Early diagnosis of Parkinson's disease gives you the best chance of a longer, healthier life.

Early Warning Signs of Parkinson's Disease

Sometimes it is hard to tell that you might have Parkinson'sdisease. Parkinson's disease is when your brain stops making an important chemical called dopamine. This chemical helps your body to move, and helps your mood. If you do have Parkinson's, you can feel better by taking a pill that helps your body to replace that chemical. Parkinson's disease will get worse slowly over time, and your doctor can help you stay healthy longer. Some of the problems listed here could be signs of Parkinson's disease.

No single one of these signs means that you should worry about Parkinson's disease. If you have more than one symptom, you should make an appointment to talk to your doctor. 

What you can do if you do have Parkinson's disease:

·         Work with your doctor to create a plan to stay healthy. This plan might include:

·         A referral to a neurologist, a doctor who specializes in the brain

·         Care from an occupational therapist, physical therapist or speech therapist

·         Meeting with a medical social worker to talk about how Parkinson's will affect your life

·         Start a regular exercise program to delay further symptoms.

·         Talk with family and friends who can provide you with the support you need.

Tremor or Shaking

Have you noticed a slight shaking or tremor in your finger, thumb, hand, chin or lip? Does your leg shake when you sit down or relax? Twitching or shaking of limbs is a common early sign of Parkinson’s disease.

Small Handwriting

Has your handwriting suddenly gotten much smaller than in it was in the past? You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. A sudden change in handwriting is often a sign of Parkinson’s disease.

Loss of Smell

Have you noticed you no longer smell certain foods very well? If  you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinson’s disease.

Trouble Sleeping

Do you thrash around in bed or kick and punch while you are deeply asleep? You might notice that you started falling out of bed while asleep. Sometimes, your spouse will notice, or will want to move to another bed. Sudden movements during sleep may be a sign of Parkinson’s disease.

Trouble Moving or Walking

Do you feel stiff in your body, arms or legs? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. You might notice that your arms don’t swing when you walk, or maybe other people have said you look stiff. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem ‘stuck to the floor.

Constipation

Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinson’s disease and you should talk to your doctor. 

A Soft or Low Voice

Have other people told you that your voice is very soft when you speak in a normal tone, or that you sound hoarse? If there has been a change in your voice you should see your doctor about whether it could be Parkinson’s disease. Sometimes you might think other people are losing their hearing, when really you are speaking more softly.

Masked Face

Have you been told that you have a serious, depressed or mad look on your face more often, even when you are not in a bad mood? This serious looking face is called masking. Also, if you or other people notice that you have a blank stare or do not blink your eyes very often, you should ask your doctor about Parkinson’s disease. 

Dizziness or Fainting

Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be signs of low blood pressure and can be linked to Parkinson’s disease.

Stooping or Hunching Over

Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease.

Hydrocephalus Surgery and Treatment in India - Best Neurosurgery Hospitals in India

Hydrocephalus also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, tunnel vision, and mental disability. Hydrocephalus can also cause death.

The clinical presentation of hydrocephalus varies with chronicity. Acute dilatation of the ventricular system is more likely to manifest with the nonspecific signs and symptoms of increased intracranial pressure. By contrast chronic dilatation (especially in the elderly population) may have a more insidious onset presenting, for instance, with Hakim's triad (Adams triad).

Symptoms of increased intracranial pressure may include headaches, vomiting, nausea, papilledema, sleepiness or coma. Elevated intracranial pressure may result in uncal and/or cerebellar tonsill herniation, with resulting life threatening brain stem compression.

In infants with hydrocephalus, CSF builds up in the central nervous system, causing the fontanelle (soft spot) to bulge and the head to be larger than expected. 
Early symptoms may also include:

* Eyes that appear to gaze downward (Sundowning)
* Irritability
* Seizures
* Separated sutures
* Sleepiness
* Vomiting

Symptoms that may occur in older children can include:

* Brief, shrill, high-pitched cry
* Changes in personality, memory, or the ability to reason or think
* Changes in facial appearance and eye spacing
* Crossed eyes or uncontrolled eye movements
* Difficulty feeding
* Excessive sleepiness
* Slow or restricted movement
* Vomiting

Signs and tests

When a health care provider taps fingertips on the skull, there may be abnormal sounds that indicated thinning and separation of skull bones. Scalp veins may appear stretched or enlarged.

