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West Syndrome

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What is West syndrome (infantile spasms)?
Infantile spasms are a type of epilepsy with a characteristic age of onset (typical age when seizures start), the pattern of seizures and electroencephalogram (EEG). This means that it is an ‘electroclinical epileptic syndrome’. The syndrome is called ‘West syndrome’ after Dr West, who first described the condition in his 4-month-old son in 1841. This type of epilepsy occurs in about one in 2,500-3,000 children.

What are the symptoms?
In 9 out of 10 children with the condition, infantile spasms occur in the first year of life, typically between 3 and 8 months old. To begin with, the attacks are usually brief and infrequent and do not occur in clusters. Therefore it is quite common for the diagnosis to be made late. The parents may initially be told their infant has colic because of the pattern of the attacks and the cry that a child gives during or after an attack.

The typical pattern is of a sudden flexion (bending forward) in a tonic (stiffening) fashion of the body, arms and legs. Sometimes, the episodes are different, with the arms and legs being flung outwards (these are called ‘extensor’ spasms). Usually, they affect both sides of the body equally.

Typically, each episode lasts just 1 to 2 seconds; there is then a pause for a few seconds followed by a further spasm. While single spasms may happen, infantile spasms usually happen in ‘runs’ or ‘clusters’ of several in a row. It is common for babies who have infantile spasms to become irritable and for their development to slow up or even to go backwards until the spasms are controlled. These babies can also behave as if they cannot see. These problems can improve if the spasms can be controlled and the EEG improves.

What is the diagnosis for West syndrome (infantile spasms)?
The diagnosis of infantile spasms is made by a combination of the typical features with a typical EEG. The EEG shows a much disorganised pattern called ‘hypsarrhythmia’. The EEG is always abnormal in children with West syndrome but sometimes this abnormality is seen only during sleep. Infantile spasms, like many other ‘electroclinical syndromes’, have lots of different causes. A particular cause will be found in 7 or 8 out of every 10 children with West syndrome. A video of the spasms is also very helpful.

Most children with infantile spasms will need a number of tests apart from the EEG. These include brain scans, blood tests, urine tests and, sometimes, spinal fluid and other tests in order to try to identify the underlying cause. The most important brain scan is the magnetic resonance imaging (MRI) scan.

What are the treatment options?
The main treatments used are corticosteroids or vigabatrin (Sabril). Nitrazepam and sodium valproate (Epilim) may also be used. There are different types of steroid that can be used. These are prednisolone (given by mouth), hydrocortisone (given by mouth or sometimes by injection) or tetracosactide (given by an intramuscular injection). Steroids must be used carefully as this treatment may cause some unpleasant side-effects. Vigabatrin may also be associated with some side-effects. Ketogenic dietary therapy (often called the ketogenic diet) may also be helpful for some infants. There may be research studies open that are relevant to this epilepsy syndrome. Your child’s doctor will be able to discuss this with you.

If your child has this syndrome they may have prolonged or repeated seizures. Your child’s doctor will discuss a ‘rescue’ or emergency care plan with you to treat any prolonged or repeated seizures. Information about treatments for children can be found on the Medicines for Children website.

In some children, infantile spasms respond easily to treatment, whereas in others they keep on happening. Most children unfortunately go on to have other kinds of seizures in later childhood including an epilepsy syndrome called Lennox-Gastaut syndrome. Most children also have learning difficulties and these may be mild or severe. The long-term outlook for West syndrome, for both the spasms stopping and the child’s development and learning, depends mainly on the cause of the syndrome.

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West Syndrome

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What is common wart?
Common warts are small, grainy skin growths that occur most often on your fingers or hands. They are rough to the touch; common warts also often feature a pattern of tiny black dots, which are small, clotted blood vessels. Common warts are caused by a virus and are transmitted by touch. It can take a wart as long as two to six months to develop after your skin has been exposed to the virus. Common warts are usually harmless and eventually disappear on their own. But many people choose to remove them because they find them bothersome or embarrassing.

