Benign Positional Paroxysmal Vertigo (BPPV)

Management Team

Benign Positional Paroxysmal Vertigo (BPPV)

Overview

Benign positional paroxysmal vertigo refers to brief intermittent attacks of rotatory vertigo, that is a sudden spinning sensation. It is precipitated by rapid change in head position. Posterior semicircular canal is affected the most followed by anterior semicircular canal in the ear.

It is caused by movements of canalith (calcium crystals in inner ear) in endolymph (fluid in inner ear)

  • Age: Most common in people aged >50 years but can occur at anytime
  • Gender: BPPV is common in women
  • Vitamin D deficiency
  • Head trauma
  • Other disorders including:
    • Labyrinthitis
    • Vestibular neuronitis
    • Meniere disease
    • Migraine
    • Inner ear surgery
  • Other conditions including:
    • Hypertension
    • Diabetes mellitus
    • Hyperlipidaemia
    • Osteoporosis
    • Non-apnoea sleep disorders

  • Vertigo (spinning sensation of head) on turning head, while sitting up or lying down, and looking up or bending down
  • May be associated with nausea or vomiting
  • Imbalance
  • Usually comes in episodes
  • Relieved by resting in one position

Neurologist

  • Clinical examination using head impulse test or Dix Hallpike manoeuvre
  • MRI brain to detect unusual features

  • Repositing manoeuvres - Epley’s, Semont’s, Brandt-Daroff exercises
  • Regular vestibular rehabilitation exercises
  • Medicines for symptomatic treatment
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Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Management Team

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Overview

Autosomal dominant nocturnal frontal lobe epilepsy is a rare genetic condition characterized by seizures that primarily occur during sleep. It originates from the frontal lobe of brain and is inherited in an autosomal dominant pattern. Thus, it has up to 75% likelihood of genetic mutation being transferred to the offsprings.

Mutations in CHRNA2, CHRNA4 and CHRNB2 genes

  • Being born with brain abnormalities
  • Family history of seizures or epilepsy
  • Developmental disability
  • Brain infections or infections
  • Seizures in infancy or early childhood

  • Seizures during sleep
  • Hand clenching
  • Arm raising or lowering
  • Vocalizations
  • Sense of fear
  • Dizziness

Neurologist

  • Clinical examination and family history
  • EEG

Antiseizure medications

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Alcoholic Fatty Liver Disease (AFLD)

Management Team

Alcoholic Fatty Liver Disease (AFLD)

Overview

Alcoholic fatty liver disease (AFLD) is the earliest stage of ALD, and is characterised by abnormal hepatic accumulation of fat (steatosis) in response to alcohol consumption; such a liver generally appears light yellow in colour. AFLD. Importantly, it can progress to more severe liver conditions, such as alcoholic steatohepatitis, liver fibrosis, cirrhosis, and liver cancer.

Chronic alcohol abuse is the primary cause of AFLD. Other factors include: 

  • Genetic factors: Some people are genetically predisposed to developing AFLD due to differences in how their liver metabolises alcohol or their ability to tolerate alcohol-related damage.
  • Nutritional deficiencies: Malnutrition and poor diet—often associated with chronic alcohol use (heavy and prolonged)—can accelerate liver damage and increase the risk of AFLD.
  • Obesity: Overweight individuals are at higher risk of developing AFLD.
  • Other liver diseases: People with pre-existing liver conditions (like hepatitis B or C infection) are more susceptible to developing AFLD.
  • Age and gender: The risk of developing AFLD increases with age, and women may be more susceptible to AFLD than men, even with lower levels of alcohol consumption.
  • Other health conditions: Diabetes, high cholesterol, and high blood pressure may increase the risk of developing AFLD.

In the early stages, AFLD may exhibit no symptoms (asymptomatic) or very mild symptoms. As the condition progresses, more symptoms can manifest; these include:

  • Fatigue: Feeling unusually tired or lethargic.
  • Pain or discomfort in the upper right abdomen: This generally observed as the upper right abdomen is the place where the liver is located.
  • Enlarged liver (hepatomegaly): The liver may become palpable (feel enlarged) upon examination.
  • Jaundice and dark urine: These conditions can occur in more advanced stages of AFLD, when the liver loses its ability to process bilirubin.
  • Loss of appetite: Reduced desire to eat.
  • Nausea and vomiting: These are often seen in more advanced liver disease.

