Brain Conditions


Chorea is neurological disorder characterized by involuntary movements of the body, which may sometimes appear like dance movements. They are irregular and do not follow any pattern, and may move from one part of the body to another, usually involving the extremities and face. The involuntary movements may involve facial grimacing, grunting noises, tongue movement and jerking, seen even during rest. Mild forms of movement may involve restlessness or fidgety movements of the hands, while more severe forms may show as an unstable dance or a continuous flow of violent, disabling movements.

The exact cause is not known, but many factors can lead to chorea:

  • Inherited disorders: Huntington"s disease, Wilson"s disease
  • Infectious disorders: AIDS, meningitis, encephalitis
  • Immune disorders: Rheumatic fever, systemic lupus erythematosus, multiple sclerosis
  • Endocrine disorders: Hyperthyroidism
  • Pregnancy
  • Medications
  • Central nervous system tumors or trauma

To investigate your condition, your physician will perform a detailed review of your medical history and physical examination. You will be examined for signs of infection and neurological symptoms. Blood tests and imaging tests such as MRI are performed to determine the underlying condition.

Your treatment is based on the underlying condition causing chorea. If the cause is infection, your doctor prescribes antibiotics. Other medications including anticonvulsants and drugs that lower the brain chemical dopamine, may be prescribed. If symptoms do not improve with medication, your doctor may suggest deep brain stimulation, a surgical procedure where electrodes are implanted in the brain to regulate nerve activity.

Epilepsy and Pregnancy

Epilepsy is a condition characterized by recurrent episodes of involuntary shaking (seizures) that occur due to abnormal electrical activity in the brain. While epilepsy does not stop you from becoming pregnant, particular care needs to be taken to protect you from seizures and also help you give birth to a healthy baby.

During pregnancy, seizures may remain the same or in some cases even reduce, but in many, it may increase due to emotional stress and reduced sleep. A seizure episode during pregnancy may cause a drop in fetal heart rate, fetal injury, and the need for premature labor and delivery. Controlling your seizures is critical during pregnancy. However, regular anti-seizure medication may produce skeletal, heart and urinary tract defects, or fetal anticonvulsant syndrome characterized by glow intellectual ability, poor language skills, problems with memory, delayed developmental milestones and autistic spectrum disorders.

If you think you might be pregnant, it is important to contact your doctor and neurologist immediately. Your doctor may alter your medications to something safer for your child and you. In addition to altering your medications your doctor will prescribe medication to reduce the chance of birth defects.

You will need to make regular visits to your doctor"s office during your pregnancy where your blood pressure and weight are checked, and blood tests are performed to assess medication levels. Your baby"s growth and development is also closely monitored. You will be prescribed with a higher dose of folic acid and vitamin K supplement as well.

Seizures do not usually occur during labor. If they do, they can be adequately managed by medication, or in case of prolonged seizures, a C-section may be performed. Breastfeeding is generally considered safe, but you are advised to check with your physician before starting.

Epilepsy in Children

Epilepsy is a condition caused by abnormal electrical activity in the brain that produces symptoms such as confusion, staring spells, and most commonly, episodes of involuntary shaking (seizures), which may be followed by periods of unconsciousness. Epilepsy usually begins in childhood.

Seizures may be generalized, involving the whole brain, or partial, where a part of the brain is involved. Generalized seizures may present as staring spells, unconsciousness, sporadic jerking movements, muscle rigidity, or loss of muscle tone causing your child to fall down. Partial seizures may produce changes in sensation (hearing, vision, smell, taste or touch), involuntary chewing, lip smacking and other repetitive movements, and emotional disturbances.

Your child"s doctor will try to rule out other possible causes of seizures before confirming a diagnosis of epilepsy. A thorough history and physical examination is performed. Your child"s doctor may order blood tests, an electroencephalogram (EEG), to study the electrical activity of the brain, and an MRI to look for brain abnormalities.

After diagnosing epilepsy, your child"s doctor will decide whether or not anti-seizure medication should be started. This will depend on the kind of epilepsy, chances of recurrence, age of your child and presence of developmental or behavioral abnormalities. If medications are ineffective, surgery may be suggested such as vagus nerve stimulation, where an implanted device reduces the frequency of seizures, or resection of specific regions of the brain from where the seizures arise. You may be advised to start your child on a low-carbohydrate, high-fat diet.

