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Neurology department at Metro hospital, Faridabad is concerned with the prevention, diagnosis and treatment of Neurological disorders, such as stroke, pilepsy, vertigo, parkinson, alzheimer’s disease and other forms of dementia, dystonia, multiple sclerosis, migraine, sleep disorders, and other neuromuscular conditions.
Our department includes the team of experienced and efficient neurologists who offers cutting-edge diagnostic approaches, including advanced neuroimaging technologies, and best of treatment modalities. The centre is facilitated by 1.5 Tesla MRI and 660-500 Slice CT Scan.
Thrombolytic Therapy in Acute stroke
Metro Hospital is doing Thrombolysis in Acute Stroke on regular basis. We have successfully thrombolysed more than 150 patients till date which is among the one of the highest number in DELHI & NCR.
The centre is facilitated by CT scan and MRI facility. We have Deptt. Of Neurology which is headed by a senior Neurologist, who has expertise in Neuro-Radiology and interprets head CT Scans to determine whether to administer thrombolytic agents to stroke patients with in golden hours.
Botox therapy in Neurology
Botox Therapy clinic launched first time in Faridabad at metro heart institute with multispecialty.
We have injected botox therapy in various indication including migraine in more than 150 patients.
On Senior Consultant & HOD Neurology Department Dr. Rohit Gupta told that Stroke/paralytic attack is the third leading cause of death & is Ist leading cause of long term disability.
This Thrombolysis in acute stroke /paralytic patients is a new therapy. Metro Hospital has already thrombolysed more than 150 paralytic patients with excellent results. There is no age limit. We have even thromoblysed more than 90 years age patients also with excellent results.
Dr. Rohit Gupta was addressing Media in Metro Hospital, Faridabad on World Stroke day. Dr. S.S. Bansal, Managing Director & Sr. Consultant cardiologist also addressed the media.
Dr. Rohit Gupta told that Thrombolysis injection dissolves the clot in the vessel supplying blood to the brain and blood flows again starts & paralysis reverses. There is no age limit for Thrombolysis .We have best CT/MRI Brain/CT perfusion which can pick the clot within seconds.
Stroke/paralytic attack can occur even in young patients below 40 years of age. 10-15% of all stroke/paralytic attacks occur in less than 40 years of age. This injection/thrombolytic therapy can be done in any patient above 18 years of age & results are excellent in young patients. The window period of Thrombolysis is 41/2 hours. The patient should reach hospital as early as possible.
Every minute counts. Every minute, there is damage to 2 million neurons, so earlier the treatment, better are the results.
Dr. S.S. Bansal told that Thrombolysis technique by injection has helped stroke patients & paralysis reverses completely in most patients. Dr. S.S. Bansal said that I congratulate Dr. Rohit Gupta for saving more than 100 paralytic patients and correcting their paralysis. He also told that this facility is available in only few hospitals in India and it could have been possible because Dr. Rohit Gupta is fully dedicated for his patients. There is 24 hrs. CT Angio and MRI with diffusion facility in the hospital which is mandatory for handling stroke patients.
Dr Rohit Gupta, Sr. Consultant Neurologist Metro Hospital, Faridabad says that Botulinum toxin (Botox) -- famous for smoothing out wrinkles on the face -- has been approved by the FDA to treat chronic migraine in adults.
The FDA says Botox injections have been shown to be effective in the prevention of migraines which are debilitating headaches that cause intense pulsing or throbbing pain and affect about 12% of patients.
"Chronic migraine is one of the most disabling forms of headache, "Patients with chronic migraine experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available."
Migraine is the commonest cause of headache, affecting about 10-15% of women and 5-8% of men. In many cases, migraine becomes chronic and leads to frequent headaches. Oral preventive therapies for migraine are available, but are ineffective in some and lead to adverse events in others. In these patients, botox therapy has a great role to play.
Botox is injected in scalp and neck muscles (frontalis, temporalis, occipitalis, cervical, trapezius, etc) using a very thin needle. The procedure can be done in the office, with little discomfort to the patient, and is completed within 15-20 minutes.
Botulinum toxin is produced by bacterium, Clostridium botulinum. Seven different subtypes of botulinum toxin (A-G) are known. A highly dilute preparation of botulinum toxin type A (Botox) was introduced in clinical practice in the 1970s and 1980s to treat squint and blepharospasm. Since then it has found uses in other areas of neurology including hemifacial spasm, writer's cramp, cervical dystonia, post-stroke spasticity.
