What are “Provoked” seizures?
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Childbirth & later: Can I breastfeed if I have Epilepsy? Breastfeeding Linked To Fewer Seizures in Kids – drkharkar
This is the final article in the complete guide to Pregnancy in Epilepsy. At the end of pregnancy, most women have normal childbirth. Occasional women may need a caesearean section. Most seizure medications are safe while breastfeeding. However, some seizure medications are less safe for the baby. Hence talking to a pediatrician before breastfeeding is essential. Table of Contents If I have Epilepsy, will I have a complicated childbirth? Usually women with epilepsy do not have complicated childbirths. For example: Researchers in Norway studied 400 thousand deliveries. They compared childbirths in women with and without epilepsy. There were only minor differences in childbirth between these two groups. Your gynaecologist should be comfortable in handling patients with Epilepsy. In less experienced set-ups, having a cesarean section may be more likely. Per se, this is not a bad thing. An elective cesarean section may ensure good mother and child health. Can I breastfeed if I have Epilepsy? Epilepsy itself is not a concern for breast-feeding. However, some medications are secreted in your milk. Your child may develop side-effects with these medications. Which seizure medications are safe while breastfeeding? Most medications can be given with adequate precutions. But in terms of seizure medications safe while breastfeeding, there are some that are less safe. You should discuss this with a pediatrician. Talk about the safety of seizure medications while breastfeeding. Discuss in detail about the pros/cons of breastfeeding. Look at the table below to find seizure medications safe for breastfeeding. This research is not complete. The question marks below indicate that we don’t know these things precisely. Least safe Less safe Possibly safe? Clonazepam and other sedating medicationsZonisamide Ethosuximide Phenytoin Oxcarbazepine Lamotrigine Zonisamide Topiramate Pregabalin Gabapentin VigabatrinPhenobarbital/Primidone Carbamazepine Valproate Levetiracetam References: Use of antiepileptic drugs during breastfeeding : What do we tell the mother? – Crettenand et al 2018 Antiepileptic drugs and breast feeding – Davanzo et al 2013 No matter which seizure medication you are taking – Check with your pediatrician before breast-feeding. Summary: Most women with epilepsy have uncomplicated childbirths. Some seizures medications are more safe while breastfeeding Make sure you check with your pediatrician before breast-feeding. Be sure to read the “Safe Pregnancy in Epilepsy Checklist”. Keywords – Can You Breastfeed While On Seizure Medication, Baby Seizure During Breastfeeding, Epilepsy And Breastfeeding, Can a Woman With Epilepsy Have a Baby, Safest Antiepileptic in Lactation, Seizure During Labor Treatment, Can You Have An Abortion If You Have Epilepsy, Anticonvulsants Contraindicated in Breastfeeding Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission. Dr. Siddharth Kharkar Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist. Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson’s specialist in Mumbai, Maharashtra, India. He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London. Call 727-624-9168 Send Message
How does Amantadine act?
(Brand names in India: Amantrel, Parkitidin) How does Amantadine act? Amantadine is a another friend of levodopa (remember: its other friend is entacapone). While it can decrease the symptoms of Parkinson’s disease, it works best when it is given to support the action of levodopa. While Entacapone can sometimes increase the side-effects of levodopa, Amantadine is the friend who smoothens out your rough edges, makes you a better person. Amantadine decreases some side-effects of levodopa and makes it more wonderful. Levodopa’s two friends: Entacapone & Amantadine. No one quite understands how Amantadine works for Parkinson’s disease. It was originally designed to kill the influenza virus. However, doctors accidentally discovered that it makes Parkinson’s disease better as well. It has one, fantastic and unique effect in Parkinson’s disease that is described below. No one quite understands how Amantadine works for Parkinson’s disease. It was originally designed to kill the influenza virus. However, doctors accidentally discovered that it makes Parkinson’s disease better as well. It has one, fantastic and unique effect in Parkinson’s disease that is described below. Use/Advantages: Treatment of “Dyskinesias”: Some patients with Parkinson’s disease start getting bothersome movements of the hands, legs and neck after a few years