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Emergency

+91-8283838392

For Helpline

0161–6617111




Departments & Clinics

The Centre houses the following Departments :

  • Department of Neurology
  • Department of Neurosurgery (Brain, Spine and Nerves)
  • Department of Interventional Neurology
 

Team of Doctors

Dr. Rupinder Singh Bhatia
  • Senior Consultant & Coordinator
  • Department of Neurology
Dr. Siddhartha Garg
  • Senior Consultant
  • Department of Neurology
Dr. Deepinder Singh
  • Senior Consultant & Coordinator
  • Department of Neuro Surgery
Dr. Sukhdeep Singh Jhawar
  • Senior Consultant
  • Department of Neuro Surgery
Dr. Gurpreet Singh Kochar
  • Senior Consultant
  • Department of Pediatric Neurology

Multiple Sclerosis and Other Demyelinating Diseases

What Is Demyelination?

Highlights

  • Myelin is an insulating material that, when it’s worn away or damaged, decreases nerve function. Damage to myelin is called demyelination.
  • There are different types of demyelination. These include inflammatory demyelination and viral demyelination.
  • MS is the most common demyelinating disease. In MS, demyelination occurs in the white matter of the brain and in the spinal cord.

Nerves send and receive messages from every part of your body and process them in your brain. Nerves allow you to speak, see, feel, and think.

Many nerves are coated in myelin. Myelin is an insulating material that, when it’s worn away or damaged, decreases nerve function. Without myelin, nerves can deteriorate, causing problems in the brain and throughout the body. Damage to myelin around nerves is called demyelination.

Nerves

Nerves are made up of neurons, composed of a cell body, dendrites, and an axon. The axon sends messages from one neuron to the next. The axon also connects neurons to other cells, such as muscle cells.

Some axons are extremely short. Others are 3 feet long. Some axons are covered in myelin. Myelin protects the axons and helps carry axon messages as quickly as possible.

Myelin

Myelin is made of membrane layers that cover an axon. This is similar to the idea of an electrical wire with coating to protect the metal underneath.

Myelin allows a nerve signal to travel faster. In unmyelinated neurons, a signal can travel along the nerves at about 1 meter per second. In a myelinated neuron, the signal can travel 100 meters per second.

Certain diseases can damage myelin. Demyelination slows down messages sent along axons and causes the axon to deteriorate. Depending upon the location of the damage, axon loss can cause problems with feeling, moving, seeing, hearing, and thinking clearly.

Causes of Demyelination

Inflammation is the most common cause of myelin damage. Other causes include:

  • Certain Viral Infections
  • Metabolic Problems
  • Loss of Oxygen
  • Physical Compression

Symptoms of Demyelination

Demyelination prevents nerves from being able to conduct messages to and from the brain. The effects of demyelination can occur rapidly. In Guillain-Barre syndrome (GBS), myelin may only be under attack for a few hours before symptoms appear.

Symptoms can come and go in chronic illnesses like multiple sclerosis (MS) and progress over years. Nerves are a key part of your body functions. Thus, a wide range of symptoms can occur when nerves are affected by demyelination, including:

  • Numbness
  • Loss of reflexes and uncoordinated movements
  • Poorly controlled blood pressure
  • Blurred vision
  • Dizziness
  • Racing heart beat or palpitations
  • Memory Problems
  • Pain
  • Loss of bladder and bowel control
  • Fatigue

Early Symptoms of Demyelination

Not everyone is affected by demyelinating diseases in the same way. However, some demyelinating symptoms are very common. Early symptoms include:

  • Loss of vision
  • Bladder or Bowel problems
  • Unusual Nerve Pain
  • Overall Fatigue

These are among the first signs of a demyelinating disease.

Types of Demyelination

There are different types of demyelination. These include inflammatory demyelination and viral demyelination.

Inflammatory Demyelination

Inflammatory demyelination happens when the body’s immune system attacks myelin. Types of demyelination like MS, optic neuritis, and acute-disseminated encephalomyelitis (ADEM) are caused by inflammation in the brain and spinal cord. Guillain-Barre syndrome (GBS) involves inflammatory demyelination of peripheral nerves in other parts of the body.

