Prof. Claus, Neurologist, was head of the Department of Neurology at the Hospital of Darmstadt in Germany. In his department approximately 5000 neurological inpatients were seen each year. Part of the department was a neurological intensive care unit and a stroke unit. In addition the department included a muscle section and clinics for epileptology, and movement disorders.
Neurologist, Prof. Claus, is certified in Epileptology, Neuroradiology, Rehabilitation Medicine, Clinical Geriatrics, Electroencephalography, Electromyography, Evoked potentials, Neurovascular ultrasound, and neuromuscular ultrasound. As neurologist he regularly lectures at the University of Heidelberg.
In 1990 he received the Richard Jung Award from the German Society of Clinical Neurophysiology and Neurology as a Neurologist. This was for his scientific work in the field of transcranial magnetic stimulation. Prof. Claus is an active member of the editorial board of the scientific Journal for Clinical Neurophysiology (Thieme Publisher, Stuttgart).
In 1986 he was Guest Research Fellow, Prof. J Kimura, Univ. Iowa, USA, for 6 weeks, and at the same year the General Medical Council, London, registered him as a Neurologist.
In 1987 he spent a year at the National Hospital Queen Square as a research fellow neurologist of the Royal Society, working with Professor P.K. Thomas and Professor Anita Harding amongst others. Since then he has retained his membership of the Queen Square Alumnus Association, and he is in regular contact with many physicians and colleagues from the United Kingdom. Prof. Claus was elected Corresponding Fellow of the American Academy of Neurology and of the Royal College of Physicians, London.
His areas of interest as a neurologist are Clinical neurology including stroke prevention, epilepsy, neurodegenerative disorders, movement disorders, polyneuropathies, and neuromuscular disorders.
Among all this Prof. Claus has a huge experience dealing with high techniques diagnostic equipments such as the colour coded duplex sonography; transcranial colour coded duplex and 24 hour blood pressure monitoring that use in Stroke prevention and Check-up and Headache work up beside the Muscle nerve investigation (neuromuscular disorders, muscle pain, entrapment neuropathies): 17-20 MHz colour coded ultrasound.
He is experienced in the use of Botulinum toxin for the treatment of dystonias, spasticity, and pain disorders.
As a neurologist, he also gives talks on various neurological topics:
Muscle pain, lumbar disc disorders, treatment of muscular strain with Botulinum toxin
Primary and secondary stroke prevention, diagnostic techniques and medical therapy
Headache – Migraine, differential diagnosis and treatment, pain treatment including Botulinum toxin in headache
Epilepsy, clinical manifestation and treatment
Peripheral nerve disorders (polyneuropathies) differential diagnosis and specific therapy
Movement disorders, clinical manifestation and treatment
Multiple sclerosis, diagnosis and therapy
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:
1) Keratitis (infection of the eye) caused by the failure to close the eye
2) Loss of taste: The tip of the tongue is also innervated by the facial nerve.
3) Sensitivity to loud noises (hyperacusis): The facial nerve innervates the stapedius muscle as well.
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.
Risk Factors
1) Family history (10%)
2) Previous episode (8%)
3) Pregnancy (three-fold risk increase)
4) Diabetes (four-fold risk increase)
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.
Differential diagnosis
Important part of the diagnostic process is to exclude other serious underlying conditions leading to similar symptoms. Differentiating between central and peripheral paralysis is the first step. Stroke and multiple sclerosis as causes for central paralysis have to be exclude.
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:
1) Injections or oral medications are improving the outcome and prognosis
2) Eye protection (a patch and eye drops preventing the eye from getting dry and developing keratitis)
3) Exercises of the affected muscles may improve the progress
4) Surgical decompression is generally not recommended
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.
You’ve been plagued by numbness and tingling in your fingers and wrist. You are waking up at night with a “pins and needles” sensation in one hand? There might be other explanations, but the symptoms suggest you may have carpal tunnel syndrome. Is it dangerous? No. But to ignore the symptoms may cause damage of the nerve and the muscles. What is to do?
In carpal tunnel syndrome (CTS), one of the nerves to the hand (the median nerve) becomes compressed as it passes through the wrist. There are different causes which can lead to CTS like occupational overstressing of the hands, injuries at the wrist with malposition of the carpal bones, arthritis, pregnancy, diabetes, overweight and others. Also a genetic predisposition is discussed. In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition.
The typical symptoms are numbness or tingling in the thumb, index, middle and ring finger, later pricking and painful paraesthesias. Sometimes the whole arm up to the shoulder is affected. This happens during the night or after awaking in the morning; but also with certain hand positions like keyboard typing, holding a phone or reading a newspaper, cycling or motor biking. The symptoms are intensified by overloading the hands by repetitive manual work. At the beginning the discomfort can be reduced by “shaking” the hands. Later a persistent numbness may occur. Left untreated, carpal tunnel syndrome can lead to constant pain and to permanent nerve and muscle damage that could severely limit your ability to use your hands.
If you have persistent signs and symptoms, especially if they interfere with your normal activities and sleep patterns, you should see your neurologist.