Part or the entire head may be larger than normal. Enlargement is most commonly seen in the front part of the head. Head circumference measurements, repeated over time, may show that the head is getting bigger.

The eyes may look "sunken in." The white part of the eye may appear above the colored part of the eye, given the eyes a "setting-sun" appearance. Reflexes may be abnormal.

A head CT scan is one of the best tests for identifying hydrocephalus. Other tests that may be done include:

* Arteriography
* Brain scan using radioisotopes
* Cranial ultrasound (an ultrasound of the brain)
* Lumbar puncture and examination of the cerebrospinal fluid (rarely done)
* Skull x-rays

Treatment
Hydrocephalus treatment is surgical, generally creating various types of cerebral shunts. It involves the placement of a ventricular catheter (a tube made of silastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (Lumbar-peritoneal shunt). An alternative treatment for obstructive hydrocephalus in selected patients is the endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on individual anatomy. This is the treatment.

Shunt complications
Examples of possible complications include shunt malfunction, shunt failure, and shunt infection, along with infection of the shunt tract following surgery (the most common reason for shunt failure is infection of the shunt tract). Although a shunt generally works well, it may stop working if it disconnects, becomes blocked (clogged), infected, or it is outgrown. If this happens the cerebrospinal fluid will begin to accumulate again and a number of physical symptoms will develop (headaches, nausea, vomiting, photophobia/light sensitivity), some extremely serious, like seizures. The shunt failure rate is also relatively high (of the 40,000 surgeries performed annually to treat hydrocephalus, only 30% are a patient's first surgery) and it is not uncommon for patients to have multiple shunt revisions within their lifetime.

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Early surgery for seizures may also be recommended if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.

For most children, medication is all that is needed to control seizures. However, some children continue to have seizures even after trying two or more different medications or a combination of medications. Seizures that fail to respond to two or more anti-epileptic drugs are called medically refractory seizures.

When medication fails to control seizures, surgery (an operation) may be considered to remove or disconnect the part of the brain that is generating the seizures. This is called the epileptogenic (seizure-causing) region of the brain.

With improvements in imaging technology and EEGs, it is now easier for doctors to define the epileptogenic areas of the brain. As a result, surgery has become a well-established method of treatment.

All children with epilepsy that cannot be controlled with medication should be considered for surgery. There appear to be some advantages to doing epilepsy surgery in children, rather than waiting for adulthood:

• Children's brains are more plastic than adults' brains, with a greater ability to compensate for portions removed during surgery.
• In some children, treating seizures earlier may prevent brain damage or changes from repeated seizures and their detrimental effects on cognition and development.

Early surgery for seizures may also be recommended if the cause of seizures is identified to be a brain lesion that is growing, such as a tumour.

Although surgery will not help every child with uncontrolled seizures, it can be a very effective treatment. Various studies suggest that 57% to 69% of babies, children, and teenagers treated with surgery become seizure-free. Between 11% and 24% continue to have frequent seizures.

This page contains an overview of the surgical process, from determining whether your child is a candidate for surgery to post-operative care. You will find more detail about each step and each surgical procedure in the other pages in this section

Who is surgery considered for?

Surgery for epilepsy is considered when:

• The child has seizures that will not improve by themselves as the child gets older.
• Drugs have been tried and have failed to control a child's seizures. Often at least two individual medications separately (monotherapy) and one combination of medications (polytherapy) will have been tried and will have failed to control seizures.
• The epileptogenic or seizure-causing region of the brain can be clearly identified and can be removed or disconnected with minimal risk of harming the child.

With advances in knowledge and technique in both diagnostic tools and surgery, broader spectrums of people with epilepsy are now being considered for surgery.

Determining whether your child is a candidate for surgery

Not every child with intractable epilepsy is a good candidate for surgery. Some children may be ruled out based on their history and EEG.

If your child's history and EEG suggest that surgery may be helpful, a detailed pre-surgical evaluation will be done and the results will be thoroughly analyzed to determine:

• whether your child will be helped by surgery
• the type and exact location of the operation

The pre-surgical evaluation may consist of one or more procedures.

Making a decision about surgery

If the doctors determine that surgery is an option for your child, you should discuss it with the doctor and with your child (if your child is old enough) and think the decision over carefully. You will need to consider the possible improvements from the surgery, the risks of surgery, the risks if your child does not have the surgery, and any alternative treatments.