Epilepsy and epileptic treatment may lead to learning disabilities and changes in behavior. Appropriate support should be provided to help your child to cope.

Epilepsy Surgery

Epilepsy is a disorder of the brain characterized by recurrent seizures which are episodes of involuntary shaking, produced as a result of abnormal electrical brain activity. Medications are available and effective in controlling a large number of epilepsy cases; however, if your epileptic attacks are severe and cannot be controlled by medications alone, or you are experiencing severe side effects from the medication, surgery may be a good option to consider.

Before deciding on surgery your doctor will confirm the exact area of your brain producing the seizure (seizure focus) and ensure that it is not responsible for vital functions such as movement and language.

Surgery may be performed to either remove the region producing seizures, interrupt nerve pathways spreading the seizures in the brain or to implant a device to treat the epilepsy. Some of the different forms of surgery performed include:

  • Lobe resection: Resection of a cerebral lobe (one of four regions that comprise most of the brain tissue), mostly the temporal lobe of your brain where seizures usually arise
  • Lesionectomy: Specific lesion (tumor or abnormal blood vessel) in your brain causing the seizure is removed
  • Corpus callosotomy: Cutting the band of nerve tissue that connects the two halves of your brain to prevent seizures from spreading to the opposite side.
  • Vagus nerve stimulation: Implantation of a device under your skin to control the vagus nerve, which is responsible for regulating activity between the brain and major organs.
  • Responsive neurostimulation: Implantation of a neurostimulator in your skull to detect and normalize abnormal electrical activities of seizures before they occur.

Surgery is effective in a large number of cases. However, as with all surgical procedures, epilepsy surgery may be associated with certain risks such as infection, bleeding, failure and requirement for reoperation or the development of new neurological problems.

You may be completely free of seizures following surgery, but may have to continue your anti-seizure medication until your doctor decides it is safe to discontinue them.

Focal Dystonia

Dystonia defines a group of movement disorders characterized by slow repetitive involuntary muscle spasms and contractions. Focal dystonia is a type of dystonia in which the movement disorder is localized to one part of the body. Focal dystonia may affect the eyelids (rapid blinking or closure), neck (contractions cause the head to twist or pull to one side), vocal cords (spasm affect voice) and arms (writer"s cramp).The two most common areas affected are the eyelids and the neck. Task-specific dystonias, such as writer"s cramp and musician"s cramp, show uncontrolled movements of the hands only during the specific task (while writing or playing an instrument) and not during other activities.

Focal dystonia may be primary, caused by an abnormality in a part of the brain called the basal ganglia which is responsible for controlling movement, or may be secondary, associated with other conditions such as multiple sclerosis and Parkinson"s disease. Most cases of focal dystonia can be identified by physical examination alone; however, your doctor may order blood tests, urine tests or imaging scans to identify related conditions, and electromyography (EMG) to measure the electrical activity of muscles.

Focal dystonia cannot be cured, but symptomatic relief can be obtained through medications and Botulinum toxin (Botox) injections, which are useful in reducing the painful muscular spasms in a particular area like the neck. Some ways of coping with focal dystonia include reducing stress, getting adequate sleep, moderate exercises and reducing the movements that trigger or worsen the condition. Sometimes touching the affected area or a surrounding area can alleviate the symptoms. This is known as a sensory trick.

Friedreich"s Ataxia

Friedreich"s ataxia is rare inherited neurological disorder affecting movement. It causes degeneration of the spinal cord and the lower part of the brain called the cerebellum, leading to progressive loss of muscle control (ataxia) and sensory functions. It is also associated with heart and spine problems.

Symptoms first appear as gait abnormality, usually between the ages of 5 and 15. This loss of muscle control later spreads to your trunk and arms. You may experience loss of sensation and reflexes, problems with speech and vision, shortness of breath. Heart problems such as cardiomegaly (enlarged heart) and fast heart rate, orthopedic conditions such as foot deformities and scoliosis, and diabetes may develop.

When you present to the clinic with the above symptoms, your doctor performs a thorough history and physical examination including testing your gait, loss of reflexes and sensations like touch. You may be asked to undergo nerve conduction studies, electromyogram (study the electrical activity of muscles), electrocardiogram and echocardiogram (study heart rhythm and rate abnormalities). MRI and CT scans of your brain and spinal cord may be ordered to rule-out other neurological problems. Blood tests may be performed to check your sugar levels, and genetic testing helps confirm on the diagnosis of Friedreich"s ataxia.

