Neurology

Epilepsy is controlled mainly by the appropriate use of anti-epileptic medication. Drug treatment, when properly applied, can result in effective seizure control in 70% – 80% of people with epilepsy. However, epilepsy may be refractory (resistant to ordinary methods of treatment) to drug therapy in a small but significant number of patients. The most common causes of refractoriness include:

• The use of a sub-optimal medication for a particular seizure type
• An inability to properly determine the type of seizure experienced by an individual by standard examination and testing methods
• An occurrence of certain neurological or psychological symptoms which can mimic seizures
• Poor drug compliance

The alternatives for the treatment of refractory seizures include epilepsy surgery, investigational medications, vagus nerve stimulation, and others.

Diagnosis and treatment of patients with chronic headaches (muscle-contraction headaches, migraine, and cluster headaches) not responding well to contemporary medications would benefit from this clinic. The holistic approach of treatment would include therapies such as newer medications in treatment of migraine, botunilum toxin injections, relaxation therapies, cognitive behavioral therapy, yoga and meditation, trigger point injection, acupressure, neurostimulation etc.

Newer diagnostic modalities and therapies are offered as part of Paediatric Neurology. We also perform surgery as a therapeutic option in a few selected cases of childhood epilepsy. There are several imaging modalities including functional studies which are routinely performed here. These include PET (Positron emission tomography), SPECT (Single-photon emission computed tomography), fMRI (Functional magnetic resonance imaging), Electrophysiology, Electrocorticography and Video EEG (Electroencephalography). There is an active learning disability program for children involving psychologists, neurologists and developmental specialists.

The clinic attends to persons with sleep disorders. Insomnia or inability to sleep is the commonest sleep problem faced by individuals. The other extreme is excessive daytime sleepiness where one’s day-to-day activities are affected by increased day time sleepiness.
The common sleep disorders seen in this clinic are insomnia, obstructive sleep apnoea, narcolepsy, restless leg syndrome and sleep problems associated with various chronic illnesses. During a sleep clinic visit initially a detailed questionnaire-based interview is taken, subsequently if needed the person undergoes specialised tests like polysomnoraphy (PSG), Multiple sleep latency test (MSLT), positive airway pressure (PAP), titration etc.
The clinics are well supported by our allied departments like Endocrinology, Psychiatry, Clinical Psychology, Holistic medicine, Pulmonology, ENT, Faciomaxillary and Bariatric surgery.

Highly specialised in providing accurate diagnosis and implementing appropriate treatment and support for patients with multiple sclerosis, the clinic has already attended to more than 100 patients with multiple sclerosis. All patients undergo clinical evaluation and are diagnosed based on modified McDonald’s criteria. They are subjected to detailed examinations including the Expanded Disability Status Scale (EDSS) and other disability scales like (Paced Auditory Serial Addition Test )PASAT, 2-hole peg test, etc., and are actively followed up. A registry of patients is also maintained.
In association with Urology department, the clinic provides specialized treatment options like Botulinum Toxin therapy for spasticity and urodynamic studies for bladder problem. The MS Clinic also helps patients to participate in various clinical trials. Basic clinical research in multiple sclerosis is also being conducted in our hospital.

The Botulinum Toxin Clinic is among one of the few regularly run such clinics in Kerala. It provides botulinum injection therapy for various disorders like hemifacial spasm, blepherospasm, oromandibular dystonia, cervical dystonia, laryngeal dysphonias, focal dystonia, post stroke spasticity, etc. It also provides botulinum toxin therapy for rarer indications like chronic migraine, refractory trigeminal neuralgia ,painful peripheral neuropathy, etc.
So far the clinic has helped more than 200 patients with their specific problems. The clinics regularly follow up the patient through a registry maintained in the department.

The Movement Disorders and Gait Service provides comprehensive evaluation and treatment of patients with Parkinson’s disease, tremor, ataxias, dyskinesias, dystonia, gait disorders, tics and Tourette’s syndrome.

The Neuromuscular Service provides comprehensive diagnostic evaluation, consultation and management of all neuromuscular disorders, including motor neuron diseases (ALS), peripheral neuropathies, myopathies, muscular dystrophy, and myasthenia gravis. We are routinely doing thymectorny for myasthenia gravis. Our cardio-thoracic surgeon has wide experience in this field and is well supported by a team of neurologists, anaesthesiologists, critical care physician and nephrologists.

Stroke is the third leading cause of death and the number one cause of disability. Recently, the introduction of thrornbolysis as treatment for acute stroke has significantly decreased the disability from stroke. Critically ill patients requiring ICU admission for their neurological illness such as intracerebral haemorrhage, neuromuscular diseases, and severe strokes are managed in a well equipped stroke and neuro-intensive care unit.