In the mid-1990s a number of people reported improvement in headaches in patients receiving botulinum toxin for other reasons. Well-conducted clinical trials of botulinum toxin in various types of headache followed. Detailed analysis of the results suggested, however, that there might be a subgroup of patients with chronic migraine who could benefit, and further trials were undertaken.
Two Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials recruited 1384 patients with chronic migraine, and randomised them to treatment with Botox® or placebo. These patients were suffering on average 20 days of headache each month, of which 18 were moderate or severe. Those randomised to Botox® received fixed-site, fixed dose injections every 12 weeks over 56 weeks. These injections covered seven specific areas of the head and neck, with a total dose of between 155-195 units. At six months, after two cycles of treatment, those treated with Botox® had on average eight less days of headache each month. After 12 months, 70% of those treated had ≤50% the number of headaches that they had done originally.
Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles. Botulinum toxin has been shown to reduce pain in a number of disease states, including cervical dystonia, neuropathic pain, lower back pain, spasticity, myofascial pain, and bladder pain. Botulinum toxin is believed to inhibit the release of peripheral nociceptive neurotransmitters, which may then have a knock-on effect on the central pain processing systems that generate migraine headaches.
Only patients with chronic migraine are eligible for treatment with Botox®. Chronic migraine is defined as headaches occurring on 15 or more days each month, at least half of which have migrainous features.
In general, all botox injection therapies are done on an out-patient basis. Patients can come after eating (fasting is not necessary). It is done without any anaesthesia, in the office setting. The entire procedure is completed in less than 30 minutes and patients are free to return home immediately after the procedure. No leave from work is required and they can join work the next day.
Neurology deptt metro hospital is running dedicated botox clinic for treating disorders like chronic migraine, hemifacial spasm, blepharospasm, post stroke spasticity, cervical dystonia, cerebral palsy & writer cramp.
A 43 old male came to Metro Hospital, Faridabad, after alleged history of road traffic accident followed by burst compression fracture of thoracic spine (D12) with cord signal changes. Due to this injury to spine he was completely bedridden & was suffering from severe backache.
He also had Bilateral weakness of lower limb muscles. This patient was advised for open surgery with 2 level above & 2 level below fusion of spine. He was told that he will start walking only after 7 days. But as he wasn't satisfied with the advice, he visited Dr. Rattnani, a senior orthopedist surgeon in Metro Hospital, Faridabad for second opinion. During evaluation on MRI it was found that his fourth thoracic vertebrae was fractured and he was having significant cord contusion @ L 4-5 level, which was causing lower limb muscle weakness. He was advised for minimally invasive surgery "percutaneous pedicle screw fixation" from D10 to L1 with L 4-5 microdiscectomy". In this procedure percutaneous pedicle screw are placed through a very small incision in skin through which Jamshidi needle is passed under 'C' arm Guidance and a path is created into the spinal vertebral body through pedicle. Guide wire is left over and with sequential dilatation space is created to deliver the screw through guide wire.
After tapping, screw is placed. This procedure requires only a very small incision on skin & no trauma is caused to surrounding muscle. It causes minimum pain & discomfort to patients as compare to traditional methods of surgery. Patient's weakness of lower limbs improved drastically & very next day he started walking. He was discharged after 2 days & recovered very fast. Facility of minimally invasive surgery for spine are available at Metro hospital Faridabad by Dr. Dinesh Rattnani, who has entensive experience in it. It is a patient friendly procedure with very fast recovery & very less discomfort.
Multiple Sclerosis is a Neurologic disorder that affects the Central Nervous System (CNS). The CNS includes the brain and spinal cord. In Multiple Sclerosis, the body's immune system begins to attack the nerves in the CNS. Nerves are like wires carrying information to and from the brain. Most nerves are covered with a layer called myelin. In Multiple Sclerosis, the immune system attacks the myelin. Most people with Multiple Sclerosis have a normal or near-normal life span.
Multiple Sclerosis often strikes young people who are in their twenties-thirties. It is also more frequent in females with 2:1 ratio.
Multiple Sclerosis is an autoimmune disease whose cause or trigger is unknown. The result is Multiple Sclerosis- multiple because many scattered areas of brain and spinal cord are affected, sclerosis because spots or patches of scar tissue formed over the damaged myelin.
Symptoms of Multiple Sclerosis very greatly depending upon where the damage to the brain tissue as occurred in the central nervous system. Symptoms may include:
These symptoms may occur in any combination and can vary from very mild to very severe.