There is no cure for the nerve degeneration seen in Friedreich"s ataxia; however, your symptoms and complications may be adequately managed by your physician. Physical therapy may be helpful in retaining muscle control of the arms and legs. Diabetes, orthopedic conditions and heart diseases can also be managed.


A headache is pain or discomfort anywhere in the region of the head or neck. Headaches are the most common health complaints experienced by every person at some point during their life. Most headaches are not serious and can be treated with medications and lifestyle changes. There are many different types of headaches and it is important to know the particular type of headache you have and also methods to treat the same.


Depending upon the cause, headaches can be divided into three major categories:

Primary headaches: Primary headaches are those headaches that are not associated with other medical conditions. The most common types of primary headaches include:

  • Tension headaches: Tension headaches are the most common type of headaches that occur when the head and neck muscles contract due to stress, poor posture, fatigue, eye strain, alcohol and tobacco use, and with hormonal changes in women before and after a menstrual period. Tension headaches may occur at any age, but occur mostly in adults and adolescents.
  • Migraine headache: A migraine is felt as a throbbing pain on one side of the head. The exact cause is unknown, but may occur from a series of changes in brain activity, and may be associated with alcohol use, smoking, lack of sleep, prolonged muscle tension and stress, changes in hormone levels during menstrual periods, or with the use of oral contraceptives. Migraines occur more often in women than men and may run in families.  
  • Cluster headaches: Cluster headache is a less common type of primary headache. The cause is unknown, but abnormalities in an area of the brain called the hypothalamus may be involved, and are triggered by certain factors such as changes in sleep patterns and use of certain medications. It is most common in men in their late 20s, and tend to run in families.

Secondary headaches: Secondary headaches are those that are caused by other underlying diseases. Some medical conditions that can cause secondary headaches include bleeding in the brain, brain tumors, meningitis and encephalitis.

Cranial neuralgias, facial pain, and other headaches: Cranial neuralgia is pain or discomfort in the head or neck caused by inflammation of the nerves located in the head and upper neck. Facial pain can be caused from a nerve disorder, an injury, or an infection in a structure of the face or it may occur for no known reason.


People with tension headaches have generalized pain in the head and neck described as a band-like tightness or pressure.

Migraine headaches often cause a throbbing or pulsating sensation usually on one side of the head. It may occur with symptoms such as nausea, vomiting, visual disturbances, and sensitivity to light and sound. The pain can last a few hours or even up to one or two days.

Cluster headaches have a characteristic grouping or clustering of attacks. People with cluster headaches usually have pain lasting for 30 to 90 minutes, once or twice daily, for weeks or months, followed by pain free periods. Attacks tend to occur at the same time each day and often wake the person from sleep. The pain is extremely painful and may occur behind and around one eye.


Your doctor will question you about your headache, its location, length, duration, causative factors and associated symptoms. Your doctor will also review your family history, medical history, diet and lifestyle. The following diagnostic procedures may be ordered:

  • An MRI or CT scan of the head may be needed to rule out other causes of the headache.
  • An X-ray of the sinuses may be taken to evaluate sinus problems.
  • Lumbar puncture (spinal tap) is the removal of cerebrospinal fluid, or CSF (fluid surrounding the spinal cord and the brain) from the spinal canal to diagnose disorders affecting the brain and spinal cord.
  • Temporal artery biopsy is the removal ofa sample of blood vessel from your temple to check for signs of inflammation.


Your doctor may suggest keeping a headache diary to help identify your headache type and recommend effective treatment.

To control tension type headaches, over-the-counter (OTC) pain medications are prescribed.

Medications for migraine headache fall into two categories:

  • Abortive medications are taken during migraine attacks as they work quickly. They are effective in people who have nausea and vomiting with their migraine.
  • Preventive medications are taken on a daily basis, to reduce the severity or frequency of the migraine attacks.

The treatment of cluster headaches is very difficult. Your doctor may treat cluster headache with oxygen inhalation, triptan medicines (constrict blood vessels and block pain pathway to brain), and the use of intranasal applications of a local anesthetic agent. Medications used to prevent additional headaches include blood pressure medications, antidepressant medications, and drugs used to treat seizures.

Headache Basics

Pain in any region of the head is called a headache. It may involve one or both sides of the head and may radiate to the neck and shoulders. You may experience dull pressure, a throbbing sensation or sharp pain that may last anywhere between an hour to days. In some cases it may indicate a serious underlying disease.

