It is estimated, there are approximately 7000+ neurological diseases and many have limited treatment options. About 80% are genetic, chronic and can often be life-threatening. Often patients endure long periods of uncertainty before their conditions are properly diagnosed. Due to limited awareness regarding healthcare and these conditions, patients are typically misdiagnosed two to three times before they’re diagnosed correctly. On an average, proper diagnosis from the time of first symptoms takes about 5 years so it becomes imperative to gain knowledge about a particular disease before opting for a treatment plan. Let’s look at a few questions around these neurological disorders and conditions for more clarity; as discussed and shared by Dr. Amit Pande, a renowned consultant neurologist with iCardin with over 13+ years of experience in this field.
Q1. What kind of diagnosis and medications can be suggested online for chronic disorders like Multiple Sclerosis, Parkinson’s disease, Peripheral/Diabetic Neuropathy and other movement disorders?
Chronic conditions give one a lot of time to gauge the symptoms, the disability and yes, so you can take time and decide the treatment for these whether online or offline. When we say time, it means you can take upto 24 hours or 48 hours to decide what kind of diagnosis, what kind of investigations you want for your diagnosis.
For example, in multiple sclerosis, because it affects everything – the eyes, the spinal cord or your sensations, it is important to analyze all these and give it due time before reaching a conclusion. You may require a MRI of the entire neural-axis, screening of the brain, eyes and spine for ruling out any damage. Of course, the history is very typical. You also need certain investigations that can be done only when the patient is under observation in a hospital/clinic setup. Why? So that cerebral spinal fluid examination can be done to determine whether a patient actually has multiple sclerosis or they have some other infection or to figure out whether it is some disease mimicking as multiple sclerosis.
In an online consultation, it is advisable to consult patients with the symptoms pre-diagnosed for multiple sclerosis. Otherwise, the entire gamut of tests like an MRI, cerebrospinal fluid, visual evoke potential, some blood investigations will be required for proper diagnosis and suggesting a treatment plan ahead.
In case of Parkinson’s disease, the diagnosis is mainly clinical. MRI alone of the brain would not help in diagnosing a patient with Parkinson’s disease. Parkinson’s disease does have myriad symptoms, the most common being Bradykinesia that describes a slow movement or a difficultly moving the body on demand. This may be related to muscle weakness, rigid muscles, or tremors. The patient may have false postural imbalance and walking difficulties. So a lot of clinical features play an important role in diagnosing Parkinson’s disease rather than diagnosing them purely on investigations.
Hence neurological conditions need different tests for reaching a prognosis/diagnosis; in the above cases one requires imaging whereas other one requires clinical examinations.
Q2. Does a second opinion really help in the field of neurology?
For example, Parkinson’s syndrome is a condition in which there are multiple subsets such as a progressive supra neural palsy which can be managed differently. Neurological conditions cannot be classified under ‘one-size-fits-all’ and we often find that a particular drug may work for a particular condition but not for another even if there are similar symptoms being exhibited. Same goes for the treatment suggestions so here is where a second opinion might work wonders. Otherwise, if you just look at the symptomatology and start the patient on a blanket treatment, it may suit one; it may not suit the other. This is possible only after eliciting a proper history and even then sometimes, one may not get it right in the first go!
In case of multiple sclerosis, it is very important to choose and recommend the correct drug – a drug with which the patient is comfortable with keeping the age factor in mind as well. What happens with multiple sclerosis is – you never know, when the next attack will come. So, you may need to gauge the comfort of the patient within first two weeks of treatment and modify it based on the response.
Previously, drug therapy for multiple sclerosis was a costly affair. A couple of years ago it would range around Rs. 90,000+ per month, and now it has reached in an affordable range of around Rs.18, 000 per month. Along with this, more options for oral medications are available for treatment making the ‘drug therapy’ not an elite term anymore in neurology. These treatment options may not be foolproof but they do decrease the relapse rate for an attack. We have to understand that when we start a treatment, it is not going to make the disease go away completely. It will control the frequency of relapses thereby decrease the morbidity. Even in Parkinson’s, drugs are mostly prescribed to control the symptoms. The disease never really goes away, it is going to remain in a patient’s brain and in their body forever.
India is one of the cheapest markets for these drugs making it more accessible for healthcare workers and masses alike.
Q3. Can a second opinion for tumors be life altering?
Sometimes, patients are diagnosed with conditions that are totally different from tumors; sometimes they may be diagnosed with stroke like symptoms that can be related to tumors. These are times when a second opinion can make all the difference. From radiology’s perspective; only the imagery of the condition can be seen but they may not be able to the see the clinical perspective. So, it is very important to correlate clinical as well as radiological perspectives for diagnosing a tumor correctly.
There have been multiple cases in which a second opinion treatment plan for the tumors has managed to alter the morbidity and mortality status of the patients. For clarity of our readers, before opting for a tumor surgery, knowing what kind of tissue is causing a tumour is important. If you know what kind of tissue damage is causing a tumour, then you can plan a treatment. Low-grade cancers usually have a better prognosis than high-grade cancers and may not need treatment right away. So, at least you know diagnostically whether the tumour is going to be responsive to treatment. If it is a high-grade tumour, then your treatment options may be limited.
One of my patients had approached with a complaint of recurring seizures and exhibited the symptoms of Parkinson’s disease. He had a mass in his brain, was advised surgery and it was medically the right thing to do considering his history and current medical reports. But the patient was sceptical for opting a surgery due to limited information regarding the same.
Considering a second opinion, we discovered post biopsy that it was a lymphoma. Now, lymphomas are very sensitive to chemotherapy as well as radiation but in most cases the patient can be cured completely or the morbidity improves and their 5 years survival rate is often more than 70%. By diagnosing tumors with operative, getting the histopathology of the tumors will help you guide patients towards an appropriate treatment plan. Most of the times, the tumors turn out to be benign. The size of tumors for example in cases of Meningioma can be overwhelming, but they are benign tumors of the brain covering and can be removed easily. They do not cause severe morbidity and are not recurrent to a great extent. Even if they are recurrent, they don’t recur often. On removal of these tumors, the patients can lead a normal life.
So the patient, who was diagnosed as a case of Parkinson’s disease, had a big Meningioma that was successfully operated and all his Parkinsonian features vanished completely. The surgery was opted by the patient post all the information given to him during the second opinion consultation, helping him understand the condition properly.
Hence it is crucial to know whether a tumor is malignant or benign, its causes, affects and post surgery affects before making a decision in order to properly channel a line of treatment.
Preventive care approach can only become a practise when we empower patients with the right information regarding any disease. It is always good to have a physician or a doctor or a specialist shed light upon the technicality and the ‘human angle’ for dealing with chronic life threatening diseases. This blog is our humble attempt to encompass both. Hope you had a good read and we promise to share more in the following weeks!