What are the symptoms?
Common warts usually occur on your fingers or hands and may be:
Small, fleshy, grainy bumps
Flesh-colored, white, pink or tan
Rough to the touch
Sprinkled with black pinpoints, which are small, clotted blood vessels

When to see a doctor?
See your doctor for common warts if:
The growths are painful or change in appearance or color
You've tried treating the warts, but they persist, spread or recur
The growths are bothersome and interfere with activities
You aren't sure whether the growths are warts
You are an adult and numerous warts begin to appear, which may indicate the immune system is malfunctioning

What causes Warts?
Common warts are caused by the human papillomavirus (HPV). The virus is quite common and has more than 150 types, but only a few cause warts on your hands. Some strains of HPV are acquired through sexual contact. Most forms, however, are spread by casual skin contact or through shared objects, such as towels or washcloths. The virus usually spreads through breaks in your skin, such as a hangnail or a scrape. Biting your nails also can cause warts to spread on your fingertips and around your nails.
Each person's immune system responds to the HPV virus differently, so not everyone who comes in contact with HPV develops warts.

What are the risk factors for Warts?
People at higher risk of developing common warts include:
Children and young adults, because their bodies may not have built up immunity to the virus
People with weakened immune systems, such as those with HIV/AIDS or people who've had organ transplants

What are the prevention options?
To reduce your risk of common warts:
Avoid direct contact with warts. This includes your own warts.
Don't pick at warts. Picking may spread the virus.
Don't use the same emery board, pumice stone or nail clipper on your warts as you use on your healthy skin and nails. Use a disposable emery board.
Don't bite your fingernails. Warts occur more often in skin that has been broken. Nibbling the skin around your fingernails opens the door for the virus.
Groom with care. And avoid brushing, clipping or shaving areas that have warts. If you must shave, use an electric razor.

