Kyphosis and Ankylosing Spondylitis

What is Kyphosis and how is it treated?

Kyphosis or “round back” is a spinal deformity that is characterised by an excessive outward curve of the spine which results in an abnormal rounding of the upper back. This exaggerated forward rounding of the spine can occur at any age but is typically seen in adolescents or older women. Age-related kyphosis is caused due to weakened spinal bones which become compressed or cracked. Adolescent kyphosis is caused by the malformation of the spine. Kyphosis causes a series of health complications such as severe back ache, breathing problems, digestive problems, limited physical functions and psychological issues such as body image problems and depression. The treatment of kyphosis depends on the severity of the condition and the patient’s age. Doctors might recommend stretching exercises and physical therapy to relieve back pain and improve spinal flexibility. Bracing is a good option in children as it can arrest the progression of the curvature. Surgery is recommended in cases where the curvature is pinching the spinal cord or nerves. Spinal fusion is a surgical procedure performed to reduce the curvature degree and bring the spine to a straight position using bone material, metal rods and screws.

What is an Kylosing Spondylitis?

Ankylosing spondylitis is a type of arthritis that affects the spine and its neighbouring joints. This condition causes the spinal joints to become inflamed, leading to severe and chronic pain. It can spread to shoulders, ribs, hips, heels and the joints of hands and feet, causing inflammation, pain, swelling and stiffness. It can also affect the eyes, lungs and heart in rare cases. There are no known causes for ankylosing spondylitis, but specialists believe that genetic and environmental factors play a role. The symptoms of ankylosing spondylitis often appear in late adolescence or early adulthood. They typically include severe back pain and swollen joints. A rheumatologist is the best person to diagnose and treat ankylosing spondylitis. Diagnosis involves a physical exam with X-rays to determine the location and possible cause. Blood work, especially the HLA-B27 test, is also necessary to confirm ankylosing spondylitis. Staying active is a good way of keeping ankylosing spondylitis at bay. Exercise and physical therapy are important in managing and treating this condition. The doctor may prescribe non-steroidal anti-inflammatory drugs to reduce inflammation and pain.

Osteoporosis – Vertebroplasty and Kyphoplasty

What are Vertebroplasty and Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally-invasive procedures performed to treat painful vertebral compression fractures in the spinal column. These fractures are commonly caused due to osteoporosis, a condition that causes the degeneration of bones. When a vertebral body becomes fractured, it becomes compressed leading to severe pain and discomfort. These compression fractures can cause one or more vertebrae to collapse, all of which are brought on by osteoporosis. Vertebroplasty and kyphoplasty are the procedures used to stabilise fracture and preserve or improve the function of fractured vertebrae. Vertebroplasty is conducted to stabilise compression fractures. It involves the use of special medical cement which is injected into the fractured site in the spine. Continuous X-rays are taken to guide the doctor to the fracture site. The cement is injected into the vertebra where it will harden and give stability. This strengthens the vertebra and provides pain relief and restores mobility of patient. Kyphoplasty is conducted to create a space in the compressed area in the fractured vertebra. A balloon is inserted into this space through a catheter where it is inflated, creating a cavity for cement injection. The balloon is gently removed and vertebroplasty is performed and cement in injected into the newly formed cavity.

Who should undergo these procedures?

Vertebroplasty and kyphoplasty are used in the treatment of painful spinal compression fractures, which are primarily caused due to osteoporosis. These procedures are recommended after other treatment options such as back brace, bed rest and pain medication have been unsuccessful. Vertebroplasty and kyphoplasty are performed on individuals who:

• Have malignant tumours in the spine which have caused vertebral compression
• Are old and frail and will likely suffer from impaired bone healing following the spinal fracture
• Suffer from long-term osteoporosis brought on by genetics, metabolic disorders or steroid treatment

For more details on vertebroplasty and kyphoplasty and how to manage osteoporosis, speak to your doctor today.

Sciatica – Symptoms, Causes and Treatment

Understanding Sciatica and its causes

Sciatica is pain in your lower extremities causes by the irritation of the sciatic nerve which arises from the lumbar spinal cord and extends toward the lower limbs. This pain is normally felt from the lower back to the back of the thighs and can extend below the knees. Sciatica typically affects only one side of the body. The most common cause of sciatica is a lumbar disc herniation which presses directly on the sciatic nerve. This inflammation is what gives rise to the sciatica pain. The irritation of nerves caused by an abnormal intervertebral disc is known as radiculopathy. Besides a herniated disc, other causes include nerve irritation caused by adjacent bone, muscle, tumours, infections, internal bleeding, injury, spondylolisthesis, spinal stenosis and caudaequina syndrome. Sciatica can also arise during pregnancy. Risk factors that can make you more prone to sciatica are age, obesity, diabetes and your occupation.