Gamma Knife Radiosurgery uses radiation to kill cancer cells and shrink tumors :Gamma Knife Surgery for Brain in India

What is Gamma Knife Surgery or Radiosurgery ?

Gamma Knife radiosurgery, also called stereotactic radiosurgery, is a very precise form of therapeutic radiology. Even though it is called surgery, a Gamma Knife procedure does not involve actual surgery, nor is the Gamma Knife really a knife at all. It uses beams of highly-focused gamma rays to treat small to medium size lesions, usually in the brain. Many beams of gamma radiation join to focus on the lesion under treatment, providing a very intense dose of radiation without a surgical incision or opening.

Gamma Knife radiosurgery is called “surgery” because a result similar to an actual surgical procedure is created by a one-session radiation therapy treatment. The beams of radiation are very precisely focused to reach the tumor, lesion, or other area being treated with minimal effect on surrounding healthy tissue.

Gamma Knife radiosurgery is most often used to treat tumors and other lesions in the brain. It is also used to treat certain neurological conditions, such as trigeminal neuralgia (a condition in which pressure on the trigeminal nerve causes spasms of extreme facial pain) and acoustic neuroma (a noncancerous tumor in the brain that affects the nerves that control hearing).

Gamma Knife radiosurgery may be used in situations where the brain lesion cannot be reached by conventional surgical techniques. It may also be used in persons whose condition is such that they might not be able to tolerate a surgical procedure, such as craniotomy, to treat their condition.

Because the therapeutic effects of a Gamma Knife procedure occur rather slowly over time, it is not used for persons whose condition requires more immediate therapy.

In what cases Gamma Knife Surgery is preferred in India?

Following are the conditions where Gamma Knife Surgery is successfuly used in India:

• Intracranial tumors such as acoustic neuromas, pituitary adenomas, pinealomas, craniopharyngiomas, meningiomas, chordomas, chondrosarcomas, metastases and glial tumors

•Vascular malformations including arteriovenous malformations

•Functional disorders such as Trigeminal neuralgia, Intractable pain , Parkinson’s disease, Essential tremors , Epilepsy and Obsessive-compulsive disorder

What are the advantages of Gamma Knife Surgery over traditional Open Surgeries?

•Non Invasive Procedure
•Very less or no complications
•Done on out patient basis so no admission required
•Cost of gamma kife surgery is lower than that of open surgery
•Minimal harm to the healthy tissue as compared to open surgery
•Very high success rate

Who can perform a Gamma Knife Surgery?

Gamma Knife Surgery is performed by a Neurosurgeon who is very well trained in performing the gamma knife surgery. In India there are some of the very good neurosurgeons for gamma knife surgery.

Back to your normal routine 

Once your treatment is complete, the head frame will be removed. If you had an angiogram, you might have to lie quietly for several more hours. Some patients experience a mild headache or minor swelling where the head frame was attached, but most report no problems. Your doctor will tell you whether or not he wants you to stay overnight for observation or if you can go home immediately. Either way, you should be able to return to work or your normal routine in another day or so.

The effects of your Leksell Gamma Knife treatment will occur over time. Radiation treatments are designed to stop the growth of tumors or lesions, which means they won’t disappear immediately but over a period of weeks or months. Your physician and Leksell Gamma Knife® team will stay in contact with you to assess your progress, which will include follow-up MRI or CT images in the near future and periodic check-ups.

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What's the difference between benign and malignant brain tumours? Latest and Advanced Treatment options for Brain Tumor in India

Brain tumours in adults

In a brain tumour, cells grow abnormally, but this doesn’t mean a tumour is cancerous.

Although brain tumours in adults can be caused by cancer, benign tumours are possible. These may be due to medical conditions or may have no obvious cause.

Primary brain tumours emerge from the various cells that make up the brain and central nervous system and are named based on the kind of cell they first form in. The most common types of adult brain tumours are gliomas, the commonest type of which is called an astrocytoma. These tumours form from cells called astrocytes, which are cells that help support the nerve cells.

The second most common types of adult brain tumours are meningiomas. These form in the meninges, the thin layer of tissue that lines the brain and spinal cord and can grow from a number of different kinds of brain and spinal cord cells.

What's the difference between benign and malignant brain tumours?

Benign brain tumours are non-cancerous. Malignant primary brain tumours are cancers that originate in the brain. They typically grow faster than benign tumours and aggressively invade surrounding tissue. Although brain cancer rarely spreads to other organs, it will spread to other parts of the brain and central nervous system.

