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© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

Sciatica is a common neurological condition described as pain, numbness, weakness, or tingling radiating from the lower back to the leg. The symptoms usually occur on one side and vary from mild to unbearable.

It is important to understand that sciatica is not a disease itself. It is rather a symptom caused by an underlying condition. In most cases the underlying condition is a herniated disc, other degenerative disc diseases or spinal stenosis.

The treatment depends on the underlying conditions. Usually Sciatica has a very good prognosis if the treatment is started early enough.

Sciatica can be caused by any underlying condition that squeezed the sciatic nerve. The sciatic nerve is a large nerve that starts in the lower back and runs down the back of each leg. It controls the muscles and the sensation of the leg and foot.

The symptoms are depending on anatomical structure and the function of the sciatic nerve (see above). The following symptoms may occur in the lower back, the buttock, the hip and the leg:

As a first step, it is important to find the underlying condition causing the sciatica. A neurologist can find the location of the lesion by the symptoms presented. Depending on the location (L4, L5, S1) symptoms in the leg may vary. The treatment depends on the underlying condition and the severity of symptoms. If the symptoms are very mild and there is no danger of worsening, the symptoms may improve on its own.

Depending on the underlying condition the treatment may include:

Usually sciatica has a very good prognosis. The sooner the underlying condition is diagnosed and the sooner the correct treatment starts, the better the outcome.

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Sciatica experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Sciatica experts, you came to the right place.

Diagnosis

Ischemic stroke or CVA (cerebrovascular accident) is a clinical diagnosis. However, the following tests need to be performed. CT scan or CT angiography, MRI, ECG (Electrocardiography), ECD (Extracranial Duplex Sonography), TCD (Transcranial Duplex Sonography), Echocardiography, blood examinations.

Treatment

The most effective treatment is the prevention of an Ischemic stroke or CVA (cerebrovascular accident). This means reducing the risk factors. To evaluate the risk of Carotid artery stenosis a neurologist can perform a ECD (Extracranial Duplex Sonography), TCD (Transcranial Duplex Sonography). Depending on the findings patients can benefit from interventional therapy, such as carotid endarterectomy. Hypertension, Atrial fibrillation, Diabetes mellitus, Dyslipidemia must be monitored closely and treated correctly. Moreover life stile changes should include: Diet, sports, reducing smoking.

In case a stroke or CVA (cerebrovascular accident) happened, time is the most important factor. Patients must be admitted and treated in a hospital within 3h. First line therapy is i.v. thrombolysis in combination with other medication.

After a stroke or CVA (cerebrovascular accident) happened, patients must take medicine to prevent a second event. This medicine keeps the blood from clotting. Moreover early rehabilitation is determining the recovery. The rehabilitation must be comprehensive and include physiotherapy, speech therapy, occupational therapy and psychology.
Other than that if you think your problem can be solved by a psychiatrist or a psychologist, you can book an appointment with them as well.

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

Bell’s palsy is an acute paralysis or weakness of the muscles of one side of the face. It is a relatively common peripheral nerve disorder and can affect people of all ages, but is most common between 15-45 years.
Many celebrities like Angelina Jolie, Anupam Kher, George Clooney, Pierce Brosnan suffered from Bell's Palsy.
Under the right treatment most patients have good recovery, although some are left with residual weakness

Bell's Palsy causes an acute paralysis of all facial muscles supplied by the seventh cranial nerve (facial nerve). It is always unilateral (one side) and involves upper and lower muscles of the face. At onset people may experiencing mild facial numbness as well. Other symptoms may include:

Bell's palsy is, by definition, idiopathic, meaning without a specific cause. However, it seems to be associated with certain viral infections. Herpes virus (HSV-1) could be found in 80% of patients. Other viral infections include herpes zoster virus, mumps virus, rubella virus and HIV. Lyme disease has to be taken in consideration as well.

For an experienced neurologist, Bell’s Palsy is mainly a clinical diagnosis. If a virus infection is suspected, blood tests may be considered. If a central paralysis cannot be excluded, a MRI might be considered. To verify the diagnosis and to predict the outcome usually a NCV (nerve conducting velocity) is performed.

Usually the treatment of Bell's Palsy  is very effective and people have a good outcome. However, symptoms can worsen during the first days of treatment. Patients should be aware of this. The outcome of the treatment is better if the treatment is started early. Therapy may include the following:

Usually the outcome of Bell's Palsy is good and most people recover within a few weeks. However, in 8% of the cases the paralysis is recurring.

• Good prognosis: partial paralysis

• Poor prognosis: Complete paralysis, loss of sense of taste after, pathology in the NCV test (nerve conducting velocity)

Most common complication of Bells Palsy are reinnervation problems. If the nerve is recovering and growing, it may by accident connect to other nerves resulting in malfunctions. This may include:

• Crocodile tears (crying while eating)

• Gustatory sweating (sweating while eating)

• Connection to chewing muscles (face twitching while eating)

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Bell’s palsy experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Bell’s palsy experts, you came to the right place.
We can also help you with the best psychologist, psychiatrist and psychotherapist available in Dubai, UAE.

Epilepsy, Convulsions, seizures or fits are some of the most common neurological disorders, with an annual incidence of 35 to 52 cases per 100,000 persons. It is a central nervous system disorder that affects the nerve cell activity in the brain characterized by the presence of recurrent, unprovoked seizures.