Viral Demyelination

Viral demyelination occurs with progressive multifocal leucoencephalopathy (PML). PML is caused by the JC virus. Myelin damage can also occur with alcoholism, liver damage, and electrolyte imbalances. Hypoxic-ischemic demyelination occurs due to a lack of oxygen or vascular disease in the brain.

Demyelination and Multiple Sclerosis

MS is the most common demyelinating disease. According to the National MS Society, it affects 2.3 million people worldwide. In MS, demyelination occurs in the white matter of the brain and in the spinal cord. Lesions or “plaques” then form where myelin is under attack by the immune system. Many of these plaques (or scar tissue) occur throughout the brain over the course of years.

The types of MS are:

  • Relapsing-remitting MS
  • Primary progressive MS
  • Secondary progressive MS
  • Pprogressive relapsing MS

Treatment and Diagnosis

There is no cure for demyelinating diseases. New myelin growth can occur in areas of damage. But new myelin is thinner and not as effective. Research is underway to increase the body’s ability to grow new myelin.

Most treatments of demyelinating disease reduce the immune response using drugs like interferon beta or glatiramer acetate. Also, people with low levels of vitamin D more easily develop MS or demyelinating diseases, so high levels of vitamin D may reduce inflammatory immune response.

Demyelination MRI

Demyelinating diseases, especially MS and optic neuritis (inflammation of the optic nerve), are detectable with MRI scans. MRI scans can often find demyelination plaques in the brain and nerves, especially those caused by MS. Your doctor may be able to locate plaques or lesions affecting your nervous system. Then, treatment can be directed specifically at the source of demyelination in your body

Dementia

Dementia is a collection of symptoms including memory loss, personality change, and impaired intellectual functions resulting from disease or trauma to the brain. These changes are not part of normal aging and are severe enough to impact daily living, independence, and relationships. While Alzheimer’s disease is the most common type of dementia, there are also many other forms, including vascular and mixed dementia.

With dementia, there will likely be noticeable decline in communication, learning, remembering, and problem solving. These changes may occur quickly or very slowly over time.

The progression and outcome of dementia vary, but are largely determined by the type of dementia and which area of the brain is affected. Diagnosis is possible through advanced brain imaging, clinical examinations, and diagnostic testing.

Common signs and symptoms of dementia

  • Memory loss
  • Impaired judgment
  • Difficulties with abstract thinking
  • Faulty reasoning
  • Inappropriate behavior
  • Loss of communication skills
  • Disorientation to time and place
  • Gait, motor, and balance problems
  • Neglect of personal care and safety
  • Hallucinations, paranoia, agitation

Normal memory changes vs. dementia

The inevitable changes of aging can be both humbling and surprising. Skin wrinkles, hair fades, bodies chill, and muscle mass wanes. In addition, the brain shrinks, working memory goes on strike, and mental speed slows. But while many people do experience mild and gradual memory loss after age 40, severe and rapid memory loss is definitely not a part of normal aging. In fact, many people preserve their brainpower as they get older by staying mentally and physically active and making other healthy lifestyle choices.

The most common forms of mental decline associated with aging are:

  • Slower thinking and problem solving – The speed of learning slows down; short-term memory takes longer to function; reaction time increases.
  • Decreased attention and concentration – More distractedness. All of the interruptions make learning more difficult.
  • Slower recall – A greater need for hints to jog the memory.

Distinguishing between normal memory loss and symptoms of dementia is not an exact science but there are some clues to look for:

Normal Memory Changes or Dementia Symptoms?

Typical Aging:

  • Complains about memory loss but able to provide detailed examples of forgetfulness
  • Occasionally searches for words
  • May have to pause to remember directions, but doesn't get lost in familiar places
  • Remembers recent important events; conversations are not impaired
  • Interpersonal social skills are at the same level as they've always been

Symptoms of Dementia:

  • May complain of memory loss only if asked; unable to recall specific instances
  • Frequent word-finding pauses, substitutions
  • Gets lost in familiar places and takes excessive time to return home
  • Notable decline in memory for recent events and ability to converse
  • Loss of interest in social activities; may behave in socially inappropriate ways

What causes Dementia and Its Symptoms?