of treatment. I want you to understand these movements. So with all respect: please allow me to describe these movements in the simplest way possible. These movements are dance-like movements, somewhat similar to the way Michael Jackson dances on stage. The Latin word for dance is chorea, and therefore these movements are called chorei-form (dance-like) movements. Since that word is very complicated, they are also called “Dyskinesias”. These movements are often time-linked to levodopa. They are maximum in intensity 30 min – 1 hour after taking levodopa. Dyskinesias are dance-like movements. Amantadine has one fantastic effect – it decreases these movements tremendously. For patients who have not been able to take enough levodopa because of these movements, it enables intake of an adequate quantity of levodopa, so that they can have a much better quality of life. It may smoothen-out the effect of levodopa, and can help in relieving “Predictable wearing OFF” to some degree. But, other stratergies such as entacapone, long-acting medications etc are much more useful for this purpose. Rarely, it can be given as the only medication for Parkinson’s disease. But when used by itself, its effectiveness is limited. Disadvantages: Most people don’t have any side-effects from Amantadine. Some people can have mild swelling or slight purplish discolouration of the feet. Since it is an anti-viral, it can decrease the effectiveness of some viral vaccines. If a live viral vaccine (e.g. Hepatitis B vaccine) needs to be given, Amantaide should be stopped 2 weeks prior and 2 days after the vaccine is administered. Amantadine can decrease the effectiveness of some vaccines. Bottom-line: It is used to control troublesome dance-like movements caused by high doses of levodopa. Although it is only modestly effective by itself, it is extremely good at smoothing out the rough edges of our superstar (levodopa), hence the sorbiquet – The lawyer of levodopa. Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.
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Non-Epileptic events (including Non-Epileptic Seizures / Stress seizures)
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Heredity: Is epilepsy a hereditary disease?
This is an article from the Safe Pregnancy in Epilepsy patient guide. In some people, Epilepsy may be hereditary. But even if you have epilepsy, the chance that your child will have epilepsy is 5% or lower. Epilepsy is inherited through abnormal epilepsy genes. These epilepsy genes may be dominant or recessive (explained below). So transmission of epilepsy can be dominant or recessive. Genetic testing for epilepsy before pregnancy may be useful in the future. At present, genetic testing for epilepsy is rarely useful. Hello! I am Dr Siddharth Kharkar, a Neurologist in Thane, India and a Neurologist in Mumbai, India. I provide Parkinson’s treatment in India and am an Epilepsy specialist in India. I provide Epilepsy surgery in India at Mumbai & Parkinson’s surgery in India. Come, let’s learn together about this important topic. Table of Contents Is Epilepsy a hereditary disease? The word hereditary means passed on from Parents to Children. People with Epilepsy can have abnormal genes. If you have epilepsy, some of your genes may be abnormal. These genes may be passed on to your children. So, Epilepsy can be an inherited disease. So no, neither epilepsy nor epilepsy medications decrease fertility in women drastically! You need to be well informed about pregnancy in epilepsy. Also, there are some extra things to take care of. These articles cover almost everything you need to know about pregnancy in Epilepsy. How commonly is Epilepsy inherited? Most children of patients with Epilepsy do not develop Epilepsy. It is unlikely that your child will have Epilepsy, even if you have Epilepsy. Overall about 1% of babies are born with epilepsy. If you have epilepsy, the chance increases but only slightly. About 5% of babies born to a parent with epilepsy will have epilepsy. For example:One Italian study looked at more than 10,000 people with Epilepsy. Only 2.5% of close relatives (parents, siblings, children) of these patients had epilepsy. Therefore, in most cases the answer to the question “Is epilepsy a hereditary disease” is NO, epilepsy is not a hereditary disease. The risk of your children getting Epilepsy is higher if: You have one of the “Dominant” genes mentioned below. You have an Epilepsy syndrome with only generalized seizures, e.g. JME. Let us know more how epilepsy is inherited. How is Epilepsy inherited? Epilepsy is inherited through abnormal genes. Epilepsy genes are present in some people with epilepsy. Many people with epilepsy do not have abnormal