The patient has a propensity to manifest recurrent episodes of disturbed behavior symptoms and sensations, including loss of consciousness. Seizures or convulsions can have profound physical and psycho-social consequences. However, one single seizure or fit does not indicate Epilepsy.

The disease can only be diagnosed if there is an underlying tendency toward recurrent, unprovoked seizures or fits.

Epilepsy has no identifiable cause in about half of those with the condition. Specialists speak about symptomatic Epilepsy if they identify a cause like a brain tumor. The most common causes of Epilepsy include:

Specialists differentiate between focal or generalized seizures, based on how the abnormal brain activity begins. A focal seizure is characterized by an abnormal activity in just one area of the brain and it could include the loss of consciousness. Generalized seizures are...

Epilepsy or Seizures are classified as (ILAE):

Diagnosing Epilepsy is a three-step process involving clinical identification of a possible seizure, consideration of differential diagnoses, and classification of the seizure. The Neurologist will...

Most people with Epilepsy can become seizure- or fit-free by taking one anti-seizure medication, called anti-epileptic medication.

The treatment of Epilepsy involves...

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Epilepsy experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Epilepsy experts, you came to the right place.
We can also help you with the best psychologist, psychiatrist and psychotherapist available in Dubai, UAE.

You are experience tingling, numbness, weakness or pain and you want to know what’s causing it? This quick guide will explain you how.

Tingling & Weakness in Hands, Feet, Legs Treatment: Symptoms & More

A disease is the underlying cause (i.e. multiple sclerosis), a symptom is how the disease presents itself (i.e. numbness in the limbs)

Tingling, numbness, weakness and pain are the most common symptoms in neurology. Why? Neurology is the science of the nerves (neurons). There are different types of Nerves in the human body:

Sensory (or afferent) neurons: send information from sensory receptors to the brain. The receptors have different locations and functions:

1. Eye - Vision

2. Nose – Smell

3. Tongue – Taste

4. Skin, inner organs – Feel, Vibration, Pressure, Pain

Motor (or efferent) neurons: send information from the brain to muscles or glands.

1. Muscles (limbs, heart, blood vessels etc..)

2. Glans (saliva etc..)

The nervous system is controlling all functions of the human body. A nerve damage is resulting in a specific function loss

1. Numbness: damage of a sensory nerve sending sensory information from the skin to the brain

2. Tingling: damage of a sensory nerve sending sensory information from the skin to the brain

3. Pain: damage of a sensory nerve sending sensory information from the skin to the brain

4. Muscle weakness: damage of a motor nerve sending a movement impulse from the brain to the muscles

Ok, tingling, numbness, weakness and pain are the most common symptoms in neurology and they are caused by nerve damages. So far so good. Now it gets a bit more complicated because we want to know where and which exact nerve is damaged. Basically there are 2 different locations possible. The CNS (Central Nervous System – Brain & Spine) and the PNS (Peripheral Nervous System – Nerves of the limbs and inner organs). It’s a bit confusing because:

Both locations can lead to the same symptoms you may experience.

For example blindness. The patient is suffering from vision loss. This can be caused by a damage of the nerve receptors in the eye, the nerve cells leading from the eye to the brain or the nerve cells in the brain itself. Tingling, numbness or pain can be caused by a damage of the nerve receptors in the skin, the nerve cells leading from the skin to the brain or the nerve cells in the brain itself.

Now it gets even more complicated because we want to know the cause of the nerve damage.

The same symptom can be caused by many different diseases.

Numbness can be caused by a squeezed nerve, by neuropathy, by multiple sclerosis or by a brain tumor etc. This shows why it is important to find the exact cause of the nerve damage.

Causes

• Multiple sclerosis

• Stroke, Transient ischemic attack (TIA)

• Migraines

• Seizures

• Nerve Damage (Neuropathy) due to Diabetes

• Nerve injury (i.e. neck injury, back injury)

• Herniated disk in your spine

• Pressure on your nerves (could be due to scar tissue, enlarged blood vessels, infection, tumors or Carpal tunnel syndrome (pressure on a • nerve at the wrist)

• Sitting or standing in the same position for a long time

• Transverse myelitis (inflammation of the spinal cord)

• Encephalitis (inflammation of the brain)

• Abnormal electrolyte levels

• A lack of vitamin B12 or other vitamin

• others

The treatment will be completely different depending on the cause.

Summarizing, we know that tingling, numbness, weakness and pain are the most common symptoms in neurology and they are caused by nerve damages. The damages can be in different locations and they may be caused by different underlying diseases.

How does a neurologist find out what is causing my tingling, numbness, weakness and pain?

In the consultation he will ask you about the symptoms you are experiencing. Onset, pain level, changes during the day or night time, development, location etc… In the neurological examination he will investigate the symptoms and check if they are on both sides, limited to a dermatome, reflexes etc. Moreover for specific damages there are specific neurological examinations like NCV (nerve conducting velocity), Evoked Potentials, MRI etc. Certain diseases like multiple sclerosis require more extensive investigations.

We hope this article could give you a short and not too medical overview of the diagnostic process in case you are experiencing the most common neurological symptoms of tingling, numbness, weakness or pain. In case you have further questions, our team also consists of experienced doctors in psychology, psychiatry and psychotherapy. Please don’t hesitate to contact us.

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.