What are the symptoms of Sciatica?

The defining aspect of sciatica is the pain that radiates from the lumbar spine to the buttocks and down to the back of the legs. This pain or discomfort can be felt almost anywhere along the sciatic nerve’s pathway. The pain can range from a mild ache to an excruciating pain or burning sensation. It may sometimes feel like an electric shock or jolt. Prolonged sitting or standing can aggravate symptoms.

How is Sciatica treated?

A physical exam and imaging tests will be conducted to confirm the cause of your sciatica pain. It is possible to alleviate the symptoms of sciatica through regular exercises and maintaining proper posture. If these self-care techniques do not work, your doctor may prescribe anti-inflammatory medication, muscle relaxants or steroid injections. If the sciatica is unbearable and is causing significant numbness, weakness, pain or loss of bladder and bowel control, surgery is often the best treatment option. The surgeon will remove the bone spur or herniated disc that is affecting the sciatic nerve. Talk to your doctor today for more information on sciatica and how it can be treated.

Spinal Deformities and Scoliosis

What are Spinal deformities?

The normal spine is designed in a way to allow optimum flexibility and support the body’s weight. When seen from the side, the spine has three gentle curves which work together to keep your body’s centre of gravity in alignment with your hips and pelvis. When viewed from behind, the normal spine is straight without any bends or curves. A spinal deformity is seen when there is an abnormal curvature which puts the spine out of alignment. A sagittal imbalance is an abnormal curvature that is visible from the side. Types of this deformity include kyphosis, chin-on-chest syndrome and flatback syndrome. Abnormal curvature visible from the back is known as scoliosis. These conditions have different causes, including congenital deformity, diseases, infections, tumours, age-related degeneration and idiopathic causes.

Understanding Scoliosis

When viewed from the back, a normal spine appears straight. If the spine has a ‘C’ or ‘S’ shaped curve, this condition is known as scoliosis. There are no identifiable causes of scoliosis, but neurological abnormalities, birth defects and genetic conditions are known to play a role. Scoliosis is typically categorised as structural or non-structural. Structural scoliosis is caused by injury, birth defect or disease and is a permanent condition. Non-structural scoliosis is a temporary curve of the spine that can be repaired.

How is Scoliosis treated?

The treatment of scoliosis depends on the degree of spine curvature as well as the patient’s age and development. If the patient is still growing and the curvature is between 25 to 40 degrees, they will need to use a brace to stop the curvature from increasing. Bracing will not straighten the spine, but it is an effective method in preventing more serious complications, especially in early cases. Surgery is recommended for people whose spinal curvature is more than 40 degrees. The standard scoliosis surgery is spinal fusion where the vertebrae are fused together using bone graft, rods and screws. The rods will keep the spine in a straight position and the bone graft will eventually fuse into the vertebrae. The screws can be adjusted as the patient grows older. If you are suffering from scoliosis, talk to a doctor today about treatment options. You could also join support groups to make living with scoliosis easier.

Understand Dystonic Syndrome

What is Dystonia?

Dystonia is a neurological condition characterised by repetitive excessive involuntary muscle contractions which result in abnormal movements and body postures. This condition makes it difficult for patients to control their movements, making it painful to maintain normal posture. Dystonia can affect the entire body or just one muscle.There are different types of dystonia and they are categorised by the body part they affect.

• Generalised dystonia affects the entire body or most parts of the body
• Focal dystonia is limited to a specific area
• Multifocal dystonia affects more than one area
• Hemidystonia affects one half or side of the body
• Segmental dystonia affects adjacent body areas

What are the symptoms of Dystonia?

The symptoms of this condition can vary from mild to severe and they progressively become worse. Some early signs are:

• Body part is twisted or flexed into an abnormal position
• Tremor-like repetitive body movements
• Foot cramps
• Involuntary pulling of the neck
• Uncontrollable blinking
• Speech difficulties
• Difficult chewing or swallowing

Fatigue and stress are known to make these symptoms worse. People with dystonia become easily fatigued due to the constant involuntary muscle contractions.

What are the causes of Dystonia?

In most cases, the specific cause of this condition is unknown. Dystonia is associated with issues in the basal ganglia, the part of the brain responsible for muscle contractions. The basal ganglia could become damaged due to brain trauma, stroke, oxygen deprivation, tumour, lead or carbon monoxide poisoning or infections. The damage affects the way nerve cells communicate with each other, which is believed to be one of the causes of dystonia.

