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MIGRAINE IN CHILDREN

What is migraine?
Migraine refers to a condition where the sufferer gets repeated headaches.

What are the other symptoms of migraine?
People may have nausea or vomiting associated with headaches. They also do not like noise or light during the headache episodes. Some children with migraine may not have headache and they may present with only repeated abdominal pain. 

Do children suffer from migraine?
Yes, children do suffer from migraine. 10-25% of children may suffer from migraines. Before puberty, migraine is more common in boys. After puberty, it becomes more common in girls.

What is the earliest age when migraine can affect children?
Migraine has been reported in children as early as 18 months old. About half of the children with migraine have their first attack before the age of 12 years.

What is the cause of migraine in children?
In most cases, there is a combination of genetic and environmental factors. Children with one parent with migraine has 50% chance of getting it, whereas children whose both parents have migraine have 75% chance of getting migraine. Most children with migraine has at least one close family member suffering from it.

How does migraine affect children’s quality of life?
Migraine in children can be as disabling as in adults. Children with migraine miss school twice as often as compared to those without migraine. They also suffer from anxiety, depression, and mood swings, and may not be able to focus in studies. They may also not enjoy sports and other recreational activities.

How is the diagnosis of migraine confirmed in children?
In most cases, the patient’s history and clinical examination are enough to make a diagnosis of migraine. However, in some cases, a brain scan may be needed to exclude other causes.

How is migraine treated in children?
Migraine can be effectively treated in children with medications.

For acute severe headaches, helpful medicines include paracetamol, ibuprofen and triptans (such as sumatriptan, zolmitriptan and rizatriptan).

To prevent headache episodes in future (migraine prophylaxis), propranolol, Flunarizine, topiramate or valproic acid may be used.

What measures can the children take to reduce the headache episodes?

1. Sleep adequately,
2. Eat food on time,
3. Avoid stress,
4. Certain triggers such as cakes, chocolates, Chinese food, too much TV/phone use, can be avoided/reduced. 

DR SUDHIR KUMAR MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist



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HEMIFACIAL SPASM

What is hemifacial spasm?
Hemifacial spasm (HFS) refers to sudden episodic involuntary contractions of muscles on one side of the face.
                                                                                   (Swedish)
Who suffer from hemifacial spasm?
Hemifacial spasm occurs in people all over the world. It occurs more commonly in people aged 40-60 years. It affects both men and women, however, slightly more common in women.

What causes hemifacial spasm?
1.     In most people, there is no specific cause for hemifacial spasm, when it is referred to as idiopathic.
2.     In some people, there is compression of facial nerve (that supplies facial muscles) by a blood vessel.
3.     In some others, the compression could be due to tumors, aneurysms (abnormal balloon-like dilatation of the vessel wall), etc.
4.     Medical problems of brain such as infarct (blood clot in brain) or multiple sclerosis can also cause HFS.

What investigations are usually needed?
A detailed clinical examination needs to be performed by neurologist. This would confirm the diagnosis. The diagnosis is based on clinical examination and no test is needed for that. However, MRI with MR Angiogram brain is needed to exclude secondary causes (as listed in points 2-4 above).

How is hemifacial spasm treated?
1.     Botulinum toxin (botox) is the treatment of choice. Botox injections are given in the affected muscles. The benefit is seen within a few days and the effect may last upto 6 months.
2.     Those who refuse botox or cannot afford it can be treated with medications such as carbamazepine, clonazepam or baclofen tablets.
3.     Those who do not respond to botox or medicines can be treated with microvascular decompression (MVD) surgery.

Can there be a serious complication due to hemifacial spasm?
If all secondary causes have been excluded with MRI of brain, we do not expect any serious complications. However, frequent closure of eyes can be a hindrance for safe driving. Moreover, it may lead to awkward situations, especially in front of people of opposite gender.

What is the long-term outcome of hemifacial spasm?
Both botox and MVD surgery are effective and safe treatments, leading to excellent long-term outcome.

DR SUDHIR KUMAR MD DM
CONSULTANT NEUROLOGIST
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/
04023607777


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PARTICIPATION IN ACADEMIC MEETINGS, CONFERENCES, CMEs 

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com

Participation in academic meetings is an important method of learning from experts and imparting knowledge to colleagues and peers. These meetings provide platforms to meet colleagues, learn and share from each other.