Your doctor will conduct a neurological examination. Tests with pressure on the median nerve at the wrist, produced by bending the wrist (Phalen`s maneuver) or tapping on the nerve (Tinel`s sign) can bring on the symptoms in many people. Important is to prove the feeling in your fingers and the strength of the muscles in your hand. Nerve conduction studies (an electrodiagnostic test) can pinpoint damage to the median nerve by measuring how fast electrical impulses move through it. Up to 10 percent of people with carpal tunnel syndrome, however, test is normal when this method is used. Other examinations like electromyogramm, SEPs (sensory evoked potentials), ultra sonic or MRI might be necessary to rule out other conditions like nerve root irritation or compression at the cervical spine.
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.
Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function, especially if you catch the condition early.
Nonsurgical therapy is possible if you have mild to moderate symptoms and the neurological examinations do not show an extensive damage at the median nerve. Medication with anti-inflammatory drugs (NSAIDs) may help relieve pain from carpal tunnel syndrome only in the short term.
The most effective conservative treatment is nocturnal splinting with a specially wrist splint. If you use it, avoid wearing it all day, since that can weaken your muscles in your wrists and hands. Wearing it all night, however, is recommended. This should be done at least for 3 month.
If the symptoms persist or the nerve conduction velocity becomes worse, surgery has to be considered. Two main types of surgery are used to relieve the pressure on the nerves inside the carpal tunnel: open carpal tunnel release and the newer endoscopic carpal tunnel release. Both are outpatient procedures performed under local anesthesia (the surgeon cuts the ligament along the middle of the palm and inner wrist). Most people make a full recovery, but in some cases (fewer than 5 percent) carpal tunnel syndrome recurs after surgery. This happens more commonly following the endoscopic procedure, which often doesn’t open up the tunnel as fully as open release.
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You fear having Alzheimer’s Dementia? You are suffering from memory loss? You have difficulties to concentrate? Don´t be afraid. To forget things doesn’t mean you are already suffering from Alzheimer Dementia. But what is Alzheimer Dementia actually?
Alzheimer´s Dementia is a chronic disease of the brain which starts slowly with mild symptoms. One symptom alone is not enough to justify the diagnosis. To forget some things some time does not make an Alzheimer´s Dementia. With ongoing age it is totally normal that your memory becomes worse. When you are 60 years it is more difficult to memorize information than with 50, and with 70 it is more difficult than with 60. That means you forget always a bit more becoming older in a natural way. It is very individual how much and how fast this process is ongoing. This depends on your gens, your general health situation, your environment you live in and your education. In scientific papers is was found that people with high education, university degrees or a sophisticated job, so called “brain workers”, get Alzheimer´s disease more seldom and later than people who work more physically. Our brain has a lot of resources to compensate deficiencies. And a well-trained brain does it better than a “lazy” brain.
There is not only one disease causing dementia. There are different kinds of dementia diseases like Alzheimer, vascular dementia or Lewy Body Disease Dementia. The syndromes of dementia can also be caused by other diseases like stroke, Parkinson, Hydrocephalus, brain tumor and others. It is the task of a neurologist to find out whether a person is suffering from dementia and if so, which kind. The most common dementia disease is the Alzheimer´s disease. Second most common form of dementia is the vascular dementia or a combination of Alzheimer’s Dementia and Vascular Dementia.
In early stages of Alzheimer´s Dementia patients are not only suffering from decline of memory but also other symptoms. People seem to be depressed because they realize their increasing problems. They feel tired, exhausted and try to avoid intellectual demanding tasks. Already in early stages of Dementia people are changing their behaviour. They are losing interest in things which were important for them before, like their job or hobbies. Patients suffering from dementia are avoiding social contacts, they want to be alone or only with very close persons like family members. The surrounding feels that something is wrong. First it is yet too little to talk or to worry about. There are always excuses to explain the changes. Then when the difficulties become more evident people feel unsecure how to talk about. Alzheimers Disease is stigmatized and for both sides it is difficult to face the facts. For the suffering person the same as for the family members or friends.
It is important to have a clear diagnosis to either stop worrying or to take action. However, in early stages it can be difficult to differentiate between forgetfulness of age and an early stage of a dementia disease. There are special cognitive tests a neurologist can apply to find out whether the memory alteration is still in age range or not. If there are symptoms of an alteration more than “what is allowed”, further investigations have to be done.
Other diseases like depression, burn out syndrome caused by too much stress, physically exhaustion and other corporal diseases have to be excluded. But how to find out whether a person is suffering from dementia?
First of all go to your neurologist and talk to him about your problems. Already by talking to a patient the doctor gets a first impression. He doesn´t only hear the complaints themselves. Important are also the duration and the progression of the problems. The way how a person speaks, the signs of memory disturbances in conversation, indication of aphasia, disturbance of time or local orientation, all this might already show first straits of a beginning dementia. The doctor also watches the spontaneous behaviour to form his opinion weather it is adapted to the situation or not. It is also important to listen to family members or other close persons. Maybe they have more information the patient eventually already forgot. Or they have another view of the changes the patient did undergo.
