonly observed.


Types of multiple sclerosis

There are different types of multiple sclerosis

1) Relapsing MS

2) Benign MS

3) Secondary progressive MS

4) Primary progressive MS


Relapsing MS

This means that symptoms disappear and then reappear.


Benign MS

After having multiple sclerosis your  condition hasn’t worsened.


Secondary progressive MS

It means when the person develop multiple sclerosis second time the symptoms become worst this time.


Primary progressive MS

This is when initially being diagnosed with multiple sclerosis that the symptoms get worse at time goes on.


Physiotherapy treatment for multiple sclerosis

Neurological physiotherapist will work with people suffering from multiple sclerosis to set goals and help to meet the aims of that person. This help to improve the quality of their life . treatment plan  include———


a) Improve muscle strength

b) Improve balance , posture and core stability

c) Gait re-education

d) Reduce risk of falls

e) Re-train normal pattern of movement

f) Help to motivate and increase energy level

g) Improve circulation


One of problem with MS is that muscles can weaken and joints can become stiff. Therefore physio will work on preventing this  through use of exercises and stretching techniques. Exercise programme will be specific and work on strengthening the muscle  used in daily activities. Passive stretching is another physiotherapy intervention to prevent stiffness in joints.. physiotherapist work to obtain maximal range of movement. Physiotherapist incorporate certain relaxation techniques in programme like breathing exercises which provide a good way of relaxation.





Article publié pour la première fois le 22/06/2011

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Treatment of Amyotrophic lateral sclerosis ( ALS)

treatment of als

There is no cure for ALS. However  first drug RILUZOLE is used for the treatment. As this drug reduces the  damage to motor neuron by decrease the release of glutamate. This drug does not reverse the damage , which occurs due to motor neuron degeneration. The main goals of treatment is to relieve symptoms and focus on improving the quality of life and make the patient mobile and comfortable. Medication mainly reduce the muscle cramps, fatigue and excess saliva. These  drugs helps to control pain, spasticity, sleep disturbances in patients.

treatment of als

Physical therapy also helps patients to become independent and improve s quality of life. Aerobic exercises like  walking, bicycling can strengthen the muscles which are unaffected and thus improves Cardio vascular health. With the help of stretching exercises Patient helps to reduce spasticity and contractures of muscles. With the use of  certain devices like Braces, walkers or wheel chair patient remain mobile and conserve energy.

Speech therapist also helps to improve the difficulty of speaking. Some  strategies  should be  adapted that makes the patient  speak louder and clearer. Some aids like speech synthesizer and computer based communication is also helpful for the patients.

Nutritionist also plays an important role,  as these patients find difficulty in eating and drinking. Nutritionist plan and prepare  several and small meal sessions through out the day to provide enough calories. Those food should be avoided that are difficult to swallow. In severe cases when the patient is not able to take food, feeding tube is inserted into the stomach that put the food directly to stomach and reduces the risk of choking and pneumonia.

In some cases , due to weakness in muscles due to which breathing becomes difficult, therefore use of nocturnal ventilatory assistance ( intermittent positive pressure ventilation IPPV) or( bilateral positive airway pressure BIPAP) may be used to help breathing during sleep.

Home care  or help with families provide emotional and financial support.

Article publié pour la première fois le 12/03/2013

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Dyslexia is a learning disability(certain learning problems like reading,  writing, reasoning) that can hinder a person’s ability to read, write, spell and something speak. Dyslexia is most common disease found in children and persist through out the  life. It is also referred as specific reading disability. The severity of dyslexia vary from mild to severe. sooner the disease is treated ,more  favourable will be the outcome. children with dyslexia have difficulty in learning. It is also defined as a disorder in children in which he fails to attain the language skills of the reading, writing and spelling. Dyslexia primarily affected boys. Dyslexia is a localized problem, one involving the sounds, and not the meaning, of spoken language. Adult dyslexic may be able to read with good comprehension, but they tend to read more slowly than non- dyslexics and may perform more poorly at nonsense word reading and spelling

Dyslexia can undergo undetected during early decades of schooling. The child become frusturated by the difficulty in  learning to read. The child may show signs of depression. Child may become  unmotivated and disliking for school. These individuals typically read at levels significantly lower than expected normal intelligence.


Types/classification of dyslexia or what causes dyslexia

There are several types of dyslexia that affects child ability to spell as well as read. these are

1) trauma dyslexia

2) primary dyslexia

3) secondary or developmental dyslexia


trauma dyslexia

It usually occurs after some form of  brain trauma or injury to the area of brain that controls reading and writing. It is not commonly found in today’s  population.


Primary dyslexia

This type of dyslexia is a dysfunction of left side of hemisphere/ brain rather than damage. It does not change with age this type of dyslexia is passed through families(hereditary) and is more common in boys.


Secondary/ developmental dyslexia

This type of dyslexia is caused by hormonal development during the early stages of foetal development. Developmental dyslexia diminishes as the child matures and it is more common in boys.

Dyslexia may affect several other functions

Visual dyslexia is characterized by number and letter reversal and the inability to write symbols in correct sequence

Auditory dyslexia involves difficulty with sounds of letters or group of letters. The sounds perceived are jumbled or not heard correctly.

Dysgraphia refers to child’s difficulty in holding and controlling a pencil.


Signs and symptoms of dyslexia

The symptoms of dyslexia depends upon the severity of disease as well as the age of individual. Therefore symptoms can be classified as

a) preschool-aged children

b) early primary school children

c) older primary school children


pre school-aged children

the symptoms include

1)delay in speech

2)slow learning of new words

3)difficulty in rhyming words, as in nursery rhymes

4)low letter knowledge

5)letter reversal or mirror writing.


Early primary school children

Symptoms are

1)difficulty in learning the alphabet or letter order

2)difficulty in identifying or generating rhyming words

3)difficulty segmenting words into individual words

4)difficulty in dictating written words

5)difficulty in associating sounds with the letters


Older primary school children

It include

1)slow or inaccurate reading

2)very poor spelling

3)difficulty reading out loud, reading words in wrong order, skipping words and sometime saying a word similar to the another word

4) tendency to omit or add letters or words when reading and writing

Several learning disabilities often occur with dyslexia, these disabilities include

Dyscalculia– in this condition people understand very complex mathematical concepts and principles but difficulty in learning basic maths facts involving addition and subtraction.

Cluttering-a disorder involving both the rate and rhythm of speech resulting in impaired speech.


Treatment of dyslexia

There are many theories about successful treatment for dyslexia, there is no actual cure for it. The school will develop a plan  with the parents to meet the child’s need. Treatment plan will focus on strengthening the child’s weaknesses. Techniques designed to help all the senses work together efficiently can also be used. Specific reading approaches that require a child to hear, see, say or multi sensory should be affective. Computers are powerful tools for these children and should be utilized as much as possible. Child should be taught compensation and coping skills.


Article publié pour la première fois le 05/07/2011

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Epilepsy and Its types

epilepEpilepsy is also called as seizures.Brain normally controls the body movements by sending small electrical signals through nerves to the muscles but when the brain sends out abnormal signals resulted in seizures or convulsions. Single seizure that does not  happen again is not epilepsy. Seizures vary from person to person. In some people  there is slight shaking of hand, while other people lose conciseness and there is violent shaking of the entire body. Sometime in some people there may be the symptoms of the seizures called as AURA before the seizure takes place. After the seizure the person does not remember the episode.

During seizure there is sudden and  abnormal high discharge of electrical activity among large number of nerve cells in the brain. Epilepsy is one of the most common disorders of CNS, occur 1 people out of every 100 people before the age of 25 . The word epilepsy is derived from Greek word which means “ATTACK” . During seizure , neuron may fire as many as 500 times a second ,much faster than normal. In some people seizure occurs occasionally but for others , it may happen up to hundred of times a day. Epilepsy is not contagious and is not caused by mental illness or mental retardation. Many people with epilepsy have normal or above- average intelligence .Sometimes seizures may cause brain damage if they are severe.


There are different types of seizures. It is mainly divided into two main forms–

Focal  and generalized epilepsy

focal seizure–

It is also called as Partial seizure and occur in just one part of brain. Seizure mainly describe the area of the brain in which it originate. In simple focal seizure person is conscious but experience sudden or unexplained feeling of joy, anger etc. . In complex focal seizure person looses consciousness and may display strange behavior like blinks, mouth movements, twitches etc. These seizures usually last for few seconds.

In some people, there may be stage of AURA an unusual sensation or warning of symptoms of epilepsy. Sometime focal seizures can be misdiagnosed  with migraine headaches which is also dream like state.

Generalized seizure–

This type of seizure occurs on both sides of brain and in this patient looses consciousness and muscle spasm, There are other types of generalized seizures like

PETIT-MAL generalized seizure–

In this type patient continuously starred into space and there is some jerky or twitching movements occur.

TONIC seizure–

In this type there is stiffening of muscles of body, mostly in back, legs or arms.

CLONIC seizures–

Clonic seizures can cause repeated and jerky movements of muscles on both sides.

MYO CLONIC  seizures–

In this there is twitching of upper body arms or legs.

 A TONIC seizures–

In this there is loss of normal muscle tone. The person may fall or drop his head.


This type is increased by flashing lights, bold, contrasting visual patterns.

ABDOMINAL epilepsy–

It commonly occurs in children. Seizure causes abdominal symptoms.

TEMPORAL LOBE seizure or Psycho motor-

There is change in mood, sensation, autonomic functions like heart rate and salivation.


Seizures mainly affects face and sometimes body.



Article publié pour la première fois le 22/03/2013

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Autism and its causes

Autism is a result  of  neurological disorder that  affects the normal brain function and leads to delay in the development of many basic skills like–

1) Ability to socialize

2) Form relationships with others

3) Proper communication

In autism there is intellectual and behavioral disabilities. With autism the different areas of the brain  fails to work together . In autism the child do not  reach the developmental milestones like crawling, Saying the first word etc on time. They are generally slow learners or having low IQ. No two people with autism  will have exactly  same symptoms. Therefore autism also called as Spectrum Disorder.


Autism is a neurological disorder but the cause is unknown. Genetic component indicates the strongest component but environmental , metabolic or immunological factors  also lead to the development of disorder.

1) Genetic cause–

There is no single gene responsible for autism, but there are different genes that combined together and increase  the risk of autism. Autism tend to run in families, so may be  related to inherit.

2) Other causes–

Autism also linked to  some medical conditions like-

a) Metabolic disorders( untreated phenylketonuria)

b) Congenital infections( rubella, toxoplasmosis)

c) Development brain abnormalities ( microcephaly,cerebral dysgenesis)

d) neurological disorders affected after birth ( bacterial menengitis) .

Other theories also plays an important role..

__ It is suggested that body’s immune system produce antibodies that attack the brains of children and lead to autism.

__ Sometime abnormalities  in brain structures also cause autistic behavior in children.

__ Autistic children  have  abnormal timing of  growth of their brains. In early childhood the brain grows faster and larger than the normal children, but later when normal children’s brain get bigger but autistic child brain grows slowly.

__ There is no such evidence that shows vaccine can  cause autism or any kind of behavioral disorder. Childhood vaccines cause autism especially measlesautism  mumps, rubella vaccine. Speculation is that a preservative used in vaccines, “Thimerosol” is responsible for  increase in autism cases.

__ Emotional trauma also plays an important  role. It is believed that early age  emotional trauma especially  bad parents  was blame but this theory was rejected.

Article publié pour la première fois le 14/03/2013

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Treatment of epilepsy

Epilepsy is a group of disorders characterized by  recurrent seizures .Brain normally controls the body movements by sending small electrical signals through nerves to the muscles but when the brain sends out abnormal signals , it results in seizures or convulsions. There are different types of epilepsy and seizures.

Epilepsy drugs are mainly used to control seizures and if  medications are not effective,  then surgery is the option. Most of  epileptic seizures are mainly controlled by  anti epilep treconvulsant drugs. The type of treatment prescribed will depend on several factors like..

 – The frequency and severity of the seizures

 –  Age of the person

  – Overall health of an individual,

  –  Medical history.


Drugs mainly  help to decrease the frequency and intensity of the  seizures. Majority  of   children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also  discontinue their medication after two or more years without seizures.

All epileptic medications have some side effects. Some of the effects include..

1) weight gain

2) Fatigue

3) loss of coordination

4) dizziness

5) loss of bone density

6) speech problems

7) skin rashes  

Some of rare side effects include–

1) Depression

2) Inflammation of some organs like liver , pancreas etc

3) Severe rash

4) Suicidal thoughts etc.

Surgery is most commonly done when tests show that  seizures originate in a small, well-defined area of  brain that doesn’t interfere  vital functions like speech, language or hearing. Most of the patients experience  great reduction in severity and frequency of seizure after surgery. Some of the surgical methods are as follows..

               1)   Multiple sub pial transaction for epilepsy: If the  epileptic seizures is in an area of the brain that is critical to speech or movement, an approach called multiple subpial transection is used. Instead of removing brain tissue, surgeons interrupt nerve fibers on the surface of the brain that carry the impulses which is  responsible for epileptic symptoms.