epilepsy genes. Many people have epilepsy due to causes such as old strokes or head trauma. These people cannot pass on epilepsy to their children. In these cases, it is incorrect to say that epilepsy is hereditary. Even if you have an abnormal epilepsy gene, it is very unlikely that your children will have epilepsy. Epilepsy genes can be Recessive or dominant. They can have incomplete penetrance. So, even if you have an abnormal epilepsy gene, it may be incorrect to say that epilepsy is hereditary. Let us know more about the terms recessive genes, dominant genes and incomplete penetrace. What are “Recessive” genes? Let us assume that you have some abnormal genes. Still, it is unlikely that your child will have epilepsy. Why is it so? It is because your child will receive two sets of genes. One set from you and another from your partner. Even if one of these sets is normal, the child will not have Epilepsy. The normal genes prevent the harmful effect of abnormal genes. These abnormal genes are called “Recessive”. Luckily, many of the genes causing Epilepsy are Recessive. So, even though epilepsy is a hereditary disease if you have recessive genes – very few members of the family actually develop epilepsy. What are “Dominant” genes? Some genes are “Dominant” in nature. This means that even if only one set of genes is faulty, the child can develop Epilepsy. If you want, you can click on the plus sign below. You will see the known Dominant genes causing Epilepsy. This table seems large! But very few people have these genes. Most people have “recessive” epilepsy genes. Dominant Epilepsy genes So, epilepsy is more likely to affect your family members (including children) if you have a dominant epilepsy gene. But even that is not a 100% certainty. If I have a Dominant epilepsy gene, will my child have Epilepsy? Even if you have a “Dominant” epilepsy gene, your child may not have Epilepsy. Sometimes abnormal genes do not cause an abnormal effect, even if they are dominant. “Incomplete penetrance” is the medical term for this phenomenon. The reasons for “Incomplete penetrance” are difficult to explain. You can read more by clicking here. But who’s arguing with nature! Incomplete penetrance is very beneficial. For example: Only 6.6% of children of Parents with JME develop JME. (read more by clicking here) Let us look at the other genes described above. Notice that it is difficult to calculate the exact chance of transmission. If you’re intersted, here is a research paper discussing this problem. Penetrance of Dominant Epilepsy genes So even if you have a dominant epilepsy gene, Epilepsy may still not be a hereditary disease! Is Epilepsy more likely to be transmitted if the Parents are related? Usually, parents have very different genes from one another. The child does get two sets of genes, one from each Parent. Even if one is an abnormal epilepsy gene, the other is frequently normal. So Epilepsy transmission to the child is not common. Marriages between close relatives (e.g. cousins) are called “consanguineous Marriages”. If the two parents are related to each other (e.g. are Cousins), then they are genetically similar. They have similar genes. Both may have the same abnormal epilepsy gene. Their child may get two sets of abnormal epilepsy genes. A child with two sets of abnormal epilepsy genes can develop epilepsy. So, Epilepsy is more likely to be a hereditary disease if the parents are closely related. Is Genetic Testing for epilepsy before pregnancy useful? Doctors don’t agree about genetic testing for Epilepsy
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What is Progressive Supranuclear Palsy? [PSP meaning]
After reading what your doctor wrote, you may have wondered: What is PSP? PSP means “Progressive Supranuclear Palsy”. It is a Parkinson’s Plus Syndrome. Some diseases are like Parkinson’s disease. But they also have extra symptoms. So, they are called “Parkinson’s Plus Syndromes”. PSP is the most common Parkinson’s Plus Syndrome. If you have PSP, the extra symptoms will be: (1) Falling (2) Trouble moving eyes. In the early stages, PSP may be misdiagnosed to be Parkinson’s disease. An MRI may help in the accurate diagnosis of PSP. Parkinson’s Plus Syndromes You can read more about Parkinson’s plus syndromes here. Do read about misdiagnosis here. It will help you understand this article. Symptoms of PSP Progressive Supranuclear Palsy (PSP) has the 4 cardinal symptoms of Parkinsonism. 