Headaches are broadly classified into 2 types:

  • Primary headaches are caused by stress, anxiety or certain triggers. They occur due to an overactive pain-sensitive region in the head and are not associated with any other condition. Common primary headaches can include tension headaches (result from tight muscles in the neck, scalp and shoulders), migraine (throbbing pain in one side of the head) and cluster headache (occurs in patterns or clusters).
  • Secondary headaches may be described as a symptom of another condition such as ear infections, sinusitis, dehydration, panic attacks, meningitis (inflammation of the membranes covering the brain and spinal cord) and concussion (brain injury), which may trigger the pain-sensitive region in the head.

If your headaches are severe and occur frequently it is necessary to contact your doctor who will perform a detailed exam of your head, ears, eyes, nose, neck, throat and nervous system, and question you about your symptoms and lifestyle to identify any triggers or underlying disease. A CT or MRI scan and blood tests may be ordered. A lumbar puncture that studies the fluid surrounding the brain and spinal canal may be helpful in diagnosing infections.

To treat tension headaches your doctor may prescribe pain medications. Medication may be provided for other symptoms such as nausea. For secondary headaches, treatment is focused on the associated condition. Your doctor may also recommend other ways of managing headaches, such as massage, relaxation therapy and avoiding triggers.

Headache: Chronic Daily

If your headaches occur on a daily basis, at least 15 days a month for 3 months, and is not associated with any underlying cause, you may have a condition called chronic daily headaches (CDH).

Chronic daily headaches may present as different types of headaches and are usually classified as:
Short duration (less than 4 hours) CDH: rare and includes

  • Cluster headaches: intense pain from neck to temple and around the eye, on one side of the face, mostly at night

Long duration (more than 4 hours) CDH: more common and includes

  • Chronic tension-type headaches: mild to moderate pain present on both sides of the head; develops from episodic tension-type headaches
  • Chronic migraine headaches: throbbing pain on one side of the head with associated symptoms such as light sensitivity and nausea, but lacking aura symptoms
  • Hemicrania continua: persistent pain that peaks in severity
  • New daily persistent headache: mild to moderate pain present on both sides of the head, with no past history of headaches

The cause of chronic daily headache is unknown, but could be due to an abnormal development of low pain threshold or lack of pain suppression in the brain.

To diagnose your headache your doctor will review your medical history and perform a physical examination to define the type of headache and possible causes. You may need to undergo CT and MRI testing to look for abnormalities, blood and urine tests, or electroencephalography to study the electrical activity of the brain.

In the absence of secondary causes, your doctor will focus treatment on preventing headaches. You may be prescribed antidepressants, anti-seizure medications, NSAIDs and blood pressure medication. Relaxation therapy may be recommended and botulinum toxin (Botox) injections may be given.

Headache: Migraine

A migraine is a type of headache characterized by severe throbbing pain on one side of the head accompanied by secondary symptoms such as nausea, vomiting and sensitivity to light, sound or smell. Other symptoms may include lightheadedness and blurry vision. A migraine may be preceded by an aura, a neurological warning sign, which may occur 10 to 15 minutes before an attack. These include flashes of light, tingling sensations, or speech problems. Sometimes, you may have migraines without an aura. A migraine may last from a few hours to 3 days.

The exact cause of migraines is unknown, but they are thought to be due to dilation and constriction of blood vessels as a result of abnormal nerve communication. It may have a genetic or environmental cause, triggered by missing meals, hormone changes during menstruation, use of birth control pills, stress, poor sleep habits, alcohol and high levels of caffeine, bright lights, loud sounds, unusual smells (paint thinner) and certain foods such as dairy, chocolate and peanuts.

When you present to the clinic with migraine symptoms, your doctor will study the nature and history of your headaches and associated symptoms and identify any family history of the condition. Blood tests, CT and MRI scans may be ordered to rule out other possible reasons for your headache.

To treat migraine your doctor may prescribe medications that prevent migraines to be taken on a regular basis, or abortive medications that are taken when a migraine occurs. Certain medications used for other purposes such as anti-nausea medication, blood pressure medications, anti-seizure medications, or antidepressants are also effective in treating symptoms of migraine.

Headache: Rebound

Long-term use of headache medications to treat conditions such as migraines may produce rebound headaches, also called medication-overuse headaches. If taken more than a few days a week on a regular basis, any pain medication can trigger rebound headaches if you already have a headache disorder.