               2)   Resective surgery for epilepsy: This type of brain surgery removes the specific area of the brain that is responsible for seizures.A resective procedure called temporal lobectomy, in which there is  removal of  portion of the temporal lobe (the most common source of epileptic seizures). This is the most common surgery performed for epilepsy.

               3)   Vagal nerve stimulation for epilepsy (VNS):

It  is a treatment in which there is  placement of  a small pacemaker under the skin near the vagal nerve in the side of the neck. This device regulates electrical activity in the brain, and in some  patients , it  reduces the frequency and severity of the seizures..


Article publié pour la première fois le 24/04/2013

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Parkinson’s Disease

parkinsons disease


Parkinson’s  Disease


parkinsons disease

A progressive disorder of the nervous system that mainly affects elderly people most often after the age of 50, which is  associated with the destruction of brain cells that produce  Dopamine . dopamine is a neurotransmitter formed in brain which is essential for normal functioning of CNS. Parkinson’s disease is also known as Paralysis agitans, Shaking Palsy. Males and females are equally affected. Slowness of movement and an inability to start a movement are hallmarks of the disease.

The pathologic change ( which causes the disease ) is degeneration / depletion of a group of nerve cell deep within the centre of the brain in an area called  “Substantia Nigra “ substantia nigra is the layer of a large pigmented nerve cells in the mid brain that produces dopamine. These  cells  use  dopamine to signal other nerve cells. As these cells stop functioning, dopamine fails to reach the areas of the brain that affect  motor function.


What causes Parkinson’s disease

Low level of dopamine ,a chemical involved in controlling movement. The shortage of this chemical occurs when nerve cells in a part of the brain ( substantia nigra ) that produces dopamine fails and deteriorate. There is  link between the Parkinson’s disease and factors such as Genetics, aging , toxins in environment and free radicals to some extent.


Symptoms of Parkinson’s disease

The type and severity of symptoms experienced by a person with Parkinson’s disease vary with each individual and the stage of Parkinson disease. Symptoms that develop in the early stages of the disease in one person may not develop until later or not at all in another person. Symptoms of Parkinson’s disease typically begin appearing between the age 50 and 60. They develop slowly and often go unnoticed by family, friends and even the person who has them.

A small number of people have symptoms on only one side of the body that never progress to the other side. The most common symptoms include

1) Tremors

2) Rigidity

3) Bradykinesia

4) Parkinson’s mask

5) Flexed or stooped posture



Tremors( involuntary, shaking, rhythmic or twitching movements) or shaking occur most commonly in hands, arms or legs. These tremors occurs when the person is awake and sitting or standing still (resting tremors) and subsides when the person moves the affected body part. Initially  tremors may appear in just one arm or leg or only one side of the body . it also affects chin , lips  and tongue.  As disease progress spread to both sides of body , but in some cases it remains on just one side. Emotions and physical stress tend to make it more  noticeable sleep. Relaxation reduce or  stop tremors.


Stiff muscles (rigidity) and aching muscles

One of the most common early sign of Parkinson’s disease is reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of legs, face, neck or other parts of body and may cause muscles to feel tired and achy.


Slow, limited movement ( bradykinesia)

When the person tries to move from a resting position ,there may be difficulty in performing tasks like difficulty in getting out of chair, or turn over in bed.


Weakness of face and throat muscles (Parkinson’s mask)

Due to the weakness of muscles of face and throat talking and swallowing becomes more difficult and person may cough, choke or drool. Speech becomes soft. Loss of movement in muscles of face can cause fixed facial expression often called Parkinson’s face.


Stooped or flexed posture

In such patients there is difficulty in walking and balance. patient usually take small steps and shuffle with his or her feet close together and bend forward slightly at the waist (called stooped posture)and have trouble in turning around.


In addition to these symptoms Parkinson’s patient show other features also

a)      Decrease coordination, changes in handwriting are common with writing become smaller . activities such as dressing and eating becomes difficult.

b)       There is cramps in the muscles and joints.

c)      Oily skin and increased dandruff

d)     Digestive and urinary problems are there, controlling urination may be difficult or sometimes there may be urgency . patient usually complaints of constipation.

e)      There is increased sweating, low B.P when person stands up(orthostatic hypotension). There is problem with sexual function.

f)       Freezing is common i.e. sudden inability to move.

g)      Problem in falling asleep(insomnia) which is due to depression or physical restlessness. These people may not be able to sleep because they cannot turn over or change position in bed.


Physiotherapy treatment of Parkinson’s disease

Exercise is an important part of treatment for the people with Parkinson’s disease. physiotherapist mainly focuses on

1)maintain muscle strength and improve coordination

2) maintain and increase endurance

3)improve flexibility and range of motion

4)improve cardiovascular fitness

5) control weight

6)reduce the likelihood of becoming constipated

7) improve balance and walking

8 ) use of walking aids correctly

Physiotherapy help to learn exercises and stretches to do at home to improve posture, strength, flexibility and endurance. Recognizing and dealing with depression is a important part of home treatment. Physiotherapy relieve muscle and joint stiffness and discomfort by the use of exercise, relaxation, physical treatment such as heat and cooling and by carefully moving joints and by stretching muscles(manipulation). People with Parkinson’s disease often develop difficulties with everyday actions such as walking, getting up from chair, turning over and getting in and out of bed. These teach how to get round these problems  and make it easier. They recommend any walking aids and appliances and other equipment that would be suitable.


Article publié pour la première fois le 13/09/2016

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Risk factors, types and diagnosis of Autism—

                                              There is no main reason for autism, but still research is going on . Some of the risk factors that may increase the
chances of autism. Some of the important risk factors are as follows–
1) Dietary factors
2) mercury poisoning
3) Inability of body to make proper use of vitamins and muscles.
4) Vaccine sensitivity owing to thimerosal
5) Breech position of baby
6) Low apgar score( Apgar score is an index which is mainly used to assess the condition of newborn at birth and five minutes after birth)
7) Birth before 35 weeks of pregnancy
8) Parental history of schizophrenia or psychosis, depression and bipolar disorder.

Types of Autism—

Autism classified as Pervasive development disorder which is category of disorders that are interchangeably with broad spectrum of
disorders mainly affecting young , children and adults called as ” Autism spectrum disorders(ASD).
Autism can be associated with other disorders like mental retardation and other medical conditions. Autism
ranges from mild to severe.

Diagnosis of Autism—

Diagnosis of autism is important because if autism is diagnosed early, more will be the chances of improvement. When there is
developmental delay in a child,further testing can help doctor whether problem is related to autism or other developmental disorder.
Therefore certain assessment has to be followed. Assessment include–
1) Behavioral assessment
2) Developmental or intelligence tests
3) Physical assessments or lab tests

Behavioral assessment include —
a) Medical history— During this part, doctor generally ask questions about child’s development.
b) Observation— Doctor want to observe the child in different situations.

Developmental or intelligence tests–
Certain tests should be done in order to check where developmental delay affects the thinking ability of the patients.

Physical assessments or Lab tests–
Physical examination can be done which include the measurement of weight, height or circumference of head in order to check the normal
growth. Hearing tests should be done especially related to social skills. Other tests like testing for lead poisoning also known as
PICA ( in which person crave for substances other than food like flecks of old paint etc). Children having delayed milestones
usually continue put items in their mouth even after this stage has passed in normally developing children.
Lab tests like chromosomal analysis may be done if there is history of intellectual disability.
Electroencephalograph is done, if there are symptoms of seizures. MRI may be done, if there are signs of difference in structure of

Early detection should be helpful. If certain signs should be discovered–
__ No babbling, pointing by 12 months.
__ No single words by 16 months.
__ Loss of language or social skills at any age.

Article publié pour la première fois le 20/03/2013

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Condition characterized by moderate to severe headache and nausea. It is 3 times more common in women than men. The typical migraine headache is unilateral (affecting one half of head), lasting from 4 to 72 hours. Approximately one-third of people who suffer from migraine headache perceive an aura. aura may be transient visual, sensory, language or motor disturbances which means that migraine will soon occur. A migraine headache is a form of vascular headache it is caused by vasodilatation(enlargement of blood vessels) that cause the release of chemicals from the nerve fibres that coil around the large arteries of  brain. Enlargement of these blood vessels stretches the nerves that coil around them and cause nerves to release chemicals. These chemicals cause inflammation., pain and further enlargement of the artery. This increasing enlargement of the arteries magnifies the pain.

Migraine commonly activate the sympathetic nervous system in the body. The sympathetic nervous system thought of as apart of nervous system that controls  and responses to stress and pain and this activation causes symptoms associated  with migraine attacks.



There are different classes of migraine which are given as under…..

1)migraine without Aura/ common migraine

2)migraine with Aura

3)Basilar sporadic migraine

4)retinal migraine


Migraine without Aura/common Aura

It involves migraine headache that are not accompanied by any aura(visual disturbances). Visual disturbances in the form of flashes of white/black lights or formation of zigzag  lines, or sometimes temporary blindness of one eye.


Migraine with Aura

It usually involves migraine headache accompanied by an aura. Less commonly an aura can occur without a headache or with a non-migraine headache. Two other varieties are familial hemiplegics migraine  and sporadic hemiplegics migraine, in which patient has migraine with aura and with motor weakness. If close relative had same type of condition then it is said to be familial hemiplegics migraine.


Basilar sporadic migraine

In this type of migraine, migraine and aura is usually accompanied by difficulty in speaking, vertigo, ringing in ears.


Retinal migraine

It involves migraine headache accompanied by visual disturbances or even temporary blindness on one eye.


Causes of migraine

Causes of migraine include triggers, serotonin, neural.


1)      Triggers


Migraine can be induced by triggers common triggers are stress, hunger, fatigue. Monosodium glutamate is frequently reported as dietary trigger. It also occur around menstruation, other hormonal influences such as menarche, oral contraceptives use, pregnancy, menopause also play an important role.


2)      serotonin


it is a type of transmitter, or communication chemical, which passes message between nerve cells. It helps to control mood, pain sensations, sexual behaviour, sleep as well as dilation and constriction of blood vessels. Lower level of serotonin in brain lead to constriction and dilation of blood vessels which triggers migraine.



When certain nerve or an area of brain become irritated migraine begins,in response to this body release chemical that cause inflammation and further irritation of nerves occur and results in pain.


Signs of migraine

Migraine typically presents with headache, severity of pain, duration and frequency is variable. Four possible phases of migraine occur

a)      prodrome occurs hours or days before headache

b)      aura immediately precedes headache

c)      pain phase/headache phase

d)     postdrome


prodrome phase

it occurs in 40-60% of patients having migraine. It consists of altered mood, irritability, depression , fatigue, yawning, excessive sleepiness, craving for certain food(chocolate), dizziness, stiff muscles especially neck muscles, hot arms, constipation/diarrhoea, increased/decreased urination.


Aura phase

20-30% sufferers experience migraine with aura. They appear gradually over 5-20 minutes and lasts for 60 minutes but sometime delayed up to several hours and can be missing entirely(silent migraine).

Visual aura consist of flashes of white/black, multicoloured lights(photophobia)or formation of dizzling  zig zag lines(scintillating scotoma). Some patients complaints of blurred vision or shimmery or cloudy vision, as they were looking through thick or smoked glasses.

Par aesthesia i.e. feeling of pins and needles experienced in hands and arms as well as in nose mouth area on same side.


Pain/headache phase

During this phase migraine headache is unilateral(one side of head), moderate to start at one side  and become generalized. Pain peaks and then subsides and usually lasts 4-72 hours in children. Frequency of attack is variable from few in life time to several a week. Headache accompanied by nausea(90%)and vomiting. Photophobia(intolerant to bright light), phonophobia(intolerant to loud noise) and osmophobia(fear or hypersensitivity to smell), blurred vision, nasal stuffiness. Diarrhoea or sweating may occur. There may be localized oedema of scalp or face, scalp tenderness, prominence of vein or artery in temple, tenderness of neck, disturbance in mood is common. Extremity tend to fell cold and moist. Sometime light headedness and feeling of faintness may occur.


Postdrome phase



Patient may feel tiredness and have head pain, gastric problems, mood changes and weakness of the body.


Diagnosis of migraine


a)      five or more attacks. For migraine with aura,2 attacks are sufficient

b) 4 hors to 3 days in duration

c) It may be unilateral(affecting half the body), moderate or sever pain in intensity, aggravation by or causing avoidance of routine physical activity

d) Presence of nausea or vomiting or sensitivity to both light and sound.

Migraine can be differentiated from other headache—- there is  extreme painful  headache, unilateral hardly 15 minutes to 3 hours. Onset is rapid.



Treatment of  migraine

Beta blockers mainly propanolol, atenolol and metaprolol. calcium channel blockers mainly amlodipine, flunarazine and verapamil. Anti convulsants like sodium valproate. Tricyclic anti depressants are commonly used. In addition to this nefazodone, amitriptyline commonly used for migraine. Low dose aspirin is beneficial for the occurrence of migraine sometime paracetamol alone or in combination with metaclopromide is given. Dihydroergotamine is also useful to some extent.