4 movement problems = “Parkinson-ism” 1. Slowness (Bradykinesia, Hypokinesia or Akinesia) 2. Uncontrolled shaking (tremor) 3. Stiffness (rigidity) 4. Unsteadiness & shuffling gait. All features are not always present. In particular, PSP patients often do not have a tremor. Parkinson’s Plus syndromes have extra symptoms. So, let us look at the “Plus” symptoms of PSP PLUS symptoms seen in PSP (Extra) 1) Falling: Falling can happen both in Parkinson’s disease and PSP. But, patients with PSP start falling early. Usually, PSP patients will fall within one year. Also, patients with PSP will fall backwards. Falling, mostly backwards, is seen in PSP. If you have PSP, you may walk with your feet wide apart to prevent falls. Falls are a big problem. They can cause injury. So, it would help if you took all measures to prevent them. Click here to learn how. 2) Trouble moving eyes: Usually, the doctor notices this problem. If you have Progressive Supranuclear Palsy (PSP), you will have difficulty moving your eyes. It becomes difficult to look up and look down. Partly because of this problem, you may sit with their head pushed backwards. (hyperextension of the neck). Look at the video below, posted by Dr. Dusan Pavlovic on youtube. This patient has trouble looking upwards. He also has some difficulty looking down. When present, difficulty looking downwards is very suggestive of PSP. https://www.youtube.com/watch?v=LU7TC0wufhg Here is another video, by Dr. Kathleen Digre at the University of Utah. It is good to know what doctors look for. But, this video is very technical. It’s okay if you do not understand it completely. https://www.youtube.com/watch?v=JlIWSilgPvc Other Plus symptoms of PSP Falling & trouble moving eyes are the main plus signs. But patients with PSP also have the other additional problems: Usually, PSP patients will fall within one year. Also, patients with PSP will fall backwards. 1. Speech: They may need to strain to talk. It may seem like they have a strangled voice. They may stutter or repeat words. 2. Swallowing: It may be difficult to push food into the stomach. Food may go into the lungs instead (aspiration). This may cause explosive coughing. If food goes into the lungs, it causes a nasty pneumonia. This is called “Aspiration”. Aspiration is a serious issue. It needs urgent attention. Read more about prevention of aspiration here. 3. Thinking: PSP patients have difficulty controlling their emotions. They may laugh or cry very easily (pseudo-bulbar affect). PSP patients may become impulsive. They may get up quickly, even though this makes them fall. Doctors call this the “rocket sign.” What causes Progressive Supranuclear Palsy (PSP)? Progressive Supranuclear Palsy (PSP) is caused by an accumulation of a waste product called “Tau” in the brain. Remember: Parkinson’s disease is caused by the collection of waste produced called “synuclein.” Accumulation of a waste product called “tau” in the brain may cause PSP. Accumulation of tau causes a decrease in dopamine activity in the brain. The exact reason why “Tau” accumulates in the brain is not known. How is PSP diagnosed? PSP is diagnosed clinically. It is diagnosed by the doctor talking to you and examining you. The most important things are: – History of frequently falling backwards, especially in the first year. – Difficulty looking downwards when the doctor examines you. A detailed conversation with and examination by your doctor is needed to diagnose PSP. Accumulation of tau causes a decrease in dopamine activity in the brain. The exact reason why “Tau” accumulates in the brain is not known. What are the MRI findings of PSP? These findings are not seen in all patients. In particular, they may not be seen in the early stages of Progressive Supranuclear Palsy (PSP). In PSP, a particular part of the brain called the”Midbrain” shrinks in size. When this happens, the following two signs may be seen on the MRI: Mickey-Mouse sign: When seen from the top, the midbrain may appear like Mickey-Mouse. Humming-bird sign: When seen from the side, the midbrain may appear like a hummingbird. Click here to see images: [Menoufia University Journal Article] Sometimes, these findings are not seen on the first MRI. In those cases, a repeat MRI after 1-2 years may show these changes. Can an F-DOPA scan or Trodat Scan diagnose PSP? Yes. F-DOPA or Trodat scans detect a decrease in dopamine activity in the brain. You can read more about them here. This is a DAT scan. The scan on the right shows decreased dopamine activity. Dopamine activity is reduced in Progressive Supranuclear Palsy (PSP), like in Parkinson’s disease. So, these scans are abnormal. The scan findings in PSP are slightly different than Parkinson’s disease. But these differences are slight. So, it isn’t easy to distinguish PSP from regular Parkinson’s disease based only on DAT / FDOPA studies. What is the treatment of PSP? You can read more about the treatment of PSP in another article. [Click here] PSP patient guide 1. What are the Parkinson’s Plus syndromes?2. What is PSP?3. 30+ Mimics of Parkinson’s & PSP 4. PSP treatment & new research: (a) Do we have a miracle cure for PSP? (b) Levodopa – actions & side-effects (c) Amantadine – actions & side-effects 5. How to avoid aspiration6. How to avoid falling7. Avoid these medications!8. Get updates by email Caution: This information is not a substitute for professional care. Do not