Rebound headache depends on the original headache being treated. They may occur frequently, nearly every day, mostly on waking, and may be accompanied by restlessness, nausea, memory problems, difficulty concentrating and irritability. Severe forms of rebound headaches may be associated with fever, double vision, stiff neck, seizures and difficulty speaking. It may worsen even after rest and pain medication and wake you up from sleep.

To treat rebound headaches your doctor may advise you to reduce or stop your current pain medication. Your symptoms may worsen initially and you may experience withdrawal symptoms such as restlessness, nausea or constipation for 2 days to sometimes several weeks. You may require hospitalization if you have developed drug dependency or if you have associated conditions such as depression and anxiety. Your doctor may prescribe alternative medications to manage your headaches and the side effects of medications. Cognitive behavioral therapy may be recommended, which teaches you ways of coping with headache.

Headache: Tension-Type

Tension-type headache is the most common type of headache and is characterized by  dull pain and tightness in the head, neck and shoulders on both sides. It may be either episodic (30 minutes to a week) or chronic (more than 15 days a month for three months) but does not usually affect activities of daily living. It is more common in women.

The exact cause of tension headaches is not known but it may be due to an increased sensitivity to stress. Poor posture, eye strain, dehydration, bright sunlight or missed meals are some of the triggers of tension headaches.

Tension headaches are usually diagnosed with a thorough physical exam and neurological tests that study the characteristics and location of your headaches. If your headaches have an unusual pattern, imaging tests such as CT orMRI may be performed to rule out underlying causes such as a tumor or injury.

Tension headaches may be treated by making appropriate lifestyle changes and avoiding triggers. Relaxation techniques such as massage, yoga and exercise may be suggested. Your doctor may prescribe simple pain relievers or muscle relaxants to treat headaches. If your headaches are frequent or severe, your doctor may prescribe medications to prevent headaches that you take on a regular basis.

Multiple Sclerosis and Bladder Problems

Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord) affecting the myelin sheath which insulates nerve cells and is important for the transmission of nerve impulses. This causes the relay of information between the brain and the rest of your body to either slow down or stop and can lead to muscle weakness, difficulty with coordination and balance, vision and speech difficulties, tremors, dizziness, and cognitive difficulties.

A large percentage of people with multiple sclerosis also have bladder problems. These may include urinary urgency, incontinence (no control over urination), nocturia (frequent urination at night), and hesitancy (difficulty initiating urination). This is caused by loss of control of the bladder muscles that governor the flow of urine. If left untreated, bladder problems can lead to urinary tract infection, kidney damage and problems with hygiene.

To aid in diagnosis, your doctor may order an ultrasound scan to check the residual volume of urine in the bladder.

Treatment is based on avoiding complications such as retention of urine and infection. Your doctor may ask you to limit your fluid intake to 2 liters per day, and minimize coffee, tea, soda and alcohol which can worsen bladder control. You will be taught to train your bladder to void only at specific interval, and perform Kegel exercises to strengthen the pelvic floor muscles that control bladder function. Your doctor may prescribe medications to help with incontinence and suppress urgency. Diapers, shields, and other absorbent material may be recommended to aid with hygiene. Certain mechanical aids such as the use of a catheter (thin long tube is inserted to drain urine), urethral insert (thin solid tube is inserted to block urine) and external urethral barriers (adhesive patch is placed over the opening of the urethra), may be used to control incontinence.

Multiple Sclerosis and Bowel Problems

Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord) affecting the myelin sheath which insulates nerve cells and is important for the transmission of nerve impulses. This causes the relay of information between the brain and the rest of your body to either slow down or stop and can lead to muscle weakness, difficulty with coordination and balance, vision and speech difficulties, tremors, dizziness, and cognitive difficulties.

Multiple sclerosis may affect coordination and control of the muscles responsible for emptying the bowels. This may lead to constipation(bowel movements are infrequent and strained), bowel incontinence (no control over bowel movements), diarrhea (frequent loose waterystools). Bowel problems can also aggravate other symptoms of multiple sclerosis such as bladder dysfunction (inability to control urine flow) or spasticity (stiff muscles).

