This concept of a ‘HEADACHE CLINIC’
is now well accepted as the most appropriate and best way to treat debilitating headaches that are an invisible misery but can still affect the quality of life. The ‘Headache Clinic’ is now looked upon as the most novel, holistic and effective approach towards treatment of headaches.
Headache’ is a very common problem in both adults and children but unfortunately it still continues to stay neglected. Recurrent head pain interferes with normal functioning and can be quite incapacitating. Frequent headaches can impair family, social and sex life. Despite the significant disability and all the recent advances, headaches in medical practice continue to be under-diagnosed and inadequately treated. Headache is therefore a huge public health burden in terms of loss of productivity and the amount spent on ineffective treatment.
Headache clinic at
operates all days and is equipped with most modern Neurological equipment. Headache clinic at Shymas Neurology
is a premiere headache and migraine health care facility devoted exclusively to the diagnosis, treatment and continued care and analysis of headaches.
We draws patients from all over the country and the sub-continent and Middle East.
Eighty percent of people suffer from back pain at some point in their lives. There are many different conditions that can result in low back pain, including: sprained ligaments, strained muscles, ruptured disks, trigger points and inflamed joints. While sports injuries or accidents can lead to injury and pain, sometimes even the simplest movements, like picking up a pencil from the floor, can have painful results. In addition, conditions such as arthritis, poor posture, obesity, psychological stress and even kidney stones, kidney infections, blood clots, or bone loss can lead to pain.
Most people do not realize how much they move their neck during the day until they are unable to do so. The degree of flexibility of the neck, coupled with the fact that it has the least amount of muscular stabilization and it has to support and move your 14 - 16 pound head, means that the neck is very susceptible to injury. You can picture your neck and head much like a bowling ball being held on top of a stick by small, thin, elastic bands. It doesn’t take much force to disrupt that delicate balance.
The spinal cord runs through a space in the vertebrae to send nerve impulses to every part of the body. Between each pair of cervical vertebrae, the spinal cord sends off large bundles of nerves that run down the arms and to some degree, the upper back. This means that if your arm is hurting, it may actually be a problem in the neck! Symptoms in the arms can include numbness, tingling, cold, aching, and “pins and needles”.
One of the most common causes of neck pain, and sometimes headaches, is poor posture. Another major cause or neck pain is a whiplash injury. Whiplash is caused by a sudden movement of the head, either backward, forward, or sideways, that results in the damage to the supporting muscles, ligaments and other connective tissues in the neck and upper back.
Visit the Shymas Neurology
Neck Pain Clinic on Monday to Friday 9am to 1pm.
This test is used to determine more about the functioning of peripheral nerves in the arms and legs. It can show if a nerve is pinched, and estimate the severity and location of the pinched nerve. EMG tests for the electrical impulse coming from the brain and/or spinal cord to the affected area. If this impulse is blocked somewhere along the spinal pathway, it may be delayed or reduced en route to its final destination (skin, muscle, finger tips, etc.) Abnormal function may imply that there is nerve injury or muscle dysfunction.
Muscles receive constant electrical signals from properly functioning nerves, and in turn they broadcast their own electrical signals. During an EMG, the electrical activity in muscles is measured. The neurosurgeon places very thin needles (like those used in acupuncture) into the muscles to record the electrical signals from the various leg or arm muscles. If a muscle is not receiving adequate impulses from its nerve, it broadcasts signals that indicate the muscle is confused.
The results of this test are often correlated with the results from the Nerve Conduction Study, which is customarily done first. This test takes 15 to 45 minutes to complete, depending on how many areas are being studied.
This test is used to help diagnose certain seizure disorders, brain tumors, brain damage related to head injuries, inflammation of the brain and/or spinal cord, alcoholism, specific psychiatric disorders, and metabolic and degenerative disorders that impact the brain. It is also used to confirm brain death in patients on life support.
About 16-20 electrodes are attached to the patient’s scalp, either with temporary, conducting glue or with extremely fine needles. The electrodes (also called leads) are small devices that are attached to wires and carry the electrical energy of the brain to a machine that reads them. A very low electrical current is sent through the electrodes and the baseline brain energy is recorded. Patients are then exposed to a variety of external stimuli, such as bright or flashing lights, noises or certain drugs. The patient is asked to open and close his or her eyes, or to change breathing patterns. The electrodes transmit the resulting changes in brain wave patterns. Since movement and nervousness can change brain wave patterns, patients usually recline in a chair or on a bed during the test. This test can take up to one hour, however, for certain disorders the patient must be asleep, and then the test will take a minimum of three hours.