2018

1. Obstetric Medicine update 2018 (Hyderabad): Delivered a lecture "When stroke strikes pregnancy"



2. Neuro Critical Care Update 2018 (Hyderabad): Organised the second Neuro critical Care update 2018 on 16th December 2018 at Apollo Hospitals, Hyderabad. There were ten lectures taken by experts and it was attended by about 70 doctors. I spoke on the topic "Current management of cerebral venous sinus thrombosis)". 



3. EPILEPSY EXPERT GROUP MEETING (13th December 2018, Hyderabad). In this meeting, I spoke on the topic "Zonisamide as a monotherapy in partial onset seizures."




4. STROKE ACADEMY MASTERCLASS (8th-9th December, 2018, Mumbai)

I was a faculty in this meeting, where I spoke on the topic "Quality monitoring in stroke care".






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PUBLICATIONS IN PEER-REVIEWED JOURNALS

Dr SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhrikumar@yahoo.com

Publications are an important means of disseminating knowledge. Many scientific journals are available online, making the access easier. In the initial part of my career, I was not keen on publishing, as I thought, the main duty of a doctor is to treat sick patients. As I was a faculty in a teaching college (CMC Vellore) during 2001-2004, teaching postgraduates was an added responsibility, leaving less time for writing and publishing. However, Prof mathew Alexander, my teacher in Neurology at CMC Vellore, stressed on the importance of publishing. This resulted in multiple publications in peer-reviewed journals. These are listed below:


2001
1. V Markandeyulu, T P Joseph, T Solomon, J Jacob, S Kumar, C Gnanamuthu. Stiff-man syndrome in childhood. J R Soc Med. 2001; 94: 296-7. 

2003
2. Sudhir Kumar. Adverse effects due to poor patient understanding of the antiepileptic medication prescriptions. Indian Pediatr 2003; 40: 801-2
3. Sudhir Kumar. Inappropriate prescription of corticosteroids in respiratory infections. Indian Pediatr 2003; 40:1111.
4. Sudhir Kumar. Overdiagnosis of cerebral malaria in patients admitted with neurological dysfunction. Q J Med 2003; 96: 688.
5. Sudhir Kumar. Medically unexplained symptoms. J R Soc Med 2003; 96: 422.
6. Sudhir Kumar. Representation of South Asian people in randomised trials: study results are interesting but not final word. Br Med J. 2003; 327: 394. 
7. Sudhir Kumar. Management of shock in children with severe P. falciparum malaria. Q J Med2003; 96: 778.
8. Kumar S, Alexander M, Markandeyulu V, Gnanamuthu C. Guillain-Barre syndrome presenting in the anti-HIV seroconversion period. Neurol India 2003; 51: 559.
9. Sudhir Kumar. Nimesulide: How safe is it? Natl Med J India 2003; 16: 233-4.
10. Sudhir Kumar. Predicting long-term morbidity in Indian patients with ischemic stroke. Neurol India. 2003; 51:285-6. 
11. Sudhir Kumar. Steroid-induced myopathy following a single oral dose of prednisolone. Neurol India. 2003; 51: 554-6.
12. Sudhir Kumar. Prophylaxis of depression in older people. Br J Psychiatry. 2003; 183:365.
13. Sudhir Kumar. Management of ocular myasthenia gravis coexisting with thyroid ophthalmopathy. Neurol India. 2003; 51:283-4.
14. Sudhir Kumar. Distal asymmetric spinal muscular atrophy involving upper limbs. Indian Pediatr2003; 40:1211-2
15. Sudhir Kumar. Health of indigenous people- health of aboriginal communities can be improved by innovative methods. Br Med J. 2003; 327: 988
16. Sudhir Kumar. Differentiating traumatic neuritis from poliomyelitis. Natl Med J India. 2003; 16: 232-3.
17. Sudhir Kumar. Anticonvulsant-hypersensitivity syndrome in a child. Neurol India. 2003; 51: 427
18. Sudhir Kumar. Prognosis in children with head injury: Inaccuracies in the analysis. Neurol India 2003; 51: 427-8.
19. Sudhir Kumar. Delayed diagnosis of myasthenia gravis due to prior empirical therapy with corticosteroids. Annals of Indian Academy of Neurology 2003; 6:171-2.
20. S Kumar, Hannah V, M Alexander, C Gnanamuthu. Rapidly progressive dementia as a presenting feature of acute disseminated encephalomyelitis (ADEM). Annals of Indian Academy of Neurology 2003; 6:167-70.
21. Sudhir Kumar. Mechanical ventilation in Guillain-Barre syndrome. Neurol India. 2003; 51:559-60.
22. Sudhir Kumar. Factors affecting functional recovery in ischemic stroke. Neurol India 2003; 51:561.

