السيدة كرستينا برمايستر – استشاريون نفسيون في دبي

In their anatomical course through the body and the limbs nerves might be damaged in various ways, the cause of damage most often being traumatic. Symptoms of nerve damage may be prickling, numbness and pain but also palsy or disorders of the bladder or the rectum. Lower back pain is one of the most common complaints today. Up to 80% of the US-Population will suffer from back pain at least ones in their lives. Back pain or lumbar pain is the largest cause of work-related absence in the United Kingdom.

Very often nerves are trapped at the spinal cord, the backbone or in their course to the limbs. The reason for this may be some injury, a slipped disk or the trapping of a nerve in a bony or connective tissue canal. A typical example is the carpal tunnel syndrome.

What to do? Prior to surgical decompression therapy, reliable neurological diagnostic methods should be applied to locate the damage exactly. Symptomatic therapy including physiotherapy and special back pain therapy might also be of help.

PTSD - Post Traumatic Stress Disorder may remain for as long as six months after a traumatic event and may be prolonged for years. Typical criteria are:

• The recollection and reliving of the event, also in dreams.
• Avoidance of anything that might call back the event. This may lead to total social withdrawal.
• The feeling of mental numbness. Affects will diminish.
• Amnesia.
• General arousal, irritability, disturbance of concentration, anxious alertness, scariness, sleeping disorders.

PTSD - Post Traumatic Stress Disorder

The prevalence of schizophrenia is 0.7%. However, of the 24,000,000 sick people worldwide only about 50% are treated adequately. The majority of the maltreated patients live in developing nations. There are two kinds of symptoms – early symptoms which may exist years before the actual outbreak of schizophrenia – and main symptoms.

About 70% of the patients show early symptoms like alteration of experience and conspicuousness in conduct although to a small extent that it will not easily be brought into connection with early signs of schizophrenia.

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Adjustment Disorder means that a normal reaction to stress starts as late as a month after the event and will continue up to six months. This still would be considered a normal reaction although also in these cases therapeutic help might be necessary.

Fear is a feeling that everybody knows as being an entirely normal feeling. Fear usually is a reaction to a frightening situation such as a bank robbery or any other dangerous situation.

Normal fear turns into anxiety disorders or phobia when a fearful reaction occurs that does not correspond to the actual event, i.e. a situation that the majority of people would rate as not frightening at all, or if the anxiety reaction is so abnormally strong that the patient has the impression he is going to vomit, to faint, to die or to go insane.

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Eating disorders are conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa and anorexia nervosa are the most common specific forms of eating disorders. Other types of eating disorders include  and OSFED. Bulimia nervosa is a disorder characterized by binge eating and purging. Purging can include self-induced vomiting, over-exercising, and the usage of diuretics, enemas, and laxatives. Anorexia nervosa is characterized by extreme food restriction to the point of self-starvation and excessive weight loss

It happens every so often that patients complaining about bodily symptoms consult numerous doctors and specialists without getting a sufficient explanation for their problems nor remedies. Such patients are definitely ill, they will have pains, functional disorders or likewise and yet the highly developed modern medicine seems unable to help them.
Trying to find release, such patients will consult doctors at frequent intervals which is called “doctor hopping”. Or, after years of looking for medical professional help without any result, they will turn to alternative medicine. This kind of behaviour expresses the enormous pressure these patients are under.
The problem, however, lies in the logical deduction that in case of physical symptoms or pain the solution must be bodily. If one is suffering from diarrhoea or pain in the feet, of course the obvious choice would be a specialist for diarrhoea or pain in the feet.

Depression is a mental disease which may express itself by

1. subdued spirit
2. loss of interest
3. social retreat
4. feeling of guilt
5. reduced self-esteem
6. attention deficit disorders
7. sleeping disorders

but also by bodily symptoms like pain or paraesthesia. Depression shows various clinical pictures which makes it very difficult to come to quick conclusions. Whereas in former times depression was simply considered to be ill humour, over the last decades depression has become recognized as a very common and serious illness.

Traumatic events or seemingly unsolvable problems can lead to a psychic reaction known as conversion. The unsolvable problem is deferred resulting in disturbances which the person concerned can no longer trace back to the basic event.