Next step are different cognitive tests. For example the worldwide used MMSE (Mini Mental State Examination), a psychometric test to prove orientation, retentiveness, alertness, speech, memory and other function. The neurological examination gives information about the different systems of the brain, peripheral nerves and muscles. Reflexes, speech, gait and locomotor system sensibility, vision, balance and the cranial nerves are checked. It is important to look whether there are any signs which could give an advice for another disease than dementia causing the problems. Blood tests, more seldom examination of the CSF (cerebrospinal fluid) were done. The CSF is the liquid the brain and the spine are covered with all over. In this CSF special peptides can be found which indicate an Alzheimer Disease (Tau-peptide, A beta-peptide).
EEG (electroencephalography) is an examination which does not hurt, comparable to the ECG (electrocardiogram) of the heart. It gives a good overview of the global cerebral function. Other electrophysiological test like AEP (acoustic evoked potentials) or SEP (sensible evoked potentials) can give more information about a lesion in the nervous system to exclude another disease. Also ultrasonic investigations of the cerebral blood flow are part of the diagnostic procedures. The neurologist will send the patient to the imaging of the brain by MRI or CT. In early stages of dementia there are no specific signs for the disease. In more progressed stages you can find signs of atrophy in special parts of the brain (in the temporal area hippocampussklerosis). But the most important reason for the imaging in early stages is again to exclude other diseases which have to be treated in a different way and which might be healed.
Therapy of Alzheimer disease is possible. With medication it is achievable to decelerate the progress of the disease, to stabilize the memory, concentration and basic life skills. In Alzheimer Disease nerve cells and nerve cell connections decay which cannot get restored. In consequence of the decay of the nerve cells the messenger substance Acetylcholine decreases. A special kind of medication, the so called “cholinesterase inhibitors”, compensates partly the deficit. By this the information processing improves again. There are other substances which influence the cerebral metabolism in a different way which might also have stabilizing effects on the cognitive functions. Coexisting symptoms like depression, sleeping disorders, anxiety or restlessness have to be treated with other drugs beside the special dementia medication.
Very important is the right contact and handling with the affected person. Lots of patience and sympathy, a quiet surrounding and good information for understanding the disease and the behaviour of the patient are absolutely essential. It is difficult and very exhausting to care for somebody in a more advanced stage when the person needs help in daily activities, in personal hygiene, in nutrition and needs observation the whole day. The family should use all the help and frontline services they could get or attend support groups.
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.
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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.
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
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.
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.
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.
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:
• Genetic influence
• Congenital abnormalities
• Antenatal or perinatal injury
• Infections such as meningitis, AIDS and viral encephalitis
• Cerebral tumors
• Traumatic brain injury
• Vascular causes (eg, stroke, vascular malformations, cerebral venous thrombosis)
• Inflammatory conditions (eg, vasculitis)
• Alzheimer disease, multiple sclerosis, and other neurodegenerative disorders
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...
Generalized seizures are the most common seizures and involve all areas of the brain and could include symptoms like staring into space or subtle body movements, stiffening of the muscles, a loss of muscle control and an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting the tongue.
The general signs and symptoms of a seizure may include:
• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms
Patients may experience an “aura” just before the seizure starts. They may feel “strange”, dizzy or nauseous and can experience changes in mood, visual perception, auditory perception or unspecific symptoms.
Epilepsy or Seizures are classified as (ILAE):
• Tonic–clonic (in any combination) seizures
• Clonic seizures
• Tonic seizures
• Atonic seizures
• Myoclonic seizures
• Myoclonic seizures
• Myoclonic atonic seizures
• Myoclonic tonic seizures
• Typical
• Atypical
• Absence with special features
• Myoclonic absence
• Eyelid myoclonia
• Epileptic spasms
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...
The Neurologist will test behavior, motor abilities, mental function and other areas to diagnose the condition and determine the type of epilepsy the patient may have. Moreover, the examination include a blood test, an EEG (Electroencephalogram) and a neuropsychological tests, in which the Neurologist assess thinking, memory and speech skills of the patient to determine which areas of the brain are affected.
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...
The treatment of Epilepsy involves first the establishment of the correct diagnosis and the identification of the syndrome/seizure type. In the second step the Neurologist will determine if medication is necessary and the last step will be to select the right medication. The selection of the right medication is very complex and needs to be individualized on the basis of the type of Epilepsy, patient characteristics and coexisting medical and psychiatric conditions.
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 or convulsions at all. In severe cases neurosurgical interference may offer help.
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.
Back pain and Neck Pain are rather symptoms than diseases. Meaning there can be various causes for your back pain or neck pain. Therefore the most important step is to find the right diagnosis by appropriate examinations. Only then the treatment can follow. To overlook serious underlying diseases and start treatment could have fatal consequences. In this article we give an overview of the most common forms of neck pain and back pain, with a special focus on disc herniation as a neurological disease.