Physiotherapy treatment of migraine

Physiotherapy uses mobilization and manipulation of joints and muscles in the neck. Therapist will suggest exercises that will help with muscle function and rehabilitation. Physio employ ultrasound or electrotherapy to ease muscle tension. Another effective treatment used to treat pain is hydrotherapy. It involves the use of water to ease pain. Use of hot water bath and cold water bath is done. Placing your feet in hot water and then put an ice pack or cold cloth on head where the pain is more intense. This stimulates circulation and eases tension in the muscles.


Article publié pour la première fois le 02/07/2011

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Symptoms and diagnosis of cerebral palsy

symptoms of cerebral palsy


symptoms of cerebral palsy


Symptoms of cerebral palsy differs from person to person. These symptoms  ranges from mild to severe. It mainly involves one side or both sides of the body or involves both arms and the legs. These symptoms mainly seen before 2 years of age and sometimes it can be  seen as early as 3 months. most of the time parents mislead  about children delay in reaching or developmental stages like  rolling, crawling and sitting.

Symptoms of  spastic cerebral palsy include tightness in muscles, gait become abnormal and arms get tucked toward the sides, legs make ” SCISSORS”. Joint contractures are common i.e. joint becomes tight and do not open up all the way. There is weakness in the muscles or loss of movements mainly in the group of muscles. Abnormal movements like Twisting or writhing in hands, feet or legs get worsen during stressful conditions. Tremors are also common. There is loss of coordination.

Learning disabilities are common but intelligence is normal. Speech problem i.e. dysarthria is common. Hearing or visual problems can be felt. Seizures  are very common. Sometime adult patients  feel pain which is very difficult to manage. Usually there is difficulty in sucking or feeding in infants. Problem in swallowing or feeling of vomiting or constipation occurs. Irregular breathing occurs. Urinary continence is common. In some cases patient may drool also.


There is mainly no medical test that confirms cerebral palsy. Diagnosis mainly involves medical history of both mother’s and father’s families. Check mother’s medical problems before and during pregnancy. Various blood and urine test may be checked. In order to rule out genetic syndrome analysis of child chromosome or DNA testing should be done. Other tests include–


It can be done in order to detect various type of abnormalities. With ultrasound you can show bleeding in the brain or damage due to lack of oxygen to the brain.


With this you can identify malformation , hemorrhages or certain abnormalities more clearer than the ultrasound.


With this test you can identify brain structures and their abnormalities.


With this test you can identify certain seizure disorders.


It may be helpful in differentiating Cerebral palsy from other muscle or nerve disorders.


Article publié pour la première fois le 06/03/2013

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Cerebral palsy stages and Risk factors..

stage of cp


Cerebral palsy is a group of disorders that mainly affects  body movements, balance and posture. In simple words Cerebral palsy  is also known as BRAIN PARALYSIS. It mainly affects the early childhood i.e. during infancy . In this disease , there is delay in the developmental milestones such as rolling , crawling, sitting and walking.

Cerebral palsy is mainly caused  because of damage in one or more parts of the brain that mainly controls the movements of the muscles  and its tone which  leads to the in coordination of the movements. Patient finds difficulty in  normal activities like balance, walking, speaking and swallowing.

stage of cp



Cerebral palsy has many types.The main  types of Cerebral palsy..

1) Spastic  Cerebral palsy

2) Dys kinetic  cerebral palsy

3) mixed cerebral palsy.

  Spastic cerebral palsy–

In spastic cerebral palsy there is increased in the muscle tone. Classification of this type mainly  depends on the body part affected. For example if both the legs are affected it is known as DIPLEGIA. In some cases there is involvement of one side of body then it is called as HEMIPLEGIA. When whole body involvement is there it is known as QUADRIPLEGIA.

   Dyskinetic cerebral palsy–

It mainly affects  coordination of movements. It is further divided into

a) Athetoid  cerebral palsy—– In this the person has uncontrolled movements and these movements can affect any part of the body including  face , mouth, or tongue.

b) Ataxic Cerebral palsy— It mainly affects  balance and coordination of the patient. In this deep perception is mainly affected. Gait of the person is improper. Patient generally finds difficulty in standing.

 Mixed Cerebral palsy–

The other type is mixed type which mainly involves combination of spastic and athetoid  cerebral palsy.


Cerebral palsy mainly involves the brain and nervous system  functions. Most of these problem occurs during first  2 years of life or sometimes while the baby’s brain is still developing. There is involvement of many risk factors that can cause cerebral palsy

1) Premature infants have the highest risk  of developing cerebral palsy  because of under development of many organs of the body.

2) Infection of brain like Encephalitis ( inflammation , irritation or swelling of the brain) , meningitis ( bacterial infection of the membranes covering meninges and spinal cord) or herpes simplex infection.

3) Infection  to the mother during pregnancy due to rubella virus.

4) Head injury or bleeding in the brain.

5) RH factor in compatibility– Difference in the mother and fetus blood causes brain damage in fetus . Most of the times it is detects early and treated in women.

6) Hypoxia  lack of oxygen  reaching the brain before or after the birth.

7) Severe jaundice.

8) Complications during labor or delivery.



Article publié pour la première fois le 06/03/2013

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Spina bifida or Cleft Spine


Spina bifida or Cleft Spine


Spina bifida is a birth defect that involves the incomplete development of the spinal cord or its coverings. The term spina bifida means “split” or “open” spine. Spina bifida is part of a group of birth defects called neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby’s brain and spinal cord and the tissues that enclose them. Most children who have spina bifida do not have problems from it

Spina bifida occurs at the end of the first month of pregnancy when the two sides of the embryo’s spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away. Other neural tube defects include amencephaly, a condition in which the portion of the neural tube which will become the cerebrum does not close, and encephalocele, which results when other parts of the brain remain unfused.


What causes spina bifida

The exact cause of this birth defect is not known. Genes and environment factors are said to be the most important cause women who have had one child with spina bifida are more likely to have another child with the disease environmental factors, such as nutrition and exposure to harmful substances, probably contribute to spina bifida. Spina bifida does seem to run in families, spina bifida can be prevented by adequate intake of folic acid. Folic acid, one of the B vitamins that is a key factor in the synthesis (the making) of nucleic acid (DNA and RNA).   before and during early pregnancy people with spina bifida appear to have abnormal  metabolism of folic acid. spina bifida may be an inborn defect in folic acid metabolism rather than a simple deficiency in this nutrient. A high fever during pregnancy may increase a woman’s chances of having a baby with spina bifida. Women with epilepsy who have taken the drug valproic acid to control seizures may have an increased risk of having a baby with spina bifida.


Types of spina bifida


The different types of spina bifida are—-


1) spina bifida occulta

2) spina bifida cystica

3) meningocele

4) myelomeningocele



spina bifida occulta


“occulta means hidden, defect is not visible or without symptoms. This is the mildest forms of spina bifida.  In occulta, the outer part of some of the vertebrae are not completely closed. The split in the vertebrae is so small that the spinal cord does not protrude. The skin at the site of the lesion may be normal, or it may have some hair growing from it; there may be a dimple in the skin, or a birthmark Most children with this type of defect never have any health problems, and the spinal cord is often unaffected. Spina bifida occulta is rarely linked with complications or symptoms. Spina bifida occulta is usually discovered accidentally when the person has an x-ray or MRI for some other reason


Spina bifida cystica

In spina bifida cystica, a cyst protrudes through the defect in the vertebral arch. spina bifida cystica may result in hydrocephalus and neurological deficits



The least common form of spina bifida is a posterior meningocele (or meningeal cyst involves the meninges, the membranes responsible for covering and protecting the brain and spinal cord. If the meninges push through the hole in the vertebrae (the small, ring-like bones that make up the spinal column), the sac is called a meningocele Fluid leaks out of the spine and pushes against the skin. You may see a bulge in the skin. In many cases, there are no other symptoms..In a posterior meningocele, the vertebrae develop normally, however the meninges are forced into the gaps between the vertebrae. As the nervous system remains undamaged, individuals with meningocele are unlikely to suffer long-term health problems, Symptoms can vary from none to partial paralysis, but these cysts can sometimes be removed with surgery, allowing the child to develop normally.




is the most severe form of spina bifida. It occurs when the meninges push through the hole in the back, and the spinal cord also pushes though. Most babies who are born with this type of spina bifida also have hydrocephalus, an accumulation of fluid in and around the brain. ecause of the abnormal development of and damage to the spinal cord, a child with myelomeningocele typically has some paralysis. The degree of paralysis largely depends on where the opening occurs in the spine. The higher the opening is on the back, the more severe the paralysis tends to be. Part of the spinal nerves push out of the spinal canal, and you may see a bulge in the skin. The nerves are often damaged, which can cause problems with walking, bladder or bowel control, and coordination. In some babies, the skin is o pen and the nerves are exposed . this is the type of spina bifida that causes the vast majority of disability. The exposure of these nerves and tissues make the baby more prone to life-threatening infections. Many individuals with spina bifida will have an associated abnormality of the cerebellum, called the Arnold Chiari II malformation In affected individuals the back portion of the brain is displaced from the back of the skull down into the upper neck.


Risk factors of spina bifida

  • Race. Spina bifida is more common among whites and Hispanics.
  • Family history of neural tube defects. Couples who’ve had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect

Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a fetus. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects

  • Some medications. Anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, perhaps because they interfere with the body’s ability to use folate and folic acid.
  • Diabetes. Women with diabetes who don’t control their blood sugar well have a higher risk of having a baby with spina bifida.
  • Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida.
  • Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early months of pregnancy may increase the risk of spina bifida.


Signs and symptoms of spina bifida

child’s symptoms will depend on how severe the defect is.

Spina bifida occurs in three forms, each varying in severity:

Spina bifida occulta. This mildest form results in a small separation or gap in one or more of the bones (vertebrae) of the spine. Because the spinal nerves usually aren’t involved, most children with this form of spina bifida have no signs or symptoms and experience no neurological problems. An abnormal tuft of hair, a collection of fat, a small dimple o a birthmark on the newborn’s skin above the spinal defect may be the only visible indication of t he condition.



Meningocele. In this rare form, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae. abies who are born with the meningocele form have a fluid-filled sac visible on the back. The sac is often covered by a thin layer of skin and can be as small as a grape or as large as a grapefruit.

Myelomeningocele n myelomeningocele, the baby’s spinal canal remains open along several vertebrae in the lower or middle back. Because of this opening, both the membranes and the spinal cord protrude at birth, forming a sac on the baby’s back. In some cases, skin covers the sac. Usually, however, tissues and nerves are exposed, making the baby prone to life-threatening infections.

Neurological impairment — often including loss of movement (paralysis) — is common. So are bowel and bladder problems, seizures and other medical complications. Many children who have severe spina bifida develop an allergy to latex (a type of rubber) Spine, hip, foot, and leg deformities are often due to imbalances in The most common bladder and bowel problems are inability to voluntarily relax the muscles (sphincters) that hold urine in the bladder and muscle strength and function resulting mostly from residual paralysis .  there is foot or leg deformities, hip dislocation, or scoliosis.

Diagnosis of spina bifida

Pregnant woman can have a blood test (maternal serum triple or quadruple screen) and a fetal ultrasound to check for spina bifida and other problems with the fetus.

If test results suggest a birth defect, she can choose to have an amniocentesis. This test helps confirm if spina bifida exists. But the test also has risks, such as a chance of miscarriage.

Treatment of spina bifida

Treatment depends on how severe the defect is. Most children with spina bifida have only a mild defect and may not need treatment. But a child with a severe defect may need surgery. If child has problems from nerve damage, he or she may need a brace or a wheelchair, physical therapy, or other aids. If y child has bladder control problems, he can use a catheter each day. It can help prevent infection and kidney damage in the child , child has little or no feeling in the limbs and can’t sense pain, he or she may get injured and not know it. the need  is to check the child’s skin each day for cuts, bruises, or other sores. A baby who also has hydrocephalus will need an operation to place a shunt in the brain. The shunt is a thin tube that helps to relieve pressure on the brain by draining and diverting extra fluid. Most affected individuals will need to  use braces, crutches walkers or wheelchairs to maximize their mobility



Article publié pour la première fois le 10/07/2011

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Amyotrophic lateral sclerosis ( ALS) and Risk factors

Risk factors of ALS

This disease is also known as GEHRIG”S syndrome. It is  disease  that progresses rapidly and mainly attacks the neurons ( nerve cells) of the brain which is responsible for voluntary contraction of muscles  and hence belongs to group of disorders called as motor neuron  disease , in which there is gradual degeneration and death of the neurons takes place and results in muscle weakness, disability and death of the person.

Motor neurons reaches from brain to spinal cord and from spinal cord to the muscles of the body. During this disease when the motor neurons die, the ability of brain to control movements are lost  and voluntary muscle action get affected results in total paralysis.. In Greek language word amyotropic means  ” No muscle nourishment.” when there is lack of  nutrition to the  muscle , it atrophies means waste away and ” lateral ” describes the area in the  spinal cord where the nerve cells are located which is mainly responsible for control the activities.  This disease was diagnosed in 1939 in a famous base ball player. Most commonly this disease occur between the ages of 40 and 70 years. this disease occur in 1-3 people/100,000 and 90-95% of doctors donot know why ALS occurs. Men are affected slightly more than women. Patients  do not have family history of disease are not considered to be the increased risk of ALS. Specific genetic defects lead to mutation of the  enzyme known as Superoxide di mutase 1 ( SOD1) is found to be a possible  cause of motor neuron death in ALS.