The problem may be deferred to the following scopes:

• Psyche: this path may lead to amnesia, flight (fugue), stupor, trance, obsession, loss of identity
• Motor system: may lead to weakness, palsy, dystonia, disturbances in coordination and loss of hold
• Sensibility: may lead to paraesthesia, prickling and physical numbness
• Brain: may lead to epileptic-like fits

Polyneuropathy means the affection of many nerves due to very different reasons and it can therefore develop many different symptoms. Most frequent are paraesthesia such as prickling, numbness, burning of the feet, but also palsies, disorders of speech and failure of cerebral nerves.

Similar to the variety of symptoms there is also a large variety of causes for this disease. The most frequent reason is a metabolic disorder such as diabetes mellitus. But also hereditary disposition, toxic inhibition or paraneoplastic development can cause polyneuropathy.

Accordingly, diagnostics and therapy of polyneuropathies are manifold and difficult. The therapeutic aim must be to prevent the deterioration of the nerves itself on the one hand and to treat the illnesses causing polyneuropathy on the other hand.
Should both turn out to be impossible, palliative methods may be used to ease the symptoms, especially pain, by applying special medication and physiotherapy.

Multiple sclerosis is an auto-immune disease in which the auto-immune system of the body attacks the nerves and especially their myelin sheaths. The illness usually starts at a fairly young age and becomes chronic. Although this disease can as yet not be entirely cured, there is a variety of new drugs which are very effective.

Besides the necessity to apply the appropriate medication in order to alleviate symptoms like palsies, pains, vision disorders, blindness and other neurological symptoms, there are also physiotherapy and other therapeutic measures that can be helpful.

Dementia is a syndrome or rather generic term to describe symptoms that follow or accompany various diseases of the brain.

Restrictions of the following neuropsychological or cognitive functions are typical features of dementia:

1. memory
2. orientation
3. comprehension and speech faculty
4. the ability to write and calculate

Alzheimer’s disease

(The most common form of dementia)

In the case of Alzheimer’s disease certain proteins accumulate inside or outside of the nerve cells of the brain. The thus affected cells deteriorate. This is why Alzheimer’s disease is called a neurodegenerative disease. The degenerated cells can no longer carry out their usual function and the distribution of neurotransmitters is reduced rapidly. The consequence of this is dementia.

Although this kind of dementia is not curable as yet, the progress of dementia may be slowed down by modern medication and mental training.

Apart from these fairly common forms of dementia there is a large variety of illnesses accompanied by dementia.
In any case, the first signs of dementia should be examined closely at an early stage to gain a secured diagnosis and act accordingly.

More information about dementia

Vascular dementia

(Second most common form of dementia)

Vascular dementia is caused by a vascular disease of the brain. Microangiopathies (damages to the small vessels) or macroangiopathies (damages to the large vessels) for example by arteriosclerosis may lead to reduced local blood flow in certain parts of the brain.

The thus affected nerve cells deteriorate and can no longer exercise their task of distributing neurotransmitters. The consequence is dementia.Since this process is locally restricted, it is important to examine the exact nature of dementia in order to start effective therapy at an early stage.

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Vertigo Causes

The causes of vertigo may be manifold. Most often vertigo is the consequence of damages to the internal ear, the equilibrium, the cerebellum or due to circulatory disturbances of the brain. But also heart diseases or low blood pressure may cause vertigo and dizziness. Even psychic disorders like panic attacks or anxiety can lead to vertigo.

Vertigo Diagnosis

It is therefore imperative that the exact nature of all vertigo complaints is determined in a multidisciplinary way involving especially the examination by a neurologist, an ear nose and throat specialist and a cardiologist.

Vertigo Treatment

Only the correct diagnosis can lead to an effective therapy either by medication, by special physiotherapy or psychotherapy or a combination thereof.

Professor Dr. med. Detlef Koempf – Neurological Expert for Vertigo & Visual Problems

Professor Koempf, Specialist for vertigo & visual Problems, is a genuine German University Professor born in Saeckingen, near Freiburg and studied medicine in Heidelberg.

After having spent one year of research in the USA, he continued his medical education at the University Hospitals Mannheim and Heidelberg and went on to work as Deputy Head at the Neurological Hospital in Erlangen.

