uscular dystrophy
The symptoms of muscular dystrophy (MD) and their severity will vary from person to person. They will depend on:
* the type of MD that you have, and
* when your symptoms first appeared.
Some of the more common symptoms for some types of MD are explained below. See the useful links section for more information about these and other types of MD.
Duchenne muscular dystrophy
Your child will first start to show signs of Duchenne MD between 1-3 years of age. The muscles around the pelvis and thighs tend to be affected first. They often appear bulkier than normal even though there is progressive weakening. Your child may:
* have difficulty walking,
* have difficulty standing up,
* be unable to climb the stairs without support, and
* have learning, or behavioural, difficulties.
Children with Duchenne MD may need a wheelchair by 10 years of age. They can also develop scoliosis, which is where their spine begins to curve sideways. This can lead to one shoulder, or one hip, being higher than the other.
By the mid-teens, some people with Duchenne MD will develop dilated cardiomyopathy. This is where the condition affects your heart muscles, causing the chambers of the heart to become enlarged and the heart walls to become thinner.
By late teens, or early twenties, Duchenne MD can begin to cause respiratory (breathing) problems. The condition can affect your intercostal muscles (the muscle tissue between your ribs) and your diaphragm (the main muscle between the chest and the abdomen that you use during breathing).
Once the heart and respiratory muscles are damaged, Duchenne MD becomes life-threatening. In most cases, someone with Duchenne MD will die from cardiac or respiratory failure before they are 30 years of age.
Becker muscular dystrophy
The symptoms of Becker MD are similar to those of Duchenne muscular dystrophy. However, they are milder and do not usually appear until a person is 10 or 11 years of age, or older. If your child has Becker MD, they may:
* be late learning to walk,
* have muscle cramps when exercising (a painful spasm in the muscle), and
* struggle with sport at school.
In their teenage years, and throughout their twenties, people with Becker MD may have difficulty running, walking quickly, and climbing stairs. As they get older, they may find it difficult to lift objects above waist height and, by around 40 or 50 years of age, they may need to use a wheelchair.
If you have Becker MD, you are also at risk of developing dilated cardiomyopathy and respiratory problems. However, Becker MD progresses at a slower rate than Duchenne MD, and those with the condition usually live a normal lifespan.
Myotonic muscular dystrophy
As with other types of muscular dystrophy, myotonic MD involves progressive muscle weakness and wasting. However, it is the smaller muscles, such as those in your face, jaw, neck, and hands that are affected, rather than the larger muscle groups in the legs.
Symptoms can include:
* myotonia (muscle stiffness),
* cataracts (cloudy patches in the lens inside your eye),
* hormonal problems,
* hypersomnolence (excessive sleeping or sleepiness), and
* behavioural problems in children.
Myotonic MD can also cause cardiac conduction abnormalities. Your cardiac conduction system generates the electrical impulses that stimulate your heart to pump. Abnormalities can cause slow and irregular heart beats (cardiac arrhythmia). Serious problems can develop in about 60-70 per cent of people who have these abnormalities. In some cases, it can cause sudden death.
Myotonic MD can appear at any time from between birth to old age, and it affects both males and females equally. The rate of deterioration is often very slow, with little change over a long period of time. You may never experience significant disability, although your heart rate will need to be monitored for abnormalities.
Limb-girdle muscular dystrophy
The symptoms of limb-girdle MD often begin during late childhood or early adulthood. There are about 15 different varieties that affect both sexes equally.
Limb-girdle MD causes weakness in the big muscle groups in your arms and legs. It usually starts with the hip girdle and progresses to the shoulder girdle (‘girdle’ means the bones that encircle this area).
If you have limb-girdle MD, you may experience:
* muscle weakness in your hips, thighs, and arms,
* loss of muscle mass in the affected areas,
* back pain, and
* heart palpitations or cardiac arrhythmias (irregular heart beats).
The muscle weakness will create problems such as:
* difficulty getting out of a low seat,
* difficulty lifting objects, and
* difficulty running.
Within 20-30 years, limb-girdle MD can progress to a level of fairly severe disability. However, the variations within this type of condition mean that your rate of progression could be better, or worse, than this.
Facioscapulohumeral muscular dystrophy
Facioscapulohumeral MD can affect both males and females. It tends to affect men slightly more than women, although the reason for this is unclear. The condition usually develops between 10 and 40 years of age and progresses slowly.
Symptoms in your child may include:
* they sleep with their eyes slightly open,
* they cannot squeeze their eyes tightly shut, and/or
* they cannot purse their lips (for example to blow up balloons).
Teenagers or adults may have aches in their shoulders, rounded shoulders, or thin upper arms. As the condition progresses, it usually affects:
* the muscles in your face (facio),
* the muscles in your shoulders (scapula),
* the muscles in your upper arms (humeral), and
* the muscles of your upper back.
In around 50 per cent of people with facioscapulahumeral MD, their leg muscles will also be affected. Between 10-20 per cent of people will require a wheelchair.
Facioscapulahumeral MD can develop unevenly, so that the muscles on one side of your body are affected more than the other. Some people may not even be aware that they have the condition until they reach old age. The slow progression means that it does not usually shorten life expectancy.
Oculopharyngeal muscular dystrophy
In oculopharyngeal MD, symptoms are not usually apparent until a person is around 50 or 60 years of age. However, the abnormal gene that causes the condition will have been present since birth. It affects the muscles in your eyes (ocular) and your throat (pharyngeal).
Symptoms of oculopharyngeal MD can include:
* ptosis (droopy eyelids),
* dysphagia (difficulty swallowing),
* progressive restriction of eye movement as the eye muscles are affected, and
* limb weakness around the shoulders and hips.
As your eyelids droop, they can cover your eyes and impair your vision. It is also possible to develop diplopia (double vision). This occurs if your eye muscles are affected unevenly and your eyes start to look in slightly different directions.
The dysphagia can eventually make it hard to swallow both solid foods and liquids, and even small amounts of saliva. However, with treatment to manage the symptoms, a person’s life expectancy is not usually altered.
बुधवार, 28 जुलाई 2010
* Definition * Symptoms * Causes
* Definition
* Symptoms
* Causes
* Preparing for your appointment
* Tests and diagnosis
* Treatments and drugs
* Coping and support
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Symptoms
By Mayo Clinic staff
Signs and symptoms vary according to the type of muscular dystrophy. In general, muscular dystrophy symptoms may include:
* Muscle weakness
* Apparent lack of coordination
* Progressive crippling, resulting in fixations (contractures) of the muscles around your joints and loss of mobility
Specific signs and symptoms vary among the different forms of MD. Each type is different in the age of onset, which parts of the body the symptoms primarily affect and how rapidly the disease progresses.
Dystrophinopathies
These types of muscular dystrophies are due to a genetic defect of the protein dystrophin.
Duchenne's muscular dystrophy is the most severe form of dystrophinopathy. It occurs mostly in young boys and is the most common form of MD that affects children. Signs and symptoms of Duchenne's MD may include:
* Frequent falls
* Large calf muscles
* Difficulty getting up from a lying or sitting position
* Weakness in lower leg muscles, resulting in difficulty running and jumping
* Waddling gait
* Mild mental retardation, in some cases
Signs and symptoms of Duchenne's usually appear between the ages of 2 and 3. It first affects the muscles of the pelvis, upper arms and upper legs. By late childhood, most children with this form of muscular dystrophy are unable to walk. Most die by their 20s or early 30s, often from pneumonia, respiratory muscle weakness or cardiac complications. Some people with Duchenne's MD may exhibit curvature of their spine (scoliosis).
Becker's muscular dystrophy is a milder form of dystrophinopathy. It generally affects older boys and young men, and progresses more slowly, usually over several decades. Signs and symptoms of Becker's MD are similar to those of Duchenne's. The onset of the signs and symptoms is generally around age 11, but may not occur until the mid-20s or even later. Those affected by Becker's MD usually are able to walk through their teens, and often well into adulthood.
Myotonic dystrophy
Also known as Steinert's disease, this form of muscular dystrophy produces stiffness of muscles and an inability to relax muscles at will (myotonia), as well as the muscle weakness of the other forms of muscular dystrophy.
Although this form of MD can affect children, it often doesn't affect people until adulthood. It can vary greatly in its severity. Muscles may feel stiff after using them. Progression of this form of MD is slow. Besides myotonia, signs and symptoms of adult-onset myotonic dystrophy may include:
* Weakening of voluntary muscles that control your arms and legs, usually beginning with the limb muscles farthest from the torso — the muscles of the feet, hands, lower legs and forearms.
* Weakening of head, neck and face muscles, which may result in the face having a hollow, drooped appearance.
* Weakening of muscles involved in breathing and swallowing. Weaker breathing muscles may result in less oxygen intake and fatigue. Weaker swallowing muscles increase the risk of choking.
* Fainting or dizziness, which may indicate that the disease is interfering with the conduction of electrical signals that keep the heart rate normal.
* Weakening of muscles of hollow internal organs such as those in the digestive tract and the uterus. Depending on which part of the digestive tract is affected, you may experience problems with swallowing as well as constipation and diarrhea. Weakness of the uterine walls may cause problems during childbirth.
* Difficulty sleeping well at night and daytime sleepiness, and inability to concentrate because of the effect of the disease on the brain.
* Frontal balding in men.
* Clouding of the lenses of the eyes (cataracts).
* Mild diabetes.
Rarely, infants have this form of muscular dystrophy, in which case it's called congenital myotonic dystrophy. The infant form is more severe, although infants with myotonic dystrophy don't experience myotonia. Signs in infants may include:
* Severe muscle weakness
* Difficulty sucking and swallowing
* Difficulty breathing
* Cognitive impairment
Facioscapulohumeral muscular dystrophy
Also known as Landouzy-Dejerine dystrophy, this form involves progressive muscle weakness involving:
* Face
* Shoulders
* Abdomen
* Feet
* Upper arms
* Pelvic area
* Lower arms
When someone with facioscapulohumeral MD raises his or her arms, the shoulder blades may stick out like wings. Progression of this form is slow, with some spurts of rapidly increasing weakness. Onset usually occurs during the teen to early adult years.
Other major types of muscular dystrophy
The other major types of muscular dystrophy include:
* Limb-girdle muscular dystrophy
* Congenital muscular dystrophy
* Oculopharyngeal muscular dystrophy
* Distal muscular dystrophy
* Emery-Dreifuss muscular dystrophy
* Myofibrillar myopathies
Limb-girdle muscular dystrophy
Muscles usually affected first by this form of muscular dystrophy include:
* Hips
* Shoulders
This form then progresses to the arms and legs, though progression is slow. Limb-girdle MD may begin from early childhood to adulthood.
Congenital muscular dystrophy
The term "congenital muscular dystrophy" refers to a group of inherited muscular dystrophies. Signs of these disorders may include:
* General muscle weakness
* Joint deformities
Congenital MD is apparent at birth or becomes evident before age 2. The course of this disorder varies significantly depending on the type. Some forms of congenital MD progress slowly and cause only mild disability, while others progress rapidly and cause severe impairment.
Oculopharyngeal muscular dystrophy
The first sign of this type of muscular dystrophy is usually drooping of the eyelids, followed by weakness of the muscles of the eye, face and throat, resulting in difficulty swallowing. Progression is slow. Signs and symptoms first appear in adulthood, usually in a person's 40s or 50s.
Distal muscular dystrophy
This group involves the muscles farthest away from the center of the body (distal muscles) — those of the hands, forearms, feet and lower legs. The severity is generally less than for other forms of MD, and this form tends to progress slowly. Distal MD generally begins in adulthood between the ages of 40 and 60.
Emery-Dreifuss muscular dystrophy
This form of muscular dystrophy usually begins in the muscles of the:
* Shoulders
* Upper arms
* Shins
Cardiac arrhythmias, stiffness of the spine and muscle contractures are other features of Emery-Dreifuss MD. Emery-Dreifuss MD usually begins in the childhood to early teen years and progresses slowly.
Myofibrillar myopathies (MFMs)
Though in some cases the MFMs affect only the muscles closest to the center of the body (proximal muscles) — such as the shoulder and hip muscles — the distal muscles also are usually involved. This group of muscle disorders also is commonly associated with:
* Stiffness of the spine
* Muscle contractures
* Nerve damage (peripheral neuropathy)
* Thickening and stiffening of the heart muscle (cardiomyopathy)
When to see a doctor
Duchenne's muscular dystrophy occurs almost exclusively in boys, although it can occur in girls. Your young child may have difficulty walking, running, rising from the floor or climbing the stairs, or may appear clumsy and fall often. These may be early indications of muscular dystrophy.