Trigeminal neuralgia

Trigeminal neuralgia is a special case of nerve pain. It is often described as the “the world’s worst pain.” Typically, patients suffer from attacks of intense, electric shock-like facial pain along the trigeminal nerve. More information here: Trigeminal neuralgia

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.

The symptoms are depending on the location of the injured or damaged nerve. Often nerves in the cervical or lumbar back are squeezed by a slipped disk causing neck or back and leg pain. Another common location is the wrist. If a nerve is squeezed here it results in pain in the hand called Carpal Tunnel Syndrome. But many other conditions can cause nerve damages in different locations such as sports related injuries of the shoulder and others.

Most important is a consultation with an experienced Neurologist. The clinical impression and physical examination are guiding the way. If the location is identified, certain nerve tests like Nerve Conducting Velocity or Electromyography may be used to verify the diagnosis or to determine the location precisely.

All conservative treatment options should be tried before a surgical intervention is considered. These treatment options also depend on the location of the damaged or squeezed nerve. Often specialized physiotherapy, certain braces and life style adjustments are successful. Moreover, an adequate pain management and other medications are essential to optimize a fast recovery. Most nerve damages are successfully treatable without surgery.

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Nerve Damage experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Nerve Damage experts, you came to the right place.
We can also help you with the best psychologist, psychiatrist and psychotherapist available in Dubai, UAE.

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

Traumatic brain injury (TBI) is a consequence of head injury in which a blow to the head results in damage to the brain due to stretch forces. TBI is the leading cause of death in North America for people below 45 years. The UAE has a comparably young population which makes TBI a very common and serious disease.

Many survivors live with significant disabilities, resulting in major socioeconomic burden as well. In 2000, the economic impact of TBI in the US was estimated to be $9.2 billion in lifetime medical costs and $51.2 billion in productivity losses.

Symptoms are often mild and hard to detect. It needs a trained specialist to diagnose and most importantly treat the condition. If treated adequately TBI has very good prognosis.

Causes

• Motor vehicle accidents
• Sport Injuries
• Falls
• Violence
• Military combat

Symptoms

Brain injury is a frequently misunderstood injury. Numerous invisible residual complaints are labelled as 'psychological' and are not well understood. A major complaint of brain injury is fatigue and overstimulation.

Overstimulation

We live in a society that is very fast, with lots of stimuli to be processed at a high speed. When someone experiences overstimulation it is harder for them to process stimuli, sounds are perceived as louder and light as brighter. Ambient noise is perceived as irritating, normal sunlight is harder to endure and one gets easily overwhelmed by crowds and lots of movements in their surrounding.

Fatigue

Due to the quick onset of fatigue it can be difficult to go to birthday parties, to go grocery shopping and to participate in social activities. The fatigue causes disturbances in thinking processes and limits the entire functioning. After reading a text, one can already be so tired that one must rest for a period to recover from the mental effort. In particular, the reading of displays (smartphone, computer, tablet) can be highly discomforting to patients who experience brain injury. In addition to the fatigue and overstimulation one notices to have more trouble remembering and concentrating. Memory and concentration becomes harder when fatigue increases.

Secondary Symptoms

When one experiences symptoms but keeps on functioning beyond their own capacity, people can develop secondary complaints. Overstimulation of the brain cannot be compared to overstimulation of the body. The body has, for example, pain signals as a warning signal. The brains gives totally different warning signals like overstimulation by light, noise or crowds, having difficulty processing stimuli, more problems with thinking (concentration and memory) and fatigue. Many people do not recognize these alarm signals, or are not adequately dealing with them and are likely to push through their complaints. The functioning outside their own capacity will further increase the complaints and ultimately exhaustion will occur. Not being able to function in the way as is desired by the patient, the patient can also develop emotional reactions which are often characterized by feelings of powerlessness and frustration. Misunderstood injury thus consists of fatigue, rapidly becoming overstimulated, experiencing a decline in performance and emotional responses.

Misdiagnosing Traumatic Brain Injuries

Brain injury patients are often misdiagnosed or not diagnosed at all. As most professionals are not specialized in diagnosing TBI, the patients hear often “there is nothing wrong”, even if they are suffering from symptoms. Or their symptoms are evaluated as “only psychological”. Not treating TBI adequately will worsen symptoms. This described process is resulting in a major socioeconomic burden (US: $9.2 billion in lifetime medical costs and $51.2 billion in productivity losses).

Diagnosis

Neuropsychological assessment is needed to get a good impression of the 'invisible' residual symptoms and how to cope with them. The neuropsychological examination is used to assess the extent of (mental) energy loss, fatigue, cognitive - / emotional changes and the impact of pain sensations.

At the start of the counseling / therapy an extended interview (anamnesis) with the patient is performed. A broad range of issues are discussed, such as what happened, what are the symptoms, has it been a breaking point in the health perception, which conditions worsen symptoms or affect it. Furthermore, we look at (medical) history, education, type of work, hobbies, social life and how complaints are limiting it. A neuropsychological examination is carried out and on the basis of the results an appropriate treatment plan is suggested. If there is not enough information available, the expertise of many other disciplines can be consulted (neurologists, internists, psychiatrists, etc.).

With this information and understanding, it is possible to establish an adequate treatment involving persons with brain injuries to understand the actual limitations and how to adapt to it.