From 1987 until 2010, Professor Koempf held the position as Director of the Neurological University Hospital of Luebeck, Germany where he worked as a Senior Consultant for Neurology, held lectures and taught students. In 2010 he was elected as General Secretary to the EFNS (European Federation of Neurological Societies) where he organizes large neurological conventions and further education for neurologists in Eastern Countries such as Russia, Belarus, Ukraine, Moldavia and others. Aim of these efforts is to standardize neurological diagnostics and treatment in Europe.

In 1998, Professor Koempf wrote an important book on the topic of “Clinical Neuro-Ophthalmology”, vertigo and visual problems which was published by the renowned Thieme Publishers. He also deals with all “Diseases of the Cranial Nerves” on which he also published a book in 2006.

Since finishing his Univerity career, Professor Koempf has been seeing patients in his private clinic in Luebeck and spends some months in Mallorca, Spain, in a Vertigo Center which he founded at Juaneda Hospital.

During his active time as Director of the Neurological Hospital at Luebeck University, Professor Koempf dealt with the whole range of neurological diseases including Parkinson’s disease, Epilepsy, Multiple Sclerosis, Cerebral circulatory disorders, stroke prophylaxis, disturbances of the memory, dementia, headaches, migraine, polyneuropathies, restles legs syndrome, back pain and diseases if the discs.

But above all, he concentrated on the numerous kinds of vertigo (of which there are about 50) as well as vision disorders or disturbances of the equilibrium. Vertigo itself is just a very general term which does not mean anything specific. One must differentiate between specific vertigo meaning everything is spinning and unspecific vertigo which may mean short loss of vision, dizziness or disturbed equilibrium.

The problem always is to find the underlying cause because very often the cause of very strong symptoms may be quite harmless whereas a slight symptomatology may indeed have a dangerous cause. In the latter case, a fast course of diagnostics is of the utmost importance in order to prevent for instance a stroke. The whole range vertigo lies between these two poles.

The most important issue when dealing with vertigo symptoms is the medical history and the correct analysis of the symptoms. At the beginning of this procedure there will be a thorough neurological examination with a focus on the eye movements. From time to time it will be necessary to carry out a psychiatric exploration as well because vertigo can be due to psychic problems. Following this will be neurophysiological investigations such as EEG, VEP, AEP or others and the DUPLEX ultrasound examination of the cranial arteries and a combined cooperation with an ENT doctor, an ophthalmologist, maybe an orthopedist and a qualified laboratory.

Despite his being in Dubai only recently, Professor Koempf realized that all services he needs for his highly specialized work are available in Dubai, predominantly offered by German colleagues such as ophthalmology, ENT, orthopedics, cardiology and laboratory. This makes diagnostics and treatment easier since they all follow the same high German standards and uncomplicated communication between them allows secured results. Professor Koempf is devoting some of his time at the moment to meeting and getting to know these colleagues in order to guarantee best results for his patients.

As main problems in this region, Professor Koempf notices so far the often faulty medicinal treatment of patients suffering from Parkinson’s disease or epilepsy, missing preventative measures for stroke and other diseases of the vessels as well as pain therapy regarding the numerous kinds of headaches or polyneuropathy caused by diabetes. Above all he is concerned about people suffering from dizziness and vertigo which is one of the most prevalent complaints presented in a neurological clinic and not to be underestimated regarding the possibly underlying serious causes.

Professor Koempf will continue to inform us about the topic of vertigo on this site.

A Stroke is a serious illness which can be fatal. It is caused by the occlusion of a blood vessel that supplies the brain. This will lead to the disturbance of relevant physical functions such as:

Acute palsies of arms, legs or parts of the face, numbness, prickling, speech disorders as well as other neurological defects.
Another cause for a stroke can be a cerebral haemorrhage which might occur due to the bursting of a cerebral vessel. Both forms of cerebral apoplexy need immediate treatment in a specialized hospital (stroke unit) where the trained doctors will try to dissolve the occlusion or stop the haemorrhage respectively.

Prior to all apopleptic events attention should be given to the above mentioned symptoms which are strong indicators of an arteriosclerotic process even though they might be only temporary. Such temporary attacks are known as TRANSIENT ISCHAEMIC ATTACKS. They must be taken seriously and must lead to the immediate consultation of a neurologist in order to avoid a more severe development of the symptoms.