2004
23. Sudhir Kumar. Recurrent seizures: An unusual manifestation of vitamin B12 deficiency. Neurol India 2004; 52:122-3.
24. Sudhir Kumar. Overweight and obesity in children. Indian Pediatr 2004; 41:200.
25. Sudhir Kumar. Missed and delayed diagnosis of neonatal meningitis. Indian Pediatr 2004; 41:959
26. Sudhir Kumar. Vitamin B12 deficiency presenting with an acute reversible extrapyramidal syndrome. Neurol India. 2004; 52:507-9.
27. Sudhir Kumar. Improving clinical course in congenital hypomyelinating neuropathy. Indian Pediatr 2004; 41:1171.
28. Sudhir Kumar. Artemether in children with severe malaria. Indian Pediatr 2004; 41:520-1.
29. Sudhir Kumar. Unusual cause of recurrent flaccid paralysis in a child. Neurol India. 2004; 52:126.
30. Sudhir Kumar. Clinical characteristics of organophosphate-induced delayed polyneuropathy.Neurol India. 2004; 52:128-9.
31. Sudhir Kumar. Nadroparin in acute ischemic stroke. Neurol India. 2004; 52:273-4.
32. Kumar S, Alexander M, Joseph M, Gnanamuthu C. Symmetrical peripheral gangrene: association with adrenaline administration. Critical Care Asia 2004;2(1):19-21
33. Sudhir Kumar. Conversion disorder in childhood. J R Soc Med. 2004; 97:98
34. S Kumar, M. Alexander, C. Gnanamuthu. Recent experience with Rett Syndrome at a tertiary care center. Neurol India 2004; 52:494-5.
35. S Kumar, N. Kesavalu, E. Chandy. Periodic lateralized epileptiform discharges in a child with solitary cysticercus granuloma. Neurol India 2004; 52:523-4.
36. S Kumar, M. Alexander, C. Gnanamuthu. Refractory status epilepticus due to cerebral venous thrombosis during late pregnancy with successful outcome. Annals of Indian Academy of Neurology.2004; 7:305-8.
37. Sudhir Kumar. A trial of antiparasitic treatment for cerebral cysticercosis.N Engl J Med 2004; 350:1686.
38. Sudhir Kumar. Epidemiological study of neurological disorders. J Indian Med Assoc. 2004; 74:108.
39. Sudhir Kumar. When to start drug therapy in epilepsy. J R Soc Med. 2004; 97:208.
40. Sudhir Kumar. Withdrawal of ventilatory support in the intensive care unit. Natl Med J India 2004; 17:28-9.
41. Sudhir Kumar. Acute reversible mania as a presenting feature of vitamin B12 deficiency. Annals of Indian Academy of Neurology. 2004; 7:309-11.
42. Sudhir Kumar. Epilepsia partialis continua stopped by insulin. J R Soc Med 2004; 97:332-3.
43. Sudhir Kumar. Psychogenic non-epileptic seizures. Indian Pediatr 2004; 41:1050-2.
44. Sudhir Kumar. Paradoxical worsening of neurological status after starting d-penicillamine therapy in a patient with Wilson's disease. Annals of Indian Academy of Neurology 2004; 7:401-402.
45. Sudhir Kumar. Why do doctors make errors? Natl Med J India 2004; 17(1):53-4.
46. Sudhir Kumar. Calvarial thickening and cerebellar atrophy following chronic phenytoin usage.Annals of Indian Academy of Neurology 2004; 7:403.
47. Sudhir Kumar. A patient's opinion is often valuable. J Postgrad Med 2004; 50:216.
48. Sudhir Kumar. Memantine:Pharmacological properties and clinical uses. Neurol India2004:52:307-9.
49. Kumar S, Kumar PR. Mimetic facial paresis. Annals of Indian Academy of Neurology. 2004; 7:405.
50. Kumar S, Kumar PR. Skin branding. J Postgrad Med 2004; 50:204.
51. S Kumar, M Alexander, C Gnanamuthu. Manual (low-volume) plasmapheresis: an effective and safe therapeutic procedure in acute neurological illnesses. Annals of Indian Academy of Neurology 2004; 7:439-40.
52. Sudhir Kumar. Bisphosphonate therapy for polyostotic fibrous dysplasia. Indian Pediatr. 2004; 41:1069-70.
53. S Kumar, M Alexander, C Gnanamuthu. Heterogeneity in clinical presentation of acute disseminated encephalomyelitis. Neurol India. 2004;52:518-9.
54. S Kumar, S Aaron. Internuclear ophthalmoplegia as the sole presenting symptom of inflammatory demyelinating lesion of the brainstem. Neurol India 2004; 52:517-8.
55. Sudhir Kumar. Rheumatological manifestations of leprosy. Indian Journal of Dermatology, Venereology and Leprology. 2004; 70:250.
56. Sudhir Kumar. Dermatological findings in chronic alcoholics. Indian Journal of Dermatology, Venereology and Leprology. 2004; 70:317.
57. S Kumar, Rashmi. Psychosomatic illness among patients attending medical outpatient department. J Indian Med Assoc. 2004; 102:330-1.
58. S Kumar, S Nair, M Alexander. Carcinomatous meningitis occurring prior to the diagnosis of large cell neuroendocrine carcinoma of the uterine cervix. J Postgrad Med. 2004;50:311-2.
59. S Kumar, P Ravi Kumar. Multi-segmental Neurofibromatosis. Indian J Dermatol Venereol Leprol2004; 70:360-2.
60. Sudhir Kumar. Differentiating paralytic rabies from post antirabies vaccine polyradiculoneuropathy. Neurol India 2004; 52:270.
61. Sudhir Kumar. Oral glucose tolerance test in patients with unexplained peripheral neuropathy. Natl Med J India 2004; 17:206.
62. Sudhir Kumar. Nimodipine in severe head injury. Neurol India 2004;52:392-3
63. Sudhir Kumar. Communications skills: is there a need for training? Natl Med J India 2004; 17:280-1.
64. Sudhir Kumar. Pituitary in psychosis. Br J Psychiatry 2004; 185:437-8.
65. Kumar S, Jacob J. Variability in the extent of sensory deficit after sural nerve biopsy. Neurol India 2004; 52:436-8.
66. Kumar S. An uncommon cause of shoulder pain in acute ischaemic stroke. J Indian Med Assoc 2004; 102:594-6.