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Teratogenicity: Are seizure medications safe in pregnancy? Antiepileptic Drugs in Women With Epilepsy During Pregnancy – Drkharkar
This is an article from the Safe Pregnancy in Epilepsy patient guide. Seizure medications can cause birth defects. It is important to choose one of the seizure medications safe in pregnancy. The safest antiepileptic in pregnancy needs to be carefully selected for each woman. It needs to minimize both seizures and birth defects. Valproate has the highest risk of causing birth defects. In terms of lowest risk of birth defects, Lamotrigine and Levetiracetam are the antiepileptics safest in pregnancy. Table of Contents Which is the safest antiepileptic in pregnancy? There are two goals of epilepsy management during pregnancy: Prevent birth defects (teratogenicity) Prevent seizures In terms of preventing birth defects, Lamotrigine & Levetiracetam are the safest antiepileptics in pregnancy. But to select the safest antileptic for you, we need to make sure your seizures are controlled. So, your doctor may advise you to take a different medication. What is “Teratogenicity”? When the sperm and egg unite, a single cell is created. Like a miracle, this single cell divides & forms arms, legs, heart, brain and other organs. Here is a video of this process: https://youtu.be/fKyljukBE70Let us quickly summarize: First 3 months – Basic organs develop. The basic spinal cord forms within 2 months. 3-6 months – The brain, spinal cord and heart start becoming more complex. 6-9 months: All organs and the baby itself rapidly increases in size! Seizure medications can cause birth defects such as a small head, or improperly formed lips. “Teratogenicity” it the medical term for this problem. We want to minimize this problem. Is there a medication labelled the “safest antiepileptic in pregnancy”? Let’s read more. What structural problems can seizure medications cause? Seizure medications can produce many kinds of structural problems. But the most common ones are: Incorrect formation of the heart – For example: an incorrect hole (ASD, VSD) etc Incorrect formation of the lips and mouth – Cleft lip Incorrect formation of the spinal cord – Spina Bifida Incorrect formation of the brain – e.g. too small – microcephaly Other problems such as kidney problems are less common. The very important things to realize are: Problems with the brain and spinal cord are more serious. Even more serious than heart problems (most heart problems are fixable). The first 3 months are a critical period of spinal cord and brain formation. So, start taking steps to reduce this risk BEFORE YOU GET PREGNANT. How can you reduce risk to the baby? There are less safe seizure medications, and there are – relatively speaking – seizures medications safe in pregnancy. Newer medications like levetiracetam top the list of seizure medications safe in pregnancy. When it comes to avoiding birth defects, Levetiracetam (along with lamotrigine) is probably the safest antiepileptic in pregnancy. Please realize one critical thing: If you have a big generalized convulsion then both your and your baby’s life are at risk. Therefore, you HAVE to keep taking seizure medications during pregnancy. You need to plan your pregnancy properly (see below). Unplanned pregnancies in Epilepsy are common. Seizure medications can make oral contraceptives ineffective. Therefore, use condoms to prevent pregnancy. Meet your doctor at least 1 year before you get pregnant. Ask him/her the following 6 questions: How likely am I to get seizures while pregnant? Can I change to a seizure medication that is safer for the baby? Can I take a lower dose of my seizure medication? Can I take fewer seizure medications? Should I start taking folic acid supplements? Do I need more frequent ultrasound or blood tests? Let us talk about each of these questions. How likely am I to get seizures while pregnant? If you are seizure-free before pregnancy, you are unlikely to have seizures during pregnancy. Ideally, you should be seizure-free for one year before getting pregnant. This also means that if your seizures are not controlled then you may want to delay your pregnancy. Give your doctor time to control them, before getting pregnant. Can I change to