Risk factors of ALS
Risk factors of ALS

There is no clear risk factors associated with ALS. In most of the cases ( 90-95%) diseases occurs randomly. This is called as sporadic ALS. Some other risk factors are–

1) Neurotoxin exposure or exposure to heavy metals or viruses are believed to be the trigger factor.

2) sometime damaging nerve fibers during surgery is also responsible for causing ALS.

3) Recent studies showed that people who are in military are of higher risk of ALS. The exact cause of development of ALS in military people is not sure but it may be due to certain traumatic injuries, some kind of viral infections, exertion or exposure to  certain metals or chemicals

4) There is possible connection between the disease and exposure to pesticides may be evident due to increase in incidence among soccer players.

5) smoking increase the risk of ALS  than in non smokers.

6) Age factors is also responsible. People between 40-60 years of age are of higher chances to have ALS.

7) Before age of 65 more  men than women develop ALS, but the sex difference disappears after age of 70 years.

Article publié pour la première fois le 12/03/2013

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Hydrocephalus and its types

Hydrocephalus is  defined as a condition which is mainly characterized by excessive accumulation of fluid in the brain.Hydrocephalus can be classified as congenital or acquired. The  indication of hydrocephalus in children and infants is  rapid increase  circumference of head  or an unusual increase in head size.  Hydrocephalus is mainly  derived from the Greek words “hydro”  which means water and “cephalus” means  head.  Hydrocephalus  is a condition in which there  is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as “water on the brain,””water actually means  cerebrospinal fluid (CSF) — It is  a clear fluid that  mainly surrounds the brain and spinal cord.Due to the excessive accumulation of CSF there is  abnormal widening of   spaces in the brain called ventricles. This widening creates  harmful pressure on the tissues of the brain.

The ventricular system is made up of four ventricles  which are connected by narrow passages.. Normally, CSF flows through these ventricles, exits into cisterns,  at the base of the brain, bathes the surfaces of the brain and spinal cord, and then reabsorbs into the bloodstream. CSF performs many functions

1)  It act as a cushion or “shock absorber”

2)It  helps to  deliver  nutrients to the brain and remove wastes from body

3)It helps  to maintain  flow between the cranium and spine and compensate for changes in intracranial blood volume (the amount of blood within the brain). The balance between production and absorption of CSF is critically important. Because CSF is made continuously,  medical conditions that block its normal flow or absorption will result in an over-accumulation of CSF.  The resulting pressure of the fluid against brain tissue is what causes hydrocephalus.


Hydrocephalus may be  classified as congenital or acquired.


Congenital hydrocephalus is  mainly present at birth and it may  be caused by  events or influences that occur during fetal development, or genetic abnormalities.


Acquired hydrocephalus develops at the time of birth or after sometime. This type of hydrocephalus can affect individuals of all ages and may be caused by injury or disease.

Hydrocephalus can  also be divided into communicating or non-communicating


Communicating hydrocephalus occurs when there is blockage in the  flow of CSF  after it exits the ventricles. This form is called communicating because the CSF can still flow between the ventricles, which remain open.


Non-communicating hydrocephalus – also called “obstructive” hydrocephalus –  It mainly occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles. One of the most common causes of hydrocephalus is “aqueductal stenosis.” In this case, hydrocephalus results from a narrowing of the aqueduct of Sylvius, a small passage between the third and fourth ventricles in the middle of the brain.

Other forms of hydrocephalus are  hydrocephalus ex-vacuo and normal pressure hydrocephalus.

Hydrocephalus ex-vacuo occurs when there is  stroke or some  traumatic injury  to the brain and causes damage . In these cases, brain tissue may actually shrink. Normal pressure hydrocephalus can happen to people at any age, but it is most common among the elderly. It may be due to sub arachnoid hemorrhage, head trauma, infection, tumor, or complications of surgery.


Article publié pour la première fois le 11/04/2013

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Symptoms of Autism

symptoms of autism                                                                          No two people with autism will have exactly same symptoms, but all people with  autism have some common  symptoms. There is significant problem in  developing non verbal communication skills such as facial expressions, body posture, eye to eye  gazing etc. Child feel fail to establish friendship with children of same age. There is lack of interest in sharing enjoyment, interests or achievements with other people. There is also lack of empathy. Autistic patients finds difficulty in understanding other person’s feeling like pain etc.

There is lack of awareness of feeling and emotions such as laughing , crying etc. These patients remain aloof and find difficulty in interacting with other people. There is repetitive body movements ( hand flapping) , abnormal posture ( toe walking) . Behavioral symptoms like extreme under activity or over activity is common. Self- injurious behavior is present. They have no apparent fear of  dangerous situation. Sometime there is lack or delay in talk. About 40% people never  speak. There is also problem to start conversation and find difficulty in continuing a conversation. There is repetitive use of language  and repeat words again and again, they heard previously called as ECHOLALIA. Autistic patients mainly  focus on pieces of toys such as wheels of car rather than playing with entire toy. They have need for sameness and routines , means these child always insist on driving same route everyday to school.

Symptoms during childhood—

Symptoms of autism mainly noticed by their parents or caregivers during the first 3 years. Autism is present at birth i.e it is congenital, but the signs of disorder or diagnosis during infancy is very difficult. During childhood, toddler does not interested in playing games or find difficulty  to talk. Sometime  they begin to talk  same as that of normal child but later on lost their language  skills. There is also hearing problem. Sometime it seems that the child is deaf but other time it appears that they hear distant sounds.

Symptoms during teen years—

During teen years, the behavior of child changes. Many teens gain their skills but still lack  their ability  to understand others. During teen years, they are of higher  risk of developing problems like depression, anxiety and epilepsy .

Symptoms in adults—

With autism , an adult can live their independent life,depends on their intelligence and  ability  to communicate . Some adults need assistance  as  some of them  are not able to speak, hear etc.



Article publié pour la première fois le 30/09/2016

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Treatment of autism

The main goals of treating child with autism is to decrease  associated defects and family distress. Main focus is to increase the quality of life and functional independence. Autism patients have additional medical conditions such as  sleep disturbances, seizures etc, therefore variety of therapies are included to treat autism___

1) Medications

2) Behavior analysis

3) occupational therapy

4) Physical therapy

5) speech- language therapy

The best treatment involves the combination of techniques.


There is no medication that control the main symptoms of ASD, but there are medications that help patients with related symptoms like aggression  anxiety, attention problem,impulsiveness, irritability, mood swings, sleep difficulty, tantrums etc. Some autistic patients also respond to gluten- free or casein- free diet.

Applied behavior analysis(ABA)—

It is used as one of the approach. The main goal is to get the child close to the normal developmental functioning. Many type of treatments like applied behavioral analysis(ABA) . Treatment and education of autistic and related communication handicapped children (TEACCH) and sensory integration.

In TEACCH picture schedule are used and other visual cues that help the child work independently and through this there is improvement in child’s adaptation and skills. ABA programs usually done under behavioral psychologist  supervision.

Specialized Therapy—

Some other therapies like speech therapy, occupational therapy or physical therapy also plays an important role.

Speech therapist helps to improve language and some social skills so that autistic child can communicate effectively.

occupational therapist and physical therapist also helps to improve coordination and motor skills. Occupational therapy can also help patients to learn to process information from senses( sight, sound, hearing, touch and smell) in more manageable ways.

Stem cell therapy for autism—

It is an effective approach for the treatment of autism and mainly based on ability of  stem cells to influence metabolism, immune system and restore damaged cells and tissues.Stem cells treatment improves blood and oxygen flow to the brain, replace damaged neurons and stimulates formation of new arteries. Stem cells leads to white and gray matter restoration and thus improves intellectual capacity. Mesenchymal stem cells improve immune system. CD34 stimulation helps formation of new arteries in hypoxic tissues  and thus increase blood flow in temporal and other parts of brain

After stem therapy following improvements seen in children–

1) Better tolerance of food and thus improves digestion.

2) Children able to fix their gaze.

3) Less fear of loud movies, bright colors etc

4) Improvement in writing skills

5) Improve attention span and concentration.


Article publié pour la première fois le 20/03/2013

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Hydrocephalus and its causes

Hydrocephalus is a condition in which there is excessive accumulation of fluid in brain and it  is mainly caused by an imbalance between how much cerebro spinal fluid is produced and how much is absorbed into the bloodstream.


Cerebrospinal fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles by way of interconnecting channels and eventually flows into spaces around the brain and spinal column. It’s absorbed primarily by blood vessels in tissues near the base of the brain. Cerebrospinal fluid plays an important role in brain

1)  It keeps the brain buoyant, allows heavy brain to float within the skull

2) Act as a cushion for  the brain to prevent injury.

3) It helps in the removal of  waste products of the brain’s metabolism

4)Flowing back and forth between the brain cavity and spinal column to maintain a constant pressure within the brain — compensating for changes in  blood pressure in the brain.


Excess cerebrospinal fluid in the ventricles occurs because of the following reashydrocephalus ons….

1)  Obstruction. The most common cause of excessive CSF  is  partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from  the ventricles to other spaces around the brain.

2)Poor absorption. Sometimes there  is a problem in  the mechanisms that makes  the blood vessels to absorb cerebral spinal fluid.This mainly occurs due  to inflammation of brain tissues from disease or injury.

3) Overproduction. In some of cases  the production of cerebrospinal fluid is  more than normal and more quickly than it can be absorbed.

   Congenital hydrocephalus  occurs at the time of birth or  during fetal development  . The main Causes include infections (e.g., cytomegalovirus [CMV], toxoplasmosis, rubella) and hemorrhaging or internal bleeding in the brain. Here are some of congenital malformations  that are commonly associated with CSF obstruction:

1) Aqueductal stenosis– It is narrowing of the pathway to the fourth ventricle

2)Arnold-Chiari malformations– condition in which small part of the cerebellum protrudes into the spinal canal

3)Dandy-Walker syndrome– There is enlarged fourth ventricle due to obstruction in pathway

4) Spina bifida–portion of the spinal cord is pushed through an abnormal opening between two vertebrae.

 Acquired hydrocephalus can occur at any age.  Some of the  conditions may cause CSF obstruction and leads to acquired hydrocephalus:

1)Bleeding (hemorrhage)

2) trauma of brain (i.e., result of injury)

3)tumor in brain

4)Cyst (i.e., a fluid-filled sac)

5)Infection (e.g., cerebral abscess, bacterial meningitis)





Article publié pour la première fois le 14/04/2013

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Cover letter sample for Microbiologist

Cover letter sample for Microbiologist

Sender’s Address

City, State, Zip code



Name of person (Recipient’s)




City, State, Zip code


Dear Mr. Last Name,

I came across your post on for a Microbiologist. I am enclosing my resume and believe once you review my experience and education you will see why I thought this position an ideal for for both of us.

I bring over 15 years of experience in the field to the table.  I have an advanced degree in microbiology and have built on that education in the professional study of microorganism through research analysis and environmental compliance. I have a thorough history as a microbiologist studying the function and structure of organisms finding ways to control and utilize them to the benefit of the industry medicine and agriculture. I have a demonstrated ability to administer the work of biological technicians and set up technical reports, study papers, and recommendations derived from research findings.

I believe I am the best and most qualified candidate for the job. Please contact me at your earliest convenience to arrange an interview to further discuss my qualification. Thank you for your time and consideration.




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Cerebral Palsy

cerebral palsy



cerebral palsy

It is defined as a term used to describe a group of chronic conditions affecting body movements and muscle coordination. “cerebral” refers to the “ brain”  and “ palsy” to a disorder of movement or posture. If someone has cerebral palsy it means that because of an injury to their brain (cerebral) they are not able to use some of the muscles in their body in the normal way (palsy). Children with cerebral palsy may not be able to walk, talk, eat or play in the same way as most other children do it.  This is mainly caused by damage to one or more specific areas of the brain, occurring during the foetal development or infancy. It can occur before, during or shortly following birth.

Cerebral palsy is neither progressive nor communicable ( able to communicate or transmitted) i.e. you cannot catch it. However it is also not “curable” In the accepted sense, although education, therapy can help the person with cerebral palsy to lead a productive life. It is important to know that cerebral palsy is not a disease, or illness. It doesn’t get worst. It is characterized by inability to fully control motor functions i.e. human motor system refers to many parts of our bodies that work together to enable us to act and move . Fine motor skills are the skills involving the smaller muscles such as in hands and gross motor skills are the skills in larger muscles such as in arms and legs. Therefore, cerebral palsy is a condition in which there has been damage to the areas of brain that control motor functions. Depending upon which area of brain involved or has been damaged people with cerebral palsy experience—–

1) Muscle tightness

2) Involuntary movement i.e. movement that is not under the control of brain.

3)  Disturbance in gait (how an individual walks) and mobility i.e. patient will not able to walk properly .there is imbalance between the nervous system and musculoskeletal system.

4) Abnormal sensation

5) Problem in hearing and speech

6) Seizures




What cause cerebral palsy

The simplest answer to this question is because your child has brain damage. cerebral palsy occurs because of brain injury before,  during or shortly after birth. There are two problems that causes cerebral palsy are

a) failure of the brain to develop properly.

b)  Neurological damage which may be due to

Lack of oxygen

Bleeding in the brain

Toxic injury, poisoning, use of alcohol or drugs by the mother.