Treatment of Dystonia

There are some medications which are given to help people with dystonia manage their symptoms. A recent treatment is the use of Botox which is injected into the affected muscle where it helps reduce involuntary contractions. Deep brain simulation is also given to some patients whose conditions have caused them to become disabled. This involves the passing of electrical pulses to the brain to reduce muscle contractions. Dystonia is a serious condition and requires medical attention. Contact your doctor today for more information on this disorder and how it can be treated.

Epilepsy and Seizures

What is Epilepsy?

Epilepsy is a neurological disorder which causes abnormal brain activity, resulting in seizures, unusual behaviour and even loss of consciousness. The hallmark of this condition is recurrent and unprovoked seizures. Epilepsy can affect anyone regardless of their age and background. An individual is diagnosed with epilepsy if they have experience two or more episodes of unprovoked seizures, or even with one seizure, there is 60% increased risk of having next seizure. Epilepsy can present itself through various signs and symptoms, including:

• Uncontrolled jerking movement of the extremities
• Temporary confusion
• Brief periods of staring blankly
• Dizziness or fainting
• Loss of awareness or consciousness
• Unresponsiveness

In most cases, it is hard to determine the cause of epilepsy. Possible causes are:

• Traumatic brain injury
• Cyst or tumour in the brain
• Stroke
• Meningitis, AIDS and other infectious diseases
• Very high fever or serious illness
• Alzheimer’s disease or dementia
• Neurological diseases or developmental disorders
• Environmental triggers
• Genetics

How is Epilepsy treated?

In many cases, epilepsy can be managed and controlled. Treatment plans depend on the patient’s health, severity of symptoms and their response to therapy. Doctors will prescribe anti-epileptic or anticonvulsant drugs to control epileptic attacks and eliminate seizures. If the condition is very serious and medication is not helpful in selected cases where a focus has been recognised, the doctor will recommend a resection surgery. This is a complex yet standardized procedure that involves the removal of the part of the brain which is causing the seizures. Patients may also be given vagus nerve stimulation (VNS) where a device is implanted to stimulate the vagus nerve to protect the brain from abnormal electrical activities

What are Seizures?

A seizure can be described as a sudden excessive and uncontrolled electrical disturbance in the brain. It is characterised by uncontrolled movements of the limbs, behavioural changes and loss of consciousness. If a person experiences two or more episodes of seizures, they are likely to have epilepsy. There are two major types of seizures: Focal seizures: These are limited to a specific part of the brain and can cause variety of physical and emotional symptoms depending upon the part of the brain It is also known as partial seizure. Generalised seizures: These occur due to rapid spread of electrical impulse to whole of the brain. They cause muscle spasms, fainting spells and falls. Generalised seizures are further classified into six types based on symptoms - tonic, clonic, tonic-clonic, atonic, myoclonic and absence seizures. Seizures are triggered or caused by various factors. Some of these include:

• High fever
• Stress
• Lack of sleep
• Bright or flashing lights
• Head trauma
• Very low blood sugar
• Alcohol or drug withdrawal

Hydrocephalus

What is Hydrocephalus?

Hydrocephalus is a condition characterized by the collection of excess cerebrospinal fluid (CSF) within the brain’s fluid-containing cavities known as ventricles. This can lead to an increase in pressure within your head, causing severe headaches and other symptoms. The term “hydrocephalus” is a combination of two terms - ‘hydro’ which means water and ‘cephalus’ which refers to the head. Although the term refers to water, the fluid that collects in the brain is CSF, which is normally found surrounding the spinal cord and brain.

What causes Hydrocephalus?

Hydrocephalus can sometimes be a consequence of head injuries, brain tumours and internal bleeding in the brain. Conditions such as meningitis, infections and complications arising from premature birth can also cause hydrocephalus. In rare cases, genetics or developmental disorders such as encephalocele or spina bifida are responsible for the development of hydrocephalus.

What are the symptoms associated with Hydrocephalus?

Symptoms of hydrocephalus vary from person to person, and people in different age groups display different symptoms. Infants with hydrocephalus show bulging fontanel, thin scalp, prominent veins in the scalp, drowsiness, vomiting, poor appetite, downward deviation of the eyes, seizures and irritability. In children, hydrocephalus causes sleepiness, blurred vision, nausea and vomiting, poor appetite, blurred vision, delayed progress in talking or walking, personality changes, poor coordination, seizures, loss of sensory motor function and inability to concentrate. Hydrocephalus in adults is characterized by headaches, memory loss, shuffling gait and bladder control issues. Older people with hydrocephalus show symptoms such as drowsiness, issues with balance and coordination, bladder control problems, impaired vision, frequent headaches and impaired cognitive skills.