Treatment

It is important to know that patients themselves often do not have a good understanding of the limitation of their symptoms and complaints, and the patient is driven to perform at pre-morbid level. Recovering from brain damage is a complex process that a patient has to go through with the help of a professional. It is necessary that one acquires knowledge in the presentation of symptoms and also get advice how to deal with it. A brain injury is essentially a neuropsychological phenomenon.

Neuropsychological Rehabilitation

In the next phase, the affected cognitive functions are reactivated and a medical fitness program is used to improve the energy level and reduce pain levels.

Often, the treatment consists of guidance of a clinical neuropsychologist which will provide insight into the complaints and why these occur. Adjustments are taught and exercise / rest schedules are discussed. During the same period, patients will follow medical fitness programs and a cognitrain program. This followed by rest periods. If pain symptoms stay apparent, a neurologist or pain doctor (anaesthesist) is considered. Often the pain sensations consist of pain in the neck and shoulders which also develops into headaches. The progress of each patient is discussed daily and programs are adapted to this feedback. The goal is to become a well- balanced individual again.

To achieve this, the main focus is on personal attention. Our view is that every person is like a fingerprint, completely unique. There is no standard protocol used to provide treatment, as each person has their own way of reacting to all aspects relating to brain injury.

The program usually has a duration of three months and the maximum group size is 12 people. The main goal of a small group is to build a personal relationship with each participant in the program.

If you think that you want to fix something else related to your mental health. GNC Dubai is providing one of the best psychiatrists in Dubai, psychologists in Dubai and psychotherapists in Dubai who can help you find the core reason and in fixing it.

Common Misconception

Often there is a misconception that the complaints of (mild) brain injury will resolve after some time. This natural recovery can only occur when conditions are optimal. One needs to perform the right activities during the recovery period in order to optimize the recovery. It should be noted that even with an optimal recovery period there may be residual complaints!

Neuropathy is term that describes a damage of the nerves. Most common symptoms include: pain (often worse at night), numbness, tingling, ‘pins and needles’, burning sensation, muscle weakness and others. The damage can be caused by different conditions such as disease, infection, injury, medications, toxins or another reason.

Types of neuropathy

• Peripheral neuropathy affects nerves in outer (peripheral) parts of the body such as the feet, legs, hands and arms.

• Proximal neuropathy affects the muscles of the hips and the shoulders.

• Focal or mononeuropathy affects only one nerve. An example is carpal tunnelsyndrome.

• Polyneuropathy affects several nerves. Most people with neuropathy have polyneuropathy.

• Autonomic neuropathy: Nerves of the autonomic nervous system are damaged leading to symptoms such as problems with digestion, blood pressure and bladder function.

• Diabetic neuropathy is caused by diabetes most commonly affects the nerves of of the hands and the feet. It can also affect nerves controlling automatic functions of the body, such as digestion, or nerves in the hips and thighs.

In the UAE Diabetic Polyneuropathy is the most common type. Therefore, we will describe this type below more extensively.

60-70% of people with diabetes are suffering from Diabetic Neuropathies. Neuropathy may be present even before diagnosing diabetes. Diabetes is the most common cause of peripheral neuropathy in the world. However, the symptoms of neuropathy are mostly unknown to the patients and difficult to diagnose. Early diagnosis is important as diabeticneuropathy can damage any nerve in the human body. Be it the nerves controlling the heart beat or the nerves of the skin.  Diabetic skin lesions are the major cause of foot amputation.

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.

Diabetic Neuropathy 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.

There are different types of neuropathy with different typical patterns of pain distribution. For instance there is the:

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. The most essential parts of the evaluation of diagnosis and therapy are...

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Neuropathy experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Neuropathy experts, you came to the right place.

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.

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.

Since more than ten years GNC is the leading clinic for Neurology in the UAE. All our Myasthenia Gravis experts are German Board Certified and have minimum professional experience of 25 years. If you are searching for the most trusted Myasthenia Gravis experts, you came to the right place.

What is Double Vision?

Patient with double vision see two images of a single object either permanently or intermittent. Double vision is also known as Diplopia. The displacement may be horizontally, vertically or diagonally. The perception of two images can also be overlapping. The symptom of double vision is to take seriously, since some causes need urgent medical treatment.

Symptoms

The symptoms of double vision can vary as described above but depending on the cause, other symptoms may be present with double vision, such as:

• Misalignment of one or both eyes
• Pain with the eye movements in one or both eyes
• Pain around the eyes, such as in the temples or eyebrows
• Headache
• Nausea
• Weakness in the eyes or anywhere else
• Droopy eyelids

Causes

There are many possible reasons for double vision. If the double vision is long-lasting or keeps coming back, reasons for it can include:

• Nerve problems: Multiple Sclerosis, Guillain-Barre syndrome, Diabetes
• Cornea problems: Herpes zoster, Dryness of the cornea
• Lens problems: Cataracts
• Brain problems: Stroke, Aneurysm, Migraine, Brain tumor, Head injury
• Muscle problems: Myasthenia gravis

Since the reasons for double vision could be life-threatening, it is very important to consult a Specialist if the symptoms do not stop.

Types

There are three types of double vision: Binocular double vision, monocular double vision and physiological double vision. The eyes of patients with binocular double vision do not work together properly and the double vision will disappear if the patient covers one eye. Monocular double vision occurs when the double vision continues when the unaffected eye is covered. In physiological double vision background objects the patient does not focus on appear doubled. This vision problem often goes unnoticed because the patient's brain can usually compensate for this type of double vision.