Most people with AFLD do not exhibit symptoms until the disease progresses to more serious stages, such as alcoholic steatohepatitis.

The first stage of diagnosis includes a full review of the patient’s medical history, including alcohol consumption patterns and assessment of liver disease signs and any pre-existing conditions, like diabetes or obesity. Other diagnostic strategies have been enumerated below.

  • Physical examination: This involves checking for liver enlargement or tenderness.
  • Blood tests: A multitude of blood tests are available for diagnosing AFLD; these include,
    • Liver function tests: Elevated ALT and AST levels can indicate liver injury; however, these tests are not specific to AFLD.
    • Alcoholic biomarkers: Elevated GGT levels and mean corpuscular volume (MCV) may indicate alcohol-related liver damage; however, these are not specific to AFLD.
    • Complete blood count (CBC): CBC can help detect signs of liver dysfunction (e.g., low platelet counts), including AFLD.
  • Imaging techniques: A variety of imaging techniques can be used to detect liver damage, including AFLD.
    • Ultrasound: This non-invasive test can assess fat accumulation in the liver.
    • CT or MRI: These can provide more detailed images of the liver and detect fat deposits.
    • Elastography: This specialised ultrasound technique can measure liver stiffness, which can indicate liver damage.
  • Liver biopsy: In some cases, liver biopsy may be used to confirm the presence of fat in the liver and assess the degree of liver damage. Biopsies are typically done when the diagnosis is uncertain or to rule out other liver diseases. 

Abstinence from alcohol is the cornerstone of AFLD treatment. Continuing to drink alcohol can worsen the liver damage, and AFLD can progress to more severe conditions, like alcoholic steatohepatitis and cirrhosis. The treatment and management modalities of AFLD include:

  • Support for cessation of alcohol consumption: Programs, therapy, or medications (such as disulfiram or naltrexone) may be prescribed to help individuals stop drinking.
  • Nutritional and lifestyle changes: A few dietary and lifestyle changes can help manage AFLD.
    • Proper nutrition: A healthy, balanced diet rich in vitamins, minerals, and antioxidants can support liver health and improve outcomes.
    • Weight loss: Gradual weight loss (5‒10% of the body weight) can help reduce liver fat and improve liver function, especially in individuals with obesity.
    • Avoiding fatty foods: Reducing the consumption of saturated fats and processed foods can help lower the liver’s fat load.
  • Managing underlying conditions: Management of pre-existing conditions can also help manage AFLD.
    • Diabetes: Proper management of blood glucose levels can help prevent further liver damage.
    • High cholesterol levels: Lowering the cholesterol levels with medications like statins may help protect the liver.
    • High blood pressure: Controlling blood pressure with medications can reduce the strain on the liver.
  • Medications: Currently, there are no medications specifically approved for AFLD; however, some studies suggest that vitamin E may help reduce liver inflammation in individuals with AFLD (especially non-diabetic individuals).

The most effective way to prevent AFLD is to reduce or eliminate alcohol intake. Other preventive measures include:

  • Maintaining a healthy weight: Obesity contributes to the development of fatty liver disease, so maintaining a healthy weight can reduce the risk of AFLD.
  • Eating a balanced diet: Avoiding excessive fats and sugars, and focusing on a nutritious diet rich in fruits, vegetables, lean proteins, and whole grains can help manage AFLD.
  • Exercising regularly: Physical activity helps manage weight and improves liver health.
  • Monitoring and managing underlying conditions: Proper management of diabetes, high cholesterol levels, and high blood pressure can reduce the strain on the liver and help prevent AFLD.
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Autonomic Neuropathy

Management Team

Autonomic Neuropathy

Overview

Autonomic neuropathy involves the autonomic nervous system and is caused by damage to the nerves controlling automatic body functions.