A child with MD may learn to walk later than other children do and may exhibit signs of muscle weakness between the ages of 2 and 6. By school age, a child with MD may walk unsteadily and on the toes or balls of the feet. Duchenne's MD usually results in children losing the ability to walk by age 12.
See your doctor if you're concerned about your child's:
* Motor abilities
* Clumsiness
* Muscle strength
* Muscle development
Once muscular dystrophy is diagnosed, medications and physical therapy can help slow its progression.
Because muscular dystrophies are inherited disorders, genetic counseling may be helpful if you're considering having children and to assess the risk of the disease in other family members.
* Symptoms
* Causes
* Preparing for your appointment
* Tests and diagnosis
* Treatments and drugs
* Coping and support
Mayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
Free
E-Newsletters
Subscribe to receive the latest updates on health topics. About our newsletters
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* Free e-newsletters
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* We do not share your e-mail address
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Symptoms
By Mayo Clinic staff
Signs and symptoms vary according to the type of muscular dystrophy. In general, muscular dystrophy symptoms may include:
* Muscle weakness
* Apparent lack of coordination
* Progressive crippling, resulting in fixations (contractures) of the muscles around your joints and loss of mobility
Specific signs and symptoms vary among the different forms of MD. Each type is different in the age of onset, which parts of the body the symptoms primarily affect and how rapidly the disease progresses.
Dystrophinopathies
These types of muscular dystrophies are due to a genetic defect of the protein dystrophin.
Duchenne's muscular dystrophy is the most severe form of dystrophinopathy. It occurs mostly in young boys and is the most common form of MD that affects children. Signs and symptoms of Duchenne's MD may include:
* Frequent falls
* Large calf muscles
* Difficulty getting up from a lying or sitting position
* Weakness in lower leg muscles, resulting in difficulty running and jumping
* Waddling gait
* Mild mental retardation, in some cases
Signs and symptoms of Duchenne's usually appear between the ages of 2 and 3. It first affects the muscles of the pelvis, upper arms and upper legs. By late childhood, most children with this form of muscular dystrophy are unable to walk. Most die by their 20s or early 30s, often from pneumonia, respiratory muscle weakness or cardiac complications. Some people with Duchenne's MD may exhibit curvature of their spine (scoliosis).
Becker's muscular dystrophy is a milder form of dystrophinopathy. It generally affects older boys and young men, and progresses more slowly, usually over several decades. Signs and symptoms of Becker's MD are similar to those of Duchenne's. The onset of the signs and symptoms is generally around age 11, but may not occur until the mid-20s or even later. Those affected by Becker's MD usually are able to walk through their teens, and often well into adulthood.
Myotonic dystrophy
Also known as Steinert's disease, this form of muscular dystrophy produces stiffness of muscles and an inability to relax muscles at will (myotonia), as well as the muscle weakness of the other forms of muscular dystrophy.
Although this form of MD can affect children, it often doesn't affect people until adulthood. It can vary greatly in its severity. Muscles may feel stiff after using them. Progression of this form of MD is slow. Besides myotonia, signs and symptoms of adult-onset myotonic dystrophy may include:
* Weakening of voluntary muscles that control your arms and legs, usually beginning with the limb muscles farthest from the torso — the muscles of the feet, hands, lower legs and forearms.
* Weakening of head, neck and face muscles, which may result in the face having a hollow, drooped appearance.
* Weakening of muscles involved in breathing and swallowing. Weaker breathing muscles may result in less oxygen intake and fatigue. Weaker swallowing muscles increase the risk of choking.
* Fainting or dizziness, which may indicate that the disease is interfering with the conduction of electrical signals that keep the heart rate normal.
* Weakening of muscles of hollow internal organs such as those in the digestive tract and the uterus. Depending on which part of the digestive tract is affected, you may experience problems with swallowing as well as constipation and diarrhea. Weakness of the uterine walls may cause problems during childbirth.
* Difficulty sleeping well at night and daytime sleepiness, and inability to concentrate because of the effect of the disease on the brain.
* Frontal balding in men.
* Clouding of the lenses of the eyes (cataracts).
* Mild diabetes.
Rarely, infants have this form of muscular dystrophy, in which case it's called congenital myotonic dystrophy. The infant form is more severe, although infants with myotonic dystrophy don't experience myotonia. Signs in infants may include:
* Severe muscle weakness
* Difficulty sucking and swallowing
* Difficulty breathing
* Cognitive impairment
Facioscapulohumeral muscular dystrophy
Also known as Landouzy-Dejerine dystrophy, this form involves progressive muscle weakness involving:
* Face
* Shoulders
* Abdomen
* Feet
* Upper arms
* Pelvic area
* Lower arms
When someone with facioscapulohumeral MD raises his or her arms, the shoulder blades may stick out like wings. Progression of this form is slow, with some spurts of rapidly increasing weakness. Onset usually occurs during the teen to early adult years.
Other major types of muscular dystrophy
The other major types of muscular dystrophy include:
* Limb-girdle muscular dystrophy
* Congenital muscular dystrophy
* Oculopharyngeal muscular dystrophy
* Distal muscular dystrophy
* Emery-Dreifuss muscular dystrophy
* Myofibrillar myopathies
Limb-girdle muscular dystrophy
Muscles usually affected first by this form of muscular dystrophy include:
* Hips
* Shoulders
This form then progresses to the arms and legs, though progression is slow. Limb-girdle MD may begin from early childhood to adulthood.
Congenital muscular dystrophy
The term "congenital muscular dystrophy" refers to a group of inherited muscular dystrophies. Signs of these disorders may include:
* General muscle weakness
* Joint deformities
Congenital MD is apparent at birth or becomes evident before age 2. The course of this disorder varies significantly depending on the type. Some forms of congenital MD progress slowly and cause only mild disability, while others progress rapidly and cause severe impairment.
Oculopharyngeal muscular dystrophy
The first sign of this type of muscular dystrophy is usually drooping of the eyelids, followed by weakness of the muscles of the eye, face and throat, resulting in difficulty swallowing. Progression is slow. Signs and symptoms first appear in adulthood, usually in a person's 40s or 50s.
Distal muscular dystrophy
This group involves the muscles farthest away from the center of the body (distal muscles) — those of the hands, forearms, feet and lower legs. The severity is generally less than for other forms of MD, and this form tends to progress slowly. Distal MD generally begins in adulthood between the ages of 40 and 60.
Emery-Dreifuss muscular dystrophy
This form of muscular dystrophy usually begins in the muscles of the:
* Shoulders
* Upper arms
* Shins
Cardiac arrhythmias, stiffness of the spine and muscle contractures are other features of Emery-Dreifuss MD. Emery-Dreifuss MD usually begins in the childhood to early teen years and progresses slowly.
Myofibrillar myopathies (MFMs)
Though in some cases the MFMs affect only the muscles closest to the center of the body (proximal muscles) — such as the shoulder and hip muscles — the distal muscles also are usually involved. This group of muscle disorders also is commonly associated with:
* Stiffness of the spine
* Muscle contractures
* Nerve damage (peripheral neuropathy)
* Thickening and stiffening of the heart muscle (cardiomyopathy)
When to see a doctor
Duchenne's muscular dystrophy occurs almost exclusively in boys, although it can occur in girls. Your young child may have difficulty walking, running, rising from the floor or climbing the stairs, or may appear clumsy and fall often. These may be early indications of muscular dystrophy.
A child with MD may learn to walk later than other children do and may exhibit signs of muscle weakness between the ages of 2 and 6. By school age, a child with MD may walk unsteadily and on the toes or balls of the feet. Duchenne's MD usually results in children losing the ability to walk by age 12.
See your doctor if you're concerned about your child's:
* Motor abilities
* Clumsiness
* Muscle strength
* Muscle development
Once muscular dystrophy is diagnosed, medications and physical therapy can help slow its progression.
Because muscular dystrophies are inherited disorders, genetic counseling may be helpful if you're considering having children and to assess the risk of the disease in other family members.
गुरुवार, 22 जुलाई 2010
pints of neurotherapy
Neurotherapy is an alternative way of healing; it has shown some very good results in case of mentally retarded children. The main philosophy behind this science is that the flow of blood is directed towards particularly weaker organs, thereby rejuvenating the organ over a period of time. Thus, it heals the disease without recourse to medicines.
Science of neurotherapy: - Neurotherapy deals with the whole body/mind system in totality. The therapy uses the by-now well-established knowledge, that our body, like all other living beings in the universe, has the vital energy to cure itself, without any interference from external sources. It does not require chemicals or medicines from outside, because the body heals itself by creating the requisite hormones and chemicals.
The philosophy behind neurotherapy involves activating or deactivating to the organ(s), through pressure or massage on the nerve channels to stimulate or depress the blood, & other body fluids and the nerve currents so as to restoring the balance and harmony of the body thus helping the body regain its equilibrium. The therapy focuses at the cause not at the symptoms of the disease.
We seek to propagate this therapy to serve humanity in better way, because this therapy can cure many diseases without any side effect and improves wholesome personality of the person
The human body contains different organs and gland which have specific functions to do. Each releases certain chemicals and hormones in specified quantity which take care of bodily activities e.g. Mouth secretes saliva which helps in digestion, intestines absorbs the nutrients from digested food etc. When each organs / glands are functioning normally and releasing their secretion properly then equilibrium of the body or health is in balance. If these organs, glands doesn't work properly and their secretions are impaired (either increased or decreased) then it leads to disorder or disease.
In the human body there are clotting factors and anti coagulants. Heparin and Plasmin are the two major anti coagulants which removes the clots in the blood. Plasmin and Heparin are produced in the lungs and liver (85%) and each and every cell (15%). In pulmonary circulation blood goes from heart to lungs for exchange of gases. Blood remains in the lungs for 0.02 sec. and , during that time heparin and plasmin are released from lungs into the blood and removes / clears all the clots of the blood or any other part of body. Same thing happens during the portal circulation also where blood goes to liver for detoxification.
In this science, around 80 points have been developed in our bodies which are pressed in such a way that blood supply is directed towards weaker portions of the body.
No instrument is used during the treatment. Body of patient is pressed with help of hands and feet for fixed time at fixed points. Patients get treatment without any pain.The diagnosis of the patient is done after watching wholesome life pattern and series of events that led to the disease. However the ND does not shy away from modern techniques to diagnose the disease correctly. The diagnosis of the disease is done with the help of modern technique but also, the initial consultation involves taking the total health history of the patient. If necessary, a further series of questions are asked to the patient. A visual analyze is carried out by examining the eyes, color of the tongue, nails, skin, etc.
Once the verbal and visual analyze are completed, further investigation involves abdominal palpation, that’s examining the tender points. Focusing on these tender points the therapist discovers the malfunctioning of any organ(s).
Based on these investigations, a final picture is drawn about the patient's condition in relation to the three biochemical forces; Alkaline-Acid-Gas. And then treatment of neurotherapy starts.
More about Neurotherapy
Although neurotherapy is boon for disabled children yet it has been extremely helpful for many other diseases particularly paralysis, joint pain, arthritis, hormonal imbalances, diabetes. No instrument is used during the treatment. Body of patient is pressed with help of hands and feet for fixed time at fixed points. Patients get treatment without any pain.
Successfully treated diseases
Mentally retarded child, Paralysis, Joint Pain, Chronic constipation, tail bone pain, Depression, Vertigo, Piles, Obesity, Hypothyroid, Insomnia, Anal fistula, Cramps, Diabetes, Cervical spondylitis, Arthritis, Angina pectoris, Menses related problem, Tennis elbow, Swelling, hair falling, Tilt, Allergy, Gastric problem, Motor neuron disease.
Some of the pressure points used in neurotherapy are described below:-
Liver Point
Liver is stimulated with supply of blood to get rid off many diseases such as heart diseases, fever, infection etc. The stimulation of liver is done by applying pressure. Time and frequency of pressure is changed according to the diseases. Like for example by applying pressure once we can increase Hemoglobin levels by doing it four times we can reduce cholesterol levels and by doing it 12 times we can produce cholic acid.
Adrenal Glands Point
Stimulation of Adrenal will help in treating Polio, Pain Joints, Medicines Side effects, inflammation, Auto-immune disease to reduce the effect of poison. It can be source of Glucio-corticoids, minerals and corticoids when stimulated with blood supply. It is often used to cure autoimmune diseases, inflammation and negative effect of diseases.