Treatment

As many different diseases could lead to the symptom of double vision it can be difficult to find out what the actual cause is. It is important to have a comprehensive examination to determine the cause of double vision. In fact, the condition may be a matter of life or death, such as a brain tumor or aneurysm. Some conditions causing double vision are difficult and sometimes impossible to fix. Some strokes and nerve palsies cause fluctuating double vision that can't be measured accurately enough to correct.

To diagnose double vision and to find out the reason for this symptom the Neurologist will use multiple methods such as blood tests, a comprehensive neurological exam, and possibly imaging studies like CT and MRI. The treatment depends on the findings. If weak eye muscles are the cause for double vision a surgery may help. If Myasthenia gravis or Diabetes is the reason medications will help.

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

Bipolar Disorder

Bipolar disorder, formerly known as manic-depressive disorder, is a quiet commonly used term these days. Many famous people declared to suffer from it; such as Robin Williams, Mel Gibson, Catherine Zeta-Jones, Amy Winehouse, Sinéad O'Connor, Britney Spears, Jean-Claude Van Damme, Axl Rose, Russell Brand, Richard Dreyfuss and many more. Moreover, many historical personalities are believed to have suffered from bipolar disorder; such as Frank Sinatra, Ernest Hemingway, Vincent van Gogh, Friedrich Nietzsche, Florence Nightingale, Edvard Munch, Edgar Allan Poe and many more.

Bipolar disorder seems to be a common disease that everybody knows somehow. But what are the facts? In this article we would like to give you an overview over the disease and answer the most common question.

Definition

As the name suggests, Bipolar Disorder is a mood disorder where patients can show both poles of the mood span alternating. Meaning patients could switch frequently from mania (“too happy”) to depression (“too sad”). But what is “too” happy or “too” sad? Who decides if it is a normal mood or a disease? The answer is clear. The suffering itself defines the disease. Meaning, the right question to ask should be: Is anybody suffering? The patient itself or the surrounding? If nobody is suffering it is absolute fine to be sad or happy sometimes. It belongs to life. The situation changes if somebody is suffering from its sadness or even is at the point to commit suicide because the suffering is so extreme that it appears like there is no way out. These people have the right and they should have an easy access to professional help. There should be no stigma holding them back. It’s not a weakness or failure in any kind. The same is applicable for the surrounding. If other people suffer from the behaviour of somebody else, they should have the possibility to express their suffering and search help; e.g. your spouse is so “happy” that he gambles away your whole savings because he continuously believes to be “lucky” the next time. Or a pilot who is so “happy” and over-confident that he believes that he doesn’t need sleep or any kind of safety measures anymore before flying you to your holiday destination. In these situations the patient himself won't suffer but there is a possibility that others will.

It is not a psychiatrist or any other doctor who decides in first place if somebody is mentally ill. It’s the patients themselfs and their surrounding.

Facts

Even though many successful people are suffering from bipolar disorders, it is a serious disease. Some facts: 11% to 15% of untreated patients are committing suicide. Up to 50% attempt suicide. More than 50% will develop drug or alcohol misuse. The divorce rate is increased three-fold. 50% will be unemployed 6 months after a manic episode. 800 out of 100,000 People living in the U.S. are suffering from it. Onset is most commonly between 15-24 years. Both sexes are equally affected. Bipolar disorders are more common in urban areas and in upper socioeconomic classes and higher educated people.

Causes

The causes of bipolar disorders are still unknown. Most probably there won’t be a single cause but a multifactorial genesis. The Stress-Vulnerability-Coping Model is a commonly used model to explain mental illnesses. Scientists could identify many different risk factors; like a positive family history of bipolar disorder. Patients whose father or mother suffered from bipolar disorder have a 20% higher risk to develop it as well. Moreover childbirth was discovered as a risk factor. 45% of women suffering from bipolar disorder had their first episode in the postpartum period. Stress - be it physical (eg physical illnesses) or psychological (eg work, relationship etc.) - seems to be a risk factor; as well as drug or alcohol abuse.

Symptoms and signs

Depression: The ICD-10 defines 3 major symptoms which are depressed mood, Loss of pleasure and interest in activities and Fatigue or loss of energy. Other symptoms could be lack of concentration and memory, hopelessness, feelings of guilt and unworthiness, suicidal tendencies, sleep disorders, loss of appetite and weight.

Mania: The ICD-10 defines 2 major symptoms which are abnormally euphoric mood or irritated mood. Further symptoms could be lack of concentration and distractibility, racing thoughts, poor judgment, reckless behavior, increased impulsivity, inflated self-esteem, increased energy, increased activity, hyperactivity, rapid speech, reduced need for sleep, increased libido and hyper sexuality.

Psychotic symptoms: in both episodes it is possible that psychotic symptoms occur.

Forms

Bipolar I disorder is described as the combination of 2 or more episodes of Mania and Depression or mixed episodes.

Bipolar II disorder is described as the combination of 2 or more episodes of Hypomania and Depression or mixed episodes.

Rapid cycling bipolar disorder is described as the combination of 4 or more episodes of Mania and Depression or mixed episodes in one year.

Ultra rapid cycling bipolar disorder is described as the combination of 4 or more episodes of Mania and Depression or mixed episodes in one month.