  • Guillain-Barre syndrome
  • Paraneoplastic neuropathy
  • Amyloid neuropathy
  • Multisystem atrophy
  • Fabry’s disease

  • Uncontrolled diabetes.
  • Other diseases including amyloidosis, porphyria, and hypothyroidism
  • Cancer

  • Diarrhoea
  • Gastroparesis
  • Postural dizziness
  • Abdominal pain
  • Pseudo-obstruction

  • Autonomic function tests
  • Gastrointestinal tests
  • Tilt-table test
  • Quantitative sudomotor axon reflex test

  • Treatment of underlying conditions
  • Managing the specific symptoms
  • Medications
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Autism

Management Team

Autism

Overview

Autism or autistic spectrum disorder (ASD) refers to a neurodevelopmental disorder impacting social behaviour, communication, and social interaction.

Exact cause is not fully understood.

  • Biological male sex
  • Family history
  • Medical conditions like fragile X syndrome, Rett syndrome, or tuberous sclerosis
  • Babies born prior to 26 weeks of gestation
  • Being born to older parents

  • No attention to auditory stimulus during infancy
  • Lack of verbal and non-verbal communication
  • Repetitive behaviours
  • Restricted interests
  • Lack of peer interaction
  • Sensory sensitivities
  • Resistance to change of environment.

Neurologist

  • Clinical assessment with various scales available to diagnose ASD
  • MRI brain and EEG to rule out acquired causes

  • Cognitive and behavioural therapies
  • Occupational therapies
  • To provide inclusive environment
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Athetosis

Management Team

Athetosis

Overview

Athetosis is a disorder that involves hyperkinetic movements, which is a slow writhing movement of fingers and hands. It may be associated with abnormal postures of the extremities, stiffness and difficulty in performing voluntary movements.

  • Brain injury
  • Stroke
  • Cerebral palsy
  • Neurodegenerative diseases such as Huntington’s disease
  • Infections or inflammations
  • Genetic disorders

  • Brain damage
  • Birth challenges such as asphyxia, haemorrhage, or stroke during pregnancy, birth, or shortly after birth
  • Jaundice in newborns
  • Stroke
  • Medications for Parkinson's disease or psychiatric disorders
  • Toxicity due to medications that elevate brain dopamine levels
  • Metabolic disorders such as Wilson's disease

  • Medicines to control muscle overactivity
  • Surgical interventions (deep brain stimulation)
  • Orthotic devices or other assistive technologies
  • Physical and occupational therapy
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Ataxia

Management Team

Ataxia

Overview

Ataxia is a neurological disorder that causes imbalance while walking or incoordination while using hands and legs. It may be due to disorders of cerebellum and its pathways.

  • Toxins such as- alcohol, drugs like phenytoin and lithium, mercury, cyanide, and others
  • Vascular- ischemic or haemorrhagic stroke
  • Inflammatory- demyelinating disorders
  • Malignancy- primary brain tumours/ metastasis/ paraneoplastic syndromes
  • Infections- herpes/ measles
  • Neuro-degenerative diseases like Multiple System Atrophy Cerebellar type (MSA-C) and Spinocerebellar Ataxias (SCAs)
  • Nutritional- vitamin E deficiency, Wernicke’s encephalopathy
  • Loss of joint position sense secondary to involvement of peripheral nerves or spinal cord
  • Chronic inflammatory demyelinating polyneuropathy
  • Paraproteinemic neuropathy
  • Disorders of metabolism- Refsum’s disease
  • Sensory ganglionopathy- paraneoplastic or Sjogren’s syndrome
  • Spinal cord disorder- spondylosis or demyelination

  • Excessive and chronic alcohol intake
  • Hypothyroidism/hypoparathyroidism
  • Celiac disease (an illness due to immune reaction to gluten)
  • Sarcoidosis (a disease that causes inflammatory cells to build up in parts of the body)
  • Multiple system atrophy
  • Multiple sclerosis
  • Intake of anti-seizure sedatives and medications
  • Cancer-triggered paraneoplastic syndrome
  • Exposure to heavy metals (mercury or lead) or solvents (paint thinner)
  • Deficiency of vitamin E, B6, B12, or B1
  • Getting too much vitamin B-6

Neurologist

  • Physical and neurological exams
  • Blood tests
  • Genetic testing
  • Imaging studies

  • Treatment is based on the underlying conditions
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Aphasia

Management Team

Aphasia

Overview

Aphasia and dysphasia are language function disorders, whereas dysarthria is disorder of articulation, which is abnormal motor production of speech. Aphasia may be associated with various neurological conditions affecting the brain cortex such as stroke, demyelination, and dementia.

