Pharmacotherapy includes Alpha 2 agonists clonidine , guanfacine, Anti-psychotics both atypical like aripiprazole, risperidone, olanzapine, ziprasidone and typical antipsychotics like haloperidol, pimozide, but antipsychotics should be given only at lower doses. Antidepressants SSRIs when tics are associated with OCD. Then benzodiazepines ( clonazepam), opioid antagonist naltrexone ( 25-75 mg/ day) also have role in some pts. Stimulants and atomoxetine in children with tics and ADHD symptoms. Baclofen , BEHAVIOUR THERAPIES ( HABIT REVERSAL TRAINING HRT) a specific therapy for tics, psychotherapy - individual, group and family therapy.
Clonidine, can help reduce tics�and�treat�symptoms of attention deficit hyperactivity disorder (ADHD) at the same time. Clonazepam, can help reduce the severity of�tics in some people by altering the way certain chemicals in the brain work.
Medication that block the dopamine, Haloperidol is first drug other resperidone, pimozide.
Antipsychotic haloperidol is first line. Other medicine used- respieridone, pimozide
ADVISABLE... HALOPERIDOL FLUPHENAZINE RISPERDAL
Haloperidol is first drug of choice
Tab brindilex 5mg od,, tab clonazepam.25mg bd ,tab tri hexyphenydyl 2 mg bd,
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Today is World Autism Awareness Day! Autism (or Autism Spectrum Disorder, ASD) is a complex neuro developmental disability which affects normal brain function. Autism usually manifests during the first three years of a person's life and tends to persist into adolescence and adulthood. 1 in 160 children has ASD. Autism has a wide spectrum of presentation, so no two people with Autism will have exactly the same symptoms. The level of intellectual functioning is extremely variable, extending from profound impairment to superior cognitive skills. Individuals with ASD often present other co-occurring conditions, including epilepsy, depression, anxiety and attention deficit hyperactivity disorder (ADHD). It is important to identify children with autism at an early age so that appropriate, structured and multi-disciplinary interventions can be made available for better developmental outcomes.Dr. Hemant Adhikari23 Likes19 Answers
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ABC OF : RESTLESS LEG SYNDROME vs SCIATICA. MAY BE USEFUL. *** Restless Legs Syndrome ( RLS ) :- SYMPTOMS OF RLS : People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations....... The sensations are usually worse at rest, especially when lying or sitting....... *** SCIATICA :- SYMPTOMS OF SCIATICA : Sciatica is a term that describes symptoms of PAIN, NUMBNESS, AND/OR WEAKNESS that RADIATE ALONG the SCIATIC NERVE FROM the LOWER BACK TO the BUTTOCKS AND LEG....... The vast MAJORITY of sciatica symptoms result from lower back DISORDERS BETWEEN the L4 AND S1 levels that put pressure on or cause irritation to a lumbar....... *** Six Most Common Causes of Sciatica :- 1. Lumbar herniated disc 2. Degenerative disc disease 3. Isthmic spondylolisthesis 4. Lumbar spinal stenosis 5. Piriformis syndrome 6. Sacroiliac joint dysfunction.......Dr. Puranjoy Saha71 Likes72 Answers
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*Restless leg syndrome (RLS* ☝ *Today about*☝ Definition Restless leg syndrome (RLS) or Willis-Ekbom disease(WED) is a common cause of painful legs. The leg pain of restless leg syndrome typically eases with motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening of symptoms and leg pain during the early evening or later at night. Restless leg syndrome Restless leg syndrome is often abbreviated RLS; it has also been termed shaking leg syndrome. Night time involuntary jerking of the legs during sleep is also known as periodic leg/limb movement disorder. History The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS. Initially published in Latin (De Anima Brutorum, 1672) but later translated to English (The London Practice of Physick, 1685), The term “fidgets in the legs” has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Epidemiology Except perhaps in Asian populations, RLS is a common disorder, occurring in about 10% of the population. The age-adjusted prevalence of RLS determined by telephone interviews in a random population of 1803 adults in Kentucky was 10%. A Canadian survey of 2019 adults estimated the prevalence of RLS symptoms at 17% for women and 13% for men. A population-based survey in West Pomerania, Germany, of 4107 subjects found an overall 10.6% prevalence. Using standardized questions in face-to-face interviews, Rothdach et al. reported an overall prevalence of 9.8% in 369 participants ages 65-83 years in Augsburg, Germany. In a study from Japan, 4612 participants living in urban residential areas were assessed for a single symptom of RLS by a self-administered questionnaire of the following two items: (1) Have you ever been told you jerk your legs or kick sometimes and (2) have you ever experienced sleep disturbance due to a creeping sensation or hot feeling in your legs? The prevalence of RLS ranged from 3% in women ages 20-29 years to 7% in women ages 50-59 years and correlated with age. In contrast to the first three studies, RLS had a higher prevalence in men than women, with the difference reaching significance in those 40-49 years old; in men there was no positive correlation with age. Face-to-face interviews of 157 consecutive individuals ages 55 years and older participating in a health screening program and 1000 consecutive individuals ages 21 years and older from a primary health care center in Singapore yielded much lower prevalence data. Using IRLSSG criteria, the prevalence of RLS in this predominantly Asian population was 0.6% in the older (1 male) and 0.1% (1 female) in the younger cohorts. In the Kentucky and Singapore studies, there was no gender difference; however, in the two German studies, the