Diagnosis

As in any mental illness first severe organic causes have to be ruled out. This should be done by a psychiatrist and include physical examination, blood tests and the MRI of the brain should not be older than 1 year. If medication should be used other diagnostic procedures may be applicable like EEG or ECG. In the second step the psychiatrist will do psychiatric examination and evaluate based on the ICD-10 or the DSM-IV the symptoms. Moreover there are neuropsychological tests available to evaluate the symptoms of manic or depressive episodes under the supervision of our top Neurologists in Dubai.

Treatment

There are very effective treatment options for bipolar disorders. The priority is to protect the patient and his surrounding from any kind of risk. Be it the sufferer itself from risky behaviour or suicide; be it his surrounding from reckless behaviour or abuse. Without adequate treatment the average woman suffering from bipolar disorder will lose 9 years of life, 14 years of effective activity, and 12 years of normal health. This is due to the fact that bipolar disorder is a chronic disease. Over 90% of people who have an episode of mania will have another. The earlier the onset, the worse is the prognosis. With treatment 90% will improve, 50% will be symptom-free.

But before going into detail, let’s have a look at the biggest obstacles on the way to get there.

Therapy motivation. The most complicated step is always the first one. Searching professional help is a difficult step for most people. It seems that the stigma of mental illnesses is widely present. Moreover the inside that treatment could be necessary is particularly in manic episodes often not sufficient. Even if the surrounding is suffering from the behaviour of the patient, the patient in a manic episode could not be aware of it. It is a difficult task for caregivers to convince the patient that there might be something wrong. Often the patients realize the consequences of their behaviour only after the manic episode is over or if it has severe consequences like jail terms or health damages. While suffering from a depressive episode the drive is often reduced to the extent that patients are not able to search for help by them self’s. This shows the importance’s of the caregivers in bipolar disorders.

The next obstacle is the maintenance of a successful therapy. Even if the patient discovered that treatment helped, it is common that they will stop medication at some point. One-third to one-half of bipolar patients stop medication against advice. As bipolar disorder is highly recurring, there is a high risk of relapse.

Pharmacotherapy

In Bipolar disorder different types of medication are used. The treatment is always individual and depends on many factors, such as experienced effects in the past, side effects, current episode, severity of symptoms etc. Commonly used medications are Mood Stabilizer, Antidepressants, Anticonvulsants and Benzodiazepines. An average treatment period could be 12 month in patients with a low risk of relapse and 5 years to indefinite in patients with high risk of relapse.

Psychology

Medication should always be combined with some kind of psychological support. It is important to establish a reliable relationship to your healthcare professional and to develop a realistic treatment plan. It could include Cognitive behavioral therapy, Family therapy or group therapy.

Psychoeducation

Particularly in bipolar disorder the knowledge about the disease is essential. For patients and caregivers as well. It’s important to identify individual risk factors and triggers and to develop strategies to avoid them. Moreover the patient has to learn to detect early symptoms of another episode.

Lifestyle

The goal is to eliminate all individual risk factors that could trigger a relapse. This could include sleep pattern, substance use, stress at work or in the family. It could be shown that a relapse is less likely if a good sleep pattern is maintained.

Support groups

To have a good psychiatrist and a professional health support is important. However, besides this it is big help to get help from other sufferers or caregivers as well. Here you can find more information about our free of charge support group.

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References

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• Davis JM, Janicak PG, Hogan DM. M in the prevention of recurrent affective disorders: a meta-analysis. Acta Psychiatr Scand. 1999;100:406-17
• Donna Sudak, MD
• Tondo L, Hennen J, Baldessarini RJ. Lower suicide risk with long-term L treatment in major affective illness: a meta-analysis. Acta Psychiatr Scand. 2001;104:163-72
• Geddes JR, Burgess S, Hawton K, et al. Long-term L therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry. 2004;161:217-22
• Goodwin GM, Bowden CL, Calabrese JR, et al. A pooled analysis of 2 placebo-controlled 18-month trials of L and L maintenance in bipolar I disorder. J Clin Psychiatry. 2004;65:432-41
• Macritchie KA, Geddes JR, Scott J, et al. V acid, V and D in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev. 2001:CD3196
• Ceron-Litvoc D, Soares BG, Geddes J, et al. Comparison of C and L in treatment of bipolar disorder: a systematic review of randomized controlled trials. Hum Psychopharmacol. 2009;24:19-28
• Rendell JM, Gijsman HJ, Keck P, et al. O alone or in combination for acute mania. Cochrane Database Syst Rev. 2003:CD4040
• Yatham LN, Grossman F, Augustyns I, et al. Mood stabilisers plus r or placebo in the treatment of acute mania: international double-blind, randomised controlled trials. [Erratum in Br J Psychiatry 2003;182:369] Br J Psychiatry. 2003;182:141-7
• Rendell JM, Gijsman HJ, Bauer MS, et al. R alone or in combination for acute mania. Cochrane Database Syst Rev. 2006:CD4043
• Lenox RH, Newhouse PA, Creelman WL, Whitaker TM. Adjunctive treatment of manic agitation with L versus H : a double-blind study. J Clin Psychiatry. 1992;53:47-52
• Meehan K, Zhang F, David S, et al. A double-blind, randomized comparison of the efficacy and safety of intramuscular injections of O , L or placebo in treating acutely agitated patients diagnosed with bipolar mania. J Clin Psychopharmacol. 2001;21:389-97
• Gijsman HJ, Geddes JR, Rendell JM, et al. A for bipolar depression: a systematic review of randomized controlled trials. Am J Psychiatry. 2004;161:1537-47
• Nolen WA, Bloemkolk D. Treatment of bipolar depression: a review of the literature and a suggestion for an algorithm. Neuropsychobiology. 2000;42:11-17
• Delbello MP, Schwiers ML, Rosenberg HL, Strakowski SM. A double-blind, randomized, placebo-controlled study of Q as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry. 2002;41:1216-23
• Derry S, Moore RA. Atypical A in bipolar disorder: systematic review of randomised trials. BMC Psychiatry. 2007;7:40
• Geddes JR, Calabrese JF, Goodwin GM. L for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Brit J Psychiatry. 2009:194:4-9
• Scott J, Garland A, Moorhead S. A pilot study of cognitive therapy in bipolar disorders. Psychol Med. 2001;31:459-67
• Beynon S, Soares-Weiser K, Woolacott N, et al. Psychosocial interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. Brit J Psychiatry 2008;192:5-11
• Miklowitz DJ, George EL, Richards JA, et al. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry. 2003;60:904-12
• Rea MM, Tompson MC, Miklowitz DJ, et al. Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. J Consult Clin Psychol. 2003;71:482-92
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What is Schizophrenia?