Severe jaundice (build up of bilrubin causes yellow colour in infant)

Infection of the nervous system like meningitis i.e. inflammation of the meningis.

The severity of brain damage depends upon the type and timing of the injury. For example In pre mature baby, bleeding into the brain causes extensive damage but longer an unborn child goes without oxygen.


Risk factors for cerebral palsy

Risk factors means that increases the chance of something occurring. The presence of risk factors in cerebral palsy doesn’t means that cerebral palsy will occur nor the absence of risk factors means cerebral  palsy will not occur. If  a risk factor is present, it means parents and health care become more observant of the infant’s development.

Risk factors associated with parents

1)      mother 40 years or older

2)      mother 20 years or younger

3)      father 20 years or younger

Risk factors associated with child

1)      first child , or child born fifth or later in family

2)      one of pair of twins, especially if one twin dies

3)      low birth weight, less than 3.5 pounds

4)      premature infant less than 37 weeks

Other risk factors

1)      Rh or ABO blood incompatibility between infant and mother i.e. when the blood type of foetus , or developing child, differs from the blood type of the mother. This occur if mother type is O and foetus is either B,A, or AB or if mother  is A and foetus is B or AB or if mother is B and foetus is A or AB. When incompatibility occurs mother creates  antibodies to defend against the blood type of infant. These antibodies cross the placenta begin destroying the foetus blood cells and results in development of Jaundice in the foetus and if untreated it develops cerebral palsy.

2) Infection of the mother to virus in early pregnancy.

3)      Attack by micro organisms on central nervous system(CNS) of infant. CNS consist of brain and spinal cord. The brain receive and process signals delivered through spinal cord and then send signals to body. In people with cerebral palsy, this signalling system doesn’t function and the attack by micro organisms on the CNS , affects the signal system and hence to be the risk factor for cerebral palsy in infant.

When more than 1 risk factor can be present at the same time, such as low birth weight and being a twin, such combination further increase the risk of cerebral palsy.         `





Types of cerebral palsy

In order to study different types of cerebral palsy, one must know about muscle tone. Muscle tone refers to the amount of tension to the movement in a muscle. Changes in the muscle tone enables us to move. For example when we bend our arm in order to do brush, we must shorten( increase the muscle tone) our biceps and at the same time lengthening of triceps (decrease the muscle tone). Abnormal muscle tone is the prominent symptom of cerebral palsy. There are mainly different types of cerebral palsy..

a)      Spastic cerebral palsy

b)      Athetoid cerebral palsy

c)      Ataxic cerebral palsy

d)     mixed cerebral palsy


Spastic cerebral palsy(i.e.stiff and difficult movement)

In this children having one or more tight muscles group which limit movements .patients having stiff and jerky movements. These having hard time to move from one position to another and also find difficulty in holding and letting go of objects.


Athetoid cerebral palsy

This type of cerebral palsy  causes damage to cerebellum and basal ganglia(areas of the brain). These are responsible for smooth. voluntary, coordinated and purposeful movement. Damage to these areas causes involuntary, purposeless movements i.e. not under control of brain, especially in face, arms. These involuntary movements often interfere with speaking, feeding , grasping and other skills. These patients have low muscle tone and having problem in maintaining the postures for sitting, and walking.


Ataxic cerebral palsy


This type of cerebral palsy is commonly rare. Children with this palsy affects the sense of balance and having poor coordination and walk with a wide base, placing their feet usually apart. Because of shaky movements (just like tremor which is seen in very old people especially when try to hold a small object). These children take longer time to complete certain tasks such as writing a sentence.


Mixed cerebral palsy

This type of cerebral palsy is mixture of both spastic and athetoid cerebral palsy. These patients show both features of  spastic and athetoid cerebral palsy.





How to diagnose  child with cerebral palsy

When an infant or child with brain damage, a variety of symptoms can lead doctors and parents to suspect something is wrong. Following symptoms can indicate cerebral palsy.

a) Lethargy or lack of alertness i.e. infant is listless and doesn’t move around normally.

b) Irritability

c) Abnormal high pitched cry

d) Trembling of arms and legs

e)  Poor feeding abilities like sucking and swallowing.

f) Abnormal posture, child favour one side of body

g) Abnormal reflexes

h) Seizure

i) Muscle tone changes from low tone to high tone

j) Child may hold his/her hand in tight fist

k)      Presence of asymmetric movement i.e. one side of body move more easily and freely than other side.

l)        Infant feed poorly i.e. tongue push the food out of their mouth forcefully.

m) Child usually appear slower in performing movements like rolling. Sitting up, crawling, walking and talking ( developmental delay)



Doctors use different specialized tests in diagnose cerebral palsy.

Computed tomography

Imaging that determine under developed areas of brain tissue.

Magnetic resonance imaging

Generates picture of brain to determine brain area that may be damaged.

Intelligence testing

Determine child from mental standard point…


Treatment of cerebral palsy

Since cerebral palsy is a group of chronic conditions therefore its treatment plan is classified as…

1)      cerebral palsy treatment with physical therapy.

2)      Cerebral palsy treatment with occupational therapy

3)      Cerebral palsy treatment with speech and language therapy


Cerebral palsy treatment with physical therapy

Stretching, range of motion and strengthening exercises are essential in all children. Neuromuscular facilitation stimulate the CNS to establish normal pattern of movements . These minimize the neurological impairments  and help in healing CNS to recognize . The parents must repeat the exercises with children every day and observe children for improvement.

Conventional exercises consist of active (performed by patient himself) , passive (performed by therapist) range of motion , stretching and strengthening exercises to improve  cardio vascular condition. Stretching exercises should be done to prevent contractures. It should not be done in order to tear muscle fibres and cause pain. Night splints should be used. Sports activities are helpful in decreasing stiffness and contractures by using wheel chair. Balancing training should be beneficial for independent walking.  Strengthening of muscles emphasizing efficient motor functions. When forced to change position for fear of contracture , the  child  needs to use his hands for balance .


Cerebral palsy treatment with occupational therapy

An occupational therapist specializes in improving the development of small muscles of body such as hands,  feet, fingers and toes. They teach daily living skills such as dressing and eating , make proper positioning for the use of wheel chair. They teach child better or easier ways to write , draw, cut with scissors, brush their teeth dress and feed themselves. They help the child to find special equipments to make everyday jobs, a little easier.


Cerebral palsy treatment with speech and language therapy

Speech and language therapist develop better control of jaw and mouth muscles to improve speech and language skills and eating abilities of the children. They create communication methods for the patients who can’t speak . speech therapist work on making their speech clearer or building their language skills by learning new words, learn to  speak in sentences.




Article publié pour la première fois le 20/06/2011

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Bell’s palsy or Idiopathic facial paralysis

bell palsy

Bell’s palsy or Idiopathic facial paralysis

bell palsy

It is defined as a paralysis(loss of nerve function or muscle power resulting in an inability to move) or weakness of the muscles of one side of face. Damage to facial nerve that controls the muscles on one side of face causes that side of face to droop means that side become flat, expressionless, taste , tear, saliva may be affected. Several diseases can cause facial paralysis, but if no specific cause can be identified it is bell’s palsy. It is the most common mono neuropathy(disease involving only one  nerve).

It is idiopathic(arising spontaneously or disease of own kind), unilateral(affecting one side of face) facial nerve paralysis. The hallmark of this  condition is rapid onset of partial or complete paralysis oftenly occurs over night. very rarely occur bilaterally (affecting both sides) result in total facial paralysis or weakness. It is thought that an inflammatory condition leads to swelling of facial nerve. The nerve travel through the skull behind the ear. Nerve swelling and compression lead to nerve damage.


Causes of Bell’s palsy

Viral and bacterial infections as well as autoimmune disorders appear to be emerging as the most frequent common threat in the cause of Bell’s palsy


1) herpes simplex virus(HSV-1)


HSV-1 was suggested as cause of Bell’s palsy. Exposure to HSV-1 is common. Most people are exposed during childhood. Kissing between relatives is the most frequent common source of exposure but may also be spread while sharing towels, utensils etc. the virus then enters the dormant state residing  on the nerve tissue. Several triggers activate the  virus. When the virus get activated, inflammation occurs. If inflammation occurs in an area where no room for swelling is to expand the nerve itself become inflamed or inflammation within the canal exerts pressure on the nerve results in compression that prevents the transmission of  signals to the muscles. When muscles are not able to receive signals to contract and relax, muscles become weakened and then paralysed. The triggers that are responsible for the activation of virus before the onset of Bell’s palsy are impaired immunity, stress, lack of sleep, minor illness, physical trauma, upper respiratory infections, auto immune diseases etc.

Other viruses include cytomegalo virus, Epstein-barr virus, rubella and mumps virus are also responsible.



HIV can cause facial paralysis and increase the chance of developing Bell’s palsy.


3) Bacterial trigger


Bacteria from some acute middle ear infection can enter the canal and as with virus bacteria can evoke an inflammatory response and compress the nerve.


4) Other causes

Facial and surgical wounds, trauma due to blunt force, temporal bone fracture, brain-stem injury, cyst and tumours can result in Bell’s palsy. Diabetes and thyroid condition are also associated with Bell’s palsy.


Signs and symptoms of Bell’s palsy

Bell’s palsy is characterized by facial drooping(mouth appears to be flat and expressionless)on the affected half, due to the improper functioning of the facial nerve(7th cranial nerve) which controls the muscles of face. Forehead muscles receive innervation from both sides of brain therefore forehead can still be wrinkled by a patient whose facial palsy is caused by a problem in one hemisphere of brain. inability to close the eye. Smile wrinkle the forehead and whistle. Speech may be mildly slurred.


General symptoms

1)      muscle weakness or paralysis

2)      forehead wrinkle disappear

3)      overall droopy appearance

4)      impossible or difficult to blink

5)      nose run

6)      difficulty in speaking

7)      difficulty in eating and drinking

8)      sound appears to be loud on affected side(hyperacusis)due to the paralysis of stapedius muscle

9)      excess or reduced salivation

10)  diminished or distorted taste

11)  pain in or near the ear

12)  drooling

Eye symptoms


1) eye closure difficult/impossible

2) lack of tears

3) excessive tearing

4) brow drop

5) sensitivity to light

Residual symptoms

1) eye appear smaller

2) blink remain incomplete

3) mouth pulls up and outwards

Treatment of Bell’s palsy

a)      Medication


The first priority in treating Bell’s palsy is to eliminate the source of damage to the nerve. Therefore medication like(prednisone and anti virals) may help to relieve the compression.



b)      Rest


Rest is important. Enough rest to maintain strength and immunity. Food particles can lodge between gums and cheek therefore oral hygiene should be maintained.


c)      for pain

for pain or discomfort moist heat can help. During the earliest days of Bell’s palsy, when the muscles are completely flaccid, moist heat(ease soreness and reduce swelling), massage(provide degree of motion) and stimulation to the muscles(increase circulation) should be given.




Eye/ear care

Take extra care to keep your eye moist. Incase if eyes become dry put eye drops in them. Manually blink your eyes using back of your fingers at regular intervals. If there is history of middle or inner ear problem an ear plug may be used. In the presence of Bell’s phenomenon(eye ball turns upward as we attempt to close the eye).

Then concentrate on looking downward towards the floor.



d)     facial exercises

1)      to relax the cheek(if the side of mouth is pulling up and to the side or cheek feels tight)

in this put your thumb inside your cheek at an angle toward the centre of ear. Grasp the outside of cheek with fingers and pull down and forward. Hold it for minimum 10 seconds upto 30 seconds is good. Shift the position towards the centre and repeat the stretch and hold. Shift still further towards the centre and repeat.

Practice speaking in front of a mirror, repeating words that use M,B,F and P while keeping yours eyelid open., in the beginning, speak softly and slowly.

Stretch muscles of the neck by tilting your head to the side and slightly back, hold it for 10 seconds.

Massage your face(both sides)using from circular motion. Start in centre and work your way out.


2) Other exercises

a) Compress lips together , pucker lips and attempt to whistle.

b) Smile without showing teeth , then smile showing teeth

c) Harden(wrinkle) the chin

d) Try to chew food using both sides of the mouth



Article publié pour la première fois le 04/07/2011

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Epilepsy risk factors and prevention

epilepBrain normally controls the body movements by sending small electrical signals through nerves to the muscles but when the brain sends out abnormal signals resulted in seizures or convulsions. Single seizure that does not  happen again is not epilepsy. Seizures vary from person to person. The important risk factors include–

1)Babies born with abnormal brain structures

2)Bleeding into brain

3)Babies who have seizure in the first month of life

4)Babies who are small for their gestational age

5)Abnormal blood vessels in brain

6)Lack of oxygen to brain

7)Serious brain injuries

8)Infection in brain like abscess, meningitis


10)Cerebral palsy

11)Seizures within days after head injury( early postraumatic seizure)

12) Family history of epilepsy

13)Fever related seizure

14)Use of illegal drugs like cocaine

15)Brain tumors.