Back pain is one of the most common symptoms presented in primary care. Up to 84 percent of adults experience back pain at some time in their lives. Back pain could occur at all ages with a peak around 40-50. Back pain is worldwide the most common cause of disability in persons younger than 40. These statistics are international not Dubai or UAE specific due to the fact that meta-reviews are not available for the UAE yet. However, the clinical work here in Dubai, UAE presents the same picture.
Symptoms could occur after lifting heavy items or other physical exercise. However, it can also occur without any previous activity, out of the blue. Nerves are having 3 functions: Pain, sensory and motor function. This explains the symptoms.
Which diagnostic procedures are indicated for your neck pain or back pain depends on your specific symptoms. Only after the consultation and physical / neurological examination the neurologist can advise which tests are necessary. If it is a simple form of neck pain or back pain mostly no further investigations are needed.
90% of acute back pain cases will fully recover. Patients with subacute or chronic back and neck pain (3 month>) still have a favorable prognosis, however not as positive as acute back pain. Moreover the treatment of chronic back pain or neck pain differs from treatment of acute pain.
There should never be a treatment without a proper examination. Only if the neurologist is sure about the diagnosis the treatment can follow. To overlook serious underlying diseases and start treatment could have fatal consequences. Before going into detail, we will answer the most common questions patients will ask:
Do I need to get surgery? Any surgery is a potential harm to the patient. Therefore there must be a clear indication. Luckily only less than 2% of patients suffering from neck or back pain need surgical intervention.
Do I need to stay in bed? If the pain is acute, you will most probably lay down anyway. If your muscles cramp and the movement is impaired you don’t have much other possibilities. After the treatment started there is no beneficial effect of prolonged bed rest. Moreover other problems like thrombosis could occur.
Transcutaneous electrical nerve stimulation (TENS) is a FDA approved, commonly used method in up-to-date pain management. It’s used for many forms of acute and chronic pain.
Acupuncture may be useful as adjunctive treatment for low back pain
Physical therapy, Massage, Occupational therapy can be used to alleviate pain and restore function (but this treatment is not encouraged in the early phase of injury)
Surgical therapy including Lumbar microdiskectomy,Spinal stabilization, Laminectomy, Endoscopic therapy, percutaneous arthroscopic diskectomy
CBT (Cognitive Behavioural Therapy) was underestimated for a long time but as new studies prove, they are highly effective. In some cases even more effective than medication, with less side effects. A recent study published by the American Psychological Association showed when it comes to chronic pain, psychological interventions often provide more relief than prescription drugs or surgery without the risk of side effects, but are used much less frequently than traditional medical treatments
Lifestyle adjustments to eliminate the risk factors, such as obesity, poor physical health, poor nutrition, smoking, heavy manual labor
Support groups are monthly meetings of 5-10 people, having one thing in common, impaired quality of life due to a chronic disease. more
For psychology and psychiatrist related problems, you can always consult a psychologist, psychiatrist or for counseling our psychotherapists are always available to help you.
Book Your Appointment With Our Back Pain Specialists - Contact
Saturday - Wednesday: 9am to 9pm Thursday: 9am - 7pm DHCC Basement parking entrance below Block A (Al Razi Bld, 64) JLT (Cluster I) Right side: 3hrs free parking Left side: all day free parking If you have any difficulties finding a parking slot, please give us a call.
Are you suffering from headaches? You are not alone! Headache is a widespread disease and one of the most common reasons to visit a Neurologist in Dubai. 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 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, neurologists assume. Typically it starts in adolescence. After the 50th year the frequency declines again.
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.
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. It’s important to report also sensations like these to your neurologist; even if you think it has nothing to do with the pain itself. 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 neurologists call 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 (4th phase) people feel tired and exhausted, concentration is still reduced, mood might be swinging.
It is a temporary dysfunction of the brain. During a migraine attack the blood vessels of the cerebral membrane are widened and inflamed. The nerve fibres around the vessels are irritated so heavily that they send pain signals.
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.
Nowadays neurologists are using very effective and fast treatment options for migraine headaches.
If you think that visiting a neurologist might not fix what you're going through. 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.
Proceedings for recreation as Yoga, autogenic training or progressive muscle relaxation techniques help, but have to be done regularly
Research could show that Cognitive Behavioral Therapy (CBT) has a positive impact on migraine patients. Even consulting a patient is able to reduce the frequency of migraine attacks. Therefore CBT was included in the Guidelines of the German Headache and Migraine Association.
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.
Constant sleep-awake cycle, also during the weekend. And eat and drink with regularity.
Avoid your personnel migraine triggers.
There are different types of medication to treat the acute attack. In easier cases common painkillers can be enough. A combination with a medication against nausea can be given. But mostly stronger medication is required. Special migraine drugs can ameliorate the attack within 2 hours in most patients. This kind of medication needs to be prescribed by a neurologist. The medication has to be taken as soon as possible. Then it helps the best. But be careful. You should not take any painkiller more often than 10-12 times a month. Otherwise there is the danger to develop an analgesic headache, which means headache by the medication itself!
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.