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Peripheral Neuropathy

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WhatIs Peripheral Neuropathy?
The name of the condition tells you a bit about what it is:
Peripheral: Beyond (in this case, beyond the brain and the spinal cord.)
Neuro-: Related to the nerves
-pathy: Disease
Peripheral neuropathy refers to the conditions that result when nerves that carry
messages to and from the brain and spinal cord from and to the rest of the body are
damaged or diseased.
The peripheral nerves make up an intricate network that connects the brain and spinal
cord to the muscles, skin, and internal organs. Peripheral nerves come out of the spinal
cord and are arranged along lines in the body called dermatomes. Typically, damage to
a nerve will affect one or more dermatomes, which can be tracked to specific areas of
the body. Damage to these nerves interrupts communication between the brain and
other parts of the body and can impair muscle movement, prevent normal sensation in
the arms and legs, and cause pain.
Types of Peripheral Neuropathy
There are several different kinds of peripheral neuropathies that stem from a variety of
causes. They range from carpal tunnel syndrome (a traumatic injury common after
chronic repetitive use of the hands and wrists, such as with computer use) to nerve
damage linked to diabetes.
As a group, peripheral neuropathies are common, especially among people over the
age of 55. All together, the conditions affect 3% to 4% of people in this group.
Neuropathies are typically classified according to the problems they cause or what is at
the root of the damage. There also are terms that express how extensively the nerves
have been damaged.
Mononeuropathy
Damage to a single peripheral nerve is called mononeuropathy. Physical injury or
trauma such as from an accident is the most common cause. Prolonged pressure on a
nerve, caused by extended periods of being sedentary (such as sitting in a wheelchair
or lying in bed), or continuous, repetitive motions, can trigger a mononeuropathy.
Carpal tunnel syndrome is a common type of mononeuropathy. It is called an overuse
strain injury, which occurs when the nerve that travels through the wrist is compressed.
People whose work requires repeated motions with the wrist (such as assembly-line
workers, physical laborers, and those who use computer keyboards for prolonged
periods) are at greater risk.
The damage to the nerve can result in numbness, tingling, unusual sensations, and
pain in the first three fingers on the thumb side of the hand. The person may awaken at
night with numbness in their hand or discover that when they perform activities like
using a hair dryer, the numbness is more noticeable. In time, carpal tunnel injuries can
weaken the muscles in the hand. You may also feel pain, tingling, or burning in your
arm and shoulder.
Here are examples of other mononeuropathies that can cause weakness in the
affected parts of the body, such as hands and feet:
Ulnar nerve palsy occurs when the nerve that passes close to the surface of the
skin at the elbow is damaged. The numbness is noted in the 4th and 5th digit of
the hand.
Radial nerve palsy is caused by injury to the nerve that runs along the
underside of the upper arm and can occur with fractures of the humerus bone in
the upper part of the arm.
Peroneal nerve palsy results when the nerve at the top of the calf on the outside
of the knee is compressed. This leads to a condition called "foot drop," in which it
becomes difficult to lift the foot.
Neuropathy can affect nerves that control muscle movement (motor nerves) and those
that detect sensations such as coldness or pain (sensory nerves). In some cases, it
can affect internal organs, such as the heart, blood vessels, bladder, or intestines.
Neuropathy that affects internal organs is called an autonomic neuropathy. This rare
condition can cause low blood pressure or problems with sweating.
Polyneuropathy
Polyneuropathy accounts for the greatest number of peripheral neuropathy cases. It
occurs when multiple peripheral nerves throughout the body malfunction at the same
time. Polyneuropathy can have a wide variety of causes, including exposure to certain
toxins such as with alcohol abuse, poor nutrition (particularly vitamin B deficiency), and
complications from diseases such as cancer or kidney failure.
One of the most common forms of chronic polyneuropathy is diabetic neuropathy, a
condition that occurs in people with diabetes. It is more severe in people with poorly
controlled blood sugar levels. Though less common, diabetes can also cause a
mononeuropathy.
The most common symptoms of polyneuropathy are:
Tingling
Numbness
Loss of sensation in the arms and legs
A burning sensation in the feet or hands
Because people with chronic polyneuropathy often lose their ability to sense
temperature and pain, they can burn themselves and develop open sores as the result
of injury or prolonged pressure. If the nerves serving the organs are involved, diarrhea
or constipation may result, as well as loss of bowel or bladder control. Sexual
dysfunction and abnormally low blood pressure also can occur.
One of the most serious polyneuropathies is Guillain-Barre syndrome, a rare disease
that strikes suddenly when the body's immune system attacks nerves in the body just
as they leave the spinal cord. Symptoms tend to appear quickly and worsen rapidly,
sometimes leading to paralysis. Early symptoms include weakness and tingling that
eventually may spread upward into the arms. Blood pressure problems, heart rhythm
problems, and breathing difficulty may occur in the more severe cases. However,
despite the severity of the disease, recovery rates are good when patients receive
treatment early.
Chronic inflammatory demyelinating polyneuropathy is a chronic form of Guillian-Barre
where the symptoms continue for months and even years. Early diagnosis and
treatment is crucial for CIDP patients, 30% of which risk eventually being confined to a
wheelchair.
What Causes Peripheral Neuropathy?
There are many factors that can cause peripheral neuropathies, so it is often difficult to
pinpoint the origin. Neuropathies occur by one of three methods:
Acquired neuropathies are caused by environmental factors such as toxins,
trauma, illness, or infection. Known causes of acquired neuropathies include:
Diabetes
Several rare inherited diseases
Alcoholism
Poor nutrition or vitamin deficiency
Certain kinds of cancer and chemotherapy used to treat them
Conditions where nerves are mistakenly attacked by the body’s own immune
system or damaged by an overaggressive response to injury
Certain medications
Kidney or thyroid disease
Infections such as Lyme disease, shingles, or AIDS
Hereditary neuropathies are not as common. Hereditary neuropathies are
diseases of the peripheral nerves that are genetically passed from parent to child.
The most common of these is Charcot-Marie-Tooth disease type 1. It is
characterized by weakness in the legs and, to a lesser degree, the arms --
symptoms that usually appear between mid-childhood and age 30. This disease
is caused by degeneration of the insulation that normally surrounds the nerves
and helps them conduct the electrical impulses needed for them to trigger muscle
movement.
Idiopathic neuropathies are from an unknown cause. As many as one-third of
all neuropathies are classified in this way.

