In a recent report published by the World Health Organization “Neurological disorders, public health challenges” states that about one billion people worldwide suffer from neurological disorders and that 6.8 million people die annually from these disorders. The spectrum of neurological disorders includes epilepsy, stroke, headache, Alzheimer’s disease and other dementias, Parkinson’s disease, multiple sclerosis, brain injuries, neuroinfectious diseases etc. Stroke is the second most common cause of mortality and a major cause of disability. At this backdrop, alternative approaches of optimal utilization of community health studies and awareness, online healthcare agencies and private sector may facilitate achieving the goal of taking neurology care to the ‘unreached’ through preventative care models.
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. As per neurologists, what factors would be helpful for deciding a particular treatment for Spinal Disorders?
Generally, if the patient is having deficit or intractable pain, a spinal surgery for the compression of a nerve root is advised. Medicines can control the weakness and pain reduction but a surgery (recommended) is what helps the disc return to its original position. Stabilizing your spine comes first, and then comes the consideration of a spinal surgery. If you want the disc to remain where it is or you want to shift it to its previous anatomical position, or you want to stabilize the spine in order to prevent further damage, you may need to think about spinal surgery. Neurologists often advice spinal surgeries for root problems or nerve compression problems, only when the patient has continuous intractable pains or they are developing a deficit or has got a sensory loss.
Secondly if there are tumors in the spinal canal, then patients can undergo a spinal surgery with limited benefits, depending on which nerves are involved, where is the location of the tumor etc. Spinal surgeries are extremely daunting because people fear that they may not be able to walk again or go back to leading their normal lives. Hence arises the dilemma of choice!
There are various fast-paced technical advances and modern age microsurgery techniques, endoscopic surgeries that have enabled neurologists try and restore faith in the success of a surgery. The fact that life cannot be the same as before and that post surgery there could be a ‘new normal’; is something patients need to absorb and be mentally prepared for. Spinal surgeries are not advised to correct the anatomy, it is mainly advised to decrease the symptoms and prevent progression. So, when you’ve got this concept and implications cleared, you can be rest assured that a surgery is the right way ahead!
Q2. What are some of the chronic neurological disorders that should never be ignored and the implications of the same?
Let’s look at a few example cases to answer this.
Example 1: A patient suffering from stroke may be put on blood thinners for a period of say 3 months and needed a follow up post the same. In some cases, the patient misses the follow-ups and ends up halting their medications without a consultation, ending up with new stroke altogether. So, the implications in such a scenario could be life threatening and a due follow up should never be ignored.
Example 2: Patients often think hypertension is nothing but increased tension in the brain; which is incorrect! Hypertension doesn’t mean that you are taking more tension. It is a long-term medical condition in which the blood pressure in the arteries is persistently elevated, hence needs to be monitored on a regular basis. Here too, in case a patient stops medications abruptly, they may end up with a new bleed or a new stroke. Doctors’ advice for any alterations is a must!
Example 3: When an epilepsy patient experiences a seizure, a doctor prescribes medication to control the episodes. The problem arises when patients feel that if they do not have a recurrence in say a period of 3 months or so, they are seizure free for life. This thought process could have major implications! Post this, I’ve had patients coming in with a flurry of seizures similar to Status epilepticus (SE), in which a single seizure lasts more than five minutes or two or more seizures within a five-minute period without the patient returning to normal between them. This is a life-threatening condition because the brain continues to fire inadvertently. Medicines and at times ventilator support may be required to stabilize the patient for this acute scenario. So, ignoring this and not following up on time can be problematic for patients.
Example 4: In chronic cases, like dementia, patients are under a lot of stress and not completely aware of what is going on due to their memory loss. In such cases more than the patient, there’s a lot of burden on the caregiver. This aspect is often neglected in the society. The caregiver’s job here is as good as taking care of a child who needs constant attention and support and that is not easy! They deserve appreciation in any form for the excellent care that they give by all doctors, family members and a society as a whole. So this ignorance may be of a different kind yet has an impact on the patient.
Bottom-line – understand the limitations of your disease/disorder, follow the treatment advice by your doctors and do timely and regular follow-ups.
Q3. How much of a percentage do genes (hereditary conditions) play in getting a neurological disease?
When the conditions are genetic, they often tend to show up in the early stages of life. For example, if your father is having certain disorder and if that particular gene has been transmitted to you, symptoms would ideally show up before the age of 35-40. It’s rare to see genetic conditions appear at the age of 60-70. And when it is genetic then you know that it is in each gene, each cell of your body, so you can’t really do much to control the disease because it is going to stay. You may work on lifestyle modifications etc. to try and reduce the impact of the disease but that’s pretty much all that can be done. So far none of the genetic therapies have been a game-changer and advanced research is yet in the nascent stages to come up with a proven gene cure therapy.
Neurological disorders pose a great challenge to healthcare in developing countries in view of limited resources and manpower that are inadequate to tackle the increasing burden. Concentrated action towards creating the right kind of awareness is an urgent necessity as we hope to empower you and your loved ones with the correct information for battling these conditions. Do share your views about this blog below.
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