Multiple Sclerosis (MS) is an autoimmune disorder in which the immune system of your own body attacks the nerves and especially their myelin sheaths. Myelin damage disrupts communication between nerve cells. Thus functions controlled by nerves could be disabled. As the nervous system is controlling almost all functions of the human body, Multiple Sclerosis may manifest itself through various symptoms. That’s why diagnosing MS is difficult and sometimes takes years. It is an unpredictable, often disabling disease and primarily occurs in young adults between the ages of 20 and 40. MS is twice as common in women as it is in men.
The cause of Multiple Sclerosis is not known but exogenous and endogenous predisposing factors may play a role. Although there is no cure for Multiple Sclerosis treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.
Vitamin D plays a part in regulating the immune system in the human body. As Multiple Sclerosis is an immune disease, Vit D could have a protective/modulating effect that influences the disease positively. read more
Multiple Sclerosis in UAE | Too Less Sun???
New Australian study showed again the link between too less sunlight / Vit D Deficiency and Multiple Sclerosis. But do we have too less sunlight in the UAE? Since 1974 (Goldberg) researchers are studying the link between too less sunlight and Multiple Sclerosis.
Studies could show that smoking and passive smoking are risk factor to develop MS. Moreover, patients with MS have a worse prognosis if they smoke compared to non-smoking patients. Furthermore MS drugs are not as effective if patients are smoking. Bottom line: Stop Smoking!
Multiple Sclerosis is often characterized by a relapsing-remitting course, with new symptoms that develop over days or weeks and usually improve partially or completely, followed by a quiet period that can last months or even years.
The signs and symptoms of Multiple Sclerosis vary with one or several of the following:
Diagnosing early MS stages can be difficult. MS symptoms can be presented by a variety of other diseases as well. A comprehensive neurological examination should be done in order to rule out other conditions that might produce similar signs and symptoms. The examination includes blood tests, a MRI of the brain and spine and a spinal tap (lumbar puncture) in which a small sample of fluid is removed from the spinal canal for laboratory analysis. This sample can show abnormalities in white blood cells or antibodies that are associated with MS. Moreover, the Neurologist will check motor strength and sensation in all limbs.
The treatment of MS is very important even though Multiple Sclerosis is a chronic, potentially debilitating disease with no cure. The treatment focusses on reducing the frequency of relapses and speeding recovery from them. The aim is a slower disease progression and the management of the symptoms. It should be coordinated in consultation with a Neurologist specialized in MS.
There are special medications for the treatment of acute attacks which reduce nerve inflammation. Other medications can lower the relapse rate and reduce the rate of formation of new lesions. Just recently new drugs have been approved for the treatment of MS.
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. However, some patients have such mild symptoms that no treatment is necessary.
In order to relief the signs and symptoms of Multiple Sclerosis the patient should try to get plenty of rest and relaxation. Meditation and or deep breathing may help. Moreover, regular exercises can help improve strength, muscle tone, balance and coordination. Swimming, walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi are mild to moderate exercise recommended for MS. Exercises also relieve stress which may trigger or worsen signs and symptoms. A balanced diet low in saturated fat but high in omega-3 fatty acids, such as those found in olive and fish oils, may also be beneficial. Studies also suggest that vitamin D may have potential benefits for MS.
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.
I've multiple sclerosis but do I look scared?
Young woman with debilitating disease launches forum to help fellow patients. Supported by the German Neuroscience Center the twenty-eight-year-old multiple sclerosis patient Maha Abbas is launching an MS Talks Forum at Dubai's Urban Bistro restaurant this month end to raise awareness about the disease XPRESS, October 14, 2015, Sharmila Dhal, Chief Reporter Dubai: Maha Abbas, 28, is a multiple sclerosis ( MS) patient with a difference.
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.
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.
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.
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.
• 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:
Characterized typically by sensory loss, weakness and painful burning of toes and feet. First symptoms of the symmetric polyneuropathy may appear in the sole of one foot or even involving half a toe, then gradually spreading circumferentially up both legs to the knees, then into thighs and finally the hands. The latter pattern is also termed as “stocking-glove” distribution. Neuropathy always is length-dependent, because the longest axons are the most vulnerable. Patients describe tingling, prickling, burning, numbness and a band like pressure.
Due to sensory deficits, small cuts and wounds will not be noticed by the patients at first thus causing seemingly inexplicable infections. Later, weakness of the muscles will develop, particularly expressed by the fact that patients cannot stand on their heels. With progressing sensory disturbances spreading up also into the tips of the fingers, patients will have difficulties holding objects. Most common is a painful burning in the feet which gets worse with high temperatures. Light stimuli applied to the numb areas may be experienced as extremely painful. Also an imbalance of the gait, getting worse in the dark, is a common symptom of patients with Diabetes.
When the onset of diabetes occurs at a juvenile age of the patients, neuropathies may be first noticed as late as in their thirties to fifties but when the onset takes place at an age over 50, they tend to occur readily with adult-onset. There is a known correlation between the occurrence of neuropathy, the duration and the severity of diabetes, body weight, body size and long-standing hyperglycaemia which must be investigated individually with each patient.