In order to treat bowel dysfunction, your physician may suggest drinking plenty of fluids (6-8 glasses a day), increasingthe fiber in your diet (cereals, whole wheat bread, fruits, vegetables, or fiber supplements), maintaining a routine for bowel evacuation and exercise. Your doctor may prescribe stool softeners, enemas and laxatives for constipation or medication to control diarrhea.

Multiple Sclerosis and Cognitive Changes

Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord) affecting the myelin sheath which insulates nerve cells and is important for the transmission of nerve impulses. This causes the relay of information between the brain and the rest of your body to either slow down or stop and can lead to muscle weakness, difficulty with coordination and balance, vision and speech difficulties, tremors, dizziness, and cognitive difficulties.

Cognitive difficulties are seen in about 50% of cases of multiple sclerosis, and include difficulties in learning, memory, attention and concentration, visual perception, finding the appropriate words while speaking, information processing, planning and organization. Your long-term memory, general intelligence and reading ability remain intact.

If you experience cognitive difficulties with multiple sclerosis it is necessary to contact your physician as there could be other causes such as ageing, drugs, depression, anxiety, fatigue or other health conditions. You may be referred to a speech pathologist, neuropsychologist or occupational therapist for further testing. Early detection and assessment are important for effective treatment outcomes, which could significantly improve your quality of life.

Cognitive issues may be treated with memory exercises, notebooks, filing systems and organizers to help processing difficulties. Your doctor may suggest disease modifying drugs that alter the course of multiple sclerosis and reduce new lesions, which may slow the progression of cognitive issues. Medications used for Alzheimer"s may be recommended to help focus and memory.

Multiple Sclerosis and Depression

Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord) affecting the myelin sheath which insulates nerve cells and is important for the transmission of nerve impulses. This causes the relay of information between the brain and the rest of your body to either slow down or stop and can lead to muscle weakness, difficulty with coordination and balance, vision and speech difficulties, tremors, dizziness, and cognitive difficulties.

Depression is frequently seen in multiple sclerosis. It can arise out of the stress of dealing with multiple sclerosis, the disease process itself, which causes abnormal nerve communications to affect mood, or the side effect of drugs used to treat multiple sclerosis.

The symptoms of depression include long periods of sadness, lack of energy, uncontrollable crying, feeling of worthlessness, lack of pleasure in activities, irritability, thoughts of death or attempting suicide, inability to sleep or a desire to sleep often. If left untreated depression may lead to suicide.

If depression affects your activities of daily living and relationships, it is necessary to seek help from your doctor. Your doctor may rule out other possible causes of depression such as illness or medicines before proceeding with treatment. You may be referred to a mental health provider for a thorough examination.

Your doctor may prescribe antidepressant medication in combination with psychotherapy to effectively treat depression.

Multiple Sclerosis and Pain

Multiple sclerosis is an autoimmune disease of the central nervous system (brain and spinal cord) affecting the myelin sheath which insulates nerve cells and is important for the transmission of nerve impulses. This causes the relay of information between the brain and the rest of your body to either slow down or stop and can lead to muscle weakness, difficulty with coordination and balance, vision and speech difficulties, tremors, dizziness, and cognitive difficulties.

Pain is present in about half of all people suffering from multiple sclerosis. It is more common in women. You may experience pain in multiple sclerosis due to immobility, wear and tear, and medication.

Some of the prominent types of pain experienced in multiple sclerosis include:

Acute pain

  • Trigeminal neuralgia: Stabbing pain in the face
  • Lhermitte"s sign: Brief electric shock-type pain in the back of your head, traveling down your spine as you bend your head forward
  • Dysesthesias(MS hug): Aching or burning pain that usually feels like constriction around the legs and feet

Chronic pain

  • Spastic pains: Muscle spasms or cramps
  • Burning, aching, prickling type pain
  • Musculoskeletal pain: Due to spasticity, pressure caused by immobility, struggle to offset gait problems and balance problems

When you present to the clinic with multiple sclerosis-related pain, your doctor will perform tests to rule out other possible causes of pain. You may be prescribed pain medication along with anticonvulsant or antidepressant medication. You are advised to exercise and stretch regularly to help with muscular pain. Other forms of pain management such as acupuncture, yoga, hypnosis, meditation and stress management may also be recommended.

Sleep Disorders

Sleep is essential for your physical health and emotional wellbeing. Everyone experiences occasional sleeping problems, but if you experience problems sleeping repeatedly, it could indicate an underlying health problem. Sleep disorders are problems associated with sleeping, including difficulty falling or staying asleep through the night, feeling sleepy during the day, or waking up feeling exhausted. Because of lack of sleep you may find it difficult to concentrate and perform activities of daily living. This lack of sleep can lead to depression, mood swings, or other health problems.