After a stroke has taken place without early efficient clinical treatment and with following severe damages and disabilities, professional rehabilitation is necessary as early as possible to regain mental and physical abilities that might have been lost.

Are you suffering from headaches? You are not alone! Headache is a widespread disease. It occurs in different types and strengths and can impair the quality of living substantially. It is possible to do something against it. But before a therapy can be started it has to be found out what the reason is and a correct diagnosis has to be made.

There are many types of headaches. The most common are the primary headaches like migraine, tension headache or cluster headache or an analgetic headache. Your neurologist has to know how your headache feels like, where it starts; whether there are accompanying symptoms, how long it lasts and how often it occurs. Then he will do different medical examinations. After he knows the diagnosis he can give you an advice for the right treatment.  Treatment is possible!

Migraine - more than only headache

Migraine is one of the most frequent neurological diseases. Around the world about 10 percent of the adults are suffering of migraine, more women than men. The difference between the genders has most likely hormonal and genetic reasons. Typically it starts in adolescence. After the 50^th year the frequency declines again.

It is a temporary dysfunction of the brain. During a migraine attack the blood vessels of the cerebral membrane are widened and infected. The nerve fibres around the vessels are irritated so heavily that they send pain signals.

The duration of a pain attack is between 4 to 72 hours. The frequency varies between once a year up to twice a week.  The pain is moderate up to very violent. The characteristic is mostly pulsating and only on one side of the skull; but in some patients also on both sides. One side is more affected than the other. Very often people are having accompanying symptoms like nausea, vomiting, visual problems and are very sensitive against light, noise and odour. By physical exercises the pain increases.

There are different migraine triggers like stress, menstruation, alcohol, especially red wine, disturbances in the sleep-awake-cycle, irregular meals, weather changes, light stimulus, odour or pain in the neck. These triggers are very individual and vary even in one individual from time to time.  But these triggers are not the causes of the disease they just stimulate it.

A typical migraine attack proceeds in 4 phases. During the lead time there exist no pains yet. There could be depressive reactions, irritability and agitation. Concentration might get reduced; people feel tired and have to yawn a lot. Oedema, constipation or a craving for sweet or greasy food may occur. The second phase might be an aura. Quite often there are visual problems with scintillating scotomas or double vision. But it also can be sensibility disturbances or movement and speech problems. An aura keeps from a few minutes up to one hour.

The third phase is the headache phase. The pulsating pain starts very often in the neck, spreads over the back of the head and settles behind the eye or at the temple. Most attacks are accompanied by vegetative symptoms. The whole body is affected. Some people are not able to continue their work. They have to lie down. They seek quietness and darkness, don`t want to hear or see anything or anybody. The duration of the headache might be up to 3 days if the attack is not interrupted by medication.

Hours or 1-2 days after a migraine attack (4^th phase) people feel tired and exhausted, concentration is still reduced, mood might be swinging.

What can you do to ameliorate the migraine?  Be active, you can do something.

Migraine prevention without medication:

• Reduce stress factors as much as possible.

• Learn good time management: plan your day schedule. Don`t forget enough time for brakes.
• Learn to say “No”.
• Don`t spread yourself too thin. Not everything has to be done right away.
• Think: “nobody is perfect!”
• Take life easier, enjoy it.

• Relaxation: Proceedings for recreation as Yoga, autogenic training or progressive muscle relaxation techniques help, but have to be done regularly

• Endurance sports like cycling, walking, jogging or swimming are good. But it is important to exercise regularly, at least three times a week for about 30 minutes.

• Try to have e very constant sleep-awake cycle, also during the weekend. And eat and drink with regularity.

• Avoid your personnel migraine triggers.

Migraine prevention with medication:

• Migraine Medical prophylaxis

In severe cases it is useful to take special medication every day to reduce the number of attacks, the length of the single attack or to improve the effect of the acute medication. This medication has to be taken for at least three quarters of a year, sometimes longer. Your neurologist will find out which medication will be the best for you and will supervise you through the therapy.