Apart from the above described symmetric form of neuropathy there are other diabetes related neuropathies in different classifications:
showing focal weakness or sensory loss of single nerves, mainly in one upper arm, one thigh or the cranial nerves.
of neuropathy are less common, but quite dramatic. They are usually acute in the onset with strong muscle weakness and pain in a thigh or upper arm, but this form rarely occurs before the age of 45. The affection of the cranial nerves causes weakness of the eye muscles accompanied by double images or facial numbness and nerve paralysis.
Many patients with Diabetes also develop dysfunctions of the autonomic nervous system: constipation, diarrhoea (particularly during the night,), abnormal sweating, hypertension, Tachy- and Bradycardia, dysfunction of the bladder and sexual impotence in males. Symptoms are also uncertain gait, imbalance, maybe syncope’s and blurred vision from lack of papillary regulation.
The distinction between the different kinds of diabetic neuropathy is crucial as far as the different approaches to diagnosis and management are concerned, but also regarding the prognosis.
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...
The most essential part of the evaluation of diagnosis and therapy are – apart from an intensive neurological examination – the electro diagnostic studies of the nerves. The examination comprises Electromyography (EMG) and nerve conduction velocity (NCV). The EMG involves recording electrical potentials by an electrode placed into the muscle, both at rest and during voluntary contractions. The NCV is carried out by stimulating the motor and/or sensory nerves electrically. From the data recorded, informative characteristics of the recorded forms of waves can be determined, thus leading to a clear picture and appropriate treatment.
In the long-term, by way of Diabetes and Complications Control, trial patients who controlled their diabetes meticulously showed significantly less neuropathy. When symptoms of neuropathy occur in patients suffering from diabetes or early signs of polyneuropathic painpatterns as described above, occur, an early neurological examination is of the essence.
Moreover, specialized neuropathic pain treatment can easy the symptoms. Common pain killers are usually not effective enough and anticonvulsants, antidepressants and other drugs need to be used.
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.
Parkinson’s disease is a progressive neurodegenerative disorder characterized by rigidity, tremor, postural instability, and slowness of movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. Very often the changes in movement are very discreet and therefore an early diagnosis is often difficult. The disease commonly causes stiffness or slowing of movement. Although Parkinson's disease can't be cured, medications may markedly improve the symptoms.
Parkinson’s disease symptoms may be mild at the beginning and often start on one side of the body. The signs and symptoms may include:
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.
In Parkinson's disease, certain nerve cells (neurons) in the brain gradually break down or die. These certain nerve cells are responsible for the design, the development and the realization of movements. The loss of neurons results in a decreased dopa level in the brain. Dopa is a chemical messenger between nerve cells. The causes of Parkinson’s disease are not known but factors such as genes and environmental triggers may play a role. However, men are more likely to develop the disease than women are and it usually starts around age 60 or older.
Early diagnosis of Parkinson’s Disease may be difficult as the symptoms are often subtle. The Neurologist will do a comprehensive history and physically examination and order tests to rule out other conditions that may be causing the symptoms. In addition he may give a certain Parkinson's disease medication. Significant improvement with this medication will often confirm the diagnosis of Parkinson's disease.
So far, there is no cure for Parkinson’s disease but certain medications can help control the symptoms. They can help manage problems with walking, movement and tremor by increasing the brain's supply of dopa. Depending on the stage of Parkinson’s Disease and the age of the patient different medications are indicated. Certain medications have only a limited effect for a few years. If the effect is not sufficient anymore the medication needs to be augmented or changed.
The main focus of the treatment will be on adequate medication and physiotherapy. Physical exercises are useful therapeutic means. In severe cases neurosurgical intervention might be necessary which is known as deep-brain-stimulation. The surgeons implant electrodes into a specific part of the brain and connect them to a generator implanted in the chest near the collarbone that sends electrical pulses to the brain. Deep-brain-stimulation may reduce Parkinson's disease symptoms.
It is necessary that the patient works closely with the Neurologist to find the right treatment. Certain lifestyle changes such as a healthy diet and physical exercises may help make living with Parkinson's disease easier. Walking, swimming, dancing, water aerobics or stretching is recommended in order to improve the balance which could be disturbed by the disease. Moreover, some types of alternative medicine such as meditation, yoga, massage, tai chi and acupuncture could be useful tools.
We can also help you with the best psychologist, psychiatrist and psychotherapist available in Dubai, UAE.
Restless Legs Syndrome (RLS) is a neurological disorder characterized by an extremely uncomfortable feeling such as creeping, throbbing, pulling, itching or needles and pins in the legs, typically in the evenings while sitting or lying down. It makes the patient feel like getting up and moving around which reliefs the unpleasant feeling temporarily. Restless Legs Syndrome mostly affects the legs, but can also affect the arms, torso, head, and even phantom limbs. It can disrupt sleep and thus leading to daytime drowsiness.
RLS symptoms often begin at the age of 40 years but up to one-third of patients develop symptoms before the age of 20 years. RLS affects estimated 7 to 10 % of the young to middle aged people and 10 to 20 % in those older than 60 years. In the Middle East region approximately 3% of the general population is affected. It is twice as often in women as in men. Especially pregnant women suffer from RLS. 25% of pregnant women develop the disorder in the last three month of pregnancy.