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Neuropathic Pain

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Neuropathic pain, or nerve pain, is one of the most intense types of chronic pain, often
described as sharp, stinging, or burning. It is pain caused by damaged nerves or a problem
with the nervous system. While neuropathic pain can be debilitating, the upside is that there
are medications to treat it, and they work by changing the way the brain interprets pain.
Symptoms
There are many terms used to describe neuropathic pain, such as:
Sharp
Shooting or "electrical shock"
Burning or "hot"
Tingling, "pins and needles," or "prickling"
Stabbing
Neuropathic pain can occur all the time or come in spurts. Likewise, neuropathic pain can
range in intensity from being mild and nagging to severe and disabling.
Interesting, neuropathic pain tends to be worse at night, which may disrupt your sleep. It also
tends to flare at rest, which may affect relaxation or meal time. Overall, the negative impact
neuropathic pain has on one's quality of life can lead to psychological problems, such as
depression and anxiety.
Causes
There are many reasons why a person may develop neuropathic pain. For instance, some
types of neuropathic pain are caused by medications, like certain chemotherapies. Others
may be the result of a disease that affects the nervous system, like Guillain-Barré syndrome,
cancer, multiple sclerosis, multiple myeloma, alcoholism, and HIV.
Neuropathic pain is also common in diseases that attack sensory nerves, such as diabetes,
and in conditions where certain nerves are inflamed or compressed, as in carpal tunnel
syndrome or sciatica. Nerve pain may also result from trauma, like with spinal cord injury,
where nerves are damaged or severed.
Phantom limb pain is another neuropathic pain disorder in which pain feels as if it is coming
from a limb that was amputated.
Unfortunately, some types of neuropathic pain have an unknown origin or a cause that is not
completely understood. Reflex sympathetic dystrophy (CRPS) is an example. Though the
cause may not be fully known, the pain is very real.
Diagnosis
The diagnosis of neuropathic pain requires a detailed medical history and physical
examination, which are often enough to determine the "why" behind a person's neuropathy.
However, sometimes the diagnosis requires an evaluation by a specialist, like a neurologist.
In this instance, the diagnosis may require more testing including blood tests, nerve tests like
an electromyography (EMG), or imaging tests, like magnetic resonance imaging (MRI) of the
brain or spinal cord.
Treatment
Treatment of neuropathic pain first entails addressing the underlying problem. For example, if
a person has neuropathic pain from diabetes, optimizing blood sugar (glucose) control is an
essential next step. Bear in mind, though, enhanced glucose control cannot generally reverse
the neuropathy, although it can prevent it from getting worse and ease current symptoms.
As another example, if a medication is causing debilitating nerve pain, removal or a decrease
in the dose of the offending drug may be all that is needed.
First-Line Medications
Besides treating the underlying problem, medication is often needed to manage neuropathic
pain.
For the vast majority of patients, treatment of neuropathic pain involves taking one of the
following:
An antidepressant like Cymbalta (duloxetine) or Elavil (amitriptyline)
An anti-seizure medication like Neurontin (gabapentin) or Lyrica (pregabalin)
In terms of side effects, nausea is the most common side effect of Cymbalta. Elavil generally
poses more of a problem, mostly because of its risk for heart toxicity, as well as other
bothersome side effects, including:
Dry mouth
Constipation
Urinary retention
Lightheadedness or dizziness when standing up
Neurontin may cause dizziness, tiredness, confusion, and swelling in the lower legs.
Lyrica may cause dizziness, tiredness, dry mouth, swelling, and blurry vision.
Second-Line Medications
Opioids like Vicodin (hydrocodone/paracetamol) and Percocet (oxycodone/acetaminophen)
are not as effective for treating neuropathic pain and, thus, are considered second-line
treatments. In addition to their questionable benefit, opioids are associated with several side
effects.
The potential side effects of opioids may severely affect a person's quality of life and include:
Nausea and vomiting
Constipation
Itching
Dry mouth
Urinary retention
Drowsiness
Memory and thinking problems
Slowed breathing
In addition to these side effects, there is a nationwide concern for opioid addiction and abuse,
which must be considered.
Unique Therapies
There are some types of neuropathic pain that may require a unique treatment plan.
For instance, if a person's neuropathic pain is localized, as is often the case in postherpetic
neuralgia, a topical (on the skin) therapy, like a lidocaine patch may be used.
In other instances, surgery may be necessary—for example, to release a compressed nerve,
as in carpal tunnel syndrome. In the case of a herniated disc, in which an inflamed spinal
nerve is a culprit behind the pain, an epidural steroid injection into the spine is sometimes
performed.
Lastly, sometimes certain medications are used to treat specific neuropathic pain conditions.
A classic example is trigeminal neuralgia, which is characterized by severe, stabbing neck
and facial pain. This disorder is treated with the anti-seizure medication, Tegretol
(carbamazepine) or Trileptal (oxcarbazepine)

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'फिट' ( मिर्गी )

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'फिट' ( मिर्गी ):

वरवर निरोगी दिसणाऱ्या मुलांमध्ये अचानक झटका येणे, शरीराच्या वारंवार विचित्र हालचाली होण्यास फेफरे वा फिटस् येणे असे म्हणतात त्यास मज्जा किंवा चेतासंस्थेचा आजार असे म्हणतात. फिटस् टाळता येत नसल्या तरी योग्य उपचारांनी त्यावर नियंत्रण राहते...