A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests are performed by medical specialists such as specialists in clinical neurophysiology, chiropractors, psychiatrists (physical medicine and rehabilitation [PMR] physicians), and neurologists who sub specialize in electrodiagnostic medicine. In the United States, neurologists receive training in electrodiagnostic medicine (performing needle electromyography and NCSs) as part of residency training and in some cases acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. PMR physicians receive this training during their residency and can get further training in a neuromuscular fellowship. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.
Electroretinography measures the electrical responses of various cell types in the retina, including the photo-receptors (rods and cones), inner retinal cells (bipolar and amacrine cells), and the ganglion cells. Electrodes are usually placed on the cornea and the skin near the eye, although it is possible to record the ERG from skin electrodes. During a recording, the patient's eyes are exposed to standardized stimuli and the resulting signal is displayed showing the time course of the signal's amplitude (voltage). Signals are very small, and typically are measured in micro volts or nano volts. The ERG is composed of electrical potentials contributed by different cell types within the retina, and the stimulus conditions (flash or pattern stimulus, whether a background light is present, and the colors of the stimulus and background) can elicit stronger response from certain components.
Angiography is a minimally invasive medical test that uses x-rays and an iodine-containing contrast material to produce pictures of blood vessels in the brain.In cerebral angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays). Cerebral angiography is also called intra-arterial digital subtraction angiography (IADSA). This phrase refers to acquiring the images electronically, rather than with x-ray film. The images are electronically manipulated so that the overlying bone of the skull, normally obscuring the vessels, is removed from the image resulting in the remaining vessels being clearly seen.
What is Epilepsy?
Epilepsy is the fourth most common neurological disorder and affects people of all ages. Epilepsy means the same thing as "seizure disorders". Epilepsy is characterized by unpredictable seizures and can cause other health problems. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person. Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well.
Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well.
has emerged as one of the most comprehensive neurological centers of its kind, diagnosing and treating a large breadth of adult and pediatric neurological diseases and conditions.
Neuromuscular junction disease is a medical condition where the normal conduction through the neuromuscular junction fails to function correctly. In diseases such as myasthenia gravis, the end plate potential (EPP) fails to effectively activate the muscle fiber due to an autoimmune reaction against acetylcholine receptors, resulting in muscle weakness and fatigue.
Myasthenia gravis is caused most commonly by auto-antibodies against the acetylcholine receptor. It has recently been realized that a second category of gravis is due to auto-antibodies against MuSK. A different condition, Lambert-Eaton myasthenic syndrome, is usually associated with presynaptic antibodies to the voltage-dependent calcium channel. It is possible for these conditions to coexist.
The neuromuscular junction is a specialized synapse between a neuron and the muscle it innervates. It allows efferent signals from the nervous system to contact muscle fibers causing them to contract. In vertebrates, the neuromuscular junction is always excitatory, therefore to stop contraction of the muscle, inhibition must occur at the level of the efferent motor neuron. In other words, the inhibition must occur at the level of the spinal cord.
Release of acetylcholine vesicles from the presynaptic terminal occurs only after adequate depolarization of the efferent nerve. Once a motor nerve action potential reaches the presynaptic nerve terminal it causes an increase in intracellular calcium concentration by causing an increase in ion conductance through voltage gated calcium channels. This increase in calcium concentration allows the acetylcholine vesicles to fuse with the plasma membrane at the presynaptic membrane, in a process called exocytosis, thus releasing acetylcholine into the synapse. Once acetylcholine is present in the synapse it is able to bind to nicotinic acetylcholine receptors increasing conductance of certain cations, sodium and potassium in the postsynaptic membrane and producing an excitatory end plate-current. As cations flow into the postsynaptic cell, this causes a depolarization, as the membrane voltage increases above normal resting potential. If the signal is of sufficient magnitude, than an action potential will be generated post synaptically. The action potential will propagate through the sarcolemma to the interior of the muscle fibers eventually leading to an increase in intracellular calcium levels and subsequently initiating the process of Excitation–contraction coupling. Once coupling begins it allows the sarcomeres of the muscles to shorten, thus leading to the contraction of the muscle.
Neuromuscular junction diseases are a result of a malfunction in one or more steps of the above pathway. As a result, normal functioning can be completely or partially inhibited, with the symptoms largely presenting themselves as problems in mobility and muscle contraction as expected from disorders in motor end plates. Neuromuscular junction diseases can also be referred to as end plate diseases or disorders.
Common peroneal nerve dysfunction is damage to the peroneal nerve leading to loss of movement or sensation in the foot and leg.