Restless Legs Syndrome symptoms are most commonly located in the deep of the calves, in the feet and thighs. Initially the patient often get an exaggerated sense of positional awareness of the affected leg, later the sensations appear or intensify even while sitting. Movement of the affected part of the body, for instance walking around brings an immediate relief, although temporary and partial and the sensations immediately return after the movement stops. These symptoms often lead to a severe sleep deficiency with secondary tiredness and loss of concentration in job or while driving a car. Some people with severe RLS are not even able to go to work.
One distinguishes between two kinds of Restless legs Syndrome: the primary and the secondary RLS.
The primary (idiopathic) RLS is a neurological disease with unknown causes. A disturbance of a neurotransmitter system in the brain is suspected. Medication which interferes with the neurotransmitter system helps reliably.
The secondary (symptomatic) RLS is most commonly associated with iron deficiency, venous disorders, polyneuropathy, folacit deficit, Diabetes, renal diseases or pregnancy.
Restless Legs Syndrome can also be induced by antiemetic, anti-depressive and anti-psychotic drugs. A primary RLS should not be considered until possible medical conditions are ruled out, especially venous disorders and polyneuropathy.
1. AGE. The syndrome affects 10 percent of people 65 and older, compared with only 5 percent of the general population.
2. SEX. Women are more likely to experience the condition than men, but the sex connection seems to be tied to pregnancy. If a woman has never been pregnant, her risk is the same as a man's.
3. LOW IRON. Diminished iron in the brain is implicated in the syndrome.
4. FAMILY HISTORY. People with a family history of the disease are at greater risk.
Harvard researchers found out that sleep deprivation – caused by Restless Legs Syndrome (RLS) – leads to higher risk of early death. Former studies linked RLS with many other conditions, including depression, high blood pressure, and heart disease. This shows that RLS is not just a discomfort or a condition causing sleep problems. It has severe effects on overall health and longevity.
The goal of a treatment of Restless Legs Syndrome is to reduce the uncomfortable sensations. Sometimes it is necessary to treat underlying conditions such as iron deficiency or peripheral neuropathy.
To reduce the restlessness in the legs there are several medications available such as medications for Parkinson’s disease which reduce the amount of motion in the legs by affecting the level of the neurotransmitter in the brain. Moreover, medications for Epilepsy may help reduce the uncomfortable feeling, as well as muscle relaxants and sleep medications. But these medications don't eliminate the leg sensations, and they may cause daytime drowsiness.
Iron place a big role in Restless Legs Syndrome. Iron levels should be measured and a deficiency should be balanced. Furthermore, a non-medical therapy includes the avoidance of caffeine, alcohol, nicotine, and medications that exacerbate Restless Legs Syndrome, physical activity and good sleep hygiene. Simple lifestyle changes often play an important role in alleviating symptoms of RLS and to learn some relaxation techniques such as yoga and meditation can lead to a significant improvement.
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.
• Bulging or herniated disk in the back (most common)
• Other degenerative disk disorders
• Lumbar spinal stenosis
• Piriformis syndrome
• Tumor and others
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:
• Pain: Often the pain is described as a sharp pain. The pain can be so severe that movements may be difficult.
• Tingling, burning, numbness or other sensory symptoms
• Weakness of the muscles and problems to move the leg
Symptoms may worsen when you cough, sneeze, or laugh, or when you sit or stand for long periods of time. Being overweight is a risk factor.
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:
• Medication: Most patients need pain relieving medication. Moreover, medication that relaxes the muscles and thus reduces the pressure on the nerve may help as well.
• Physiotherapy: Initially it is important to reduce any movement that puts pressure on the sciatic nerve. Moreover, strengthening and stretching exercises may applicable. Applying heat or icing brings relief in some patients.
• CBT: Large studies could show that Cognitive behavioral therapy is effective in reducing the pain and coping with the symptoms.
• Injections: In severe cases injections that reduce the pain and inflammation may help.
• Surgery: Surgery should always be the last option and is not required in the vast majority of cases.
Read more about specific treatment of slipped or bulging disk here.
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.
Ischemic stroke, also known as CVA (cerebrovascular accident) or CVI (cerebrovascular insult) or Brain Attack is defined as an interruption of blood flow within one of the brain feeding arteries. Thus the effected brain areas are losing their function and if not treated in time, the nerve cells are dying. Depending on the affected area a stroke can have various clinical signs.
Most common causes of an ischemic stroke or CVA (cerebrovascular accident) are arteriosclerosis and cardiac embolism following atrial fibrillation. Other causes are vasculitis, arterial dissection or diseases causing hyper-coagulation (blot clotting). There are certain risk factors associated with ischemic stroke or CVA (cerebrovascular accident): age over 60, male gender, Hypertension, Atrial fibrillation, Diabetes mellitus, Dyslipidemia, Cigarette smoking, Migraines.