prevalence was higher in women and in the Japanese study it was higher in men. The Canadian study reported a significantly higher occurrence of bedtime leg restlessness in women. Types Restless legs syndrome (RLS) can be either primary or secondary, and the causes vary. Primary RLS is a neurological disorder. Although the majority of people with RLS begin to experience symptoms in their middle years, some may have signs of the problem in childhood. Their symptoms may slowly progress for years before becoming a regular occurrence. Secondary RLS tends to be more severe than the primary type and stems from another underlying condition, including the following: Anemia or low blood-iron levels Folate deficiency Nerve damage due to diabetes or other conditions Kidney disease or dialysis Attention deficit disorder (ADD) Attention deficit/hyperactivity disorder (ADHD) Pregnancy Rheumatoid arthritis Parkinson’s disease Risk factors RLS/WED can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men. Restless legs syndrome usually isn’t related to a serious underlying medical problem. However, RLS/WED sometimes accompanies other conditions, such as: Peripheral neuropathy: This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism. Iron deficiency: Even without anemia, iron deficiency can cause or worsen RLS/WED. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency. Kidney failure: If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in your blood can decrease. This, with other changes in body chemistry, may cause or worsen RLS/WED. Causes The cause of restless leg syndrome is unknown in most people. However, restless leg syndrome has been associated with Pregnancy, Obesity, Smoking, Iron deficiency and anemia, Nerve disease, Polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions), Other hormone diseases such as diabetes, and Kidney failure (which can be associated with vitamin and mineral deficiency). Some drugs and medications have been associated with restless leg syndrome including: Caffeine, Alcohol, H2-histamine blockers (such as ranitidine [Zantac] and cimetidine [Tagamet]), and certain antidepressants (such as amitriptyline [Elavil, Endep]). Occasionally, restless leg syndrome run in families. Recent studies have shown that restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome. Symptoms The International Restless Legs Syndrome Study Group described the following symptoms of restless legs syndrome (RLS): Strange itching, tingling, or “crawling” sensations occurring deep within the legs; these sensations may also occur in the arms. A compelling urge to move the limbs to relieve these sensations Restlessness — floor pacing, tossing and turning in bed, rubbing the legs Symptoms may occur only with lying down or sitting. Sometimes, persistent symptoms worsen while lying down or sitting and improve with activity. In very severe cases, the symptoms may not improve with activity. Other symptoms of RLS include the following: Sleep disturbances and daytime sleepiness Involuntary, repetitive, periodic, jerking limb movements that occur either in sleep or while awake and at rest; these movements are called periodic leg movements of sleep or periodic limb movement disorder. Up to 90% of people with RLS also have this condition. In some people with RLS, the symptoms do not occur every night but come and go. These people may go weeks or months without symptoms (remission) before the symptoms return again. Complications Restless legs syndrome rarely results in any serious consequences. However, in some cases severe and persistent symptoms can cause considerable mental distress, chronic insomnia, and daytime sleepiness. In addition, since restless legs syndrome (RLS) is worse when resting, people with severe RLS may avoid daily activities that involve long periods of sitting, such as going to movies or traveling long distances. Diagnosis and test There’s no single test for diagnosing restless legs syndrome. A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results. Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if there’s any uncertainty. There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are: an overwhelming urge to move your legs, usually with an uncomfortable sensation such as itching or tingling your symptoms occur or get worse when you’re resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night Blood tests Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome. For example, you may have blood tests to rule out conditions such as anaemia, diabetes and kidney function problems. It’s particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated with iron tablets. Sleep tests If you have restless legs syndrome and your sleep is being severely disrupted, sleep tests such as a suggested immobilisation test may be recommended. The test involves lying on a bed for a set period of time without moving your legs while any involuntary leg movements are monitored. Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS). Treatment and medications Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms. Other non-drug RLS treatments may include: Leg massages Hot baths or heating pads or ice packs applied to the legs Good sleep habits A vibrating pad called Relaxis Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time. Drugs used to treat RLS include: Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain. Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed. Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness. Narcotic pain relievers may be used for severe pain. Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Neurontin, and Horizant. Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep. Lifestyle and home remedies Making simple lifestyle changes can help alleviate symptoms of RLS/WED. Try baths and massages: Soaking in a warm bath and massaging your legs can relax your muscles. Apply warm or cool packs: Use of heat or cold, or alternating use of the two, may lessen your limb sensations. Try relaxation techniques: such as meditation or yoga. Stress can aggravate RLS/WED. Learn to relax, especially before bedtime. Establish good sleep hygiene: Fatigue tends to worsen symptoms of RLS/WED, so it’s important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get adequate sleep. Some people with RLS/WED find that going to bed later and rising later in the day helps in getting enough sleep. Exercise: Getting moderate, regular exercise may relieve symptoms of RLS/WED, but overdoing it or working out too late in the day may intensify symptoms. Avoid caffeine: Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps.Dr. Shailendra Kawtikwar9 Likes15 Answers