How is Hydrocephalus treated?

A neurological exam is conducted to determine the severity of the condition. This exam will include ultrasounds, CT scans or MRI scans. Surgery is often the best way to treat hydrocephalus. Your neurologist will determine the best treatment depending on your case.

Treat Movement Disorders

The term “movement disorders” is used to describe a group of neurological conditions that cause voluntary or involuntary abnormal movements of the body. They can cause increased or slow movements. There are several types of movements disorders, some of the most common ones are listed below. Ataxia: This condition affects the cerebellum, the part of your brain that control coordinated movement. Symptoms include uncoordinated movement and speech, clumsy gait etc. Chorea: This condition causes brief, repetitive, irregular involuntary movements of the face, mouth, limbs and trunk. Dystonia: This condition is characterised by sustained involuntary muscle spasms and contractions which may affect the whole body or only one part. It causes twisting and repetitive movements. Tremor: This causes involuntary shaking of the hands, head, feet and other parts of the body. Multiple system atrophy: This is a rare progressive neurological condition which affects various brain systems. It causes movements disorders like parkinsonism or ataxia along with impaired bladder function and low blood pressure. Parkinson’s disease: This is a slow progressive neurodegenerative disease that is characterised by slow decreased movements, tremors, stiffness or imbalance. Parkinsonism: This is a group of conditions which exhibit symptoms similar to those of Parkinson’s disease. Huntington’s disease: This is a genetic progressive neurodegenerative disease which causes uncontrolled movements, impaired cognition and psychiatric conditions. Tourette syndrome: This neurological condition is characterised by ‘tics’ - repetitive movements and vocal sounds. Wilson’s disease: This is a rare genetic disorder which causes an excessive amount of copper to accumulate in the body, leading to neurological issues. Progressive supranuclear palsy: This is an uncommon neurological condition that affects balance, eye movements and walking. Restless legs syndrome: This condition causes abnormal, unpleasant feelings in the lower extremities when the individual is lying down or relaxing. Symptoms often go away when the legs are moved. Cervical dystonia: This disorder affects the neck muscles, causing long-lasting spasms and intermitted contractions. This causes the neck to involuntarily turn in different ways. Tardive dyskinesia: This is a neurological condition which is brought on by long-term use of specific drugs used in the treatment of psychiatric conditions. It is characterised by involuntary movements like eye blinking and grimacing. For details on specific movement disorders and how to treat them, contact our neurologists today.

Treat Neuroinfections

What are Neuroinfections?

Your body can sometimes be attacked by harmful bacteria, viruses and other microorganisms which cause diseases or infections. These diseases can vary from mild disturbances to life-threatening problems. Microbes can affect different parts of your body, including the nervous system. After invading the nervous system, these organisms multiply, leading to what is called a neuroinfection. This infection can affect different parts of the nervous system, from the spinal cord to the brain, including nerves and muscles. Different microorganisms cause different neuroinfections. The most common neuroinfectious diseases include:

• Encephalitis and meningitis, where the membranes surrounding the spinal cord and brain become inflamed. Often caused by viral or bacterial infections and can lead to disability or death.
• HIV-associated neurodegeneration, a neurological condition brought on by HIV infection that is immune to antiretroviral therapy.
• Progressive multifocal leukoencephalopathy, a viral neuroinfection that leads to loss of memory, coordination and language ability.
• HTLV 1 myelopathy hereditary spastic paraparesis, a progressive disease affecting the spinal cord which results in weak and stiff legs.
• Neurosarcoidosis, a chronic inflammatory neuroinfectious disease characterized by headaches and facial weakness.
• Transverse myelitis, a neuroinfection that causes the sides of the spinal cord to become inflamed, leading to pain, paralysis, weakness, bladder and bowel dysfunctions and sensory problems.

How are Neuroinfections treated?

Diagnosing neuroinfectionscan be very tricky. The most common forms of treatment include antibacterial and antiviral medications which may be combined with anticonvulsive or anti-inflammatory medicines. Neuroinfection treatment is often complex and involves evolving and innovative techniques. Currently, there are no cures for these conditions. Talk to your neurologist if you or someone you know is suffering from a suspected case of neuroinfections.