Epilepsy can be life long, but many people having history of multiple seizures will stop having seizures. People who are younger when seizure start are more likely to stop having seizures. In most of people with epilepsy, seizure can be controlled with medication.


Epilepsy remains unknown therefore, there is no way to prevent seizures. Certain important points help to prevent epilepsy due to head injury includes

1) Wear seat belt while driving

2) Equip your car with air bags

3) Wear an approved helmet while riding bike or doing other activities like skating.

These points will minimize the  risk of of  injury of seizure. Good prenatal care including high blood pressure treatment and infections during pregnancy

Article publié pour la première fois le 03/04/2013

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Diagnosis of epilepsy

epilepsyNumber of tests have been done to diagnose epilepsy. Sometime people have symptoms similar to seizure but they are non – epileptic events caused by other disorders. Therefore in order to make difference between these disorders and epilepsy  close observation and certain tests should be done..

1) EEG( Elecrtoencephalogram)–

In this electrodes are placed on scalp and brain waves are detected. Through EEG , certain abnormalities in the brain can be detected by electrical activity. People with epilepsy have changes in their normal pattern of brain waves even when they are not experiencing seizure. EEG should be performed within 24 hrs of patients  seizure. EEG can be performed while patient is sleeping. During EEG video monitoring can be done in order to find out the nature of person’s seizure. Trough EEG some other disorders like cardiac arrhythmia’s or narcolepsy can also be ruled out.

2) Brain Scans–

Brain scans can also be used in diagnosing epilepsy. It mainly include computed tomography(CT) , positron emission tomography(PET) and magnetic resonance imaging( MRI)

Through CT and MRI scans reveals the brain tumors , cysyt or other structural abnormalities  PET can be used to monitor brain’s activity. SPECT( single photon emission computed tomography) is new kind of brain scan mainly used to locate seizure foci n brain.Sometimes magnetoencephalogram(MEG) can be done in order to detect magnetic signals generated by neurons in brain. MEG does not require electrodes and it detects signals deeper in the brain than EEG

3) Medical History–

Detail medical history , symptoms and duration of seizure is the best method to determine epilepsy and its kind. Patient who is suffering from seizure does not remember anything therefore care givers play vital role in evaluation.


Blood tests can be done . These samples mostly detect metabolic or genetic disorders associated with seizures. With blood test some other problems like infections, anemia, diabetes, lead poisoning also trigger seizures can be detected.


Other tests can be done . These tests help to measure motor abilities, behavior capacity of an individual in order to determine how epilepsy affects person.

Article publié pour la première fois le 03/04/2013

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Alzheimer’s Disease (DM)

Alzheimer disease

Alzheimer’s Disease (DM)

Alzheimer disease


It is the most common form of Dementia among older people. Dementia is brain disorder that affects person’s ability to carry out daily activities. AD  begins slowly. It first involves the parts of brain that control thought, memory and language. People with AD may have  trouble in remembering things that happened recently or names of people they know. AD usually begins after age 60. the earliest cause of AD is unique for every individual. The earliest observable symptom are often mistakenly thought to be age related or manifestations of stress.


Causes of AD

AD is caused by reduced synthesis of neurotransmitter acetylcholine. The amyloid(peptides of 36-43 amino acids that appear to be the main constituent of amyloid plaques). .Hypothesis  postulated that amyloid beta deposits are the fundamental cause of this disease.

The Tau hypothesis, the idea that “Tau proteins (proteins that stabilize microtubules) abnormalities initiate the disease cascade. Tau begins to pair with other threads of Tau , eventually , they form neurofibrillary  tangles inside nerve cell bodies.


Symptoms of AD

Symptoms of AD is divided into four stages

1) Pre-dementia features

2) Early features

3) Moderate features

4) Advanced features


Pre-dementia features

First symptoms are often mistakenly attributed to “aging” or “stress”. These early symptoms can affect the daily living activities. The most noticeable deficit is memory loss, which shows up difficulty in remembering recently learned facts and inability to acquire new information.

Problem with executive functions like planning, flexibility and thinking or impairment in semantic memory (memory of meanings, concept of relationships)occur. Apathy (lack of emotions) can be observed and remain more persistent.  Neuropsychiatric symptoms (deals with mental disorders ) are common.


Early features

In this difficulty with language perceptual problems or Apraxia(carry out learned  purposeful movements) are prominent. AD doesn’t affect all memory capacities equally. Old memories of patient’s life(episodic memory), the memory of body on how to do things(such as using fork to eat) are affected to lesser degree than new memories.

Language problems are mainly affected by decreased word fluency. While performing fine motor tasks such as writing, drawing or dressing are little affected. As disease progress people with AD cannot perform task independently.


Moderate features

In this patient being unable to perform most common activities of daily living. Speech difficulties become evident due to an inability  to recall things which may lead to frequent incorrect words. Reading and writing skills are also progressively lost. Long term memory which was previously intact, become impaired. Common manifestations are wandering, irritability and leading to crying, aggression, delusion and urinary continence occurs.


Advanced features

During this patient completely dependent on caregivers. Language is reduced to simple phrases or even single word or may be complete loss of speech. Even if patient looses his speech he can fully understand and return emotional signals. Aggression and Apathy is on extreme. Patient will not able to perform the simplest task without assistance. These patients even lost the ability to feed themselves


Physiotherapy treatment of AD

Physiotherapy will improve independence with everyday activities such as bed mobility, walking and climbing the stairs as well as advising the family and carers about help outside treatment sessions.

Benefits of physiotherapy for AD patients

1)improving activities

2)improve functioning

3)maximizing mobility

4)reducing pain

5)  Relieving  stiffness

6) reduce risk of falling

7) maintaining independence


Passive or active range of motion should be given to the patient to keep the muscles strong and flexible  to make functional activities much easier. Balancing training should be given so that patient attain confidence and hence reduces the risk of falling. Gait retraining should be taught to the patient to increase the mobility. stretching exercises should be given in order to prevent pain. In addition to this strengthening of various muscle groups should be done so as to attain less dependency.


Article publié pour la première fois le 22/06/2011

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Symptoms and diagnosis of Amyotrophic lateral sclerosis (ALS)

symptoms and diagnosis of als

The symptoms may include muscle weakness and atrophy due to degeneration of upper and lower motor neurons. because of atrophy and weakness patient lose the ability to initiate and control the voluntary movements.

The earlier symptoms of ALS also include  twitching, cramping or stiffness of the affected muscles. These may be slurred speech. The symptoms depend on which motor neuron in body is affected or damaged first. Patient with leg affected may experience difficulty in walking or running or notice some kind of stumbling or tripping. Dropped foot is also common. Arm onset patients experience difficulty in manual tasks such as button their shirts, turning a key in a lock. The symptoms remain confied to one limb for longer period of time for the whole length of illness known as monomelic amyotrophy. These patients also find difficulty in  speaking or swallowing. These patients speak slurred, quieter or show nasal characters . Other symptoms include  difficulty in  swallowing or loss of mobility. Sometime respiratory problems may be common, because intercostal muscles get affected and patient finds difficulty in breathing.

In some cases, difficulty in moving or swallowing takes place. Patient is not able to speak or form words. sometime drooling or gagging is also present. Upper motor neuron symptoms are also present like tightness and stiffness in muscle, reflexes become exaggerated i.e. hyperreflexia, including overactive gag reflex. Lower motor neuron symptoms include muscle weakness and atrophy. Pseudobulbar effects are also common also known as emotional liability in which patient looses control over emotions.

In the later stage aspiration pneumonia is common  and requires feeding tube. Diaphragm and intercostal muscles get weak therefore forced vital capacity and inspiratory pressure is reduced. There is head drop due  to weakness of neck muscles.

symptoms and diagnosis of als


Physical examination through doctor  and know about medical history helps to determine ALS. Physical examination  shows-

1) Weakness

2) Tremors, Spasm, Twitching .

3) Abnormal reflexes

4) Difficulty in walking

5) Increased reflexes at joints

6) Difficulty in controlling emotions( emotional liability)

7) Loss of gag reflex

8) Twitching of tongue.

Other tests include–

a) Blood test– That helps to rule out other conditions.

b) Breathing test– That  is mainly used to check the involvement of lung muscles.

c) Cervical spine CT or MRI– Helps to rule out any disease or injury at neck that mimics ALS.

d) Electromyography– Wire electrode is  inserted to see the function of nerves or measure nerve conduction velocity.

e) Genetic testing to know family history of ALS.

f) Head CT/MRI– In order to rule out other conditions like spinal cord tumors, herniated disc, syringomyelia etc.

g) Lumbar puncture can be done.






Article publié pour la première fois le 12/03/2013

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Tetanus(lock jaw)


Tetanus(lock jaw)


Tetanus is a serious bacterial disease that affects the muscles and nerves, which is mainly caused by contamination of wounds from bacteria that live in the soil, in animals and in human intestines. It is mainly caused by bacterium clostridium tetani(tetanus bacteria). The bacteria usually enter the body through a deep cut, or puncture wounds as caused by rusty nails, splinters or insect bite. Burns or any break in the skin are also potential entryways for the bacteria. It is acquired through contact with the environment; it is not spread from person to person.

Tetanus occurs when a wound becomes contaminated with bacterial spores. Infection follows when spores become  activated, multiply and then produce a very strong toxin(poison) called tetanospasmin that affects the muscles.

It is characterized by muscle stiffness that usually  involves the jaw and neck and then involves the other parts of body. Death occur due to breathing difficulties and heart abnormalities. Tetanus more commonly  occur in old people or in agriculture workers who contact with animal manure or in people having improper immunization. also occur in newborn because their mothers are not immunized against tetanus.

Tetanus toxin affect the site of interaction between the nerve and muscle called as neuro muscular  junction. The tetanus toxin amplifies the signals from nerve to the muscle which causes the muscle to tighten up in a continuous contraction. Tetanus toxin can also affect the neonates within first two weeks after the birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate.


What causes tetanus

Tetanus is often associated with rust, especially rusty nails. The rough surface of rusty metal provides a  primary habitat for C.tetani and nail is to puncture the skin and deliver bacteria into the wound and cause infection in an environment that lacks oxygen. Hence, stepping on a nail(rust or without it)may result in tetanus infection.


Signs and symptoms

tetanus mainly affects the muscles. The incubation period(time between the exposure to the bacteria in a contaminated wound and development of initial symptoms) of tetanus ranges from 2 days to 2 months, but it is commonly within 14 days of injury.

It is estimated that further the injury site is from central nervous system, the longer the incubation period. The shorter the incubation period, the more severe be the symptoms. therefore different forms of tetanus


Generalized tetanus

It is the most common form of tetanus, usually presents with a sign of “lock jaw”(patient is not able to open his mouth), facial spasm followed my stiffness in the neck muscles, difficulty in swallowing. Other symptoms include increased temperature, sweating and elevated blood pressure and episodic rapid heart rate. Spasm(involuntary contraction of group of muscles)may occur frequently and lasts for few minutes.


Neonatal tetanus

It is a form of generalized tetanus occur in newborns, infants who have not acquired immunity because the mother has not been immunized with tetanus toxoid. It usually occurs  through infection of unhealed umbilical stump, particularly when the stump is cut with non-sterile instrument


Local tetanus

It is rare form of tetanus, in which patient has persistent contraction of muscles in the area of injury. Local tetanus is generally mild but sometime it become fatal.


Cephalic tetanus

This is also a rare form of disease, occur most commonly with ear infection in which C. tetani is present in the middle ear, or following injury to the head. In this there is the involvement of cranial nerve , especially in the facial area.


Treatment of tetanus

Treatment is directed towards stopping toxin production and controlling muscle spasm. In more severe cases, breathing assistance with an artificial respiratory machines. An effective vaccine called tetanus toxoid has been available. Adults should get a tetanus shot, or booster, every 10 years

All children should be immunized against tetanus by receiving a series of five DTaP vaccinations(protects from diphtheria, tetanus and pertussis) which generally started at 2 months of age and completed at 5 years of age. Booster vaccination is recommended at 11 years of age.


Side effect of tetanus immunization

The most frequent side effects are usually mild and include soreness, swelling or redness at the site of injection


Article publié pour la première fois le 07/07/2011

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Symptoms of Epilepsy

epilep symSymptoms of epilepsy differs from person to person. In some people there is simple staring while others have violent shaking or loss of consciousness. Seizure type mainly depends on the part of brain affected and the cause of epilepsy. In some people ,there is stage called “AURA” in which person have strange sensation like tingling sensation or emotional changes occur before actual seizure.


It is commonly called as absence seizure. It occurs in people under 20 years of age. This type of seizure occur mainly for few seconds and involve staring or absence spells. These episodes occur many times a day. During this seizure there is difficulty in learning and lack of attention should be noticed . Person stop walking, find difficulty in mid- sentence and then start again few seconds later. During these seizure, person does not fall. There is change in muscle activity like fluttering eyelids, lip smacking, hand fumbling etc, change in alertness or consciousness is there . Seizure may be triggered by hyper ventilation or flashing lights in some cases, but after the seizure person awake, think properly and unaware of seizure.