Schizophrenia is a brain disorder. It affects the way a person acts, thinks and sees the world. Often people with schizophrenia have different perception of reality and even lose contact with reality. They might see things, that others do not see or might hear voices that others do not hear (hallucinations). They might even speak in a confusing way or might believe in their own „reality“(delusion). Even some people feel persecuted or constantly watched (paranoia). Others have a disorganized behaviour or so-called „negative symptoms“, such as lack of emotional expressions or lack of enthusiasm. If a person shows symptoms as a radical change in personality and an impaired functioning plus a distorted or non-existent sense of reality we speak in medical terms of „psychosis“.

Schizophrenia typically begins in the early adulthood, between the age of 15 and 25. Women tend to develop first symptoms several years later than men, typically around the age of 25. However, men are more affected than women. Symptoms might develop slowly or sometimes it shows the full syndrome immediately. Early warning signs of schizophrenia could be a social withdrawal, depression, suspiciousness or inappropriate laugh or crying. It is important to be aware of early symptoms, because the earlier the disorder is diagnosed the better it can be treated.

Schizophrenia is affecting approximately 0.7 to 1.0 percent of the adult population worldwide. About 26 million people worldwide are affected by schizophrenia. We would therefore estimate to have about 50'000 people suffering from schizophrenia in the UAE.

While schizophrenia is among the common mental disorders, anxiety and mood disorders such as depression are 5 to 10 times more frequent. In the past years there was a longstanding opinion that the prevalence of schizophrenia varied little from population to population. Today we have indications that the rates of schizophrenia can vary in different regions due to the influence of cultural, urban and geographic factors. For example migrants have higher prevalence’s then native-born individuals and developed countries higher prevalence’s then non-developed countries. The highest prevalence is among people with low socioeconomic status living in developing nations. Recent studies suggest that environmental factors related to urban residence may contribute to development of schizophrenia.

The WHO published data 2002 regarding the prevalence of schizophrenia and we know, that the disorder tends to be the highest in Oceania and Middle East and Asia compared to Australia, Japan and Europe.

Symptoms and Signs

There are two kinds of symptoms – early symptoms which may exist years before the actual outbreak of Schizophrenia - and main symptoms. The early symptoms include the 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.

The main symptoms of Schizophrenia are Delusions, Hallucinations, disorganized speech, disorganized behavior and negative symptoms like diminished emotional expression or avolition. These symptoms mark the active phase of the disorder which emerges after a stressor or substance abuse or without any identifiable stressor. Patients often suffer from social disorders due to a loss of personal abilities such as initiative, interest, and pleasure in life and other people. Their emotions may be blunted and there may be a poverty of speech and diminished activity and self-care. Moreover Schizophrenia often affects cognitive areas such as memory and attention. A lack of decision-making capability is common, especially in older patients.

Causes

Today the causes of schizophrenia are not fully known. It appears to be a result of a complex interaction between genetic (hereditary) and environmental factors. Schizophrenia has a strong hereditary component, which means, that individuals with a first-degree relative who has schizophrenia have a 10 percent chance to develop the disorder, so an approximately 15 times higher risk than the average population.

But it is important to mention, that the disorder is only influenced, not determined by genetics. So we know that the inherited genes make a person vulnerable to get schizophrenia, but the environmental factors act on the vulnerability and trigger the onset of the disorder. From research we know, that „stress-inducing“factors might be involved in schizophrenia, such as prolonged birth, malnutrition before birth or prenatal exposure to a viral infection. Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, also may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia.

Stigma

In many cultures mental health is a theme that is not openly discussed and even stigmatized. We would help many patients when we could overcome being „speechless “and support them to seek for professional help. This would be the first step to get a treatment and improve the quality of life for the patients and their families. An obstacle for many patients with early symptoms is also that mental disorders are often poorly covered by health insurances resulting in further delays of diagnosis and treatment.