Kundli Point
Stimulation of Pineal gland help to treat infection Inflammation, to increase Melatonin level in blood, stop pre mature old age. Pineal is activated to produce Melatonin which is used to maintain and prolong youth. Activity of pineal is also important for diseases infections and inflammations.
Neck Less Point
In Neurotherapy, this point help to treat Headache, Tiredness, Migraine. Necklace is extremely important point to treat in different types of headaches like tension, migraine etc. It relaxes muscles and brings calmness to mind and body.
Medulla Point
By stimulation Medulla, We can stimulate Hypothalamus, Cranial nerves III, IV, VI.
By stimulating Vagus 10th , we can stimulate serotonin, Acetylcholine, Dopamine.
Depending upon the frequency of applying pressure at medulla point. Medulla point, if applied six times can be used to stimulate hypothalamus. It also reduces pain by not allowing sensory nerves to go to brain.
If applied 8 times it releases Serotonin, which in turn is useful in treatment of Insomnia.
When applied 20 times it releases dopamine and is given to patients of idiopathic Parkinson’s disease.
When applied 30 times it releases Prostaglandin.
Pancreas Point
Stimulation of Pancreas help to treat Sugar, Cataract, Tumour Cyst, HBP, Renal diseases, Weakness, Loss of appetite, Eye- diseases, Skin problem cracked heels. Pan point also help for somatostatin, Glycogen, Pancreatic enzymes.
Basic fundamental of neurotherapy is to apply pressure is to stimulate the organ. When pressure is applied to pancreas point 2 times it produces Somatostatin, when given 5 times it stimulates pancreatic enzymes to dilute acidity of stomach. When given 10 times , it reduces triglycerides.
Science of neurotherapy: - Neurotherapy deals with the whole body/mind system in totality. The therapy uses the by-now well-established knowledge, that our body, like all other living beings in the universe, has the vital energy to cure itself, without any interference from external sources. It does not require chemicals or medicines from outside, because the body heals itself by creating the requisite hormones and chemicals.
The philosophy behind neurotherapy involves activating or deactivating to the organ(s), through pressure or massage on the nerve channels to stimulate or depress the blood, & other body fluids and the nerve currents so as to restoring the balance and harmony of the body thus helping the body regain its equilibrium. The therapy focuses at the cause not at the symptoms of the disease.
We seek to propagate this therapy to serve humanity in better way, because this therapy can cure many diseases without any side effect and improves wholesome personality of the person
The human body contains different organs and gland which have specific functions to do. Each releases certain chemicals and hormones in specified quantity which take care of bodily activities e.g. Mouth secretes saliva which helps in digestion, intestines absorbs the nutrients from digested food etc. When each organs / glands are functioning normally and releasing their secretion properly then equilibrium of the body or health is in balance. If these organs, glands doesn't work properly and their secretions are impaired (either increased or decreased) then it leads to disorder or disease.
In the human body there are clotting factors and anti coagulants. Heparin and Plasmin are the two major anti coagulants which removes the clots in the blood. Plasmin and Heparin are produced in the lungs and liver (85%) and each and every cell (15%). In pulmonary circulation blood goes from heart to lungs for exchange of gases. Blood remains in the lungs for 0.02 sec. and , during that time heparin and plasmin are released from lungs into the blood and removes / clears all the clots of the blood or any other part of body. Same thing happens during the portal circulation also where blood goes to liver for detoxification.
In this science, around 80 points have been developed in our bodies which are pressed in such a way that blood supply is directed towards weaker portions of the body.
No instrument is used during the treatment. Body of patient is pressed with help of hands and feet for fixed time at fixed points. Patients get treatment without any pain.The diagnosis of the patient is done after watching wholesome life pattern and series of events that led to the disease. However the ND does not shy away from modern techniques to diagnose the disease correctly. The diagnosis of the disease is done with the help of modern technique but also, the initial consultation involves taking the total health history of the patient. If necessary, a further series of questions are asked to the patient. A visual analyze is carried out by examining the eyes, color of the tongue, nails, skin, etc.
Once the verbal and visual analyze are completed, further investigation involves abdominal palpation, that’s examining the tender points. Focusing on these tender points the therapist discovers the malfunctioning of any organ(s).
Based on these investigations, a final picture is drawn about the patient's condition in relation to the three biochemical forces; Alkaline-Acid-Gas. And then treatment of neurotherapy starts.
More about Neurotherapy
Although neurotherapy is boon for disabled children yet it has been extremely helpful for many other diseases particularly paralysis, joint pain, arthritis, hormonal imbalances, diabetes. No instrument is used during the treatment. Body of patient is pressed with help of hands and feet for fixed time at fixed points. Patients get treatment without any pain.
Successfully treated diseases
Mentally retarded child, Paralysis, Joint Pain, Chronic constipation, tail bone pain, Depression, Vertigo, Piles, Obesity, Hypothyroid, Insomnia, Anal fistula, Cramps, Diabetes, Cervical spondylitis, Arthritis, Angina pectoris, Menses related problem, Tennis elbow, Swelling, hair falling, Tilt, Allergy, Gastric problem, Motor neuron disease.
Some of the pressure points used in neurotherapy are described below:-
Liver Point
Liver is stimulated with supply of blood to get rid off many diseases such as heart diseases, fever, infection etc. The stimulation of liver is done by applying pressure. Time and frequency of pressure is changed according to the diseases. Like for example by applying pressure once we can increase Hemoglobin levels by doing it four times we can reduce cholesterol levels and by doing it 12 times we can produce cholic acid.
Adrenal Glands Point
Stimulation of Adrenal will help in treating Polio, Pain Joints, Medicines Side effects, inflammation, Auto-immune disease to reduce the effect of poison. It can be source of Glucio-corticoids, minerals and corticoids when stimulated with blood supply. It is often used to cure autoimmune diseases, inflammation and negative effect of diseases.
Kundli Point
Stimulation of Pineal gland help to treat infection Inflammation, to increase Melatonin level in blood, stop pre mature old age. Pineal is activated to produce Melatonin which is used to maintain and prolong youth. Activity of pineal is also important for diseases infections and inflammations.
Neck Less Point
In Neurotherapy, this point help to treat Headache, Tiredness, Migraine. Necklace is extremely important point to treat in different types of headaches like tension, migraine etc. It relaxes muscles and brings calmness to mind and body.
Medulla Point
By stimulation Medulla, We can stimulate Hypothalamus, Cranial nerves III, IV, VI.
By stimulating Vagus 10th , we can stimulate serotonin, Acetylcholine, Dopamine.
Depending upon the frequency of applying pressure at medulla point. Medulla point, if applied six times can be used to stimulate hypothalamus. It also reduces pain by not allowing sensory nerves to go to brain.
If applied 8 times it releases Serotonin, which in turn is useful in treatment of Insomnia.
When applied 20 times it releases dopamine and is given to patients of idiopathic Parkinson’s disease.
When applied 30 times it releases Prostaglandin.
Pancreas Point
Stimulation of Pancreas help to treat Sugar, Cataract, Tumour Cyst, HBP, Renal diseases, Weakness, Loss of appetite, Eye- diseases, Skin problem cracked heels. Pan point also help for somatostatin, Glycogen, Pancreatic enzymes.
Basic fundamental of neurotherapy is to apply pressure is to stimulate the organ. When pressure is applied to pancreas point 2 times it produces Somatostatin, when given 5 times it stimulates pancreatic enzymes to dilute acidity of stomach. When given 10 times , it reduces triglycerides.
मंगलवार, 20 जुलाई 2010
cp
Neurotherapy is a veritable break-through in the world of healing!
Though the therapy is a panacea for most disorders plaguing mankind, it is highly effective in treating special children - who are mentally and/or physically challenged, bringing about a substantial improvement in the quality of their life.
It has its roots in a very old therapy of ancient India, which has been revamped and revived by the efforts of Dr. Lajpatrai Mehra of Mumbai, India, who is the founder of this unique technique.
The healing effects of Neurotherapy cover a wide spectrum of disorders in both the young and the old alike.
Among children, we have brought substantial improvement in the quality of life in children with congenital problems such as hole in the heart, club foot and also in children with genetic disorders such as Down Syndrome.
However, the uniqueness of this therapy lies in the fact that it has produced quite remarkable results in treating the following disorders, too.
* Cerebral palsy
* Spasticity
* Epilepsy
* Fits
* Mental retardation
* ADHD (Attention Deficit Hyperactivity Disorder)
What is the Definition of Cerebral Palsy?
Cerebral palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development, or during infancy. It can also occur before, during or shortly following birth.
"Cerebral" refers to the cerebrum. This is the upper crust of the brain. This is the area concerned with sending signals for voluntary movement of all parts of the body.
"Palsy" or paralysis means a disorder of movement or posture. If someone has cerebral palsy, it means that because of an injury to the cerebrum, they are not able to use some of the muscles in their body in the normal way (palsy). Children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children. However there are cases where children with CP have even excelled in some fields. The most recent example is the case of the young boy in a wheelchair on TV Laughter Channel, who, from the age of six or so became a participant in the channel. Today, inspite of this disability, he has risen from the ranks of a participant to become a formidable anchor of the program.
Cerebral palsy is neither progressive nor communicable. It is also not "curable" in the accepted sense of allopathic medicine, although education, physiotherapy and applied technology can help the stiffening of the muscles. It is important to know that cerebral palsy is not a disease or illness. It isn\'t contagious and it doesn\'t get worse. Children who have cerebral palsy will have to live with it all their lives.
Cerebral palsy is characterized by an inability to fully control motor function, particularly muscle control and coordination. Depending on which areas of the brain have been damaged, one or more of the following may occur:
* muscle tightness or spasm
* involuntary movement
* disturbance in gait and mobility
* abnormal sensation and perception
* impairment of sight, hearing or speech
* Seizures, also known as Fits
Spasticity
Spasticity is a disorder of the body\'s motor system in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with gait, movement, and speech. The person with the spastic muscles may or may not feel it, know about it or want to do something about it. The human motor system is not always linked with the sensory, systems nor the voluntary-muscle systems.
Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, brain trauma, severe head injury, some metabolic diseases such as adrenoleukodystrophy, and phenylketonuria.
Allopathic treatment may include such medications as baclofen, diazepam, dantrolene, or clonazepam; muscle stretching, range of motion exercises, and other physical therapy regimens to help prevent joint contractures (shrinkage or shortening of a muscle) and reduce the severity of symptoms; or surgery for tendon release or to block the connection between nerve and muscle, so that the muscle does not contract. The connection between nerve and muscle may also be blocked temporarily, without surgery, by injecting botulinum toxin into the muscle. Some USA states have also issued marijuana to help treat spasticity. However, baclofen can show severe withdrawl symptoms when taken for along time, it might yield to hallucinations and /or seizures. Similarly, diazepam is habit forming and may lead to drug abuse.
Epilepsy
Epilepsy (sometimes referred to as seizure disorders) are a group of common chronic neurological disorders that are characterized by recurrent unprovoked epileptic seizures. These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy at any one time. Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases. Not all epilepsy syndromes are life long – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as a group of syndromes with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain
Seizures are temporary abnormal electro-physiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. They can manifest as an alteration in mental state, tonic or colonic movements, convulsions, and various other psychic symptoms such as déjà vu etc.. They are caused by a temporary abnormal electrical activity of a group of brain cells. The medical syndrome of recurrent, unprovoked seizures is termed epilepsy, but some seizures may occur in people who do not have epilepsy.
Unprovoked seizures are often associated with epilepsy and related seizure disorders.
Causes of provoked seizures include:
* head injury
* intoxication with drugs
* drug toxicity, for example aminophylline or local anaesthetics
* normal doses of certain drugs that lower the seizure threshold, such as tricyclic antidepressants
* infection, such as encephalitis or meningitis
* fever leading to febrile convulsions (but see above)
* metabolic disturbances, such as hypoglycaemia, hyponatremia or hypoxia
* withdrawal from drugs (anticonvulsants and sedatives such as alcohol, barbiturates, and benzodiazepines)
* space-occupying lesions in the brain (abscesses, tumors)
* seizures during (or shortly after) pregnancy can be a sign of eclampsia
Mental retardation
Mental retardation is a controversial term for a pattern of persistently slow learning of basic motor and language skills ("milestones") during childhood, and a significantly below-normal global intellectual capacity as an adult. One common criterion for diagnosis of mental retardation is a tested intelligence quotient (IQ) of 70 or below.