one of the seizure medications safe in pregnancy? Some medications are not in the list of seizure medications safe in pregnancy. These tend to be the older seizure medications. Of the seizure medications safe in pregnancy, levetiracetam is the most commonly used one. As far as avoiding birth defects is concerned – Levetiracetam is (along with lamotrigine) the safest antiepileptic in pregnancy. But here is a critical point. When you select seizure medications safe in pregnancy, the one you choose has to control your seizures AND minimize risk to the baby. For you, that is the safest antiepileptic in pregnancy. Let us look at this table:Least safe Less safe Valproate Phenobarbital Carbamazepine Phenytoin Carbamazepine Oxcarbazepine And this one: More safeSafety not clearly knownLevetiracetam LamotrigineZonisamide (probably safe) Lacosamide (probably safe) Gabapentin (proabbly safe) Clobazam & clonazepam (probably slightly unsafe) Out of all these medications, Valproate is the least safe seizure medication in pregnancy. Valproate causes malformations in about 10% of babies. The flip-side of course is that (even with this medication) ~90% of babies have no such problems. Talk to your doctor if you are taking medications in the “least safe” column. Ask your doctor whether you can try one of the “More safe” medications instead. Often, such a switch is reasonable to attempt. Sometimes, the answer may be “No, there would be a very high risk of seizures”. Remember: When you select a seizure medications safe in pregnancy, the one you choose has to control your seizures AND minimize risk to the baby. This answer can depend on the type of your Epilepsy. For example:Let’s consider JME, a common type of epilepsy. In JME, switching from Valproate (Least safe) to Levetiracetam (More safe) is usually possible. Remember: After a switch, be seizure-free for 1 year before getting pregnant. Should you change to seizure medications safe in pregnancy AFTER getting pregnant? Almost always, the answer to this question is No. Once you get pregnant, it is usually best to continue with your current medication. The American Academy of Neurology (AAN) guidelines discuss this problem. Switching seizure medications after getting pregnant is usually not a good idea because: You could lose control of your seizures. While changing from one medication to
Parkinson’s Plus Syndromes [5 important mimics]
What are the Parkinson’s Plus Syndromes? It is best to think of the Parkinson’s Plus syndromes as the sisters of Parkinson’s disease. Although many diseases are similar to Parkinson’s disease, the changes they produce and their symptoms are slightly different. It’s why we think of these diseases as the sisters of Parkinson’s disease. Another name for them is the “Parkinson’s Plus” syndromes.Another name for them is the “Parkinson’s Plus” syndromes. PSP, MSA, CBD, and other “Parkinson’s Plus” diseases are like the sisters of Parkinson’s disease. There are three common Parkinson’s Plus syndromes. Parkinson’s Plus Syndromes 1. Progresive Supranuclear Palsy (PSP) 2. Multiple System Atrophy (MSA) 3. Cortico Basal Degeneration (CBD) Ideally, the specific Parkinson’s Plus Syndrome should be identified correctly before the start of treatment. But in the early stages of the disease, this may be difficult, and sometimes impossible. You ca read more here [external link: Frontiers in Neurology]. Because it is sometimes impossible to tell PSP, MSA, and CBD apart, doctors sometimes diagnose the patient as having a “Parkinson’s Plus” syndrome without noting the specific disease. As the years go by, the appearance of characteristic features (such as eye movement problems in PSP) may enable your doctor to make a more precise diagnosis. Which Symptoms May Indicate a Parkinson’s Plus Syndrome? If you have any of the following features, you may have a Parkinson’s Plus syndrome. These features are called “red flags”. This means that if you have one of these symptoms, your doctor is supposed to pause and think. Red flag. Your doctor will be extra careful if you have any of the following symptoms. ‘Red Flags’ suggesting that you may have a Parkinson’s Plus Syndrome 1. Lack of response to Levodopa. 2. Frequently falling down, especially backwards. 3. Severe talking or swallowing problems. 4. Problems with eye movement. 5. Impotence. 6. Blurring of vision. 7. Blacking out when rising from a seated position. 8. Problems with thinking or memory loss. 9. Personality changes. 10. Symptoms only in the legs while the arms and hands are completely normal. 