Epilepsy is a condition characterized by the propensity to have recurrent seizures (“fits”). It is one of the most common neurological disorders seen in children. The control of epilepsy is achieved mainly through the appropriate use of anti-epileptic medication. Drug treatment, when properly administered, can result in effective seizure control in 70% – 80% of people with epilepsy; however, epilepsy may be refractory to drug therapy in a small but significant number of patients. They may need complimentary treatments like resective surgery.

Syncope (fainting) is defined as falling down and being unconscious for a short period of time. Usually, there is complete recovery in a matter of seconds or a few minutes. Fainting is a symptom and not a disease. It occurs due to temporary reduction of blood supply to the brain. There are many different reasons for fainting.

Sleep disorders are common but often under diagnosed medical problems. A thorough sleep evaluation can characterize the extent of the problem and direct the appropriate management practice. AIMS features a modern sleep lab that can perform polysomnography and sleep latency testing. Various breathing disorders can be assessed and ameliorated via respiratory assertive devices.

The brain and spinal cord constitute the central nervous system while the nerves coming from them and connecting to the muscle constitute the peripheral nervous system. These nerves allow you to move your body parts and also to appreciate feelings such as pain, temperature, touch and limb position from the surface of your body. They also connect to internal organs that allow involuntary actions such as breathing, sexual function and digestion. Any damage to the nerves of the peripheral nervous system is called peripheral neuropathy.

Services provided are counseling, guidance, and rehabilitation for patients with the following disorders:

• Developmental Speech and Language Problem
• Deviant Speech and Language
• Post-Larynegectomy Speech Disorder
• Aphasia
• Dysarthria
• Hearing Problem
• Dysphagia

Myasthenia gravis is a disease causing fluctuating muscle weakness. It can affect any skeletal muscle of the body, however the limb, swallowing and eye movement muscles are more commonly affected.

Headaches are caused in several different ways. Although migraines are the most common form of headache, different types of migraine headaches will require different treatment modalities. Proper classification and treatment selection is critical.

A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Thrombolysis is a special form of treatment that helps in breaking arterial blocking blood clots by means of interarterial as well as intervenous drugs. AIMS is also a recognized referral centre for carotid endarterectomy. Other disorders treated are:

• Parkinson’s disease and other movement disorders
• Wilson’s disease
• Vertigo
• Neuromuscular disorders
• Critical care neurology
• Fibromyalgia syndrome
• Childhood neurological problems
• Neurological complications of HIV infection
• Neurological rehabilitation
• Dementias
• Nutritional and vasculitic illness
• Inborn Errors of Metabolism

EEG is the name commonly used for electroencephalography. Just like the ECG records the electrical activity of the heart, EEG records the electrical activity of the brain. It is safe and painless. Electrodes (small metal, cup-shaped discs) are pasted to your scalp and record the electrical activity.

Evoked potentials are potentials recorded from scalp in response to a brief auditory, visual or electrical stimulation to nerves to assess the hearing (BAEP – brainstem auditory evoked potential), visual (VEP – Visual evoked potential) or sensory (SSEP – somatosensory evoked potential) pathways respectively. This is a painless test for evaluating the functioning of various pathways.

A Polysomnogram (PSG) is a painless test designed to monitor and evaluate sleep characteristics and physical stage during sleep. Subject will spend the night in a private bedroom at the sleep lab. Small electrodes or sensors will be painlessly attached to different parts of body to monitor brainwaves, heart function, breathing and muscle activity. The subject will be videotaped to correlate body position and movement with physiological data. Subjects have to complete a proforma related to sleep details before and after the study.

Multiple Sleep Latency test is designed to evaluate the degree of sleepiness in patients with sleep disorders. Small electrodes or sensors will be painlessly attached to different parts of your body to monitor brain waves, heart function and muscle activity. During the test patients will be asked to nap at two hour intervals for 4 to 5 times in the day. At the start of each period the technologist will check the sensors and then instruct patients to try to go to sleep.

The ENMG (Electro Neuro Myography) examination is a diagnostic examination of nerve and muscle function. Nerve conduction studies are performed by placing discs on the skin over the nerves or muscles and recording their responses to electrical stimulation of the nerves.

Intra-operative electrophysiological monitoring is routinely performed during scoliosis surgery. This monitoring helps the surgeon to signal if there is any undue pressure or potential damage to the spinal cord in the potentially reversible phase. Intra-operative somatosensory evoked potential, motor evoked potential, brain stem auditory evoked potential, facial nerve stimulation and identification of central sulcus with sensory evoked potentials are some of the procedures routinely performed.

Tests such as sympathetic skin response to sensory and auditory stimuli, RR interval variability during posture changes, RR interval variation during respiration and during valsalva manouver are routinely performed for patients with dysfunction of autonomic nervous system. These tests often provide useful information about the severity of involvement with significant impact on treatment and prognosis.