Common Conditions treated at the Office
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Attention-deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral syndrome that occurs during childhood, which manifests as inattention, impulsivity, and hyperactivity. The term attention-deficit disorder (ADD) refers to the condition without hyperactivity.
Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease, is a progressive neuromuscular disease that destroys cerebral and spinal motor, resulting in progressive atrophy and weakness of skeletal muscles.
Alzheimer’s disease (AD) is a progressive degenerative disorder in which there is loss of brain cells (neurons), resulting in the loss of memory and other cognitive functions such as judgment and reasoning.
Back and Neck pain is often from stress or strain on the muscles or ligaments that support the spine, but can sometimes be from disc (Cushions between the vertebrae) problems, facet joints (joints between the bones of the neck and back) and bone spurs which can pinch nerves in the neck or back which may refer pain into the arm (Cervical Radiculopathy) or the leg (Lumbar radiculopathy or sciatica).
Bell’s palsy is a facial paralysis resulting from damage to the facial nerve, which connects to all the muscles of the face. Facial nerve paralysis causes distortion of facial features and interferes with normal facial function. It has to be distinguished from a small stroke which can also affect facial muscles.
Blepharospasm refers to involuntary eyelid muscle contraction affecting both eyes. It can start with excessive blinking but the excessive forced eye closure can lead to functional blindness with difficulty reading and driving. Medications may help in mild cases, but Botox therapy is the most effective treatment.
Botulinum toxin injection therapy (also known as “BOTOX therapy” or onabotulinumtoxinA) is used to treat:
- Dystonia – neuromuscular disorder that produces involuntary muscle contractions such as Blepharospasm
- Hemifacial spasm
- Spasmodic torticollis
It is also used for limb spasticity (e.g., following stroke, spinal injury or in patients with multiple sclerosis.)
The goal of the therapy is to reduce muscle spasms and pain. In October 2010, the U.S. Food and Drug Administration (FDA) approved BOTOX injections to treat chronic migraines in adults who experience headaches on 14 or more days each month. Botox treatment has to be repeated every 3 to 4 months.
Carpal tunnel syndrome (CTS) is the most common nerve compression or entrapment, and occurs in the Median nerve at the wrist in a tight passageway called the Carpal tunnel. This condition often results in tingling, pain, numbness initially, and can progress to muscle weakness, in the hand in some patients if untreated. CTS is often associated with repetitive activities (e.g., typing and mechanical work with hands).
Cerebral palsy refers to non-progressive damage to motor areas in the brain that impair the body’s ability to control movement and posture usually associated with events that occur before or during birth. Symptoms can be mild to severe and include spastic weakness, coordination problems and may include involuntary movements. There may also be associated learning disabilities and seizures.
Dementia refers to a loss of memory and cognitive functions caused by disease or trauma. Tests are done to find the cause and to determine if it is reversible or irreversible.
Fibromyalgia is a chronic musculoskeletal pain syndrome affecting spinal and limb muscles and joints. Pain may be accompanied by sleep problems, fatigue, irritable bowel, and depression. The onset may occur spontaneously or after trauma.
Headache refers to pain in one or more areas in and around the head. Primary headaches which are benign, account for over 90 percent of all headaches and include:
Secondary headaches are associated with an underlying condition such head trauma, infection, tumor etc.
Hemifacial spasm is a disorder caused by irritability of the Facial nerve and is characterized by frequent, involuntary muscle contractions (spasms) on one side of the face. The early symptom is usually an intermittent spasms of the eyelid muscle, which then spreads and eventually involves all of the muscles on the affected side of the face. Mild case may be helped by medications. Botox injections are extremely effective and some patients may need microvascular decompression of the facial nerve
Migraine headaches are often throbbing and may be one sided (unilateral). Associated symptoms may include:
- Sensitivity to light, sound, and smells
There may be triggers for some patients like
- Hormonal changes (during menstrual cycle, barometric pressure change)
- Certain foods (sharp cheese, dark chocolates) alcohol (especially red wine) etc
Movement disorders are diverse neurological conditions that affect the speed, fluency, and quality of movement. These may include
- Ataxia (lack of coordination)
- Dystonia (involuntary movement and prolonged muscle contraction) such as
- Spasmodic torticollis (affecting neck muscles)
- Blepharospasm (affecting eye muscles )
- Hemifacial spasms (affecting one half of the face) and are often treated with Botox injections;
- Huntington’s disease (Familial chronic progressive chorea);
- Parkinson’s disease (tremors, rigidity, slow movements and stooped posture and gait imbalance)
- Tics (Habit spasms – muscle contractions with partial control over the movements);
- Tremor (e.g., essential tremor, involuntary slowly progressive tremor – often familial and sometimes confused with Parkinson’s disease)
Multiple sclerosis (MS) is an inflammatory, autoimmune, chronic condition, that affects the brain and spinal cord. Myelin that insulates nerves and facilitates the conduction of nerve impulses is the initial target of inflammatory destruction in multiple sclerosis.
MS is characterized by intermittent damage to myelin, called demyelination. Symptoms vary depending on location and severity of lesions and can include weakness, balance problems, numbness, and vision loss. MS symptoms can worsen (exacerbation) and improve (Remission), and develop in different areas of the body at different times.
Myasthenia gravis (MG) is a chronic autoimmune disorder that results in progressive, often fluctuating skeletal muscle weakness. In early stages, eye and facial muscles are affected with droopiness of the eyes or double vision. But if untreated, it causes limb weakness and swallowing and breathing problems.