Aphasia occurs due to damage in the part of the brain responsible for language comprehension and expression.

  • Spontaneous speech disturbance such as difficulty in articulation, fluency, grammar, word substitution, and loss of intonation
  • Difficulty in remembering the names of objects or people
  • Inability to comprehend words or instructions or concepts
  • Inability to repeat words or phrases
  • Difficulty in reading and writing

  • Learning disabilities such as dyslexia
  • Rare gene changes

Neurologist

  • Clinical examination
  • MRI brain to detect the underlying cause of aphasia or dysphasia

  • Treatment of underlying disorder
  • Speech therapy to improve comprehension and verbal output
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Amyotrophic Lateral Sclerosis (ALS)

Management Team

Amyotrophic Lateral Sclerosis (ALS)

Overview

Amyotrophic lateral sclerosis (ALS), also referred to as motor neuron disease, is a progressive neurological condition that impacts the nerve cells responsible for regulating muscle movement. The average life expectancy is 2–5 years, but the actual prognosis varies on an individual basis.

Unknown aetiology, but mutations in certain genes are responsible for 5–8% of cases

  • Progressive weakening of muscles in various body parts
  • Progressive muscle thinning and wasting
  • Difficulty in speaking or swallowing
  • Flickering and twitching of muscles
  • Weakness of muscles involved in respiration, causing respiratory failure and aspiration of food and oral secretions, ultimately leading to death

  • Trauma to the head, neck, or spine
  • Traumatic brain injuries

Neurologist

  • Clinical examination
  • Electrophysiological tests like electromyography (EMG)/nerve conduction study (NCV)
  • MRI of spinal cord and other blood tests to eliminate possible conditions causing similar complaints like cervical myopathy, IGLON5 disease, and paraneoplastic syndromes

  • Clinical management of symptoms
  • Riluzole and edaravone can prolong the life expectancy by a few months
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Alzheimer’s Disease

Management Team

Alzheimer’s Disease

Overview

Alzheimer’s disease accounts for one of the most prevalent causes of dementia among people aged ≥65 years (with a prevalence rate of 4.4%) and is presented more commonly in females than in males. Familial cases are observed at a younger age. Genes involved in Alzheimer’s disease include  APP, presenilin 1 and 2, and apolipoprotein E4. The initial stage of dementia is manifested as mild cognitive impairment, and presents a progression risk of 10–15% to Alzheimer’s disease.

Deposition of abnormal amyloid proteins in brain

  • Memory impairment involving recent memory and daily events
  • Challenges in acquiring and remembering new information
  • Visuospatial impairment (such as getting lost while driving)
  • Difficulty in doing learned motor activities (apraxia) like wearing clothes
  • Difficulty in finding words
  • Repetitiveness or asking the same thing repeatedly
  • Forgetfulness of past events in advanced stages
  • Behavioural changes in the form of decreased social interaction, aggressiveness, and occasionally hallucinations

  • Family history
  • Age
  • Cardiovascular diseases
  • Sedentary lifestyle
  • Head injuries
  • Loneliness and depression
  • Down’s syndrome

Neurologist

  • Clinical scores like detailed neurocognitive assessment, mini-mental state examination (MMSE), and Montreal cognitive assessment (MOCA)
  • MRI brain to evaluate loss of hippocampal volume and temporal lobe atrophy
  • FDG PET scan to check hypometabolism in these areas

  • Cognitive rehabilitation
  • Medical management through acetylcholine receptor inhibitors, N-methyl-D-aspartate receptor antagonists
  • Managing behavioural and psychiatric complications
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