These children are unable to communicate well. These kids lack control on their phsyical activities such as holding their neck straight and in some cases they are unable to sit. And they can not express their feelings.
According to neurotherapy, most of the problems in children are due to hypoxia. Whichever part of the brain is affected due to hypoxia usually diseases are named according to that affected part. However, neurotherapy does not engage itself with the names of the diseases. It focuses to provide blood, nutrition and oxygen to the affected parts of the brain. As blood reaches there, body starts to respond.
ADHD
Attention Deficit Hyperactivity Disorder (ADHD), also previously called Attention Deficit Disorder (ADD), is a behavior disorder that can manifest as hyperactivity, difficulty concentrating, inattention, or a combination. There is a well-known controversy about the frequency of the use of the drug Ritalin for treatment of behavior disorders such as Attention Deficit Hyperactivity Disorder (ADHD) and hyperactivity.
Symptoms:-
Some of the symptoms of Attention Deficit Hyperactivity Disorder include:
* Inattention
* Hyperactivity: Excessive action and lack of control
* Poor attention span
* Easily distracted
* Failure to listen to instructions
* Getting bored easily
Diagnosis basis of neurotherapy: -
in most of the cases, as explained above, the major cause of such diseases is hypoxia. However, we consider following factors too.
* Whether the delivery of the baby was premature or not?
* Did mother suffered from hypertension during pregnancy?
* Did she ever take heavy dosages of medicines for abortion?
* Did mother suffer from viral or mumps during pregnancy?
* Did she suffer from Malaria, typhoid etc?
* Did mother suffered from acute depression during pregnancy?
* Whether there was injury in the hand during delivery?
* Whether uterus dried up before the birth?
* Whether the problem is genetically induced or not?
After the diagnosis, we give the children required treatment. There might be injury in the brain such as in case of paralysis. Modern medical science artificially induces heparin or other drugs which often could not reach the affected portions of the brain because of the presence of blood brain barrier. Thus it may not always give good results in hypoxia and brain-injury related diseases.
But in neurotherapy we are able to produce heparin, plasmin and sodium bicarbonate by stimulating liver, lungs and pancreas, because these secretions are part of the body, the blood brain barrier allows them into brain which in turn opens up these, clots, infarcts and regularizes the circulation / nutrition to the brain cells which in turn gets activated and corresponding areas in body starts getting activated. That is how we are able to cure the above mentioned diseases/abnormalities.
Though the therapy is a panacea for most disorders plaguing mankind, it is highly effective in treating special children - who are mentally and/or physically challenged, bringing about a substantial improvement in the quality of their life.
It has its roots in a very old therapy of ancient India, which has been revamped and revived by the efforts of Dr. Lajpatrai Mehra of Mumbai, India, who is the founder of this unique technique.
The healing effects of Neurotherapy cover a wide spectrum of disorders in both the young and the old alike.
Among children, we have brought substantial improvement in the quality of life in children with congenital problems such as hole in the heart, club foot and also in children with genetic disorders such as Down Syndrome.
However, the uniqueness of this therapy lies in the fact that it has produced quite remarkable results in treating the following disorders, too.
* Cerebral palsy
* Spasticity
* Epilepsy
* Fits
* Mental retardation
* ADHD (Attention Deficit Hyperactivity Disorder)
What is the Definition of Cerebral Palsy?
Cerebral palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development, or during infancy. It can also occur before, during or shortly following birth.
"Cerebral" refers to the cerebrum. This is the upper crust of the brain. This is the area concerned with sending signals for voluntary movement of all parts of the body.
"Palsy" or paralysis means a disorder of movement or posture. If someone has cerebral palsy, it means that because of an injury to the cerebrum, they are not able to use some of the muscles in their body in the normal way (palsy). Children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children. However there are cases where children with CP have even excelled in some fields. The most recent example is the case of the young boy in a wheelchair on TV Laughter Channel, who, from the age of six or so became a participant in the channel. Today, inspite of this disability, he has risen from the ranks of a participant to become a formidable anchor of the program.
Cerebral palsy is neither progressive nor communicable. It is also not "curable" in the accepted sense of allopathic medicine, although education, physiotherapy and applied technology can help the stiffening of the muscles. It is important to know that cerebral palsy is not a disease or illness. It isn\'t contagious and it doesn\'t get worse. Children who have cerebral palsy will have to live with it all their lives.
Cerebral palsy is characterized by an inability to fully control motor function, particularly muscle control and coordination. Depending on which areas of the brain have been damaged, one or more of the following may occur:
* muscle tightness or spasm
* involuntary movement
* disturbance in gait and mobility
* abnormal sensation and perception
* impairment of sight, hearing or speech
* Seizures, also known as Fits
Spasticity
Spasticity is a disorder of the body\'s motor system in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with gait, movement, and speech. The person with the spastic muscles may or may not feel it, know about it or want to do something about it. The human motor system is not always linked with the sensory, systems nor the voluntary-muscle systems.
Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. It may occur in association with spinal cord injury, multiple sclerosis, cerebral palsy, brain trauma, severe head injury, some metabolic diseases such as adrenoleukodystrophy, and phenylketonuria.
Allopathic treatment may include such medications as baclofen, diazepam, dantrolene, or clonazepam; muscle stretching, range of motion exercises, and other physical therapy regimens to help prevent joint contractures (shrinkage or shortening of a muscle) and reduce the severity of symptoms; or surgery for tendon release or to block the connection between nerve and muscle, so that the muscle does not contract. The connection between nerve and muscle may also be blocked temporarily, without surgery, by injecting botulinum toxin into the muscle. Some USA states have also issued marijuana to help treat spasticity. However, baclofen can show severe withdrawl symptoms when taken for along time, it might yield to hallucinations and /or seizures. Similarly, diazepam is habit forming and may lead to drug abuse.
Epilepsy
Epilepsy (sometimes referred to as seizure disorders) are a group of common chronic neurological disorders that are characterized by recurrent unprovoked epileptic seizures. These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy at any one time. Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases. Not all epilepsy syndromes are life long – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as a group of syndromes with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain
Seizures are temporary abnormal electro-physiologic phenomena of the brain, resulting in abnormal synchronization of electrical neuronal activity. They can manifest as an alteration in mental state, tonic or colonic movements, convulsions, and various other psychic symptoms such as déjà vu etc.. They are caused by a temporary abnormal electrical activity of a group of brain cells. The medical syndrome of recurrent, unprovoked seizures is termed epilepsy, but some seizures may occur in people who do not have epilepsy.
Unprovoked seizures are often associated with epilepsy and related seizure disorders.
Causes of provoked seizures include:
* head injury
* intoxication with drugs
* drug toxicity, for example aminophylline or local anaesthetics
* normal doses of certain drugs that lower the seizure threshold, such as tricyclic antidepressants
* infection, such as encephalitis or meningitis
* fever leading to febrile convulsions (but see above)
* metabolic disturbances, such as hypoglycaemia, hyponatremia or hypoxia
* withdrawal from drugs (anticonvulsants and sedatives such as alcohol, barbiturates, and benzodiazepines)
* space-occupying lesions in the brain (abscesses, tumors)
* seizures during (or shortly after) pregnancy can be a sign of eclampsia
Mental retardation
Mental retardation is a controversial term for a pattern of persistently slow learning of basic motor and language skills ("milestones") during childhood, and a significantly below-normal global intellectual capacity as an adult. One common criterion for diagnosis of mental retardation is a tested intelligence quotient (IQ) of 70 or below.
These children are unable to communicate well. These kids lack control on their phsyical activities such as holding their neck straight and in some cases they are unable to sit. And they can not express their feelings.
According to neurotherapy, most of the problems in children are due to hypoxia. Whichever part of the brain is affected due to hypoxia usually diseases are named according to that affected part. However, neurotherapy does not engage itself with the names of the diseases. It focuses to provide blood, nutrition and oxygen to the affected parts of the brain. As blood reaches there, body starts to respond.
ADHD
Attention Deficit Hyperactivity Disorder (ADHD), also previously called Attention Deficit Disorder (ADD), is a behavior disorder that can manifest as hyperactivity, difficulty concentrating, inattention, or a combination. There is a well-known controversy about the frequency of the use of the drug Ritalin for treatment of behavior disorders such as Attention Deficit Hyperactivity Disorder (ADHD) and hyperactivity.
Symptoms:-
Some of the symptoms of Attention Deficit Hyperactivity Disorder include:
* Inattention
* Hyperactivity: Excessive action and lack of control
* Poor attention span
* Easily distracted
* Failure to listen to instructions
* Getting bored easily
Diagnosis basis of neurotherapy: -
in most of the cases, as explained above, the major cause of such diseases is hypoxia. However, we consider following factors too.
* Whether the delivery of the baby was premature or not?
* Did mother suffered from hypertension during pregnancy?
* Did she ever take heavy dosages of medicines for abortion?
* Did mother suffer from viral or mumps during pregnancy?
* Did she suffer from Malaria, typhoid etc?
* Did mother suffered from acute depression during pregnancy?
* Whether there was injury in the hand during delivery?
* Whether uterus dried up before the birth?
* Whether the problem is genetically induced or not?
After the diagnosis, we give the children required treatment. There might be injury in the brain such as in case of paralysis. Modern medical science artificially induces heparin or other drugs which often could not reach the affected portions of the brain because of the presence of blood brain barrier. Thus it may not always give good results in hypoxia and brain-injury related diseases.
But in neurotherapy we are able to produce heparin, plasmin and sodium bicarbonate by stimulating liver, lungs and pancreas, because these secretions are part of the body, the blood brain barrier allows them into brain which in turn opens up these, clots, infarcts and regularizes the circulation / nutrition to the brain cells which in turn gets activated and corresponding areas in body starts getting activated. That is how we are able to cure the above mentioned diseases/abnormalities.
शुक्रवार, 2 जुलाई 2010
Frequently Asked Questions On Epilepsy
DEFINITION:
- What is the difference between “Fits” and “Epilepsy”?
- Does a person who gets only a single fit have epilepsy?
- What are the different types of epilepsy?
- What are the common causes of epilepsy?
- What are the main features of different seizure types?
- What are Febrile convulsions?
- How common are Febrile convulsions?
- What is the outcome of children with febrile convulsion?
- Can new-born babies have seizures?
- What is the relation of mental retardation and epilepsy?
- Can mental stress cause epilepsy?
- How common is epilepsy after head trauma?
- Does excitement predispose to fits?
- Can some people bring on their fits?
TREATMENT:
- To what extent can drug treatment help in patients with epilepsy?
- How long the treatment should be continued?
- What are the main principles of drug treatment for epilepsy?
- Why is it important to take anti-epileptic drugs regularly?
- What is the effect of anti-epileptic drugs on behaviour?
- Can epilepsy be cured?
- What is the risk of seizure recurrence after stopping anti-epileptic treatment?
- Should the anti-epileptic drug be discontinued during any other intercurrent illness?
- What should be done if the patient forgets to take a dose of anti-epileptic drugs?
- Can a person with epilepsy and on treatment with anti-epileptic drugs take alcoholic drinks?
- What should be done if some one gets an epileptic fit on the road side or any where else?
- How frequently should a person with epilepsy visit the treating doctor?
- What is the effect of fits on the memory?
- Can seizures cause brain damage?
- What is the role of different investigations like EEG, CT scan, and MRI scan in the diagnosis of epilepsy?
- Blood levels of anti-epileptic drugs are frequently prescribed by doctors. What is the role of getting blood levels done?
What is the prognosis of epilepsy?
It must be pointed out that MOST patients who develop seizures DO NOT BECOME EPILEPTICS. The usual prevalence rate of chronic epilepsy in the population is about 5 per 1000. On the other hand it has been estimated that up to 5% of the general population can experience non-febrile seizures at some point in their lives. So, almost one-tenth of all people who experience a single non-febrile seizure may go on to develop chronic epilepsy later on in life. The worldwide experience is that with early and proper treatment, almost 70% persons with epilepsy will achieve complete or near complete seizure control and almost 50% of these will be able to stop their treatment. In newly diagnosed persons with epilepsy, the future outcome is excellent if fits are adequately controlled with anti-epileptic drugs early in the course of treatment. If seizures are not controlled adequately or it takes a longer time to control fits, the prognosis is not that good. It must be remembered that early and effective treatment of epilepsy improves the long-term outlook for such persons. The prognosis of chronic epilepsy is somewhat different. It has been estimated that almost 20-25% of newly diagnosed epilepsy patients will develop chronic epilepsy. These people do have some problems due to their epilepsy but most of them also are entirely normal between seizures.