Diagnosis

Schizophrenia is a clinical diagnosis. Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms. The tests may include a complete blood count, urinalysis, a metabolic profile, imaging studies and psychological evaluation. Best Psychologist in Dubai will assess the patient's mental state by asking about thoughts, moods, hallucinations, suicidal traits, violent tendencies or potential for violence, as well as observing their demeanor and appearance. Patients with suspected schizophrenia should be referred for a psychiatric assessment. At least one of the symptoms must be delusions, hallucinations or disorganized speech.

If you're unable to know what your mental health concern is, we can help you with that using our best Neurologist in Dubai, Psychiatrist in Dubai, and Psychologist in Dubai's help.

Treatment of Schizophrenia

Schizophrenia can be treated and the outlook for the disorder continues to improve. However, only 50% of patients receive adequate help. Very often people under appropriate and continuous treatment can live a regular life and work. It should be treated with a complex setting that includes medication, psychotherapy and the establishment of a strong support network. Unfortunately, many patients do not receive the appropriate treatment today because of a lack of social acceptance and/or the inability to recognize the need for treatment by the patients themselves.

An effective treatment requires a combination of medication and psychotherapy. Treatment helps relieve many symptoms of schizophrenia, but most people who have the disorder cope with symptoms throughout their lives and most will remain on antipsychotics for the rest of their lives. Nevertheless, antipsychotics should not be used as a single-treatment modality. Therapy and psychosocial interventions should continue.

Psychosocial treatments help patients deal with the everyday challenges of the illness. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work. Support Groups can be an effective adjunct to medication as well and help patients reach out to others facing similar challenges. Support groups may also help family and friends cope.

However, many people with schizophrenia can lead rewarding and meaningful lives.

© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)

Somatoform Disorders

Somatoform disorders are defined as somatic (bodily) symptoms without a sufficient somatic (bodily) cause. Only after somatic causes are ruled out, psychological factors can be taken into consideration. The presentation of the symptoms is the same, regardless if they are caused by somatic or psychological factors. A good example is common back pain. It can be caused by a pinched nerve as a somatic cause. The exact same pain can be cause by psychological factors, too. For most people this seems to be hard to believe. However, somatoform disorders are among the most common psychiatric disorders and occur in 10 to 15% of primary care patients.

Somatoform disorders can cause almost all kind of symptoms. From pain over irritable bowel syndrome up to the fear of a brain tumor. As it is very natural to believe in a somatic reason, patients tent to undergo various medical investigations – even unnecessary surgeries. Sometimes patients are searching for a reason that explains the symptoms for years. They are consulting doctors frequently, which is called “doctor hopping” and often turn to alternative medicine. This kind of behavior expresses the enormous pressure these patients are under.

It is important to understand that these patients are ill, they will have pains, functional disorders or likewise. People with somatoform disorders are not faking their symptoms and their symptoms can significantly affect daily functioning. Their pain often has a dramatic impact of work, relationships, and other activities.

Types and Symptoms

1. Somatization disorder / Somatic Symptom Disorder

This type of somatoform disorder includes symptoms such as pain, neurologic problems, sexual problems, gynecological, cardiologic and gastrointestinal complaints. Patients often have a long history of medical problems but never a diagnosis that could really explain all their symptoms.

2. Undifferentiated somatoform disorder

One speaks of an undifferentiated somatoform disorder if the patient has one or more physical complaints of unexplained symptoms for at least six months.

3. Hypochondriasis

If a patient is concerned about having a serious disease and believes that minor complaints are signs of very serious medical problems he is suffering from this type of somatoform disorders.

4. Conversion disorder

In this type the patient has neurological symptoms such as paralysis, blindness, hearing loss or a loss of sensation or numbness without any medical cause.

5. Pain disorder

Patients with pain disorder typically experience pain that started with a psychological stress or trauma such as chronic headache after a stressful life event.

Diagnosis

Finding the diagnosis can be difficult and time consuming. A comprehensive medical examination including laboratory work and radiologic scans is needed to determine possible causes of the symptoms. It is very important to not overlook any somatic (bodily) cause. On the other side the patient shall be protected from unnecessary medical investigations and surgeries. If the examination does not reveal a clear source of the pain a somatoform disorder could be considered.

If you're unable to know what your mental health concern is, we can help you with that using our top Neurology Doctor, Psychiatry Doctor, and Psychology doctor's help.

Treatment

A strong doctor-patient relationship plays a key role in the effective treatment of somatoform disorders. For the patient it is important to understand that treating a somatoform disorder doesn’t mean neglecting the possibility of a somatic cause. It is not an either or decision the patient has to make. Treating a somatoform disorder correctly is rather an addition to the attempts the patient did so far. The doctor will evaluate all performed procedures and decide with the patient which further investigations are necessary and which ones are not. Patient and doctor together will develop a concept that takes all factors influencing the disease in consideration. These factors can be very different from patient to patient. Depending on this, different forms of treatment are effective. Cognitive behavioral therapy is used since it focuses on correcting distorted thoughts, unrealistic beliefs and behaviors that prompt health anxiety. The focus is rather on the improvement of daily functioning then on managing symptoms. Stress reduction is often an important part of getting better. Antidepressant medications can support the psychotherapy. Moreover, Support Groups can be helpful as well as stress reduction exercises, physical therapy and massage. The doctor will develop an individual treatment plan for each patient.