Multiple Sclerosis is not always easy to diagnose because early symptoms are so common with other CNS related disorders and there is no single definitive neurological or laboratory test that can confirm or rule out Multiple Sclerosis. However recent advances in Magnetic Resonance Imaging (MRI) are helping to clarify diagnosis.
Yes, to a degree of stopping the further damage to myelin and reducing the progression of disease. Many medications are available today to help people with Multiple Sclerosis. These work to slow the progress of the disease and reduce the number of attacks and are called disease modifying treatments. Other medications can be helpful in managing some of the symptoms of Multiple Sclerosis, such as fatigue, stiffness, pain bladder or bowl problems, or mood difficulties. Other treatments can also help shorten the course of symptoms during an attack.
A 13 years old Iraqi girl came to Metro Hospital, Faridabad with history of Scoliosis since the age of 2 years which progressed so much so that she could hardly walk without severe backache.
Scoliosis is a musculoskeletal disorder in which there is a sideways curvature of the spine, or backbone. A normal spine, when viewed from behind, appears straight. But a spine affected by scoliosis shows evidence of a lateral, or side-by-side curvature, with the spine looking like an "S" or "C" and a rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side. In other words scoliosis has been defined as a curvature of the spine measuring 10 degrees or greater.
Spinal curvature from scoliosis may occur on the right or left side of the spine, or on both sides in different sections. Both the mid and lower spine may be affected by scoliosis.
In over 80 percent of cases, the cause of scoliosis is unknown - a condition called idiopathic scoliosis. Scoliosis is more common in females than males.
Preliminary investigations and assessment by team of orthopedic surgeons; it was found that she was suffering from scoliosis toward right side with 40 degree rotation.
This much high degree of rotation puts this case into severe degree of scoliosis where surgical correction is required to stop the progression of the curve and prevent further deformity. With this type of severe deformity, other methods of correction like bracing donot help much.
Surgical correction is done by correction, stabilization, and fusion of the curve of spine.
This procedure is a very fine one and need lots of operative skill of the surgeon, informed Dr S.S.Bansal, MD and senior Interventional Cardiologist, Metro Hospital, Faridabad. These kind of severe curve deformities need skilled hands and we are fortunate that our team of ortho surgeon is one of the best team of the region, added Dr Bansal.
After explaining and discussing the operative option with relatives, the patient was taken for surgery and correction was done followed by putting implant (rods and screws).
The little girl recovering fast and was mobilized very next day of surgery, told Dr Bansal.
Department of orthopedics have done many complexed procedures in both domestic and international patients with satisfactory results and such complicated procedures are being done successfully due to very good critical care backup and good team of anesthetist at Metro Hospital.
The patient is ready to go back to her country.
The four year old girl was operated at the age of 4 months elsewhere for swelling in back and hydrocephalus. Even at age of four years she was not able to move her limbs properly and there was no bladder bowel control and no sensation in limbs.The most common reason for swelling in the back is meningomyelocele. Meningomyelocele is a type of spina bifida, a kind of birth defect in which the spinal canal and the backbone do not close before birth which otherwise should close. The spinal cord and the meninges (the tissue that covers the spinal cord) may actually protrude through the child's back
She was investigated. Her MRI LS spine was done which revealed tethered cord at L5 level with spina bifida . She was taken for surgery and normal dura was identified at L3 level and dura was opened to see the cord. Cord was adhered to sac at L5 level . Cord was dethered by taking care not to injure nerve roots and under bladder bowel fibres Postoperatively there was improvement in power and sensation of her lower limbs.
Meningomyelocele is a kind of birth defect in which the spinal canal and the backbone don't close before birth. The affected body parts are those below the location of the problem, specifically the legs, bladder, and bowels.In some children, these body parts are only mildly affected. Others might have complete loss of control of their bladder and/or bowel. The legs may be partially or completely paralyzed or lack sensation Doctors do not know exactly why this condition occurs. It is thought that a lack of folic acid before and during early pregnancy impairs the development of the spinal cord. This condition is usually diagnosed during the second trimester of pregnancy when women can have a blood test called the quadruple screen. The test can screen for several conditions including meningomyelocele, Down syndrome and other congenital diseases of the baby. Most women who carry a baby with neural tube defects have elevated levels of maternal alpha fetoprotein (AFP). If the screen test is positive, further testing including a pregnancy ultrasound and/or amniocentisis.