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A 10 year old baby cme in emergency with c/o convulsion many episodes.and fever.. h/O convulsion since 3 days after birth ..patient disoriented.MRI brain done on Jan. 2015 given as... vital stable.plz suggest the diagnosis and managmentDr. Rehman Khan1 Like11 Answers
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Homoeo Doctor Dx & Rx.. (Share your valuable experience) ۔ SPINA BIFIDA ? ۔ is a birth defect that involves the incomplete development of the spinal cord or its coverings. The term spina bifida comes from Latin and literally means "split" or "open" spine. Spina bifida occurs at the end of the first month of pregnancy when the two sides of the embryo's spine fail to join together, leaving an open area. In some cases, the spinal cord or other membranes may push through this opening in the back. The condition usually is detected before a baby is born and treated right away. Types of Spina Bifida The causes of spina bifida are largely unknown. Some evidence suggests that genes may play a role, but in most cases there is no familial connection. A high fever during pregnancy may increase a woman's chances of having a baby with spina bifida. Women with epilepsy who have taken the drug valproic acid to control seizures may have an increased risk of having a baby with spina bifida. The two forms of spina bifida are spina bifida occulta and spina bifida manifesta. Spina bifida occulta is the mildest form of spina bifida. "Occulta" means hidden, meaning that the defect is covered by skin and not open. Most children with this type of condition never have health problems and the spinal cord is often unaffected. Some can have symptoms if the hidden defect is severe enough. Spina bifida manifesta includes two types of spina bifida: Meningocele involves the meninges, the membranes responsible for covering and protecting the brain and spinal cord. If the meninges push through the hole in the vertebrae (the small, ring-like bones that make up the spinal column), the sac is called a meningocele. Myelomeningocele is the most severe form of spina bifida. It occurs when the meninges push through the hole in the back, and the spinal cord also pushes though. Most babies who are born with this type of spina bifida also have hydrocephalus, an accumulation of fluid in and around the brain. Because of the abnormal development of and damage to the spinal cord, a child with myelomeningocele typically has some paralysis. The degree of paralysis largely depends on where the opening occurs in the spine. The higher the opening is on the back, the more severe the paralysis tends to be. Children with spina bifida often have problems with bowel and bladder control, and some may have attention deficit hyperactivity disorder (ADHD) or other learning difficulties, such as hand-eye coordination problems. Diagnosing Spina Bifida Expectant parents may be able to find out if a baby has spina bifida by taking certain kinds of prenatal tests. The alpha-fetoprotein (AFP) test, performed between the 16th and 18th weeks of pregnancy, measures how much AFP, which the fetus produces, has passed in the mother's bloodstream. If the amount is high, the test is repeated because in many cases, high AFP readings are false. If the second result is high, other tests will be done to double-check and confirm the diagnosis. Doctors also may use ultrasound to see if a baby has spina bifida; in some cases, the spinal defect can be seen on the ultrasound study. Amniocentesis also can help determine whether a baby has spina bifida. A needle is inserted through the mother's belly and into the uterus to collect fluid that is tested for AFP. Maternal folic acid deficiency has been linked to spina bifida, and researchers believe that many cases can be prevented if women of childbearing age consume 0.4 milligrams (400 micrograms) of folic acid every day, and continue to take it throughout the first trimester. It is important that folic acid consumption start before the onset of pregnancy to provide the best protection. Good sources of folic acid include eggs, orange juice, and dark green leafy vegetables. Many multivitamins contain the recommended dose of folic acid, too. Symptoms of Spina Bifida Babies who are born with spina bifida occulta often have no outward signs or symptoms. The spinal cord does not protrude through the skin, although a patch of hair, a birthmark, or a dimple may be present on the skin over the lower spine. But other forms of the disease have obvious signs. Babies who are born with the meningocele form have a fluid-filled sac visible on the back. The sac is often covered by a thin layer of skin and can be as small as a grape or as large as a grapefruit. Babies with myelomeningocele also have a sac-like mass that bulges from the back, but a layer of skin may not always cover it. In some cases, the nerves of the spinal cord may be exposed. A baby who also has hydrocephalus will have an enlarged head, the result of excess fluid and pressure inside..Dr. Azher Ansari4 Likes7 Answers