During this seizure whole body is involved. It is also known as GRAND MAL SEIZURE. These type of seizure occurs at any age. During this there is muscle rigidity which is followed by muscle contraction and loss of consciousness . There may be biting of tongue, clenched teeth or jaw, there is incontinence of urine and stool. There is difficulty in breathing. Sometime there is blue color of skin occurs. After the seizure person have normal breathing , severe headache, drowsiness. Person feel sleepy for 1 hour or there is loss of memory of events during seizure episodes.Person is confused after the episode. There is weakness of one side of body after seizure  for few minutes to few hours. It is called as TODD’s PARALYSIS.


Focal seizures occurs in specific part of brain and in this electrical activity is limited to area of brain. Partial seizures can be classified into simple or complex. In simple seizure memory is not affected but in complex memory is affected before, during and immediately after the seizure. Patient with focal seizure does not lose consciousness  During this there is abnormal muscle contraction or relaxation takes place. There is also abnormal movements of mouth, lip smacking, turning of eyes . Abnormal sensations like numbness, tingling etc can occur. Other symptoms include hallucinations, sweating, flushed face, increased heart rate, dilated pupils, black out spells, change in emotions etc.



Article publié pour la première fois le 02/04/2013

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Causes and complication of cerebral palsy


cerebral palsy

Cerebral palsy is a group of disorders that mainly affects  body movements, balance and posture. In simple words Cerebral palsy  is also known as BRAIN PARALYSIS. It mainly affects the early childhood i.e. during infancy . In this disease , there is delay in the developmental milestones such as rolling , crawling, sitting and walking. There are many causes of  cerebral palsy.

Cerebral palsy  mainly begins in  prenatal period because of  events happened during pregnancy, when the fetus is developing inside the mother’s womb. Other important cause is premature birth. Children that mainly born prematurely can develop serious respiratory problem due to improper development of lungs . This can lead to  decreased oxygen to the brain that results in cerebral palsy. In some  premature infants there is development of some holes in the white matter of brain  called peri ventricular leuko malacia. The white matter is mainly responsible  for the normal processing of signals that are transmitted throughout the brain and from brain to the rest of the body.

Other cause include accidents of brain development, genetic disorder, stroke or blood clots. The other important causes of cerebral palsy involves birth asphyxia in which there is lack of oxygen to the brain  during delivery occurs. Less common factors like child abuse during infancy can also lead to brain damage and results in cerebral palsy.


There are many complications of cerebral palsy . Some of them are as follows..

1) Contracture–

Contracture mainly involves shortening of the muscle tissue due to tightening of muscle. Contractures reduces  bone growth and causes bones to bend results in joint deformities  or dislocation.

2) Malnutrition–

In cerebral palsy there is swallowing or feeding problems that leads to malnutrition .

3) Depression–

                                            Cerebral palsy patient challenges certain disabilities and that leads to social deprivation and patient feels depressed.

4) Early aging–

Early aging results due to stress on body or poor development of heart, lungs or other body organs.

5) Osteoarthritis–

There is abnormal alignment of joints due to spasticity and results in degenerative bone disease called as osteoarthritis.

6) Post impairment syndrome–

Due to stress on body , there is pain, fatigue or weakness in the body that alter everyday functions.

  Other less complications are Bowel obstruction, Pneumonia by choking, reduced communication skills or scoliosis.

Article publié pour la première fois le 06/03/2013

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Transverse myelitis

Transverse myelitis

Transverse myelitis

Transverse myelitis

Transverse myelitis(TM) is a neurologic syndrome of spine that is caused by inflammation across the spinal cord. Inflammation is usually a protective response, which generally includes swelling, pain, heat and redness, however in case of transverse myelitis, the inflammatory  response causes damage to the spinal cord, resulting in varying degree of weakness and sensory symptoms. The symptoms and dysfunction that occurs is usually dependent on the level of spine where the inflammation is located.

TM is believed to be linked with immune system. It is possible that the immune system is attacking the body’s own spinal cord. It occurs in both children and adults. Attacks of inflammation can damage or destroy myelin, the fatty insulating substance that covers the nerve cell fibers. This damage causes nervous system scars that interrupt communication between the nerves in the spinal cord and rest of the body. Typically the higher the spinal cord is affected, the more severe the impairement. Nerves in the cervical(neck)region control signals to the neck, arms, hands and muscles of breathing(diaphragm). Nerves in the thoracic region supplies signal to the torso(foot) and some part of arms. Nerves at lumbar(mid back) control signals to the hip and legs and sacral nerves located within the lower segment of the spinal cord provide signal to the groin, toes and some parts of legs. Damage at one segment will affect function at that segment and segments below it. In patients with transverse myelitis, inflammation occur at thoracic level, causing problem with leg movements and bladder and bowel control, which require signals from the lower segment of the spinal cord.


Causes of transverse myelitis

The inflammation that causes an extensive damage to the nerve fibers of the spinal cord may result from viral infections or abnormal immune reactions. Viral agents include varicella zoster( that causes chicken pox) herpes simplex cytomegalo virus Epstein virus , HIV virus  hepatitis A and rubella. Bacterial skin infections, middle ear infections have also been associated with the condition. In auto immune diseases, the immune system which normally protects the body from foreign organisms, mistakenly attack the body’s own tissue, causing inflammation and damage to the myelin within the spinal cord.


Symptoms of transverse myelitis

Transverse myelitis  may be either acute (developing over hours to several days) or subacute (usually developing over 1 to 4 weeks). Initial symptoms usually include localized lower back pain, sudden paresthesias (abnormal sensations such as burning, tickling, pricking, or tingling) in the legs, sensory loss, and paraparesis (partial paralysis of the legs). Paraparesis may progress to paraplegia (paralysis of the legs and lower part of the trunk). Urinary bladder and bowel dysfunction is common. Many patients also report experiencing muscle spasms, a general feeling of discomfort, headache, fever, and loss of appetite. Depending on which segment of the spinal cord is involved, some patients may experience respiratory problems as well From this wide array of symptoms, four classic features of transverse myelitis occur: (1) weakness of the legs and arms,

(2) pain,

(3) sensory alteration,

(4) bowel and bladder dysfunction.

Most patients will experience weakness of varying degrees in their legs; some also experience it in their arms. Initially, people with transverse myelitis may notice that they are dragging one foot or that their legs seem heavier than normal. Coordination of hand and arm movements, as well as arm and hand strength may also be compromised. Progression of the disease leads to full paralysis of the legs, requiring the patient to use a wheelchair. Pain is the primary presenting symptom of transverse myelitis. The pain may be localized in the lower back or may consist of sharp, shooting sensations that radiate down the legs or arms or around the torso(foot) Patients who experience sensory disturbances often use terms such as numbness, tingling, coldness, or burning to describe their symptoms. Bladder and bowel problems may involve increased frequency of the urge to urinate or have bowel movements, incontinence, difficulty voiding, the sensation of incomplete evacuation, and constipation. Recovery may be absent, partial or complete and generally begins within 1 to 3 months


What tests are conducted to diagnose transverse myelitis

In order to rule out other diseases and disorders, Physicians must conduct a physical examination and a number of additional tests like

  • Blood Tests: Used to screen for possible viruses or vitamin deficiencies.
  • MRI (magnetic resonance imaging): Provides images of the brain and spinal cord so that lesions can be identified.
  • Lumbar Puncture: Provides information about white blood cell count and immune system activity

A lumbar puncture involves removing a small amount of spinal fluid from the spinal cord. The spinal fluid provides information about white blood cell counts. It can also demonstrate any abnormal activity of the immune system.


Treatment of transverse myelitis

Several therapies target the acute signs and symptoms of transverse myelitis:

Intravenous steroids

Steroids help reduce the inflammation in the spinal column.

Pain medication.

spinal cord damage include common pain relievers, including  acetaminophen , ibuprofen, naproxin; antidepressant drugs and anticonvulsant drugs.

Nondrug therapy

Other therapies focus on long-term recovery and care:

Physical therapy.

Physical therapy helps to increase strength and improve coordination. physical therapist will likely teach  how to use assistive devices, such as a wheelchair, canes or braces, if needed.

Occupational therapy.

This type of therapy helps people with transverse myelitis learn new ways of performing day-to-day activities, such as bathing, preparing a meal and housecleaning.


A psychotherapist can use talk therapy to  treat anxiety, depression, sexual dysfunction, and other emotional or behavioural issues that may cause transverse myelitis.

Some individuals living with transverse myelitis have had success with acupuncture. There is no evidence that this therapy works, but it has been deemed successful by some individuals.



Article publié pour la première fois le 07/07/2011

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Causes and complications of Amyotrophic lateral sclerosis ( ALS)

complications of ALS

The main cause of ALS is not clear. It may be discovered that mutations in the gene that produces SOD1 enzyme is associated with ALS. This enzyme act as  antioxidant that protects body from Damage due to radicals. Free radicals are highly reactive molecules, produced by cells during normal metabolism of body. If not neutralized , these free radicals can accumulate and responsible for damage to DNA and proteins within cells. Yet it is not clear that how SOD1  gene mutation leads to motor neuron degeneration but it has been theorized that accumulation of free radical may result in faulty functioning of this gene.

Studies also foccused that role of Glutamate is also responsible for motor neuron degeneration. Glutamate is neurotransmitter in the brain and in ALS patients glutamate level is higher in serum and spinal fluid and the neurons began to die when they get longer period of exposure to glutamate. Auto immune responses suggest one of the important cause of motor degenerative disorders. Antibodies may directly or indirectly impair the function of motor neurons, interfering with the transmission of signals between the brain and muscles.

Other environmental factors is also responsible such as an exposure to toxic or infectious agents, dietary deficiency or trauma. Other research may show that genetic predisposition are also involved in the development of ALS.

complications of ALS



ALS degenerate the motor neurons and lead to the weakness of the muscles. Some common complications are as follows–

1) Problem in eating–

Patients with ALS, generally choke easily. Because of malnutrition, dehydration and weight loss occurs. These patients may aspirate their food or liquors and can cause pneumonia i.e. infection of the  lungs. Due to this infection  patient have shortness of breath, coughing, chills and fever. In order to overcome these eating problems, feeding tube is used, which delivers patient’s food right to the stomach.

2) Breathing problems–

In motor neuron disease due to degeneration of motor neurons, the muscles in the chest wall and diaphragm gets affected and leas to breathing problems. Due to this breathing problem, patient requires ventilator to breath properly or sometime surgical procedure like trachestomy in which opening of wind pipe help them to breathe is helpful. Studies show that ALS patients die from respiratory failure within 4-5 years.

3) Dementia–

ALS  patients have increased risk of dementia i.e. from fronto temporal dementia or Alzheimer’s disease. In fronto temporal dementia patients have shrinkage in the parts of temporal or frontal lobe and they find  difficulties in writing  speaking or in appropriate behavior and in Alzheimer’s disease, patient have memory problem or show withdraw towards society.

4) Inability to care–

As in ALS there is weakness in muscles that makes the patient finds difficulty in walking or climbing. Due to muscle problem  tremors, twitching or muscle spasm is also common.

Article publié pour la première fois le 12/03/2013

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Trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia

It is a chronic pain condition that affects the trigeminal nerve or 5th cranial nerve , largest nerve of the head, which carries the sensation from face to the brain. if there is trigeminal neuralgia even , mild stimulation of the face- such as from brushing your teeth or putting on make-up can increase the pain. This disorder causes extreme burning or shock like  face pain that lasts from few seconds to as long as 2 minutes per episode.

Trigeminal nerve has three branches— the ophthalmic, the maxillary and the mandibular branch. The ophthalmic or upper branch supplies sensation to the scalp, forehead and the front of head. The maxillary or middle branch passes through the cheek, upper jaw, teeth and gums and to the side of  nose and the mandibular or lower branch supplies the lower jaw, teeth gums and bottom lip.. the attacks are said by those affected to feel like an electric shock or sometime a type of crushing pain. In the days before an attack begins, some patients may experience a tingling or numbness or somewhat constant and aching pain. TN occur most often in people over age 50, but it can occur at any age and is more common in women than in men.


What causes trigeminal neuralgia

The presumed cause of trigeminal neuralgia is a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes wearing away of the protective coating around the nerve(myelin sheath) and cause hyper active functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area serve by the nerve. TN may be the part of aging process—- as blood vessels lengthen they can come to rest and pulsate against a nerve. TN symptoms can also occur in people with multiple sclerosis. The deterioration causes the nerve to send abnormal signals to the brain. in some cases the cause is unknown and it is said to be (idiopathic) at that time.


Signs and symptoms of trigeminal neuralgia

TN is characterized by sudden, severe electric-shock like pain that is typically felt on one side of the jaw or cheek. Pain may occur on both sides of the face, although not at the same time. The attacks of the pain, which generally lasts several seconds and may repeat in quick successions, come and go throughout the day. These episodes can last for days, weeks or months.

The intense flashes of pain can be triggered by vibration or contact with the cheek(such as when shaving, washing the face or even apply make-up), brushing teeth, chewing, eating, talking or being exposed to wind. The bouts of pain rarely occur at night, when the patient is sleeping. The attacks often worsen over time. Due to intensity of the pain, some patients may avoid daily activities because they fear of impending attacks. There is also a variant type of trigeminal neuralgia called atypical trigeminal neuralgia. This is also called as trigeminal neuralgia type-2. these patients experience severe underlying pain similar to migraine in addition to shock like pain. In some cases pain may be intense like burning sensation rather than shock. Sometime pain occurs in combination of shock like, migraine like or burning type. Firstly pain focused in one spot and then spread in a wider pattern.