Q: Are their any voluntary bodies or associations for the help of persons with epilepsy in India?
A: There are two recognized organizations at the national and international level that look into various aspects of epilepsy. The Indian Epilepsy Association (IEA) looks after the non-medical and social aspects of epilepsy while the Indian Epilepsy Society (IES) is responsible for the medical aspects. At the international level, the corresponding bodies are the International Bureau for Epilepsy (IBE) and the International League against Epilepsy (ILAE). Additionally, there are many self help groups in large cities that are mainly managed by persons with epilepsy and their caregivers.
Q: What is the future outlook for person with epilepsy?
A: We all must remember that people with epilepsy are an integral part of our society and must be encouraged to lead a normal life. The society must realize that we should treat epileptics as we treat anyone with some other disease. Those who have epilepsy must consider it as a part of their lives and learn to live with it. Then only shall a person with epilepsy be able to earn his own livelihood and contribute his/her share to the society. If we continue to discriminate and stigmatize the epileptics, we shall have to support them. All those concerned with health administration, must think and plan about these and other aspects of epilepsy and the people with epilepsy in India. In the last few decades there have been significant advances in the health care facilities available to persons with epilepsy. At present a large number of fairly effective new anti-epileptic drugs are available. The surgical techniques for epilepsy surgery have significantly improved and are now being offered at a few centres in our country to all those patients who may be suitable candidates. The concept of ‘Epilepsy Centres’ that can provide comprehensive epilepsy care is fast catching up even in developing countries like India. We need many such “Epilepsy Centres” that can provide the best possible care to all sections of our society within our limited resources. There are costs for doing such things, but the costs for not doing them are perhaps higher!!!
The recent revolution in molecular biology, and in particular, the Human Genome Project, offers unparalleled opportunities for identifying the genetic causes of human epilepsy. The genes for some of the human epileptic syndromes have already been identified. It is expected that such efforts in epilepsy are likely to transform our knowledge about the mechanisms involved in the genesis of seizures and human epilepsies in the not-too-distant future. The better understanding of the genesis of seizures is expected to result in the development of new and more effective anti-epileptic drugs. In addition, new pharmacology based on “gene therapy” is expected to open up new frontiers that will result in the better control of different seizures types. On the whole, the future of persons with epilepsy is definitely bright and those affected can certainly look forward to a much better quality of life.
: Are persons with epilepsy employable?
Most often it is difficult for epileptic persons to find suitable employment after disclosing their epilepsy. On one hand, a person whose seizures are completely controlled without any disabilities should be considered on equal terms as anyone else for most of the jobs. On the other hand, someone who has poorly controlled seizures with some handicaps will not be able to find any job in the public or private sector.
As with other activities, the decision about job suitability should also be individualized keeping in mind the type and frequency of seizures and the associated handicaps. However, some jobs are not recommended for persons with epilepsy. These include defence services, fire services, working with unguarded machinery, working at heights, driving a motorized vehicle, railway engine driver etc. Persons with epilepsy whose seizures are well controlled should be acceptable for most of the other jobs. In case a person develops epilepsy while in service, than the employer should help finding a suitable alternate job for that person.
Can persons with epilepsy participate in sports and leisure activities?
Sports and other types of recreation form an integral part of the daily activities of all young and not so young individuals. Here again a plethora of misbelieves and misconceptions exist. Most of the times, people are surprised to learn that most people with epilepsy can lead an active life. It should be remembered that a person with epilepsy is abnormal only during the ‘seizure’. Such people when not having seizures should be able to lead a life with normal physical and outdoor activities. It is important to know that regular exercise makes epileptic people feel good and builds their self-confidence. It also helps them to maintain body weight in normal range and takes care of a lot of depression that is often associated with a chronic problem like epilepsy. People with epilepsy may get a fit during a physical activity and even otherwise but it does not mean that something drastic will always happen at that time. Over reaction to a fit should always be avoided.
By sensible planning, most sports activities can be made safe for people with epilepsy. Each case must be dealt on individual merits and one should always plan for a realistic physical or recreational activity. Many factors like seizure type, frequency, and associated handicaps should be considered before deciding about sports and leisure activities in relation to persons with epilepsy. In general most sports and leisure activities like ball games, athletics, cycling, dancing etc can be safely undertaken by epileptic persons whose seizures are well controlled. Swimming can also be allowed under supervision of a competent observer. TV and Video games are also safe except in patients whose seizures are triggered on by moving lights. There is no special risk to epileptic persons while traveling. It is important that they should carry sufficient medicines with them and take the medicines at scheduled time. Flying in an airplane is also safe but the airlines staff should be told in advance if fits are not adequately controlled.
Can persons with epilepsy have a normal married life?
A: From a medical point of view, persons with epilepsy can marry. However, in some countries there have been laws and in others even now there are laws that prevent persons with epilepsy to marry. It is important that the would be spouse of a person with epilepsy should be aware of the situation. This prevents a lot of unnecessary misunderstandings later on in life. Counseling for marriage is a very delicate and special situation where extreme caution is necessary. The belief that epilepsy (especially in young girls) can be cured by marriage invariably complicates the whole problem and all efforts must be made to get rid of this notion. On the other hand, epilepsy should not be a bar to marriage in individuals with good seizure control. In a case where the seizures are too frequent with poor control, marriage may be inadvisable because of the obvious handicap. The individual should be told to inform the prospective marriage partner of the nature of the problem so that subsequent disasters can be avoided. It is useful to remember that anyone can have seizures and at any age.
It should be understood that only some types of epilepsy have a hereditary basis. In such situations, the epileptic person is at risk of passing the epilepsy on to his/her children. In practical terms, the chance of one epileptic parent passing on epilepsy to the child is small. The risk of a child of an epileptic parent having epilepsy is only marginally higher than the risk of a child born to non-epileptic parents except when the parents have one of the well-defined hereditary epileptic syndromes. However, if both parents have epilepsy the risk of their children developing epilepsy is substantially higher than in general population. It is, therefore, medically recommended that most patients with epilepsy can marry and have children. As in many other situations, such decisions need to be taken separately for each individual keeping in mind many factors that may affect the decision. The marriageable girls with epilepsy must be reassured that most of the drugs can safely be continued throughout pregnancy and the risk of the baby is not greater than the harm that may be caused by stopping the treatment and precipitating seizures.
Q: What is the effect of epilepsy on pregnancy and pregnancy on epilepsy?
A: It has been seen that in 1/4 of pregnant women with epilepsy the seizures can worsen, in another 1/4 the seizures can improve and in the remaining half there is no change in the seizure frequency during pregnancy. Epilepsy can affect the pregnancy in many ways. Seizures during pregnancy can harm both the pregnant woman and her baby, especially if the seizures are frequent. Practically all the drugs that are used to treat epilepsy have effect on the fetus. Carbamazepine is probably safer than other anti-epileptic drugs available today. On the whole, there may be about 2-3 times more risk of an abnormal baby being born to epileptic mothers who are on treatment as compared to the general population. Even with this increased risk, almost 90 to 95% epileptic mothers can have a normal baby. The anti-epileptic drugs must be continued in the same dosage during the entire pregnancy. Treatment with one drug is preferred as the harmful effects to the baby increase if more than one drug are used. Occasionally estimation of drugs level in the blood may be required. The delivery of epileptic mothers should always be carried out in a well-equipped medical setup (preferably in a hospital) with regular antenatal visits. It must again be pointed out that most of epileptic mothers usually have an eventful pregnancy and produce normal and healthy babies.
Q: Can mothers with epilepsy breast feed their babies while taking anti-epileptic drugs?
A: Most of the anti-epileptic drugs taken by mothers are excreted in breast milk but their concentration varies according to chemical properties of the drug. Drugs like phenobarbitone can have significant concentration in the milk and infants being fed on such milk can be lethargic and irritable. Carbamazepine can also be present in low concentrations in breast milk but diphenylhydantoin and valproate rarely cause any problems. On the whole, most mothers having epilepsy can safely breast-feed their babies while taking their anti-epileptic drugs. In case of any problems, they should get in touch with their treating doctor.
Q: Is any special care needed for children with epilepsy while at school or play?
A: Epilepsy is common in school going children. Most children with epilepsy can be in a normal class or school and have the same intelligence and learning abilities as compared to children without epilepsy. Some children (those with poorly controlled seizures or associated handicaps) may need special attention while at school and play. Children with epilepsy, whose fits are well controlled, must be encouraged to express their full potential as they can do as well as their peers. Children with poorly controlled seizures can be on multiple drugs and have associated physical or mental handicaps. They can have poor school performance due to frequent fits and effect of anti-epileptic drugs on the learning and memory. These situations should be recognized and proper attention given as and when possible. Such children should not be overprotected. Concern about safety of children with epilepsy may lead to them being stopped from their daily activities. Such restrictions are often unnecessary and should be individualized for each child. Children whose seizures are controlled can participate in most normal activities including sports, athletics, cycling etc. Even those who do not have complete control of seizures can carry out most such activities under supervision. Most children with epilepsy can watch TV and play with video games.
What is the role of different investigations like EEG, CT scan, and MRI scan in the diagnosis of epilepsy?
The electroencephalograph (EEG) which records the electrical activity of the barn cells has its own limitations. It is helpful, when it is clearly abnormal but 40-50% of patients with epilepsy have a normal single inter-ictal EEG. On the other hand, about 5% of non-epileptic patients may have non-specific EEG abnormalities. Despite its limitations, the EEG is a simple non-invasive and relatively inexpensive test that gives useful information if used judiciously and correlated with the clinical description of seizures. When abnormal, it is helpful in making a correct diagnosis of epilepsy and may even help in the choice of anti-epileptic drug therapy in a given case. The availability of CT scanning in larger cities of our country has been of a great help in the management of some cases of epilepsy, epecially where an underlying pathology is suspected as the cause of seizures. Magnetic resonance imaging (MRI) is now established to be a better and safer diagnostic modality than CT scanning for the detection of an epileptogenic focus or the suspected abnormality in the brain of patients with seizures. Q: Blood levels of anti-epileptic drugs are frequently prescribed by doctors. What is the role of getting blood levels done? A: There is no role of routinely checking the blood levels of anti-epileptic drugs. However, estimation of blood levels is important to check compliance, to correlate side effects with drugs, to know the drug interactions in patients receiving more than one drugs for control of their seizures, and in certain situation where metabolism of drugs may be altered like during pregnancy, very old or very young age, and in presence of hepato-renal disease. Next» SCHOOLING |  |
To what extent can drug treatment help in patients with epilepsy
A: There has been a significant improvement in the drug treatment of epilepsy in the last few decades. The world wide experience is that complete control of seizures can be expected with appropriate drugs in almost 75% of newly diagnosed, previously untreated patients of epilepsy. The choice of drugs mainly depends on the type of seizures in a given patient. Drug treatment should only be started when the diagnosis of epilepsy has been established beyond doubt. To begin with it is always better to start with a single most appropriate drug (monotherapy). It is not recommended that patients should be started with two or more anti-epileptic drugs (polytherapy). The drug chosen is usually introduced gradually, in small doses because most drugs have some side effects if these are introduced rapidly. The final maintenance dose is usually built up over a period of a few weeks.
Q: How long the treatment should be continued?
A: The duration of treatment is dependent upon many factors like the type of epilepsy, age of the patient, control of seizures etc. In most cases, however, the treatment is continued for a period of 3 years after achieving complete seizure control. The treatment should never be stopped suddenly and the decision to stop treatment must be taken by the doctor in-charge of the patient.
Q: What are the main principles of drug treatment for epilepsy?
A: The principles of drug treatment in epilepsy are:
- The seizures can be completely controlled in almost 60-70% of newly diagnosed untreated cases of epilepsy.
- Most patients can be treated with one or a maximum of two anti-epileptic drugs.
- The choice of drug is made on the basis of seizure type and the previous response to the treatment, if any.
- The dose of drugs is maintained so that it produces the maximum control of seizures without any toxicity or side effects.
- The importance of regular treatment and its objectives must be understood by the patient and family members. Anti-epileptic treatment will not be successful without the co-operation and proper understanding of the patients.
