OVERVIEW
The department of neurology is one of the oldest neurology departments in the city of Coimbatore. Established in 1989, by Dr. K. Asokan, Chief Neurologist of the Hospital, the department has pioneered the management of stroke, epilepsy, headache, nerve and muscle disease with botox injections, neuro immunological disorders and neuro degenerative disease.
The Department of Neurology uses cutting edge medical technology and techniques to treat patients with neurological disorders. Our EEG & EMG Lab is well equipped and run by expert personnel and an assistant medical officer, who are available around the clock. Botox injections are administered to treat neuromuscular disorders. We are also renowned for our expertise at treating Guillain Barre syndrome.
Neurologists at Sri Ramakrishna hospital use thrombolysis to treat ischaemic strokes. Intravenous, intracranial Thrombolysis can be done during any time of the day, with MRI facilities throughout the day. We also concentrate on quality of life once danger is averted. Specialised stroke rehabilitation is used to help patients recover from the effects of a stroke. Our neurologists work with a huge team of physiotherapists, psychologists, pathologists and many more, to ensure patients have the best chance of complete recovery. The Department of Neurology has also had great success with treating autoimmune encephalitis, multiple sclerosis and other auto immune disorders through the use of immunotherapy. In addition to this, neurologists closely support the Department of Neurosurgery in treating a host of conditions ranging from trigeminal neuralgia to tumours. Read more about how we tackle neurological disorders inside this section.
MEDICAL CONDITIONS
Stroke! That dreaded word which conjures up images of a dear old relative who was bedridden and miserable in the last years of his or her life. A well known word but one that is largely misunderstood by people.
A common misconception is that it happens to the elderly. In India more than 1.2 million people suffer from strokes every year and a considerable number of them (an estimated one in five) are aged under 40.
A 'stroke' is what occurs when blood flow to the brain is suddenly cut off. In such a situation, brain cells immediately begin to deteriorate and die. It is imperative to restore blood flow to the brain as quickly as possible in order to avert brain damage and potential death. The interruption of blood flow could be cause either by blockage or by bleeding. Blockage of an artery causes what is known as an 'ischaemic stroke'. It is the most common and it causes about 87% of strokes. Bleeding causes what is called 'haemorrhagic stroke'. It is rarer but considerably more dangerous.
We at Sri Ramakrishna Hospital employ state of the art technology to treat strokes in order to not only save patients’ lives but also their quality of life.
Cluster headaches are bouts of intensely painful headaches. Typically they begin at night, usually a couple of hours after the patient goes to sleep. More painful than migraines, they (thankfully) last for shorter periods of time. The attacks occur over extended time periods of weeks or months, hence the name. Between 'clusters' they can disappear for months or even years. They do however tend to be cyclical, occurring at the same times of the year. The root cause is unfortunately unknown but the source of the pain is the trigeminal nerve which is the nerve in the face that controls sensations of heat and pain. The nerve is activated and causes eye pain which is closely associated with the headaches.
Among other treatments, we offer radio frequency ablation to help patients overcome their debilitating pain.
The same trigeminal nerve is the source of probably among the most excruciatingly painful experiences we know of. Known as ‘trigeminal neuralgia’ and commonly referred to as ‘tic doloreux’ the pain takes the form of stabbing shock-like jolts which occur in volleys lasting from seconds to two minutes. The whole attack can sometimes last up to two hours. Searing, burning, jolts, aches - trigeminal neuralgia can present a whole range of pain, all of which can cripple a person physically and mentally. The constant pain is a cause of deep despair among patients. But, with modern medicine, there are a host of treatment options available to patients ranging from medication to surgery to radio frequency ablation.
Encephalitis is a rare and dangerous condition which presents as swelling or inflammation of brain tissue. This can have dangerous permanent ramifications ranging from personality changes to impaired brain function and even loss of life. Encephalitis has a number of causes, some of them unknown. At least 20% of cases are what is known as ‘autoimmune encephalitis’.
Autoimmune diseases or disorders are those which take place when the body’s own defence system (immune system) attacks healthy tissue as if they were foreign invaders. In Autoimmune Encephalitis, the body’s immune system attacks healthy brain tissue causing swelling and impaired functions. While it has probably been around forever, it has only been recognised as a disease as recently as this millenium.
Given its wide-ranging symptoms, its causes and treatments, it is treated by teams comprising as many as four different types of specialists - neurologists, psychiatrists, rheumatologists and immunologists. Among the most advanced treatments for this condition is immunotherapy which we are proud to offer.
Guillain Barre Syndrome is another rare condition in which the immune system attacks the peripheral nervous system. A terrifying autoimmune disorder, It begins with a feeling of weakness in the legs and extremities. This feeling can spread rapidly throughout the body in anywhere from two days to two weeks. The symptoms increase in severity to a point where the patient can experience complete paralysis. Even the respiratory muscles are affected, causing patients to require mechanical assistance to breathe. Guillain Barre syndrome must be treated exclusively in a hospital. The exact cause of it has not yet been determined but it is known that patients are affected by it after suffering from a viral or bacterial infection.
The autoimmune system attacks peripheral nerves, damaging the myelin sheath of the nerves. This causes a disruption in information flow to the brain. Unable to communicate with the brain and central nervous system, bodily functions begin to suffer.