In a healthy brain, mass and speed may decline in adulthood, but this miraculous machine continues to form vital connections throughout life. However, when connections are lost through inflammation, disease, or injury, neurons eventually die and dementia may result. The prospect of literally losing one's self can be traumatic, but early intervention can dramatically alter the outcome. Understanding the causes of dementia is the first step.

In the past 20 years, scientists have greatly demystified the origins of dementia. Genetics may increase your risks, but scientists believe a combination of hereditary, environmental, and lifestyle factors are most likely at work.

Dementia can be Caused by:

  • Medical conditions that progressively attack brain cells and connections, most commonly seen in Alzheimer's disease, Parkinson's disease, or Huntington's disease.
  • Medical conditions such as strokes that disrupt oxygen flow and rob the brain of vital nutrients. Additional strokes may be prevented by reducing high blood pressure, treating heart disease, and quitting smoking.
  • Poor nutrition, dehydration, and certain substances, including drugs and alcohol. Treating conditions such as insulin resistance, metabolic disorders, and vitamin deficiencies may reduce or eliminate symptoms of dementia.
  • Single trauma or repeated injuries to the brain. Depending on the location of the brain injury, cognitive skills and memory may be impaired.
  • Infection or illness that affects the central nervous system, including Creutzfeldt-Jakob disease and HIV. Some conditions are treatable, including liver or kidney disease, depression-induced pseudo dementia, and operable brain tumors.

Can Dementia be Prevented or Delayed?

Recent research suggests that good health habits and mental stimulation may prevent dementia altogether or at least delay its onset. Just as physical exercise keeps you physically fit, exercising your mind and memory can help you stay mentally sharp, no matter how old you are.

Strategies to improve mental clarity and keep your brain functioning optimally:

  • Exercise consistently
  • Eat a brain-healthy diet
  • Challenge your mind
  • Get regular and restful sleep
  • Minimize stress
  • Avoid smoking and limit drinking

Types of Dementia

All dementias involve cognitive decline that impacts daily living. However, it's important to pinpoint the specific type of dementia in order to optimize treatment. More than 50 conditions involve dementia, but the most common types of dementia are Alzheimer's disease and vascular dementia.

Alzheimer's Disease

Alzheimer's disease is the most common form of dementia, accounting for up to two-thirds of all diagnosed cases. If your dementia symptoms are the result of Alzheimer's disease, medications can delay the onset of more debilitating symptoms. Early diagnosis can prolong independence and is the first step towards treatment, management, and living life fully.

10 Warning Signs of Alzheimer’s Disease

  1. Memory loss sufficient to Disrupt Daily Life – such as forgetting recently learned information, important dates or events, asking for the same information over and over, relying more and more on memory aides or family members.
  2. Problem-solving Difficulties – An inability to follow plans, work with numbers, follow recipes, or keep track of bills.
  3. Trouble completing familiar daily Tasks – Driving to a familiar location, remembering rules to a game, completing assignments at work.
  4. Confusion over Time or Place – Losing track of dates and seasons, or forgetting where you are or how you got there.
  5. Difficulty understanding visual images – Trouble reading, judging distances, colors, or contrast, or recognizing your own reflection.
  6. Problems with spoken or written words – Difficulties following a conversation, finding the right word, or calling things by the wrong name.
  7. Misplacing Things – Putting things in unusual places, unable to retrace steps, accusing others of stealing.
  8. Poor judgment – Decline in decision making, giving away large sums of money, paying less attention to personal grooming.
  9. Withdrawal from work or social activities – Trouble remembering how to complete a work project or favorite hobby, avoiding sports or social events.
  10. Changes in Mood – Becoming confused, depressed, suspicious, fearful, or anxious. Easily upset when out of comfort zone.

Vascular Dementia

Vascular dementia results from a series of small strokes or changes in the brain's blood supply. Sudden onset of symptoms may be a sign of this dementia. Vascular dementia severely impacts memory and cognitive functioning. However, there are ways to prevent and reduce its severity.

Mixed Dementia

Mixed dementia is a condition in which Alzheimer's disease and vascular dementia occur simultaneously. The combination of the two types of dementia most commonly occurs in people of an advanced age, often indicated by cardiovascular disease and dementia symptoms that get worse slowly over time.