2005
67. Singh S, Kumar S, Joseph M, Gnanamuthu C, Alexander M. Cerebral venous sinus thrombosis presenting as subdural haematoma. Australasian Radiology 2005;49:101-3.
68. Sudhir Kumar. Factors leading to underdiagnosis or under-reporting of AIDS. Trop doct. 2005; 35:124.
69. S Kumar, J Vijayan, J Jacob, S Aaron, M Joseph, M Alexander, C Gnanamuthu. Cervical spine injuries in 64 attempted suicidal hangings in India. Trop Doct 2005;35:198-200.
70. Sudhir Kumar. Factors precipitating breakthrough seizures in well-controlled epilepsy. Indian Pediatr 2005; 42:182-3.
71. Sudhir Kumar. Severe autonomic dysfunction as a presenting feature of Wilson's disease. J Postgrad Med 2005; 51:75-6.
72. Sudhir Kumar. Wilson's disease presenting as status epilepticus. Indian Pediatr. 2005; 42:492-3.
73. Sudhir Kumar. Tongue biting and epilepsy. Indian Pediatr 2005; 42:296.
74. Sudhir Kumar. Painful mononeuritis multiplex in idiopathic thrombocytopenic purpura. Indian Pediatr 2005; 42:621-2.
75. Sudhir Kumar, Rashmi. Branding: A harmful practice. Indian Pediatr 2005;42:721.
76. Sudhir Kumar. Valproate-induced bleeding: report of two cases and review of literature. Indian Pediatr 2005; 42:833-4.
77. Sudhir Kumar. Neurofibromatosis type 1 manifesting with Tourette syndrome. Neurol India2005;53:361-2.
78. Sudhir Kumar. Punding in Parkinson's disease related to high-dose levodopa therapy. Neurol India 2005;53:362.
79. Sudhir Kumar. Thyrotoxic periodic paralysis. Thyroid Research & Practice 2005; 2: 12-8.
80. Sudhir Kumar. Calcified vertebral artery and dense basilar artery sign in a patient with basilar territory infarction. Neurol India 2005;53:125.
81. Aaron S, Kumar S, Vijayan J, Jacob J, Alexander M, Gnanamuthu C. Clinical and laboratory features and response to treatment in patients presenting with vitamin B12 deficiency-related neurological syndromes. Neurol India 2005;53:55-8.
82. Kumar S, Prabhakar S. Guillain-Barre syndrome occurring in the course of Dengue fever. Neurol India 2005;53:250-1.
83. Datta SS, Premkumar TS, Chandy S, Kumar S, Kirubakaran C, Gnanamuthu C, Cherian A.Behaviour problems in children and adolescents with seizure disorder: associations and risk factors. Seizure:European Journal of Epilepsy 2005;14:190-7.
84. Garikapati R, Kumar S, Prabhakar S. ATL in refractory epilepsy with normal MRI-volumetric criteria? Epilepsia 2005; 46:600.
85. Kumar S, Chandy E. Asymmetric depression of amplitude in electroencephalography leading to a diagnosis of ipsilateral cerebral tumor. Annals of Indian Academy of Neurology 2005;8:33-5.
86. S Kumar, G Rajshekher, S Prabhakar. Management of myasthenic crisis. Neurol India 2005;53:241.
87. S Kumar. Preventive therapy of migraine. Neurol India 2005;53:243.
88. S Kumar, G Rajshekher, S Prabhakar. Positron emission tomography in neurological diseases. Neurol India 2005;53:149-55.
89. S Kumar. Recombinant activated Factor VII for acute intracerebral hemorrhage. Indian Journal of Critical Care Medicine 2005;9:11-13.
90. S Kumar, P Ravi Kumar, N Manasseh. Massive pneumocephalus and meningitis following spine instrumentation. Annals of Indian Academy of Neurology 2005;8:55-7.
91. S Kumar. Guillain-Barre syndrome in leprosy patients. Indian J Lepr. 2005;77:162-8.
92. S Kumar. Cranial nerve involvement in leprosy. Indian J Lepr. 2005;77:177-8.
93. S Kumar, G Rajshekher, S Prabhakar. Dense basilar artery sign preceding basilar artery territory infarction. Annals of Ind Acad Neurol 2005;8:321-2.