Symptoms of an ischemic stroke or CVA (cerebrovascular accident) are depending on the affected area of the brain. Often symptoms occur suddenly and are affecting one side. It could be sudden loss of vision, weakness of a limb (paresis), numbness or loss of sensory, problems speaking or swallowing, loss of consciousness, headache, nausea and others. If the symptoms fully recover, the neurologist speaks about an TIA, transient ischemic attack.
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.
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.
You are experience tingling, numbness, weakness or pain and you want to know what’s causing it? This quick guide will explain you how.
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..)
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:
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.
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.
• 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
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.
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.
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.
• Motor vehicle accidents
• Sport Injuries
• Falls
• Violence
• Military combat
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.
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.
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.
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.
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).
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.
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.
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.
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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!
Approximately 15% of the population is suffering from dizziness, vertigo, imbalance, lightheadedness, giddiness or unsteadiness. Vertigo is the perception of movement without actual movement (illusion of motion). Most commonly it is the sensation of spinning (either the room spinning or the person spinning). But it can be the sensation lateral movement, swaying or tilting, too. Vertigo is a type of dizziness. However, dizziness could also include other symptoms which not necessarily come with the feeling of spinning, such as imbalance, lightheadedness, giddiness and unsteadiness. Vertigo is a symptom, not a diagnosis. Meaning that vertigo can be caused by a wide range of diseases; from harmless to life threatening. In this article we focus on the most common neurological diseases.
Most commonly patients will experience the feeling of dizziness, vertigo, imbalance, lightheadedness, giddiness or unsteadiness. Moreover postural instability and feeling of falling or actual falling. Patients often need to sit or lie down and are suffering from nausea or vomiting. Ataxia (walking difficulties) and nystagmus (eye movements) could be present. Depending on the underlying cause the following symptoms could be present: hearing loss, tinnitus, ear pressure, visual problems. Moreover numbness of the skin, muscular weakness, coordination problems, speech or language difficulties, difficulty swallowing.
The causes of vertigo or dizziness can be manifold. There are various diseases that could cause the symptom of vertigo. It can be a disease of the ear or inner ear, the vestibular nerve or the brainstem. It could take comprehensive examinations to find out the real cause. Here we would like to highlight the most common causes.
1. Benign paroxysmal positional vertigo (BPPV): Benign paroxysmal positional vertigo is the most common cause of vertigo. Certain head movements can provoke a vertigo attack. The attacks are short (<30sec). Often the vertigo attack occurs in the night while rolling over in bed. This from of vertigo is caused by small crystals of calcium deposits in the ear canal that periodically become dislodged by specific head positions or movements. It is a very common form of vertigo.
2. Vestibular neuritis: Vestibular Neuritis is caused by an inflammation of the nerve to the semicircular canals, which helps control the balance. It is characterized by a sudden severe attack of vertigo, which lasts for seven to ten days.
3. Ménière disease: This disorder of the inner ear causes spontaneous episodes of vertigo along with fluctuating hearing loss. It is often attended by a Tinnitus (ringing in the ear) and a feeling of pressure or fullness in the ear.
5. Labyrinthitis: An inflammation of the inner ear structure called the labyrinth, caused by untreated bacterial infections of the middle ear. It can also cause loss of hearing.
6. Head trauma: A violent blow on the head can cause damage to the inner ear. This may lead to balance problems like Vertigo or Dizziness, temporary or permanent.
7. Others: Migraine, Superior canal dehiscence syndrome, Otitis media, Herpes zoster oticus, heart diseases and low blood pressure, Parkinson disease, Brain Stroke, Brain tumor, Acoustic neurome, Vestibular schwannoma, Epilepsy, Chiari malformation, Multiple sclerosis, Cholesteatom, Perilymphatic fistula, Superior semicircular canal dehiscence syndrome, Autoimmune disease, Psychological disorders like panic attacks or anxiety
First step should always be a consultation (important is the onset, triggers, duration, frequency, accompanying symptoms of the vertigo) and a comprehensive neurological examination (including coordination, nystagmus and gait testing). Only then a experienced neurologist can evaluate which further tests could be necessary. Such as Dix-Hallpike test, AEP, auditory evoked potentials, Vestibular evoked myogenic potentials, audiogram (hearing test), Tympanometry, Videonystagmography, Electrocochleography, Computed tomography (CT) or MRI
The treatment of vertigo depends on the underlying cause. Only if the neurologist could find out the cause by the above mentioned procedures the treatment should start. If the cause is life threatening like an acute stroke immediate action has to be taken. Most commonly the treatment is not that urgent. In the following we give you a short overview of possible treatment options. However, which ones apply depends on the findings I the diagnostics.
1. Repositioning maneuvers for BPPV (eg Epley maneuver or Semont maneuver)
2. Pharmacotherapy: Vestibular suppressants (Meclizine, benzodiazepines), corticosteroids and diuretics, β-blockers, calcium-channel blockers, antidepressants, anticonvulsants.
3. Physical Exercise or physical therapy Generally speaking physical activity is positive because the inner ear gets trained by this. Dangerous situations or the risk of falling should be avoided of course.
4. Lifestyle: In case of migraine vertigo trigger situation should be avoided. Further migraine treatment cou can find here.
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.
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