Myopathies are diseases that weaken muscles. Myopathies can be caused by inherited genetic defects (e.g., muscular dystrophies), or by endocrine, inflammatory (e.g., polymyositis), and metabolic disorders among other causes.
Peripheral neuropathy is a general term referring to disorders of peripheral nerves. Diabetes Mellitus is the commonest cause for peripheral neuropathy. However, there are other causes such as deficiencies of B12 vitamin or certain autoimmune inflammatory neuropathies which are treatable, or certain genetic causes which are not treatable. Many people suffer from the disorder without ever identifying the cause (Idiopathic).
Obstructive Sleep apnea (OSA) results from a collapse and blockage of the upper airway during sleep. Patients often have loud snoring while sleeping, and may be observed by a partner to have periods of apnea (stop breathing briefly for a-few seconds). This results in sleep disruptions causing daytime drowsiness and fatigue because of lack of restful, and deep restorative sleep at night.
There is often inability to concentrate and forgetfulness. Patients with OSA are often overweight and at risk for high blood pressure, heart disease and stroke depending on the severity of the sleep apnea.
Parkinson’s disease is a chronic, progressive neurodegenerative movement disorder resulting from the loss of dopamine-producing nerve cells in the substantia nigra. Patients develop tremors, rigidity, slow movement and poor balance while walking
Restless legs syndrome (RLS) is an irresistible urge to move their legs while at rest. They experience a vague, uncomfortable feeling while at rest that is only relieved by moving the legs.
Periodic limb movement disorder (PLMD) is involuntary, intermittent limb movement during the night which can cause poor sleep and may lead to sleep maintenance insomnia and/or excessive daytime sleepiness. RLS and PLMD are distinct disorders but they often occur simultaneously.
Complex regional pain syndrome (CRPS), formerly called reflex sympathetic dystrophy (RSD) and causalgia, is a chronic, painful, condition that affects the skin, muscles, joints and bones. The syndrome usually develops after an injury to a limb. RSD/CRPS is characterized by various degrees of burning pain, excessive sweating, swelling, and sensitivity to touch. Pain may begin in one area of the limb and can spread to other limbs. Two types of RSD/CRPS have been defined:
- Type 1 (CRPS I)—without nerve injury
- Type 2 (CRPS II)—with nerve injury
Epilepsy is characterized by recurrent seizures that are caused by abnormal electrical activity in cerebral nerve cells. Idiopathic epilepsy has no known cause; Symptomatic epilepsy results from a known condition, such as stroke, head injury, tumors etc.
Sleep is essential for normal nervous system function and for the ability to function optimally – both physically and mentally. The most common sleep disorders are
Strokes occur when blood flow to a region of the brain is interrupted, and results in death of a region of brain tissue. There are two main types of stroke:
- Ischemic stroke is caused by blockage in an artery that supplies blood to the brain resulting in a deficiency in blood flow (ischemia).
- Hemorrhagic stroke is caused by the bleeding of blood vessels (hemorrhage) in the brain.
Torticollis or Spasmodic Torticollis (ST), is a Cervical dystonia with intermittent or sustained contractions of the muscles around the neck which control the position of the head. This causes the head to lean to one side, or be pulled forward or backward. The shoulders may also be uneven and some patients experience tremors in the head or arms. Torticollis is usually accompanied by constant and sometimes extreme pain. Botox therapy is the most effective treatment for the condition.
Traumatic brain injury (TBI) is damage to the brain caused by a direct blow to the head or sudden deceleration. The severity of the injury may range from minor to major. Patients with even mild concussions can have variable duration of post concussive symptoms which can affect their ability to work, resulting in lost earnings and productivity.
An Essential tremor is a benign, often hereditary tremor – rhythmic involuntary shaking often affecting the hands but can spread to the head and voice. Characteristically, essential tremors become more pronounced during activities such as writing or using a utensil. It has to be distinguished from Parkinson’s disease, which often occurs at rest and diminishes with movement.
Trigeminal neuralgia, also called tic douloureux, is an extremely painful neurological condition that occurs as a result of damage to, or pressure on, the fifth cranial nerve, also called the trigeminal nerve.
Trigeminal neuralgia causes sudden, severe “electrical-shock-like” sharp lancinating pain, on one side of the face. Treatments include medications that work on the nerves causing the pain. Occasionally, some patients need surgical procedures if medications are not tolerated or do not control the pain
Nervous system (NS) tumors can develop in either the brain or spinal cord, The symptoms depend on the location of the tumor. Benign tumors and cancerous tumors that originate in the nervous system are referred to as primary tumors. Tumors that spread to the nervous system from a site elsewhere are called metastatic tumors. Symptoms depend on the location of the tumor.
Neurologists may be involved in the diagnosis of the tumor and managing some of the symptoms such as seizures resulting from the tumor. Surgery (performed by Neurosurgeons) and radiation are the most common treatments for brain tumors.
Vertigo is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling, and is often a result of a disorder in the central vestibular system (i.e., Labyrinth, vestibular nerve, brainstem, and cerebellum).
Benign paroxysmal positional vertigo (BPPV); is a common benign cause for vertigo where crystals from the Otolith organs in the inner ear (the utricle and saccule) can become dislodged and move into one of the semicircular canals result in vertigo with certain movements of the head.
Vertigo can be caused by more serious conditions such as strokes, inflammatory conditions, and tumors. Vertigo also needs to be distinguished from non-spinning dizziness which has different causes.