The treatment is surgical correction which includes proper skin covering and dethering of cord . In our case in first surgery which was done outside only skin covering was done and dethering was not done so the patient had persistent symptoms which were relieved by dethering of cord
Dr S.S. Bansal MD and Sr. interventional cardiologist congratulated the entire deptt of Neuro surgery and in particular Dr. Dinesh Ratnani for the challenging surgery.
He added that in Neurosurgery deptt of Metro Hospital is consistently doing such complicated and demanding procedure and many foreign patients have also been treated for their complicated brain and spine diseases.
He especially mentioned about minimally invasive neurosurgical procedures, which are very patient friendly with quick recovery and early discharge from hospital.
After the cardiac pacemaker now it is time for Brain Pacemaker which is now being used for various chronic disorder of the brain like Parkinson disease, all kinds of tremor, dystonia, epilepsy and obsessive compulsive disorder.
Dr. Alok Gupta the head of Neurosurgery deptt. at Metro Hospital Faridabad has implanted a brain pacemaker in a Iraqi lady Saadia who had Parkinson disease for the last 5 years. Before surgery she was crippled, was unable to walk, had tremor that was not controlled with medication. After the pacemaker surgery done 1 week back she is better by 80-90% and her all the symptoms have improved and medications have reduced significantly and is able to walk freely.
This is a first time in Faridabad that a pacemaker is implanted for Parkinson disease says Dr. S.S. Bansal Head of Metro Hospital. Brain pacemaker is like a cardiac pacemaker which is implaned below the collar bone on left side. The pacemaker sends electrical impulses to different areas of brain through very tiny wires that goes through a small hole in the skull behind hair line on both side. These electrical impulses control the symptoms of the disease by altering the circuits. Patient is given a hand held programmer through which she can switch off and switch on the pacemaker and can also control the setting of the pacemaker at home. The surgery is also called as Deep Brain Stimulation.
Parkinson disease is seen in elderly individual and is because of deficiency of chemical dopamine. Initially disease is treated with medications but after few years medicines causes side effects and cannot control the symptoms. Then this pacemaker is advised says Dr. Rohit Gupta - Chief Neurologist Metro Hospital.
Dystonia is a genetic disorder which causes abnormal and uncontrollable movements of all the limbs. There is no definite medicine for dystonia but pacemaker can control the symptoms of certain form of dystonia.
Pacemaker was also used by Dr. Alok Gupta for the first time in Asia for uncontrolled epilepsy in a lady living in Faridabad. Now she is seizure free. Now all instrument to implant this pacemaker is available in Metro Hospital Faridabad.
Dr. Alok Gupta has also used pacemaker to treat obsessive compulsive disorders, where patient feel dirt all around and start cleaning himself repeatedly, washes hand again and again.
The pacemaker surgery is very safe as wires are very thin and does not cause brain injury. Future use of this pacemaker would be for chronic depression, memory loss and patient who are in coma for long time.
The cost of pacemaker surgery is 7-8 Lac of Rupees. Same surgery would cost 70-80 Lac Rupees in USA. This pacemaker surgery is approved by US FDA and European Health Authorities.
A 46 year old lady was suffering from excruciating pain on her right side of face for last 15 days. Pain was so severe that she was not able to open her mouth and was not eating anything. Her pain used to appear on washing face also so she hadn't wash her face for one week. She was successfully treated by Department of neurosciences at Metro Hospital Faridabad and was admitted under Dr. Dinesh Rattnani, the Head of Neuro Surgery. As she did not tolerate Medical treatment by Carbamazepine, Dr. Rattnani advised for Radiofrequency ablation of fifth cranial nerve. Her successful RFA was done at Metro Hospital Faridabad with help of pain management team. Procedure was done under mild sedation. This was a minimally invasive procedure through which maxillary & mandibular nerves were treated by creating two lesions at temperature of 700 for 70 seconds. Now the patient is painfree & performing all day to day activities.
Information about Trigeminal neuralgia:
The classical (TN) is a sharp shooting lanciating shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episod over face . It commonly affects outer side of cheek and jaw.
The exact cause is not known but it can be caused by a blood vessel pressing on the trigeminal nerve. This compression causes damage to the protective coating around the nerve.
Pain may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek like shaving, washing the face, brushing teeth, eating, drinking, talking, or being exposed to the wind. The pain may affect a small area of the face or may spread TN is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective.
Mostly the diagnosis is clinical however MRI Brain is required to look for any abnormal loop or any tumor or multiple sclerosis
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