The peroneal nerve is a branch of the sciatic nerve, which supplies movement and sensation to the lower leg, foot and toes. Common peroneal nerve dysfunction is a type of peripheral neuropathy (damage to nerves outside the brain or spinal cord). This condition can affect people of any age.
Dysfunction of a single nerve, such as the common peroneal nerve, is called a mononeuropathy. Mononeuropathy means the nerve damage occurred in one area. Certain body-wide conditions can also cause single nerve injuries. Damage to the nerve disrupts the myelin sheath that covers the axon (branch of the nerve cell). The axon can also be injured, which causes more severe symptoms.
Common causes of damage to the peroneal nerve include the following:
- • Trauma or injury to the knee
- • Fracture of the fibula (a bone of the lower leg)
- • Use of a tight plaster cast (or other long-term constriction) of the lower leg
• Crossing the legs regularly
• Regularly wearing high boots
• Pressure to the knee from positions during deep sleep or coma
• Injury during knee surgery or from being placed in an awkward position during anesthesia
Common peroneal nerve injury is often seen in people:
- • Who are very thin (for example, from anorexia nervosa)
- • Who have certain autoimmune conditions, such as polyarteritis nodosa
- • Who have nerve damage from other medical problems, such as diabetes or alcohol use
- • Who have Charcot-Marie-Tooth disease, an inherited disorder that affects all of the nerves
When the nerve is injured and results in dysfunction, symptoms may include:
What is dementia?
- • Decreased sensation, numbness, or tingling in the top of the foot or the outer part of the upper or lower leg
- • Foot that drops (unable to hold the foot up)
- • "Slapping" gait (walking pattern in which each step makes a slapping noise)
- • Toes drag while walking
- • Walking problems
- • Weakness of the ankles or feet
- • Loss of muscle mass because the nerves aren’t stimulating the muscles
Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
Many conditions and diseases cause dementia. The most common cause of dementia in older people is Alzheimer’s disease. Other causes include different kinds of brain changes that lead to vascular dementia, Lewy body dementia, and frontotemporal disorders.
is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.
Symptoms of Alzheimer's
- • Alzheimer's is not a normal part of aging
- • Alzheimer's worsens over time
- • Alzheimer's has no current cure, but treatments for symptoms are available and research continues.
The most common early symptom of Alzheimer's is difficulty remembering newly learned information.
We see patients with a wide variety of cognitive disorders, including:
- • Alzheimer's disease
- • Frontotemporal dementia
- • Lewy Body Dementia and dementia associated with Parkinson’s disease
- • Vascular dementia
- • Familial dementia
- • Rapidly progressive dementia
- • Rare dementia subtypes
- • Mild cognitive impairment
- • Other disorders of cognitive impairment
If you or a loved one has been diagnosed with Alzheimer's or a related dementia, you are not alone, visit Shymas Neurology
for all kind of dementias.
There are four main causes of infections of the central nervous system (CNS): bacterial, viral, fungal and protozoal. Infections of the central nervous system (CNS) pose a unique challenge to physicians, due to both the potential morbidity and mortality that they cause as well as the inherent difficulties involved in their treatment. These infections mainly involve meningitis, encephalitis, and brain abscesses, and tend to cause more morbidity and mortality on average than infections involving other organ systems. Due to their potential for adverse consequences, it is important for the physician to be well versed in the presentations and care of the more common CNS infections, as these represent a not infrequent etiology of complaints seen from the primary care clinic to the surgeon's bed to even the psychiatric ward.
Visit Shymas Neurology
for all kind of CNS infections.
Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs. Your nerve cells, also called neurons, send the messages that control these muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.
Some Examples of neuromuscular disorders include
- • Amyotrophic lateral sclerosis
- • Multiple sclerosis
- • Myasthenia gravis
- • Spinal muscular atrophy
Many neuromuscular diseases are genetic, which means they run in families or there is a mutation in your genes. Sometimes, an immune system disorder can cause them. Most of them have no cure. The goal of treatment is to improve symptoms, increase mobility and lengthen life.
Patients with neuromuscular diseases can have weakness, loss of muscle bulk, muscle twitching, cramping, numbness, tingling, and a host of other symptoms. Problems with the nerve-muscle junction can also cause droopy eyelids, double vision, and weakness that worsen with activity. Some neuromuscular disorders can also cause difficulty with swallowing and sometimes with breathing.
Visit Shymas Neurology
clinic for all kind of Muscle and Nerve Diseases.
Paediatric Neurology clinic offers one of the nation’s leading treatment programs for infants, children and adolescents with neurological problems. We treat children with brain and neurological conditions with a multidisciplinary approach led by physicians in our department of neurosurgery and our department of Paediatrics.