• Therapy of the acute migraine attack:

There are different types of medication to treat the acute attack. In easier cases a painkiller like Panadol or Ibuprofen can be enough. A combination with a medication against nausea can be given. But mostly stronger medication is required. The triptans, a group of special migraine drugs, ameliorates the attack within 2 hours in most patients. The medication has to be taken as soon as possible. Then it helps the best.   But be careful. You should not take any painkiller or any triptan more often than 10-12 times a month. Otherwise there is the danger to develop an analgetic headache, which means headache by the medication itself!

Epilepsy is an illness of the brain which expresses itself in fits or seizures or convulsions. The most well-known form of fit is the generalized tonic-clonic seizure or convulsions, which comes along with loss of consciousness, drop or convulsions. There are, however, other forms of seizures that are not so commonly known, which express themselves in the twitching of an arm or a leg or disorder of consciousness or absences.

The causes for epilepsy are manifold and can have their origin in brain damage or hereditary facts. However, due to the drug development of recent years there are very efficient possibilities to treat patients with epilepsy so effectively that the majority can lead an entirely normal life without any seizures at all. In severe cases neurosurgical interference may offer help.

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Myasthenia gravis is an autoimmune disease that causes muscle weakness. The body is producing antibodies which are attacking the junction between nerve and muscle.

Most common symptoms of Myasthenia gravis are ocular symptoms (50%) of Drooping of the eyelids (ptosis), double vision (diplopia) and blurred vision. The disease can generalize including symptoms like weakness of facial and extremity muscles. Moreover patients could have difficulties in chewing, swallowing and speech. Respiratory weakness may produce acute respiratory failure.

The symptoms of Myasthenia gravis are negatively influenced by exercise, heat, illness, and stress. Normally they worsen in the evening and get better after resting.

Often myasthenia gravis is associated with other disease like rheumatoid arthritis , scleroderma and systemic lupus erythematosus. 65% of patients with myasthenia gravis have a hyperplasia of the thymus. 15% of patients with myasthenia gravis present a Thymoma.

Myasthenia gravis is a clinical diagnosis by specialized neurologist, supported by specific tests including Cholinesterase inhibitor tests, antibody detection test, EMG (Electromyography), Computed tomography (CT) and MRI of the chest, to detect thymoma or thymic hyperplasia.

The treatment of Myasthenia gravis is effective and most patients are able to live normal lives. Based on the clinical findings it could include certain drugs (Cholinesterase inhibitors, Immunosuppressant agents, Intravenous immune globulin (IVIG)), Plasmapheresis, Thymectomy, Physical therapy and Lifestyle changes.

Extreme life events may produce individual patterns of reaction. Such events might be the death of a partner, war, experiences, separation, accidents, experience of violence, traumata or abuse. To some people this might be the case even with simple things like attendance of school, a move or likewise. Of course it is only natural for a person confronted with a stressful event to feel sad, shocked or unable to understand what is happening.

However, if this reaction takes too long or does not stop at all or the reaction in itself is inadequate to the event thus leading to an increased impairment of the person concerned, this person needs professional help.
The reactions to life events can be manifold producing for instance restricted consciousness, decreased attention, disorientation, amnesia or depression, desperation, anxiety or aggression but also bodily symptoms like sweating, heart throbbing and blushing are common.

If the reaction occurs immediately after the event and disappears fairly rapidly, this is called acute reaction to stress. This is a normal reaction. However, depending on the severity of the symptoms professional help may be needed for a short time.

Parkinson’s disease belongs to the group of movement disorders and expresses itself by trembling (tremor), rigidity (limb stiffness) and akinesia (diminishment of movements). Very often the changes in movement are very discreet and therefore an early diagnosis is often difficult. In the long run, however, Parkinson’s disease may result in severe handicaps and disabilities.

Aetiologically this is caused by the deterioration of specialized nerve cells which are responsible for the design, the development and the realization of movements.

However, there may be other symptoms such as a reduction of superior intellectual brain functions, psychic symptoms such as depression but also disorders of vegetative bodily functions.
Whereas in treating Parkinson’s disease the main focus will be on adequate medication, physiotherapy, dancing or other physical exercises are also useful therapeutic means.In severe cases neurosurgical intervention might be necessary which is known as deep-brain-stimulation.