- The reduction of dosage or withdrawal of anti-epileptic drug should always be performed slowly and in consultation with the doctor incharge of the patient.
Q: Why is it important to take anti-epileptic drugs regularly?
A: The aim of taking anti-epileptic drugs is to obtain adequate control of fits. It is very important to maintain a constant level of the drugs in the brain to control seizures. In order to achieve that, a constant level of the drug in the blood is required. It is therefore, very important to take medicines regularly.
Q: What is the effect of anti-epileptic drugs on behaviour?
A: Most anti-epileptic drugs do not have any effect on the behaviour. Phenobarbitone (Gardenal or Luminal) and its related drug called Primidone (Mysoline) are known to cause over activity in about one third of the children who are treated with these drugs.
Q: Can epilepsy be cured?
A: Epilepsy can not be cured in the real sense of the term. Epilepsy is a disease like hypertension, asthma and diabetes mellitus. Seizures can be totally controlled in almost 75% cases with epilepsy. In some people, especially children the seizures never recur after stopping their anti-epileptic treatment. These people can be considered to be cured of their epilepsy. In addition, very few people can be cured of their fits by surgical means.
Q: What is the risk of seizure recurrence after stopping anti-epileptic treatment?
A: A number of factors are known to influence the risk of relapse of seizure after withdrawal of medications in patients who have been seizure free for 2-3 years while on treatment. In no individual case can the safety of anti-epileptic withdrawal be absolutely guaranteed. Usually, almost half the cases whose treatment is stopped go into complete remission. If a patient has epilepsy secondary to brain damage or partial seizures, the risk of seizure recurrence is much higher and in most such cases, the treatment should be continued for many more years even if the seizures are controlled. It is a common experience that among patients being considered for withdrawal of anti-epileptic drugs, recurrence of seizures is most common while the drugs are being withdrawn or soon after the withdrawal is completed. In our experience the maximum risk of seizures recurrence is within three months of the drug withdrawal. If a patient has no fits for 4 to 5 years after the drug withdrawal, then his/her chance of having recurrence of seizure is extremely small.
Q: Should the anti-epileptic drug be discontinued during any other intercurrent illness?
A: It is very common mistake to stop the anti-epileptic drug when the patient has fever or nay other intercurrent illness. The anti-epileptic drugs should never be stopped in such circumstances. If the patient vomits within an hour or so of taking the drugs, an extra dose can be given after some time. It must always be remembered that the medicines used in the treatment of the intercurrent illness can have some pharmacological interactions with the anti-epileptic drugs. It is always better to inform the treating physician about the patient’s dosage schedule of the anti-epileptic drugs so that necessary precautions can be taken.
Q: What should be done if the patient forgets to take a dose of anti-epileptic drugs?
A: It is not uncommon for many patients to forget to take a dose of their anti-epileptic medication once in a while. Very often the patient may not even remember if a dose was taken or not. In such a situation it is better to take an extra tablet within the same 24 hours period rather than risking the occurrence of seizure due to low levels of the drugs in patient’s blood.
Q: Can a person with epilepsy and on treatment with anti-epileptic drugs take alcoholic drinks?
A: An occasional drink or a glass of beer is unlikely to have any bad effect o a person who is on treatment with anti-epileptic drugs. However, it must be remembered that:
- After a couple of drinks, it is very easy to forget taking the anti-epileptic drugs. This can result in seizures getting precipitated.
- Alcohol affects the brain and slows one down. Some of the anti-epileptic drug especially phenobarbitone has the same affect and it is best to avoid such combinations.
- Heavy drinking can provoke seizures especially during the morning after an alcoholic binge.
- Prolonged alcohol intake can damage the liver. As with most other drugs, anti-epileptic medications are also broken down in the body by the liver. Abnormal liver function as a result of alcoholic damage can change the effectiveness of anti-epileptic drugs.
Q: What should be done if some one gets an epileptic fit on the road side or any where else?
A: It is important to know what should NOT be done if some one is having a fit.
- DO NOT attempt to force anything between the teeth, as a spoon or wooden piece can break the teeth while a cloth can cause choking. Even if the tongue gets bitten, it usually heals in the next few days.
- DO NOT attempt to stop the convulsive movements as it may result in injury to the person.
- DO NOT allow people to crowd around the convulsing person.
- DO NOT put a shoe, onion or any other thing in front of the patient’s nose.
On the other hand, DO THE FOLLOWING:
- Allow the seizure to be completed. Turn the patient on to one side and ensure that he/she can breathe freely.
- Shift the patient away from any dangerous place/object and loosen all the tight clothing.
- The patient may be confused after the fit, and may need to the reassured with sympathy but without fuss.
- Help the patient so that he/she can continue his/her activity. Transfer the patient to a doctor/hospital if the patient gets recurrent fits, has injury or does not become conscious.
Q: How frequently should a person with epilepsy visit the treating doctor?
A: This is mostly an individual decision but if the epilepsy is well controlled, a check-up once in 3-4 months is enough. Persons who have poorly controlled seizures or are on multiple drugs may need to visit the doctor more frequently. In certain situations like epilepsy and pregnancy, epilepsy in the elderly and recurrent febrile convulsions more frequent visits may be required.
Q: What is the effect of fits on the memory?
Q: Can seizures cause brain damage?
A: A single brief seizure probably causes no permanent damage to the brain. Prolonged grand-mal seizures or even febrile convulsions can definitely damage the brain. In addition, seizures occurring one after the other without the patient becoming conscious in between two seizures, can also damage the brain. It is an accepted fact that any seizure lasting for 20 to 30 minutes can results in brain damage which is not secondary to the fit itself but results from the lack of oxygen supply to the brain during the prolonged fit.
What is the best way to diagnose epilepsy
A: The diagnosis of epilepsy is essentially made on clinical grounds. A clear eyewitness account of the fit is the most important factor in the diagnosis of epilepsy. Investigations like electroencephalogram (EEG) are helpful but the diagnosis is largely based on the clinical history. Even in the most experienced hands, many cases of epilepsy are incorrectly diagnosed while some cases of epilepsy are often missed. Other investigations like CT and MRI scan are helpful in finding the possible cause for epilepsy in many cases. Some other investigations like SPECT, Long-term Video-EEG, and neuro-psychological testing are helpful in selected cases only.
Q: How can you diagnose pseudo-seizures?
A: The description of these seizures in association with peculiar circumstances most often is helpful in the diagnosis. Many times the diagnosis can be extremely difficult but with modern technology it is now possible to diagnose pseudo-seizure in almost all the cases. We now utilize the technique VIDEO – EEG in which the manifestations of the fit are recorded with a video camera and EEG is also recorded simultaneously. Such patients do not exhibit any EEG abnormality during the fit. Once a correct diagnosis is arrived at, these patients with pseudo-seizures can then be managed accordingly.
What are the different types of epilepsy?
A: Most often epilepsy is classified according to the type of seizures or fits. The commonest forms are tonic clonic seizures (grand mal) and complex partial seizures (temporal lobe). There are many other seizures types that can be seen in persons with epilepsy. Epilepsy can also be classified according to the possible cause for the fits. Epilepsy is best looked at as a symptom, the causes of which are variable and multifactorial. Any disease of the brain can cause epileptic fits of some type. Some types of epilepsies tend to be familial and occur at a particular age.
Q: What are the common causes of epilepsy?
A: Some common causes of epilepsy in children are cerebral palsy (most often due to complications related to child birth), infections of the brain, metabolic and certain systemic diseases, any structural disease of the brain, head trauma and certain hereditary diseases. In adults structural brain disease, trauma, infections, toxins etc. are more often the cause. It must be remembered that in about 50% of cases of epilepsy, no cause can be determined even with the best of technology available today and the epilepsy is believed to be “idiopathic” in these cases. The “idiopathic” epilepsies are currently believed to have a genetic basis in their etiology.
Q: What are the main features of different seizure types?
A: The seizures can be divided into two main types : Generalized and Partial (Focal). The Generalized seizures are characterized by features of involvement of both the halves of the brain (cerebral hemispheres) simultaneously from the onset of attack. They may be tonic-clonic (grand mal), brief absences (petit mal) or even sudden, brief jerks of limbs (myoclonic). Partial (Focal) seizures start in one cerebral hemisphere and the electrical activity does not spread to the other side of the brain. Thus the term “Partial Seizure” means that only some part of the brain is involved. In some partial seizures, consciousness may be retained initially but then the fit may become secondarily generalized and the patient will become unconscious and have a major convulsion. The characteristics of a partial seizure reflect the part of the brain involved, and a wide variety of symptoms may thus occur. Partial seizures are divided into two main categories:
* Simple partial seizures, in which there is no alteration of consciousness and the patient may have jerking of hand or foot or face. Less commonly, there may be tingling or numbness in the involved parts.
* Complex partial seizures (temporal lobe), in which consciousness is lost or impaired and are often followed by complex automatisms. During this period the patient may stop all activities, look blank, stare ahead and may be involved in automatic chewing or swallowing movements, repetitive utterances, wandering behavior, fumbling with clothes or other semi-purposeful motor activities. As has been pointed out earlier that frequently the partial seizure that may be simple or complex, may spread within a short time to become a generalized seizure. In such cases, the features of partial seizures may be remembered as the “aura” (warning). The generalized seizure is usually a tonic-clonic convulsion.
Q: What are Febrile convulsions?
A: Febrile convulsions are epileptic fits occurring in relation to fever in children aged between 6 months and 5 years. The convulsion is usually brief and lasts for a few seconds to about a minute.
Q: How common are Febrile convulsions?
A: It should be remembered that almost 3% of all children will have one febrile convulsion. Most febrile convulsions occur in children between the ages of 1 – 2 years. It is estimated that almost 1/4 to ½ of children who get a febrile convulsion will have recurrent attacks and 1/3 will have a close family member with a history of febrile convulsion.
Q: What is the outcome of children with febrile convulsion?
A: Febrile convulsion can look very frightening for the parents who may think that their child is dying. This is not true as febrile convulsions are mostly harmless. The outcome of children with simple febrile convulsions is usually excellent. The outcome is not good if the convulsion is prolonged, confined to one half of the body, when it occurs in a child with a background of abnormal development or neurological dysfunction, and if the first convulsion occurs before 6 months of age. It is estimated that in such children about 5% will develop epilepsy later in life while only 1% of children with simple febrile convulsions develop subsequent epilepsy.
Q: Can new-born babies have seizures?
A: It is a well-known fact that anyone at any age can have seizures and new-born babies are no exception. Fits during the first month of life are not uncommon and usually occur in the first week of life. Most often the cause of fits in the neonatal period is an underlying metabolic abnormality (low blood sugar, calcium or magnesium). These causes can easily be diagnosed and treated accordingly. Such infants do not necessarily suffer from epilepsy in later life. In some children problems at birth can result in damage to the brain. The brain damage can be due to difficulties during labour, bleeding into the brain, lack of oxygen supply to the brain or developmental abnormalities of the brain itself. In many of such children, epilepsy can develop during later life.
Q: What is the relation of mental retardation and epilepsy?
A: About 3% of all children can be defined as mentally retarded. Mental retardation may be due to genetic, developmental, peri-natal, or environmental causes. Epilepsy occurs in up to 50% of patients with mental retardation.
Q: Can mental stress cause epilepsy?
A: Epilepsy is usually not caused by mental stress. However, it is well known that mental stress can certainly make the fits worse or even precipitate seizures in patients who are known to have epilepsy even while on treatment.
Q: How common is epilepsy after head trauma?
A: The risk of developing epilepsy is related to the severity of injury. In persons with open head injuries (when the coverings of brain are penetrated) about 40% develop epilepsy later on in life as compared to only 5% of those with closed head injury. Other factors that predispose to development of epilepsy in persons with head injury are associated bleeding in the brain, occurrence of seizures within the first week of injury and prolonged period of unconsciousness after the injury. It has been estimated that almost half the patients with epilepsy secondary to head trauma develop it within the first year of injury and about 75% develop within two years. In some series it has been estimated that almost 10 – 15% of all cases of epilepsy are secondary to head trauma.
Q: Does excitement predispose to fits?
A: Yes. It is known that some people with epilepsy can have fits when they are excited.
Q: Can some people bring on their fits?