Shymas Neurology provide the most up-to-date and highest quality care for children with a wide range of neurological disorders. We strive to better understand the developing nervous system and diseases through cutting edge research. We work with patients and their families to educate them about their disorder and provide them with ongoing care and support.
The pediatric neurology service coordinates medical treatment and therapy for children with neurological conditions.
Special interests include:
- • Concussion
- • Neonatal neurology
- • Brain malformations
- • Headache/migraine
- • Metabolic diseases affecting the nervous system
- • Neuro-oncology
- • Pediatric sleep disorders
- • Developmental disorders including autism
- • Pediatric neuromuscular disorders including muscular dystrophy and congenital myopathies
- • Neurological complications of other pediatric diseases
We provides diagnosis for pediatric neurological disorders using advanced technologies such as:
Dr. Shyma has additional specialization in Paediatric Neurology
Stroke is always a medical emergency. Time = Brain. If you think someone is suffering a stroke visit a doctor immediately or Call 112.
- • Angiography
- • Computed tomography (CT) scanning, 3D reconstruction CT
- • Neurophysiological testing: routine electroencephalogram (EEG), video-monitored EEG, 24-hour ambulatory EEG, evoked potentials
If you think someone is having a stroke call 0484-4182888 or 112 for help
Stroke Care Units:
What happens for people after a stroke is different for everybody. It depends on what sort of stroke a person has had and where in the brain the stroke has happened. Different people will recover in different ways. A stroke happens when the supply of blood to the brain is suddenly interrupted. Some strokes are fatal while others cause permanent or temporary disability.
The longer a stroke remains untreated, the greater the chance of stroke related brain damage. Emergency medical treatment soon after symptoms begin improves the chance of survival and successful rehabilitation.
Facial weakness, arm weakness and difficulty with speech are the most common symptoms or signs of stroke, but they are not the only signs.
Using the F.A.S.T. test involves asking these simple questions:
Check their face. Has their mouth drooped?
Can they lift both arms?
Is their speech slurred? Do they understand you?
Is critical. If you see any of these signs, Visit Doctor immediately
What to do while you wait for the ambulance
If you think someone is having a stroke call 0484-4182888 or 112
- • If the person is conscious, lay them down on their side with their head slightly raised and supported.
- • Do not give them anything to eat or drink. Loosen any restrictive clothing that could cause breathing difficulties. If weakness is obvious in any limb, support it and avoid pulling on it when moving the person.
- • If they are unconscious, check their breathing and pulse and put them on their side. If they do not have a pulse or are not breathing start CPR straight away.
- • If you are unsure how to perform CPR the ambulance call taker will give instructions over the phone.
The Shymas Neurology
Movement Disorders Center provides comprehensive, compassionate and timely treatment to our patients. Our excellence in treating, researching and teaching about movement disorders, including ataxia, dystonia, essential tremor and Parkinson's disease, allows us to provide the best care for all our patients.
Parkinson’s disease (PD)
is the most common neurodegenerative cause of parkinsonism, a clinical syndrome characterized by lesions in the basal ganglia, predominantly in the substantia nigra. PD makes up approximately 80% of cases of parkinsonism.
REQUEST AN APPOINTMENT : Call : +91 484-4182888
Vertigo/Dizziness is defined as feelings of unsteadiness, wooziness, and lightheadedness; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo). These sensations occur even when standing still or lying down.
More than 4 out of 10 people experience an episode of dizziness significant enough to send them to a doctor. Dizziness changes your sense of balance and can increase your risk of falling.
What causes dizziness?
For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Dizziness is generally not serious. However, it may be the result from problems associated with the inner ear, brain, or heart. It can also be the result of medications.
One of the most common causes of dizziness is inner ear disorders.
Tips to reduce falls include:
- • Sit on the edge of the bed for several minutes in the morning before standing up.
- • Change positions or turn slowly and have something nearby to hold onto.
- • Never walk in the dark. Keep walkways well lit. Install night lights in all rooms. Always turn on a light before entering a dark room.
- • Keep medical conditions under control by taking prescribed medications and/or following a prescribed diet.
- • Learn and practice exercises that can improve balance, such as Tai Chi or yoga.
- • Use a cane or walker for more severe walking problems.
- • Wear low-heeled shoes, walking shoes, or other flexible shoes with good traction.
- • Install hand grips in baths and showers.
- • Always use handrails when walking up and down stairs.
- • Remove home hazards such as floor throw rugs, loose electrical cords, stools or other small pieces of furniture that can trip people, and all other floor clutter.