मज्जा किंवा चेतासंस्थेच्या आजारांतला झटका केवळ दहा ते तीस सेकंदांचा असतो. काही वेळा त्यानंतर मूल बेशुद्ध पडते किंवा डोळे फिरवते. या आजारात तीव्र झटका हा एकाचवेळी संपूर्ण शरीरात येतो. यात तोंड, हातपाय तसेच शरीरातील अन्य स्नायूंवर परिणाम होऊ शकतो. मेंदूकडे पोहोचणाऱ्या संवेदना काही वेळासाठी यात खुंटतात, त्यामुळे यावेळी मेंदूत अधिक कंपने दिसून येतात. काहीवेळा तापाचे प्रमाण वाढल्याने फेफरे येतात. हा काळ पंधरा मिनिटे ते अर्धा तास इतका असतो.

लक्षणे
- पहिल्या टप्प्यांत चक्कर येणे, डोळ्यापुढे अंधारी येणे, शरीर सैल पडणे अशी लक्षणे जाणवतात.
- फेफरे किंवा फिट येण्याच्या टप्प्यांत काही तीव्र संवेदना कारण ठरू शकतात.
- मेंदूमधील कंपनांमध्ये किंवा कामात अडसर निर्माण होणे.
- खूप ताप, अचानक वाढलेला रक्तदाब वा मधुमेह.
- अतिनैराश्य.
- रक्तदाबाचे प्रमाण खाली जाणे.
- चक्कर येऊन आदळल्याने शरीर सैल पडणे.
- श्वसनाचा वेग मंदावणे.

रुग्णांची प्राथमिक काळजी
1. फिटस् येत असतील तरी सतत या आजाराच्या दडपणाखाली राहू नये. दुखापत होईल, असे काम हाती घेऊ नये, उदा. विस्तवाजवळ काम करणे, उंचावर चढणे, जोरात वाहन चालवणे
2. डोळ्यावर तीव्र प्रकाशझोत येईल अशा ठिकाणी काम करणे टाळावे.
3. औषधोपचार सुरु असतील तर त्यात खंड पाडू नये.
4. प्राणायाम, योगा या सारख्या वेदनांवर नियंत्रण ठेवणाऱ्या थेरपीज् महत्त्वाच्या असतात. त्यांचा वापर करावा.
5. हा त्रास असणाऱ्या रुग्णांमध्ये औषधांनी थोडी झोप येते. पण, त्यामुळे औषधे बंद करू नयेत.

फिटस् रोखण्याचे उपचार
- फिट आली तर रुग्णाच्या तोंडाजवळ चप्पल सरकवली जाते. ही अतिशय चुकीची कल्पना आहे. दातामध्ये पट्टी, चमचा किंवा कपडा सरकवण्याचा प्रयत्न केला तर इजा होऊ शकते. रूग्णाला दाबून धरले तरी त्याला इजा होते.
- रुग्णाला कुशीवर झोपवावे, त्याची लाळ गळू द्यावी. त्यानंतर, रुग्णाला धीर द्यावा. फीट आली असता नाकात उग्र वासाचे वेखंड फुंकावे पण ते नाकात जाणार नाही याची काळजी घ्यावी. ते नसल्यास मिठाच्या पाण्याचे एक-दोन थेंब त्यावेळी नाकपुडीत सोडावेत. लगेच करायचा उपाय म्हणून त्याचा उपयोग होतो. या रुग्णांना मानसिक आधार देणे, हे सर्वांत महत्त्वाचे आहे.
- नैराश्यामुळे फिटस् येण्याचे प्रमाण वाढू शकते. सकस पोषक आहार, नियमित व्यायाम, मोकळ्या हवेतला वावर वाढवल्याने फिटस् येण्याचे प्रमाण निश्चितच कमी करता येते.

Dr. Sandip Nimbhorkar
Dr. Sandip Nimbhorkar
BAMS, Ayurveda Naturopathy Specialist, 21 yrs, Pune
Dr. Nitin Shingare
Dr. Nitin Shingare
MS/MD - Ayurveda, Ayurveda Dermatologist, 9 yrs, Pune
Dr. Pavan Prakash Pargaonkar
Dr. Pavan Prakash Pargaonkar
BHMS, Family Physician, 6 yrs, Pune
Dr. Amar S. Shete
Dr. Amar S. Shete
BAMS, Family Physician, Pune
Dr. Pradnya  Gurav
Dr. Pradnya Gurav
MD - Homeopathy, Adolescent And Child Psychiatrist Homeopath, 8 yrs, Pune
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