A: Yes, it is possible but not common in connection with genuine fits. Some children and young people are known to get fits while over breathing or watching flickering light. In such cases they can bring on a fit at a time that my suit them. The more often seen fits that are known to be brought on by individuals are known as pseudo-seizures or false fits. These fits may look like being real to an untrained observer or a common person on the street. People who get pseudo-seizures bring on a fit to achieve some purpose (e.g. to get out of a difficult situation), although they may be doing it subconsciously. Pseudo-seizures can pose a serious problem in their diagnosis and treatment even to a well-trained Neurologist.
Next» DIAGNOSIS
Q: What are the common causes of epilepsy?
A: Some common causes of epilepsy in children are cerebral palsy (most often due to complications related to child birth), infections of the brain, metabolic and certain systemic diseases, any structural disease of the brain, head trauma and certain hereditary diseases. In adults structural brain disease, trauma, infections, toxins etc. are more often the cause. It must be remembered that in about 50% of cases of epilepsy, no cause can be determined even with the best of technology available today and the epilepsy is believed to be “idiopathic” in these cases. The “idiopathic” epilepsies are currently believed to have a genetic basis in their etiology.
Q: What are the main features of different seizure types?
A: The seizures can be divided into two main types : Generalized and Partial (Focal). The Generalized seizures are characterized by features of involvement of both the halves of the brain (cerebral hemispheres) simultaneously from the onset of attack. They may be tonic-clonic (grand mal), brief absences (petit mal) or even sudden, brief jerks of limbs (myoclonic). Partial (Focal) seizures start in one cerebral hemisphere and the electrical activity does not spread to the other side of the brain. Thus the term “Partial Seizure” means that only some part of the brain is involved. In some partial seizures, consciousness may be retained initially but then the fit may become secondarily generalized and the patient will become unconscious and have a major convulsion. The characteristics of a partial seizure reflect the part of the brain involved, and a wide variety of symptoms may thus occur. Partial seizures are divided into two main categories:
* Simple partial seizures, in which there is no alteration of consciousness and the patient may have jerking of hand or foot or face. Less commonly, there may be tingling or numbness in the involved parts.
* Complex partial seizures (temporal lobe), in which consciousness is lost or impaired and are often followed by complex automatisms. During this period the patient may stop all activities, look blank, stare ahead and may be involved in automatic chewing or swallowing movements, repetitive utterances, wandering behavior, fumbling with clothes or other semi-purposeful motor activities. As has been pointed out earlier that frequently the partial seizure that may be simple or complex, may spread within a short time to become a generalized seizure. In such cases, the features of partial seizures may be remembered as the “aura” (warning). The generalized seizure is usually a tonic-clonic convulsion.
Q: What are Febrile convulsions?
A: Febrile convulsions are epileptic fits occurring in relation to fever in children aged between 6 months and 5 years. The convulsion is usually brief and lasts for a few seconds to about a minute.
Q: How common are Febrile convulsions?
A: It should be remembered that almost 3% of all children will have one febrile convulsion. Most febrile convulsions occur in children between the ages of 1 – 2 years. It is estimated that almost 1/4 to ½ of children who get a febrile convulsion will have recurrent attacks and 1/3 will have a close family member with a history of febrile convulsion.
Q: What is the outcome of children with febrile convulsion?
A: Febrile convulsion can look very frightening for the parents who may think that their child is dying. This is not true as febrile convulsions are mostly harmless. The outcome of children with simple febrile convulsions is usually excellent. The outcome is not good if the convulsion is prolonged, confined to one half of the body, when it occurs in a child with a background of abnormal development or neurological dysfunction, and if the first convulsion occurs before 6 months of age. It is estimated that in such children about 5% will develop epilepsy later in life while only 1% of children with simple febrile convulsions develop subsequent epilepsy.
Q: Can new-born babies have seizures?
A: It is a well-known fact that anyone at any age can have seizures and new-born babies are no exception. Fits during the first month of life are not uncommon and usually occur in the first week of life. Most often the cause of fits in the neonatal period is an underlying metabolic abnormality (low blood sugar, calcium or magnesium). These causes can easily be diagnosed and treated accordingly. Such infants do not necessarily suffer from epilepsy in later life. In some children problems at birth can result in damage to the brain. The brain damage can be due to difficulties during labour, bleeding into the brain, lack of oxygen supply to the brain or developmental abnormalities of the brain itself. In many of such children, epilepsy can develop during later life.
Q: What is the relation of mental retardation and epilepsy?
A: About 3% of all children can be defined as mentally retarded. Mental retardation may be due to genetic, developmental, peri-natal, or environmental causes. Epilepsy occurs in up to 50% of patients with mental retardation.
Q: Can mental stress cause epilepsy?
A: Epilepsy is usually not caused by mental stress. However, it is well known that mental stress can certainly make the fits worse or even precipitate seizures in patients who are known to have epilepsy even while on treatment.
Q: How common is epilepsy after head trauma?
A: The risk of developing epilepsy is related to the severity of injury. In persons with open head injuries (when the coverings of brain are penetrated) about 40% develop epilepsy later on in life as compared to only 5% of those with closed head injury. Other factors that predispose to development of epilepsy in persons with head injury are associated bleeding in the brain, occurrence of seizures within the first week of injury and prolonged period of unconsciousness after the injury. It has been estimated that almost half the patients with epilepsy secondary to head trauma develop it within the first year of injury and about 75% develop within two years. In some series it has been estimated that almost 10 – 15% of all cases of epilepsy are secondary to head trauma.
Q: Does excitement predispose to fits?
A: Yes. It is known that some people with epilepsy can have fits when they are excited.
Q: Can some people bring on their fits?
A: Yes, it is possible but not common in connection with genuine fits. Some children and young people are known to get fits while over breathing or watching flickering light. In such cases they can bring on a fit at a time that my suit them. The more often seen fits that are known to be brought on by individuals are known as pseudo-seizures or false fits. These fits may look like being real to an untrained observer or a common person on the street. People who get pseudo-seizures bring on a fit to achieve some purpose (e.g. to get out of a difficult situation), although they may be doing it subconsciously. Pseudo-seizures can pose a serious problem in their diagnosis and treatment even to a well-trained Neurologist.
Next» DIAGNOSIS
A: It is estimated that the overall “incidence” of epilepsy (number of new cases observed over a fixed period of time) lies between 20 - 50 cases per year per 100,000 persons in a general population. The usual “prevalence” rate (number of persons with epilepsy during a specified time) is 500-1000 cases per 100,000 persons in the population. Going by these statistics, there will be about 2,600 – 6,500 new cases of epilepsy every year in Delhi and New Delhi alone (estimated population of 1.3 crores) and 200,000 to 500,000 new cases in the whole of India (estimated population about 100 crores). Similarly at the present time there may be approximately 65,000-130,000 persons with epilepsy in Delhi/New Delhi and about 50-100 lakhs in whole of India respectively.
The following practical points need to be remembered:
1. One in 20 people will have an epileptic seizure at some point in their lives.
2. One in 100-200 people in a general population has epilepsy at any given time.
3. About 50–70% patients will develop epilepsy (have their first seizure) before the age of 18 years.
EPILEPSY IS CLEARLY, THEREFORE, A MAJOR PUBLIC HEALTH PROBLEM.
The following practical points need to be remembered:
1. One in 20 people will have an epileptic seizure at some point in their lives.
2. One in 100-200 people in a general population has epilepsy at any given time.
3. About 50–70% patients will develop epilepsy (have their first seizure) before the age of 18 years.
EPILEPSY IS CLEARLY, THEREFORE, A MAJOR PUBLIC HEALTH PROBLEM.
Q: What is the difference between “Fits” and “Epilepsy”?
A: Epilepsy is simply defined as a condition in which the patient is prone to get epileptic “seizures” or “fits”. Anyone having two or more unprovoked fits or seizures can be said to have Epilepsy. Epilepsy clearly is not a homogenous entity, but may vary widely in its forms, causation and severity.
An epileptic fit or seizure is caused by brief, excessive and abnormal discharge of nerve cells in the brain. It is something like a small “electrical storm” or ‘short circuiting” in the brain. The abnormal discharge of electrical activity may involve a small part of the brain or even the whole brain itself. The symptoms of an epileptic fit depend upon the part of the brain that is activated by abnormal electrical discharges and it results in an abnormal movement, sensation, thought process and even unconsciousness. This explains the variation in the clinical types of seizures that can occur in different individuals.
A: No. Epilepsy means that the person has recurrent (more than one) fits. A single fit in a person does not mean that he/she has epilepsy. It is estimated that majority of people who have had an isolated, single fit will never have another one. On the other hand, persons who are destined to develop epilepsy will have the second fit after a variable interval, usually within one year of the first fit.
An epileptic fit or seizure is caused by brief, excessive and abnormal discharge of nerve cells in the brain. It is something like a small “electrical storm” or ‘short circuiting” in the brain. The abnormal discharge of electrical activity may involve a small part of the brain or even the whole brain itself. The symptoms of an epileptic fit depend upon the part of the brain that is activated by abnormal electrical discharges and it results in an abnormal movement, sensation, thought process and even unconsciousness. This explains the variation in the clinical types of seizures that can occur in different individuals.
A: No. Epilepsy means that the person has recurrent (more than one) fits. A single fit in a person does not mean that he/she has epilepsy. It is estimated that majority of people who have had an isolated, single fit will never have another one. On the other hand, persons who are destined to develop epilepsy will have the second fit after a variable interval, usually within one year of the first fit.
गुरुवार, 1 जुलाई 2010
Bowing
Bowing
Parents of children who have bowed legs often want to know if the child's legs are abnormal. To help answer that question, here are some basic facts about bowing. This section will give you an idea of what the physician is thinking about when he or she is examining your child.
First, bowing or the technical term genu varum (genu = knee, varus / varum = angles in) is a part of the normal development of a child. The role of the physician is to determine if the bowing is physiologic (part of normal development) or pathologic (due to some disease process). Physiologic bowing will improve as the child grows without treatment, while pathologic bowing will tend to worsen over time without treatment. The bowing can arise from the lower portion of the femur near the knee, the knee joint itself, the upper shin bone near the knee, or a combination of these areas.
Normally, an infant is born with bowed legs. Over time, the leg alignment will correct and usually straightens out by about eighteen months of age. By the time the child is three to four years old, he or she will normally develop a knock-kneed alignment. The technical term for this is genu valgum (valgus/valgum = angles out). This genu valgum will then correct somewhat by the age of five to six years old, leaving the normal adult alignment of slight genu valgum (slight knock-kneed).
Listed above are the mean ages for these changes to occur so half of the children will correct their bowing earlier and half will correct it later. Occasionally, the bowing never fully corrects. That is why some adults have bowed legs. So you can see, there is a wide range of normal when looking at bowed legs. Physiologic bowing does not require any treatment other than observation for correction as the child grows.
Internal tibial torsion (inward twist of the tibia caused by intrauterine positioning), also called medial tibial torsion, can complicate matters by making the bowing appear worse than it really is, as we see the side of the knee relative to the foot rather than the front. Correction of the torsion will make the legs appear straighter. Fortunately, internal tibial torsion tends to correct itself without treatment up until the age of four to six years, thereby correcting the visual bowing also.
Many disease processes effecting bone growth cause pathologic bowing. Two of the more common diseases known to cause bowing are Rickets and Blount's disease.
Rickets:
Rickets is a generalized skeletal disease involving Vitamin D metabolism. Vitamin D is vital for bone mineralization. Although this vitamin is important it does not act alone. The term 'rickets' predates the later and current notions of the actual causal chemistry. So older usage's run counter to current more precise etiologic (based on cause) uses of the term. In the older sense, a child with bowing of bones, with thickened ends of bones (including ribs), often irritable, and eventually (when x-ray allowed) noted to be associated with widened growth plates which did not fully calcify - that was called rickets. Calcium as Ca++ interacts with Phosphate as PO4= such that at a certain concentration, the calcium can precipitate. The body uses several mechanisms to keep the two at a certain level. When that is off - either by the Ca++ or by the PO4= then the syndrome may manifest.
Dietary deficiency of Vitamin D is the most familiar (to the public) form of rickets. Dietary supplementation of Vitamin D has gone a long way toward abolishing dietary rickets, but it still occasionally seen in less developed countries and in circumstances of dietary peculiarity. Because of this, the hereditary forms of rickets are more commonly seen. Rickets causes a distinctive cupping and widening of the growth plates which can be recognized on a plain x-ray along with other characteristic findings.