11. Rapid progression of the disease. What is the Treatment for a Parkinson’s Plus Syndrome? The treatment for a Parkinson’s Plus syndrome is the same as the treatment for Parkinson’s disease itself. Many patients respond to Levodopa. However, what’s challenging is that sometimes Levodopa does not have a dramatic effect. It may also happen that this effect may not last for many years. Therefore, the response to levodopa is somewhat unpredictable. Once it enters the brain, Levdoopa is converted into Dopamine. That being said, a significant proportion of patients with Parkinson’s Plus syndromes respond positively to a comprehensive treatment effort. This effort should include the treatment of special problems associated with each syndrome. Therefore, it is crucial to figure out which kind of Parkinson’s Plus syndrome early you have so that these specific problems can be treated. For example: In PSP, the patient frequently falls backwards because the areas of the brain responsible for balance are not functioning well. In this case, balance training can help. In MSA, the patient can fall because of a drop in blood pressure when they get up. In this case, they should drink enough water and try to get up slowly to prevent falls. Some medications can also prevent falls. What is Progressive Supranuclear Palsy (PSP)? PSP is the most common of the “Parkinson’s Plus” syndromes. Patients with PSP frequently fall backwards. To know more about PSP, click here: [PSP patient guide] What is Multiple System Atrophy (MSA)? MSA is the second most common of the “Parkinson’s Plus” syndromes. Patients with MSA have trouble with a part of their nervous system that controls blood pressure, heart rate, sweating and sexual function. To know more about MSA, click here: [MSA in detail] What are Other Types of Parkinson’s Plus Syndromes? There are many other Parkinson’s Plus Syndromes. Since it’s not possible to describe each of these in detail here, I will mention their names and certain key characteristics. Corticobasal Degeneration: Characterized by difficulty using automatic movements of an arm or hand. Dementia with Lewy Bodies: Characterized by hallucinations & disorganized behaviour. Frontotemporal dementia (“Pick’s disease”): Characterized by personality changes, including impulsivity and dis-inhibition. Here is a nice review of many Parkinson’s Plus Syndromes. It is very nicely written, but a bit detailed: [McFarland et al 2016, Neurology Continuum]. PSP patient guide 1. What are the Parkinson’s Plus syndromes?2. What is PSP?3. 30+ Mimics of Parkinson’s & PSP 4. PSP treatment & new research: (a) Do we have a miracle cure for PSP? (b) Levodopa – actions & side-effects (c) Amantadine – actions & side-effects 5. How to avoid aspiration6. How to avoid falling7. Avoid these medications!8. Get updates by email Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.
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What are “Epilepsy Syndromes”?, Classification and Definition of Epilepsy Syndromes – Drkharkar
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DBS for Parkinson’s Disease – Realistic expectations.
1) It is not magic DBS is not a magic solution or a miracle cure. 2) Expected benefits It leads to increased ON-time (4-6 hours on average) and decreased severity of symptoms during the OFF time. However, even after DBS many patients will still experience fluctuations and OFF-times. 3) Non-motor benefits DBS may also cause improvements in non-motor symptoms such as improving the quality of your sleep. 4) Some symptoms do not improve DBS does not improve all symptoms of Parkinson’s disease. Some symptoms, such as unsteadiness do not respond to DBS treatment. Other symptoms such as freezing while walking, may show variable improvement. 5) You will need to keep taking medications You will need to take some medications even after DBS. The doses of medications after GPi-DBS may remain the same, or may even increase. Medication doses can be reduced after STN-DBS, but this is done carefully and gradually over 3-6 months. 6) DBS programming takes some time DBS Programming can take many months to complete. During this time, you can expect a gradual recovery of motor function. However, finding the optimum parameters for the maximal benefit can take up to 6 months. 7) Few people may not improve Most patients improve after DBS surgery. Some patients do not show adequate improvement even if the electrode is properly positioned, and the programming is done correctly. This lack of response in some patients happens in all institutions throughout the world. Some, but not all, of these patients may show improvement after advanced programming techniques. The exact reason why some people do not respond adequately is not known. Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor’s permission.
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