Triggers that increases pain

A variety of triggers may set off the pain of trigeminal neuralgia, including


1) shaving

2) stroking your face

3) eating

4) drinking

5) brushing your teeth

6) talking

7) putting on makeup

8) exposure to wind

9) smiling

10) chewing.



Treatment of trigeminal neuralgia

Treatment options include medicines such as anticonvulsants and tricyclic antidepressants. Typical analgesics and opoids are not usually helpful in treating sharp, reoccurring pain caused by TN. If medication fails then surgery should be recommended. Certain techniques like acupuncture , biofeedback, vitamin therapy, nutritional therapy and electrical stimulation of the nerve is beneficial. Sometime alcohol injections provide temporary pain relief by numbing the areas of face.


What will be the prognosis

The disorder is characterized by reoccurrence and remissions. Due to the intensity of pain, even the fear of impending the attack may prevent activity. Trigeminal neuralgia is not fatal.


Article publié pour la première fois le 07/07/2011

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Treatment Of Cerebral palsy

treatment of cerebral palsy

Treatment of  cerebral palsy mainly depends on the  symptoms of patient . Care of patients with Cerebral palsy is complicated, it requires different services . Main goals of the treatment is to reduce the complications of the disease. various treatment  for cerebral palsy are as follows….

treatment of cerebral palsy


Rehabilitation includes physical therapy, Use of certain equipments. Physical therapy mainly focuses on Streching, physical exercises and other activities that develop  muscle strength and flexibility of the patients. The main goal is to maximize the function and decrease the contracture . Certain specific skills like  sitting, walking etc can be improved. Braces, splints , casts , walkers , customized wheel chairs should be used. Spasticity can be reduced  to improve range of motion.

Occupational therapist also help these patients to learn certain physical skills  so that they become as independent a possible.

Speech therapist help these patients to improve their communication skills. Due to poor tone or uncontrolled movements in the mouth or tongue patient is not able to speak properly . Therefore speech therapist help these patients to develop these muscles, improve tone and thus improve speech.

Opthalmologist can cure or improve visual problems. In some patients gastroesophageal re-flux( which is mainly caused by regurgitation of  acid from stomach), feeding or swallowing  is common. Gastroenterologist, nutritionist, or dietitian help these patients to improve their digestive system or feeding problems. Swallowing therapy improves patient so that they can eat or drink independently. In severe cases  patients can be feed through feeding tube.

Most of patients have breathing problems due to the improper development of lungs.  Therefore  pulmonologist help these patients to cure their lung diseases.


The main goal of medication in cerebral patients is to reduce spasticity, abnormal movements and seizures . Common medications that mainly reduce spasticity and abnormal movements include  Dopaminergic drugs that increases the level of dopamine and help to reduce the abnormal movements. Muscle relaxants are also used to relax the muscles directly . medications that are mainly used to control seizures include  anti convulsants,  benzodiazepines . These agents mainly stop the seizure activity or  re occurrence of seizures.


Certain surgical methods are also used to treat cerebral palsy. They are as follows..

a) Dorsal Rhizotomy–   During this procedure , few specific nerves are cut at the level of their roots where they mainly branch off the spinal cord. This mainly works to reduce spasticity  and thus improves ability to sit or stand.

b) Implantation of  baclofen pump— In this procedure  drug baclofen is placed in the abdominal wall to deliver the continuous dose  to the spastic group of muscles and thus helpful in reducing the spasticity.

c) Skeletal disorders like scoliosis or dislocation can be corrected by surgery. Spasticity can also be corrected by other surgical procedures  like  tenotomy( Division of tendon)  or tendon -lengthening procedures

d) In some cases vagal nerve stimulation can be done in order to stimulates the vagal nerve in the neck and helpful to decrease epileptic disorders.


Feed the patient with semi solid meals so that patient can eat properly. Specific utensils can be used so that it helps the patient to chew and swallow food easily. While using toilet patient feels difficulty due to stiff joints ,so modification in toilet seats can be helpful. Practice the patients for self grooming . Provide that clothes that can be easy to wear or remove.   Drooling is another problem that cause skin irritation around the chin, mouth and chest. Application of lotions  to these areas reduce the irritation.






Article publié pour la première fois le 06/03/2013

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Cerebral Meningitis

Cerebral Meningitis

Cerebral Meningitis


Cerebral Meningitis

Meningitis is a serious inflammation of meninges, thin membranous covering of the brain and spinal cord. Since meningitis is very serious and dangerous infection because the brain cells are very delicate and if enough brain tissue is damaged by an infection, life-long handicaps will remain. Meninges are the three separate membranes of the brain.these are-

1)Dura layer(outermost layer)

2)Arachnoid  layer(middle layer)

3)Pia layer(inner most layer)


Dura layer

It is the toughest, outermost layer of the brain and is closely attached to the inside of the skull.


Arachnoid layer

It is the important layer because this layer has involvement of the normal flow of cerebrospinal fluid (CSF) which is the lubricating and nutritive fluid that bathes both brain and spinal cord.


Pia layer

It is the inner most layer the pia,  helps the direct blood vessels into the brain.

The space between the arachnoid and pia contains CSF, which protects the brain from trauma. Therefore meningitis is the inflammation (protective attempt by organism to remove injurious stimuli and initiate healing) of the membrane covering the brain and spinal cord collectively called as Meninges. Because of the infection of the brain and spinal cord this condition is classified as Medical Emergency.




Causes of meningitis

Meningitis is usually caused by infection from viruses or microorganisms. Most common are due to infection with viruses, with bacteria, fungi and parasites being the next most common cause. It may also result from non-infectious cause


This  type of bacteria  causes  bacterial meningitis in various age groups. In pre-mature babies/newborns upto 3 months. In old cases group B streptococci causes meningitis. Listeria  Monocytogenes may affect newborn and occur in epidemics. Older children are more commonly affected by Neisseria Meningitidis. Streptococcal pneumoniae also causes meningitis. Recent trauma to the skull lead to bacteria in the nasal cavity and enter the brain causes infection. Meningitis  also occur in individuals whose immune system is impaired i.e. fight against infection get reduced or entirely absent. People having infection in head, neck and ear can lead to meningitis.

Tuberculous meningitis, meningitis due to infection with mycobacterium tuberculosis, where tuberculosis is common and common in AIDS patients.


This is usually due to virus but it may be due to bacterial meningitis. Fungal meningitis for example due to Cryptococcus neoformans, typically seen inpeople with immune deficiency . amoebic meningitis, due to infection with amoeba such as naeglesia fowleri common in fresh water sources.


Virus that causes meningitis include enterovirus, herpes simplex virus type-2, varicella zoaster virus, mumps virus


This cause is assumed when there is increased level of eosinophills (a type of blood cells) in CSF . common parasites are– Angiostrongylus cantonesis, gnathostoma spinigerum.

Non infectious cause

It occur as a result of non-infectious causes like spread of cancer to meninges(malignant meningitis) and certain drugs (antibiotics ) rarely migraine causes meningitis.


When bacteria reaches the meningis by one of two main routes i.e. through blood stream or through direct contact between meningis and nasal cavity. Once bacteria enter the blood stream, they entered the subarachnoid space. As a result there is large scale inflammation occur in the space, because of the response of immune system to the entry of bacteria into the CNS large amount of cytokines released and lead to cerebral edema(swelling of brain due to fluid leakage from blood vessels. When large number of white blood cells enters CSF, causing inflammation of meninges, leading to edema (interstitial edema)i.e. swelling due to fluid between cells. In addition to this blood vessels become  inflamed leads to decreased blood flow causing cytotoxic edema.. these form of edema lead to increased intracranial pressure causes infection.



Clinical features

In adults, severe headache is the most common symptom of meningitis occur in 90% of cases, followed by nuchal rigidity (inability to bend the neck forward due to increased neck muscle tone)nuchal rigidity, high fever and altered mental status are the three important features that mainly present in44-46% of cases. Other signs include-

Photophobia(intolerant to bright light), phonophobia(intolerant to loud noise), vomiting dizziness, seizures,. Joint pains.

Small children may become irritable and look unwell. In infant upto 6 months of age bulging(soft spot on top of baby’s head)may present. High pitch moaning cry, dislike of being handled, blank expression, refuse to feed.

In meningitis certain sign’s are present

a) Brudzinski’s sign is present in which when we flex(bend the neck forward)it causes involuntary flexion of knee and hip.

b) kernig’s sign is also present. In this  patient lies in supine (lying down with face up)with hip and knee bend. This test is positive when some body bends  the  knee it causes pain. )

c) jolt accentuation manoeuvre which helps to determine meningitis reporting fever and headache.The patient is told to rapidly rotate his or her head horizontally if it does not makes the headache worse, meningitis is unlikely.

In menengiococcal meningitis(meningitis caused by neisseria meningitdis) rashes are common(small, numerous, irregular, purple/red spots mainly on trunk, lower extremities, palm of hands, sole of foot, mucus membrane and conjuctiva.




Diagnosis of meningitis

The most important test in identifying or ruling out meningitis is analysis of CSF through lumbar puncture. It is contraindicated(not done) if there is mass in the brain or intracranial pressure is elevated.

Lumbar puncture is done by positioning the patient, usually lying on the side, applying local anaesthetic and inserting a needle into the dural sac(sac around spinal cord)to collect CSF. When this has been achieved the “opening pressure “of the CSF is measured by using a manometer. The pressure is normally between 6 and 18 cm water. In bacterial meningitis pressure is elevated. If fluid is cloudy, high level of protein, white and RBC’s or bacteria suggest bacterial meningitis.



Article publié pour la première fois le 02/07/2011

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Fibromyalgia Cycle


Fibromyalgia Cycle

Fibro means (fibrous tissue) myo(muscle) and algos(pain) meaning muscle and connective tissue pain. It is a medical condition characterized by pain and allodynia(painful response to pressure). In other words it is a common syndrome in which a person has a long term, body pain and tenderness in joints, muscles and soft tissues. It is more common in females. Fibromyalgia has been considered either a musculoskeletal disease or neuropsychiatric condition.


Causes of fibromyalgia


According theory of fibromyalgia, patients have lower threshold of pain because of increased sensitivity in the brain to pain signals. main causes which are responsible  are as under


1) genetic predisposition

2) stress

3) dopamine dysfunction.

4) abnormal serotonin metabolism

5) sleep disturbances

6) infection with virus

7) physical or emotional trauma

Genetic factors play an important role in the development of fibromyalgia. For example there is a high aggregation of fibromyalgia in females.

Stress may be precipitating factor  in the development of fibromyalgia. Sometime dopamine dysfunction may cause fibromyalgia, this is due to the disruption of normal dopamine-related neurotransmission.


Signs and symptoms of fibromyalgia

The universal symptom of fibromyalgia is pain, the pain in fibromyalgia is not caused by tissue inflammation instead seem to have increased sensitivity to different sensory stimuli and low pain threshold. Body pain of fibromyalgia can be aggravated by noise, weather change and emotional stress.

Pain involves both sides of the body. It usually affects neck, buttocks, shoulder, arms, upper back and chest. Tender points are the localized areas of body that are tender(cause pain) to light touch. Tender points are commonly found around elbows, shoulder, knees, hips, back of head and side of breast bone.

Fatigue occur in 90% of cases. Fatigue is mainly due to abnormal sleep. These patients lack deep restorative level of sleep. These patients awaken in morning without feeling fully rested, sometime awake with muscle aches or sensation of muscle fatigue as if they had been working out all night.

Mental disorders occur. It include poor concentration, forgetfullness (difficulty in remembering things), mood changes, irritability, depression and anxiety.

Other symptoms include migraine(condition characterized by moderate to severe headache and nausea), tension headache, numbness, tingling, abnormal pain,  Painful and frequent urination.

Treatment of fibromyalgia

Pregabalin, duloxeline and milnacipran have been shown to reduce pain. Tricyclic antidepressants were most affective against pain, fatigue  and sleep problems. Selective serotonin reuptake inhibitors had lower side effects. Tramadol, centrally acting analgesics moderately affective in treating pain. Tramadol combined with paracetamol is also effective to some extent.

Muscle relaxants such as cyclobenzaprine plays an important role as it helps to relieve skeletal muscle spasm and has been used for fibromyalgia treatment.

Tizanidine is used to treat spasm, cramping and tightness of muscles.


Physiotherapy treatment for fibromyalgia

Exercise improves fitness and sleep and may reduce pain and fatigue. It helps in


a) reducing pain

b) reducing muscle stiffness

c) reducing tender points

manual treatment is used to increase range of motion and decrease pain and swelling. Tissue massage along with stretching exercise are commonly used


physical treatment helps to increase muscle and joint flexibility while decreasing swelling and encouraging wounds to heal. It includes use of whirlpool/hydrotherapy or use of deep heating with hot packs/paraffin waxing.


Electrotherapy techniques help to encourage healing and decrease pain and muscle spasm.


Biofeedback and muscle stimulation is helpful to some extent.




Article publié pour la première fois le 04/07/2011

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