- • Ask your primary care doctor to refer you to a vestibular rehabilitation program. These individualized balance-retraining exercise programs teach ways to decrease dizziness, improve balance, and improve overall ability to perform activities of daily living.
- • If you have dizziness or vertigo, avoid activities such as driving until your doctor gives you approval. Also, avoid any heights, such as climbing a ladder, as they can put you in danger.
Botulinum toxin injection therapy (also known as "BOTOX therapy") is used to treat dystonia - neuromuscular disorder that produces involuntary muscle contractions, or spasm - that affects muscles that control movement in the eyes, neck, face, limbs, voice box, or the smooth muscle in the bladder. The goal of the therapy is to reduce muscle spasm and pain.
Botulinum toxin therapy can be used to treat symptoms in both adults and children. Patients are seen at the clinic for a variety of neurological conditions such as dystonia (blepharospasm, spasmodic torticollis, writer’s cramp), hemifacial spasm, spasticity in stroke, cerebral palsy, muscle spasms, and excessive drooling.
Dystonia is a neurologic disorder of unknown cause that causes involuntary muscle spasms. Symptoms of twisting, pulling or prolonged contractions typically start in the face, neck or hands for adults. Secondary dystonias due to injury or stroke can appear at any age. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face or vocal cords.
Cerebral palsy is a common, non-progressive neurologic disorder of children that causes stiffness and lack of muscle control in arms and/or legs. Botulinum toxin can be useful when combined with other medical and surgical therapies. Botulinum toxin is commonly used in children who experience toe walking, crouched gait, scissoring (crossing of the legs), or tightness in the arms/ hands.
Dr Shyma is specialised in Botox therapy. For appointments, call +91 484-4182888
Computed tomography, also known as a CT scan, is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. Neurological CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis (narrowing of the spinal canal), a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury, and other disorders. Many neurological disorders share certain characteristics and a CT scan can aid in proper diagnosis by differentiating the area of the brain affected by the disorder.
Scanning takes about 20 minutes (a CT of the brain or head may take slightly longer) and is usually done at an imaging center or hospital on an outpatient basis. The patient lies on a special table that slides into a narrow chamber. A sound system built into the chamber allows the patient to communicate with the physician or technician. As the patient lies still, x-rays are passed through the body at various angles and are detected by a computerized scanner. The data is processed and displayed as cross-sectional images, or “slices,” of the internal structure of the body or organ. A light sedative may be given to patients who are unable to lie still and pillows may be used to support and stabilize the head and body. Persons who are claustrophobic may have difficulty taking this imaging test.
Occasionally a contrast dye is injected into the bloodstream to highlight the different tissues in the brain. Patients may feel a warm or cool sensation as the dye circulates through the bloodstream or they may experience a slight metallic taste.
Although very little radiation is used in CT, pregnant women should avoid the test because of potential harm to the fetus from ionizing radiation.
Chronic pain syndrome (CPS) is a common problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy.
What causes chronic pain, and what can you do about it?
Some cases of chronic pain can be traced to a specific injury that has long since healed -- for example, an injury, a serious infection, or even a surgical incision. Other cases have no apparent cause -- no prior injury and an absence of underlying tissue damage. However, many cases of chronic pain are related to these conditions:
• Low back pain
• Arthritis, especially osteoarthritis
• Multiple sclerosis
• Nerve damage (neuropathy)
Negative emotions, including sadness and anxiety, seem to aggravate chronic pain. For example, people who dwell on their discomfort tend to be more disabled by chronic pain than people who try to take their pain in stride. And among people with chronic pain stemming from a work-related injury, those who report poor job satisfaction fare worse than those who say they like their jobs.
Clinic consider chronic pain a condition of its own, requiring pain treatment that addresses the patient’s physical and psychological health.
Video EEG. What is it?
It is a more specialized form of an EEG test. VEEG permits the study of your brainwave activity at the same time that a seizure or a spell is occurring. It helps doctors determine the nature of a seizure or spell as well as how to most effectively treat the condition.
Video EEG monitoring is the most informative test for establishing the diagnosis of epilepsy and differentiating it from other forms of seizure activity. It is a non-invasive procedure that locates the region of the brain where seizures begin, making medical or surgical treatment more precisely targeted and successful.
Why is this test performed?
To diagnose episodic events (those which happen from time to time). These events may be, but are not limited to:
• Epileptic seizures
• Fainting or blackout spells
• Spells of unknown origin
• Hallucinations or behavior problems
is trained in the specialty of epilepsy. The epilepsy monitoring unit offers a better and faster diagnosis for epilepsy and related seizures.