Diagnosis is difficult as the early symptoms are similar to a host of other conditions. Doctors will need to take a complete medical history of the patient. To confirm suspicions of Guillain Barre Syndrome, nerve conductivity tests will be performed, as will a spinal tap or lumbar puncture, for analysis of cerebrospinal fluid. Treatment may include immunoglobulin therapy and plasmapheresis.
TREATMENTS & PROCEDURES
Here at Sri Ramakrishna Hospital, we take pride in ensuring the very best possible care is made available to patients. Patients who are suffering from an ischaemic stroke may be treated using a drug to ‘bust’ the clot, in order to try and restore blood flow to the brain. The medicine prescribed is called recombinant tissue plasminogen activator (rt-PA) or alteplase. The procedure of administering the medicine is called thrombolysis.
Thrombolysis itself can only be administered in a very strict set of circumstances. In most cases, patients can receive thrombolysis only within the first four and a half hours of suffering from the stroke. This is why when it comes to getting a stroke patient to a hospital for treatment, every minute counts. In rare circumstances, doctors may choose to administer thrombolysis as much as six hours after the attack.
It is important to know that thrombolysis may not be administered for a number of reasons such as- The patient having a bleed in the brain
- The inability to ascertain the exact time when the stroke occurred
- The patient doesn’t reach the hospital in time
- The patient has a bleeding disorder
- The patient had undergone major surgery recently
- the patient had suffered from a head injury or another stroke within the previous three months
- the patient may be on medication which isn’t compatible with rt-PA
In addition to helping minimise the effect of strokes, at SRH, we focus on the quality of life of the patient after danger is averted. Stroke patients may suffer from varying degrees of inhibition of mobility and so on. We offer specialised stroke rehabilitation with a veritable army of experts comprising neurologists, physiotherapists, occupational therapists, speech therapists and pathologists, psychologists and so on. Together they work towards improving the patients’ mobility, locomotion, self care, communication, cognition and control of bowels and bladder function. You can rest assured that in our hands, patients have the very chance of recovery and the chance to lead a long and fulfilling life.
Ablation simply means the removal of tissue. Radio Frequency Ablation (RFA) is a surgical technique wherein high frequency heat is aimed at different parts of the body in order to achieve a desired result. It may be used on tissue or tumour or, in this case, nerves. The last is used when patients suffer from chronic pain.
As we’ve seen, the trigeminal nerve is the centre of all heat and pain sensation in the face. Sometimes, medication is simply not enough to tackle the searing pain of cluster headaches and neuralgia. In these cases, Radio Frequency Ablation is an excellent treatment option.
At Sri Ramakrishna Hospital, a surgeon will put you under general anaesthesia. A needle is then inserted via the mouth so it reaches the trigeminal nerve. The patient is then awakened and stimulated to ensure that the needle is at the correct location. The patient is then put back under general anaesthesia and high frequency heat is aimed at the trigeminal nerve. This basically ‘injures’ the nerve enough to ensure it doesn’t communicate pain any more. There is a fairly high success rate for this procedure with nearly 80% of patients expressing relief from their overwhelming pain. There is a chance of recurrence of pain within a timeframe of a couple of years but this is a treatment which can be repeated at that juncture. Overall, an excellent prognosis for patients suffering from a debilitating condition.
The immune system is the body’s defence system against infection or ‘foreign invaders’. It can work against diseases by recognising the difference between healthy cells and cancer cells for example. Sometimes however the immune system can’t recognise the invader and the healthy cells and it turns on itself.
Immunotherapy is a term used for a collection of treatments that work on the immune system of the body, trying to modify it to act to the advantage of the patient, or at least not to his or her detriment. Several clinical trials have demonstrated that immunosuppressive agents and treatments can have a positive effect on autoimmune conditions such as autoimmune encephalitis and multiple sclerosis. However the medications themselves can have a host of side effects and these therefore need to be prescribed by highly skilled medical specialists.
We at Sri Ramakrishna Hospital offer the very highest levels of care and state of the art treatments to our patients, including immunotherapies for auto immune disorders. Our team of world class specialists prescribe and closely monitor the effects of the procedures and treatments to ensure the very best outcomes for our patients.
While there are no known cures for Guillain Barre Syndrome, there are treatments which can alleviate the severity of the condition and hasten patient recovery.
Plasmapheresis: Also known as plasma exchange, plasmapheresis is a process wherein blood is removed from the body. It is then processed to separate the red and white blood cells from the plasma. The red and white blood cells are then reintroduced into the patient’s body without the plasma, which is immediately replaced by the body. This process appears to reduce length and severity of the Guillain Barre attack, although scientists still aren’t able to ascertain exactly why. One theory is that the process of plasmapheresis helps to remove antibodies and other factors which could cause damage to the nerves.
Immunoglobulin Therapy: Immunoglobulin Therapy consists of giving high doses or injections of proteins which the immune system ordinarily uses in small quantities to attack invading foreign bodies. It has been found that these immunoglobulins, which are derived from a pool of many ordinary donors, can help reduce the immune system’s attack on the nervous system.
At Sri Ramakrishna Hospital, doctors and surgeons routinely use state-of-the-art treatments such as plasmapheresis and immunoglobulin therapy to treat patients suffering from Guillain Barre syndrome.
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