However, rickets, in today's terminology, is really a family of entities. Vitamin D in the diet isn't really an active agent, but rather a precursor, a build it yourself kit for what is often called "active vitamin-D". The substance in the diet must first be absorbed, altered by the liver, then altered further by the kidney, then changed again in the skin by sunlight before it is in the active form. If any of those steps is faulty, then dietary vitamin D will be no more active than sand or jelly beans.
Therefore, even with a normal intake of "vitamin-D", if any of the needed bodily steps are not functional, a rickets syndrome may be seen. Caught early, while there is lots of growth remaining, corrected growth can undo deformations which have not gone too far. Correction by supplements is from corrected growth. No growth, no correction. Adults will not correct bowed bones by diet.
The little girl on the right has a genetic form of rickets seen only in the females of her family (four generations). A dominant defective gene disabled her ability to activate the vitamin D form found in food. Dietary change would do little.
At an early time, by giving her a processed already activated form of vitamin D which gets around her inherited bodily inability to activate it, her deformities went away. Her younger sister with similar findings behaved in exactly the same manner. Although boys in alternate generations could also land this particular gene defect, four generations in this girl bearing family managed to dodge this outcome. The girls treated early have statures greater then mother, grandmother and great grandmother by age 8.
Active vitamin supplementation will not undo deformities if they are addressed too late for remaining corrective growth to get the job done. If the activated form of the vitamin fails to alter the course of things then rather than blame the key (vitamin D) we need to suspect the lock. Hormones or vitamins work like keys by fitting into something that responds. If that something is defective, then it gets even more difficult to get around.
On the left we see an extreme form of rickets with multiple tiny fractures caused by a defect in the mechanism which uses vitamin D, that is there is no deficiency of the vitamin or the activated form. Odd metabolic work around tricks are required when this occurs. This form of rickets has interaction with zinc, magnesium, and interestingly, growth hormone. In genetic disorders, it is not uncommon that a so called something defect actually involves more than the something that names it, as deep biochemical alterations often have broad, metabolic echoes.
The complexity of the treatment of rickets varies with the complexity of the curvatures. Most cases are treated with medicine alone, but extreme cases, such as the one above, require surgical correction.
Blount's Disease:
Blount's disease affects the inner edge of the upper shin bone at the knee growth plate (epiphyseal plate - runs horizontally across the knee), causing it to decrease its rate of growth in the portion of the growth plate that is closest to the leg's inseam. The outside part of the growth plate continues to grow normally, leading to progressive bowing.
Blount's disease affects two different age groups. There is infantile Blount's, seen in young children, and adolescent Blount's, seen in teenagers. In both groups, the children tend to be overweight for their age. This bowing deformity is always associated with internal tibial torsion (an inward direction of the ankle and foot relative to the direction of the knee - see above picture). The left knee, above, is aimed dead straight ahead, yet the ankle is directed toward the child's right.
If infantile Blount's is diagnosed early enough, bracing can be instituted. We have had good results bracing children as young as two years old. Usually by the age of three, treatment will require a tibial osteotomy (surgery of the tibia) to straighten the lower extremity. Many will wait and "see how it goes", and let the most effective bracing period go right by. In a special parallax-free three exposure x-ray of the full leg from hip to ankle, with the knee carefully aimed straight ahead, a line through hip and ankle centers ought to pass through knee center. If that line passes outside the bone of the knee, then the angulation will worsen with time and not self-correct. We have seen no such reversals in that subset of children. We prefer to brace as bracing early not only works better but heads off the addition damage to the inner growth plate caused by the angular mechanical (nut cracker) compression caused by the bowed leg.
Depending on how crushed the growth plate is, the bowing may recur after surgery. Tibial osteotomy (tibia = shin bone, osteo = bone, tome = to cut) is also part of the treatment for the adolescent. There are many different techniques for performing the osteotomy. No matter what technique is chosen, the osteotomy must correct the bowing and twist (tibial torsion) at the same time. Bracing also attempts to correct both deformities at the same time.
X-rays are helpful for diagnosing Blount's disease as well. But there is an important detail to be aware of when taking these x-rays. Usually an anterior -posterior (AP) view of the lower extremity is obtained with the knee pointed straight ahead (ignoring the foot direction). The growth plates are checked for any abnormality, such as is seen in rickets and other diseases. Angle measurements about the proximal tibia as well as between the tibia and femur are made, which will help determine if Blount's disease is present. Importantly, a line from the center of the hip joint to the center of the ankle joint is drawn as discussed above. This is the best prognosticator for progression.
This line is the weight bearing line of the lower extremity. If it passes completely beyond the knee joint substance, then whenever weight is placed on the leg it is passed from the hip to the ankle levered through the very medial part of the knee. The leverage amplifies the forces. This will tend to make the bowing worse over time, damaging the growth plate, and is an indication for treatment of the bowing.
Parents of children who have bowed legs often want to know if the child's legs are abnormal. To help answer that question, here are some basic facts about bowing. This section will give you an idea of what the physician is thinking about when he or she is examining your child.
First, bowing or the technical term genu varum (genu = knee, varus / varum = angles in) is a part of the normal development of a child. The role of the physician is to determine if the bowing is physiologic (part of normal development) or pathologic (due to some disease process). Physiologic bowing will improve as the child grows without treatment, while pathologic bowing will tend to worsen over time without treatment. The bowing can arise from the lower portion of the femur near the knee, the knee joint itself, the upper shin bone near the knee, or a combination of these areas.
Normally, an infant is born with bowed legs. Over time, the leg alignment will correct and usually straightens out by about eighteen months of age. By the time the child is three to four years old, he or she will normally develop a knock-kneed alignment. The technical term for this is genu valgum (valgus/valgum = angles out). This genu valgum will then correct somewhat by the age of five to six years old, leaving the normal adult alignment of slight genu valgum (slight knock-kneed).
Listed above are the mean ages for these changes to occur so half of the children will correct their bowing earlier and half will correct it later. Occasionally, the bowing never fully corrects. That is why some adults have bowed legs. So you can see, there is a wide range of normal when looking at bowed legs. Physiologic bowing does not require any treatment other than observation for correction as the child grows.
Internal tibial torsion (inward twist of the tibia caused by intrauterine positioning), also called medial tibial torsion, can complicate matters by making the bowing appear worse than it really is, as we see the side of the knee relative to the foot rather than the front. Correction of the torsion will make the legs appear straighter. Fortunately, internal tibial torsion tends to correct itself without treatment up until the age of four to six years, thereby correcting the visual bowing also.
Many disease processes effecting bone growth cause pathologic bowing. Two of the more common diseases known to cause bowing are Rickets and Blount's disease.
Rickets:
Rickets is a generalized skeletal disease involving Vitamin D metabolism. Vitamin D is vital for bone mineralization. Although this vitamin is important it does not act alone. The term 'rickets' predates the later and current notions of the actual causal chemistry. So older usage's run counter to current more precise etiologic (based on cause) uses of the term. In the older sense, a child with bowing of bones, with thickened ends of bones (including ribs), often irritable, and eventually (when x-ray allowed) noted to be associated with widened growth plates which did not fully calcify - that was called rickets. Calcium as Ca++ interacts with Phosphate as PO4= such that at a certain concentration, the calcium can precipitate. The body uses several mechanisms to keep the two at a certain level. When that is off - either by the Ca++ or by the PO4= then the syndrome may manifest.
Dietary deficiency of Vitamin D is the most familiar (to the public) form of rickets. Dietary supplementation of Vitamin D has gone a long way toward abolishing dietary rickets, but it still occasionally seen in less developed countries and in circumstances of dietary peculiarity. Because of this, the hereditary forms of rickets are more commonly seen. Rickets causes a distinctive cupping and widening of the growth plates which can be recognized on a plain x-ray along with other characteristic findings.
However, rickets, in today's terminology, is really a family of entities. Vitamin D in the diet isn't really an active agent, but rather a precursor, a build it yourself kit for what is often called "active vitamin-D". The substance in the diet must first be absorbed, altered by the liver, then altered further by the kidney, then changed again in the skin by sunlight before it is in the active form. If any of those steps is faulty, then dietary vitamin D will be no more active than sand or jelly beans.
Therefore, even with a normal intake of "vitamin-D", if any of the needed bodily steps are not functional, a rickets syndrome may be seen. Caught early, while there is lots of growth remaining, corrected growth can undo deformations which have not gone too far. Correction by supplements is from corrected growth. No growth, no correction. Adults will not correct bowed bones by diet.
The little girl on the right has a genetic form of rickets seen only in the females of her family (four generations). A dominant defective gene disabled her ability to activate the vitamin D form found in food. Dietary change would do little.
At an early time, by giving her a processed already activated form of vitamin D which gets around her inherited bodily inability to activate it, her deformities went away. Her younger sister with similar findings behaved in exactly the same manner. Although boys in alternate generations could also land this particular gene defect, four generations in this girl bearing family managed to dodge this outcome. The girls treated early have statures greater then mother, grandmother and great grandmother by age 8.
Active vitamin supplementation will not undo deformities if they are addressed too late for remaining corrective growth to get the job done. If the activated form of the vitamin fails to alter the course of things then rather than blame the key (vitamin D) we need to suspect the lock. Hormones or vitamins work like keys by fitting into something that responds. If that something is defective, then it gets even more difficult to get around.
On the left we see an extreme form of rickets with multiple tiny fractures caused by a defect in the mechanism which uses vitamin D, that is there is no deficiency of the vitamin or the activated form. Odd metabolic work around tricks are required when this occurs. This form of rickets has interaction with zinc, magnesium, and interestingly, growth hormone. In genetic disorders, it is not uncommon that a so called something defect actually involves more than the something that names it, as deep biochemical alterations often have broad, metabolic echoes.
The complexity of the treatment of rickets varies with the complexity of the curvatures. Most cases are treated with medicine alone, but extreme cases, such as the one above, require surgical correction.
Blount's Disease:
Blount's disease affects the inner edge of the upper shin bone at the knee growth plate (epiphyseal plate - runs horizontally across the knee), causing it to decrease its rate of growth in the portion of the growth plate that is closest to the leg's inseam. The outside part of the growth plate continues to grow normally, leading to progressive bowing.
Blount's disease affects two different age groups. There is infantile Blount's, seen in young children, and adolescent Blount's, seen in teenagers. In both groups, the children tend to be overweight for their age. This bowing deformity is always associated with internal tibial torsion (an inward direction of the ankle and foot relative to the direction of the knee - see above picture). The left knee, above, is aimed dead straight ahead, yet the ankle is directed toward the child's right.
If infantile Blount's is diagnosed early enough, bracing can be instituted. We have had good results bracing children as young as two years old. Usually by the age of three, treatment will require a tibial osteotomy (surgery of the tibia) to straighten the lower extremity. Many will wait and "see how it goes", and let the most effective bracing period go right by. In a special parallax-free three exposure x-ray of the full leg from hip to ankle, with the knee carefully aimed straight ahead, a line through hip and ankle centers ought to pass through knee center. If that line passes outside the bone of the knee, then the angulation will worsen with time and not self-correct. We have seen no such reversals in that subset of children. We prefer to brace as bracing early not only works better but heads off the addition damage to the inner growth plate caused by the angular mechanical (nut cracker) compression caused by the bowed leg.
Depending on how crushed the growth plate is, the bowing may recur after surgery. Tibial osteotomy (tibia = shin bone, osteo = bone, tome = to cut) is also part of the treatment for the adolescent. There are many different techniques for performing the osteotomy. No matter what technique is chosen, the osteotomy must correct the bowing and twist (tibial torsion) at the same time. Bracing also attempts to correct both deformities at the same time.
X-rays are helpful for diagnosing Blount's disease as well. But there is an important detail to be aware of when taking these x-rays. Usually an anterior -posterior (AP) view of the lower extremity is obtained with the knee pointed straight ahead (ignoring the foot direction). The growth plates are checked for any abnormality, such as is seen in rickets and other diseases. Angle measurements about the proximal tibia as well as between the tibia and femur are made, which will help determine if Blount's disease is present. Importantly, a line from the center of the hip joint to the center of the ankle joint is drawn as discussed above. This is the best prognosticator for progression.
This line is the weight bearing line of the lower extremity. If it passes completely beyond the knee joint substance, then whenever weight is placed on the leg it is passed from the hip to the ankle levered through the very medial part of the knee. The leverage amplifies the forces. This will tend to make the bowing worse over time, damaging the growth plate, and is an indication for treatment of the bowing.
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