Some of the common types of sleep disorders include:

  • Insomnia:  Insomnia is a type of sleep disorder in which the person has difficulty falling asleep or staying a sleep.
  • Sleep apnea: Sleep apnea is a common sleep disorder in which breathing stops or gets very shallow during sleep. These breathing pauses last between 10 to 20 seconds or more.
  • Restless leg syndrome (RLS): Restless leg syndrome is a disorder characterized by a tingling or prickly sensation in the legs and an urge or need to move the legs.
  • Narcolepsy: Narcolepsy is a sleep disorder that causes excessive daytime drowsiness and sudden onset of  sleep.
  •  Parasomnias: This refers to abnormal behaviors that occur during sleep. Parasomnias include nightmares, night terrors, sleep walking, and sleep talking, head banging, wetting the bed and grinding teeth.


Sleep Disorder treatment can be classified into two main categories: pharmacological treatment and non-pharmacological treatment.

Pharmacological treatment includes any prescription or non-prescription medications to help prevent the onset of the symptoms or treat the developed symptoms. Depending on the type of disorder, treatment could include sedatives (in case the condition is related to insomnia), or stimulants (in case the condition is related to narcolepsy or sleep apnea).

Non-pharmacological sleep treatment refers to those options that do not require the use of prescription or non-prescription drugs. These may include behavioral therapy, medical equipment, surgery, and other options. Surgery may be needed to correct the anatomic abnormalities of the upper airway which can lead to the onset of obstructive sleep apnea. Behavioral treatments for sleep problems may include relaxation training, cognitive therapy, stimulus control (SC), sleep restriction therapy (SRT), and sleep hygiene. Behavioral therapy can be used to treat people with insomnia, parasomnias, bedwetting, and other sleep problems. Another option is the use of different types of medical equipment such as “continuous positive airway pressure" (CPAP) and bilevel "” or BiPAP for the treatment of sleep apnea. CPAP is a device that prevents narrowing of the airway during inspiration and expiration by providing a persistent increased pressure. Another similar option is “bilevel" in which the face mask allows for two different alternating pressures: one with inhalation and one with exhalation. Other non-pharmacological treatment options for sleep disorders include mandibular advancement devices, nasal strips, positional therapy, and playing didgeridoo (a wind instrument) to strengthen the upper airway.

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 also be helpful.

Status Epilepticus

Status epilepticus is a neurological disorder where a seizure lasts for a more than 5 minutes or occurs in clusters (closely spaced events) over a prolonged period with little or no recovery in between. It may be convulsive (associated with convulsions) or non-convulsive. It may occur as a result of stroke, low blood sugar, too much alcohol, changing or stopping medications or metabolic disturbances. Convulsive status epilepticus is considered a medical emergency as it can lead to brain damage and death if left untreated. Non-convulsive status epilepticus is rare and generally not considered a medical emergency, and may present as changes in mental status, vision, speech, fluttering eyelids and lip smacking.

When you present with the above symptoms, your doctor will check your cardiac and respiratory functions, provide oxygen and start an intravenous line. Drugs are then administered to control the seizures. Blood and urine tests are performed to check your levels of glucose and electrolytes. If any underlying cause is identified, appropriate treatment is provided.

Sudden Unexplained Death in Epilepsy (SUDEP)

Sudden unexplained death in epilepsy (SUDEP) is a rare condition that usually occurs in young or middle-aged individuals with a history of epilepsy. Death happens suddenly and may not necessarily be preceded by a seizure. The cause is unexplained, but a possible explanation is that the region of the brain that controls the functioning of the heart or breathing is damaged by seizures. Death may be caused by a combination of apnea (difficulty in breathing), being face down on the bed and increased collection of fluid in the lungs, which impairs the exchange of gases.

Your chances of developing this condition increases if you have severe and more frequent seizure attacks, have developed epilepsy at an early age and take multiple antiepileptic drugs in high doses. Males are more affected than females.

You may reduce your chances of developing this condition by taking your antiepileptic medications as prescribed by your doctor, having regular doctor visits and avoiding triggers for seizures. Caretakers are advised to monitor you whenever possible, provide first-aid (turn you over to one side to facilitate proper breathing) and learn cardiopulmonary resuscitation (CPR).