Less common forms of Dementia

  • Pick's Disease – Pick's disease affects personality, orientation and behavior. It may be more common in women and occurs at an early age.
  • Creutzfeldt-Jakob Disease – The disease progresses rapidly along with mental deterioration and involuntary movements.
  • Huntington's Disease – Huntington's is an inherited, degenerative disease. The disease causes involuntary movement and usually begins during mid-life.
  • Parkinson's Dementia – Parkinson's is a progressive disorder of the central nervous system. In later stages of Parkinson's disease, some patients develop dementia.
  • Lewy Body Dementia – This disease causes symptoms similar to Alzheimer's disease. Individuals with Lewy Body dementia experience hallucinations and can become fearful.

Epilepsy

Epilepsy is a condition that affects the brain and causes repeated seizures.

Seizures

The cells in the brain, known as neurons, conduct electrical signals and communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses, which can cause the brain and body to behave strangely.

The severity of seizures can differ from person to person. Some people simply experience an odd feeling with no loss of awareness, or may have a "trance-like" state for a few seconds or minutes, while others lose consciousness and have convulsions (uncontrollable shaking of the body).

Some people may only have a single seizure at some point during their life. If they do not have a high risk of having further seizures, they would not be regarded as having epilepsy.

Signs and symptoms

Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.

People with seizures tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to 3 times higher than the general population, with the highest rates found in low- and middle-income countries and rural versus urban areas.

A great proportion of the causes of death related to epilepsy in low- and middle-income countries are potentially preventable, such as falls, drowning, burns and prolonged seizures.

Causes

Epilepsy is not contagious. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and has no identifiable cause.

Epilepsy with a known cause is called secondary epilepsy, or symptomatic epilepsy. The causes of secondary (or symptomatic) epilepsy could be:

  • Brain damage from prenatal or perinatal injuries (e.g. a loss of oxygen or trauma during birth, low birth weight),
  • Congenital abnormalities or genetic conditions with associated brain malformations,
  • A severe head injury,
  • A stroke that restricts the amount of oxygen to the brain,
  • An infection of the brain such as meningitis, encephalitis, neurocysticercosis,
  • Certain genetic syndromes,
  • A brain tumor.

Diagnosing epilepsy

Epilepsy is usually difficult to diagnose quickly. In most cases, it cannot be confirmed until you have had more than one seizure.

It can be difficult to diagnose because many other conditions, such as migraines and panic attacks, can cause similar symptoms.

If you have had a seizure, you will be referred to a specialist in epilepsy, normally a neurologist (a doctor who specialises in conditions affecting the brain and nervous system).

The doctor will ask about your medical and personal history and whether you use any medicines, drugs or alcohol.

The doctor may be able to make a diagnosis of epilepsy from the information you give, but they might run further tests such as an electroencephalogram (EEG) or magnetic resonance imaging (MRI) scan.

However, even if these tests don't show anything, it is still possible that you have epilepsy.

Treating epilepsy

Treatment for epilepsy is used to control seizures, although not everyone with the condition will need to be treated.

It may sometimes be possible to control your epilepsy solely by avoiding things that trigger your seizures, such as sleep deprivation and alcohol.

While some people may need to be treated for the rest of their lives, this is not always the case. Sometimes people have epileptic seizures at one stage in their life, only for them to become less frequent or disappear as they get older. This is more common if seizures first occur in childhood or early adulthood.

Treatment overview

Anti-epileptic drugs (AEDs) are usually the first choice of treatment for epilepsy. About 70% of people with the condition are able to control their seizures with AEDs.

Usually, AED treatment will not begin until after you have had a second seizure because a single seizure is not necessarily a reliable indicator that you have epilepsy.

In some cases, treatment may begin after a first seizure if:

  • An electroencephalogram (EEG) shows brain activity associated with epilepsy
  • A magnetic resonance imaging (MRI) scan shows damage to the brain
  • You have a condition that has damaged the brain, such as a stroke

For some people, brain surgery may be an option. However, this is only the case if removing the area of the brain where epileptic activity starts would not cause damage or disability. If successful, there is a chance your epilepsy will be cured.

If surgery is not an option, an alternative may be to implant a small device under the skin of the chest. The device sends electrical messages to the brain. This is called vagus nerve stimulation.

Sometimes, a special diet is used for children whose seizures are difficult to control and do not respond to treatment with medication.

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