Benign brain tumours usually have clearly defined borders and are not usually deeply rooted in brain tissue. This makes them easier to surgically remove, assuming they are in an area of the brain that can be safely operated on. However, even after they've been removed they can still come back, though benign tumours are less likely than malignant ones to recur.

Although benign tumours in other parts of the body can cause problems, they are not generally considered to be a major health problem or to be life threatening. However, even a benign brain tumour can be a serious health problem. Brain tumours damage the cells around them by causing inflammation and putting increased pressure on the tissue under and around it as well as inside the skull.

What are the symptoms of a braintumour in adults?

Symptoms of brain tumours vary according to the type of tumour and the location. Because different areas of the brain control different functions of the body, where the tumour lies affects the way it's manifested.

Some tumours have no symptoms until they are quite large and then cause a serious, rapid decline in health. Other tumours may have symptoms that develop slowly.

A common initial symptom of a brain tumour is headaches, but a lot of things besides a brain tumour can cause headaches. However, brain tumour headaches may be described as worse in the morning and then better after a couple of hours. Often they occur when a person is sleeping and will cause the person to wake up. The headache may be accompanied by vomiting and may get worse when the person changes position, coughs or exercises. The headaches also typically don't respond well to the usual headache remedies.

Other common symptoms include:

·         Seizures

·         Changes in speech or hearing

·         Changes in vision

·         Balance problems

·         Problems with walking

·         Numbness or tingling in the arms or legs

·         Problems with memory

·         Personality changes

·         Inability to concentrate

·         Weakness in one part of the body

It's important to keep in mind that these symptoms can be caused by a number of different conditions. You shouldn't assume you have a brain tumour just because you experience some of them. Seek medical advice if you are concerned.

How are brain tumours diagnosed?

The doctor starts by asking questions about your symptoms and taking a personal and family health history. Then he or she performs a physical examination, including a neurological examination. If there's reason to suspect a brain tumour, the doctor may request one or more of the following tests:

·         Scanning tests such as a CT (CAT) scan or MRI to see detailed images of the brain.

·         Angiogram, which involves the use of dye and X-rays of blood vessels in the brain to look for signs of blockage.

·         Spinal tap/Lumbar puncture, which examines fluid taken from the spinal cord.

The doctor may also ask for a biopsy to determine whether or not the tumour is cancer. A tissue sample is removed from the brain either during surgery to remove the tumour or with a needle inserted through a small hole drilled into the skull before treatment is started. The sample is then sent to a laboratory to see if there is any cancer present.

Brain Tumor Treatment at World Best Cancer Hospitals in India

• Surgery : Surgery is often the first treatment if the tumour can be removed without causing harm to the surrounding brain tissue. Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors.The team of doctors includes neurosurgeons (surgical specialists in the brain and nervous system), oncologists, radiation oncologists (doctors who practice radiation therapy), and of course, your primary health-care provider. A patient's team may include a dietitian, a social worker, a physical therapist, and probably other specialists.
• Chemotherapy : Chemotherapy is not used to treat all brain tumours. It may be used for people with high-grade primary brain tumours, either as an initial treatment alongside radiotherapy, or where the tumour has come back. In this situation, chemotherapy is unlikely to be able to cure a brain tumour, but it can sometimes shrink a tumour down or slow its growth, which can reduce symptoms.
• Radiation therapy : Radiation therapy (also called radiotherapy) is the use of high-energy rays to kills tumor cells, thereby stopping them from growing and multiplying.Radiation therapy may be used for people who cannot undergo surgery. In other cases, it is used after surgery to kill any tumor calls that may remain. Radiation therapy is a local therapy. This means that it affects only cells in its path. It does not harm cells elsewhere in the body or even elsewhere in the brain
  
  Latest and Advanced Treatment options for Brain Tumor in India

Brain Tumor is no more a scary health condition as modern technology and advanced surgical modalities now offer near perfect clinical outcomes and the patients can soon return to normal life after surgery.

Brain Suite - Intra-operative MR Navigation Microsurgery

Trans-Nasal Endoscopic Removal of brain Tumor through the nose

Stereotactic Radiosurgery - Gamma Knife & Novalis TX

Tumor Embolization using Neuro Interventional Radiology

CyberKnife Radiosurgery