Tardive dyskinesia

Tardive dyskinesia is a neurological side-effect of the long-term intake of neuroleptics, a class of drugs prescribed for gastrointestinal, neurological and psychiatric diseases such as schizophrenia and bipolar disorder. The condition is characterized by involuntary, repetitive movements of the face, lips, tongue, trunk, arms and legs. Movements may include tongue protrusion, rapid blinking, puckering and smacking of the lips, and swinging the jaw back and forth.

Treatment usually consists of stopping the offending drugs and replacing them with more appropriate ones. Newer antipsychotic drugs have a lower risk of developing tardive dyskinesia. Early intervention has the best results, however, symptoms may persist even after withdrawal of the medication. Botulinum toxin and dopamine-depleting agents may be helpful in these cases.

Todd"s Paralysis

Todd"s paralysis is temporary paralysis following a seizure (abnormal electric brain activity). It usually occurs on one side of the body, and the area of the brain affected by the seizure reflects the part of the body that is affected by paralysis. The paralysis may be partial or complete, lasting from half an hour to 36 hours, after which it resolves on its own. Speech and vision may also be affected in Todd"s paralysis. Todd"s paralysis is usually seen in those with epilepsy (recurrent seizures).

This condition may present like a stroke, so care needs to be taken to differentiate between the two as both require different treatments. Treatment is usually only supportive as the condition is temporary. The cause of the seizure and its affects need to be identified and treated


A tremor is an involuntary muscle movement characterized by shaking of a body part, usually the hands and arms, and difficulty holding and controlling objects. It may also involve other parts of the body such as the vocal cords and head. A slight tremor is normally present in all of us, especially the elderly. It increases when we are angry, fearful, under stress, fatigued, smoke, drink a lot of caffeine or as a response to certain medications.

Tremors due to a neurological disease that do not resolve require medical intervention. Neurological causes of tremors may be due to conditions such as Parkinson"s disease and dystonia (a movement disorder); damage to the cerebellum (the lower part of the brain) due to stroke, tumor or disease; psychological disorders; and alcoholism. Tremors occur due to problems in regions of the brain that control muscles.

Tremors may be resting tremors, which occur in a body part at rest, as seen in Parkinson"s disease, or action tremors, which may occur when holding a body part against gravity or performing a task.

When you present with tremors, your doctor reviews your medical history and performs a physical examination to determine the characteristics of your tremor and if there is any underlying disease. Blood, urine and imaging tests such as CT or MRI scans may be performed. Neurological tests and electromyography may be ordered to assess motor and sensory skills.

Tremors can improve with the treatment of the underlying cause. Therapies may include:

  • Medication
  • Psychotherapy
  • Reduction or stoppage of medications causing tremors
  • Physical therapy to improve muscle coordination and control
  • Surgery if the symptoms are severe and conservative options fail
  • Avoidance of alcohol and caffeine which may be triggers

Tremor: Essential Tremor

A tremor is an involuntary muscle movement characterized by shaking of a body part. A slight tremor is normally present in all of us, especially the elderly. Tremors due to a neurological disease that do not resolve require medical intervention. Essential tremor is a neurological condition which causes rhythmic shaking of a part of the body, especially the hands, when performing simple tasks such as writing or drinking from a glass. It is the most common type of tremor seen in those above age 40, and is not associated with any other disorder. Essential tremors may be an inherited condition due to genetic abnormalities. It may also occur due to changes in the part of your brain that controls muscle movement.

Essential tremors usually begin slowly, mostly involving a hand and occur when you try to engage in a task. It is worsened with movement, fatigue, stress, stimulants such as caffeine, and temperature changes. Your head may be involved making rhythmic up and down or side to side motions. It may also affect your voice.

When you present with essential tremor, your doctor will review your family and medical history and perform a thorough physical examination. Neurological tests, performance tests (perform certain tasks) and certain blood and urine tests may be ordered to look for a possible cause and to rule out other conditions.

You may not require treatment if your symptoms are mild, but if you cannot perform activities of daily living your doctor may prescribe blood pressure or anti-seizure medications, tranquilizers or Botox injections. Physical or occupational therapy may be recommended to improve muscle control and coordination. Surgical techniques such as deep brain stimulation, where a device is implanted in your brain to reduce tremors, may be suggested if your symptoms are severe and other treatment fails.