2006
94. S Kumar, Badrinath HR. Early recombinant factor VIIa therapy in acute intracerebral hemorrhage: Promising approach. Neurol India 2006;54:24-7.
95. S Kumar. Plasmapheresis in acute disseminated encephalomyelitis. Indian Pediatr2006;43:77-8.
96. SS Datta, S Kumar. Hypomania as an aura in migraine: case report. Neurol India 2006;54:205-6.
97. SS Datta, S Kumar. Clozapine-responsive cluster headache. Neurol India 2006;54:200-1.
98. SS Datta, R Jacob, S Kumar, S Jeyabalan. A case of subacute sclerosing panencephalitis presenting as depression. Acta Neuropsychiatrica 2006; 18: 55-7.
99. SS Datta, TS Premkumar, S Fielding, S Chandy, S Kumar, JM Eagles, A Cherian. Impact of pediatric epilepsy on Indian families. Epilepsy and Behavior. 2006;9:145-51.
100. S Kumar, M Alexander, C Gnanamuthu. Cranial nerve involvement in patients with leprous neuropathy. Neurol India 2006;54:283-5.

2007
101. S Kumar. Expansion of traumatic intracerebral hemorrhage: treatment implications with recombinant Factor VIIa. Neurol India 2007;55:81.
102. S Kumar. Basilar artery thrombosis. Annals Ind Acad Neurol 2007;10;61-2
103. S Kumar, G Rajshekher, S Prabhakar. Isolated complete third nerve palsy due to midbrain hemorrhage: clinico-radiological correlation. Annals Ind Acad Neurol 2007;10:187-8.
104. S Kumar. Thrombolysis with tissue plasminogen activator: Protocol violation is not an option.Neurol India 2007;55:174.
105. S Kumar. Pseudoxanthoma elasticum and cerebral ischemic stroke. Indian J Dermatol Venereol Leprol 2007; 73: 433-4.

2008
106. S Kumar, G Sandhya, R Reddy, G Rajshekher, S Prabhakar. Idiopathic transverse myelitis: corticosteroids, plasma exchange, or cyclophosphamide? Neurology 2008; 70:160.
107. G Rajshekher, S Kumar, S Prabhakar. Reversible electrophysiological abnormalities in hypokalemic periodic paralysis. Indian Pediatrics 2008;45:54-5.
108. S Kumar, G Rajshekher, S Prabhakar. Isolated bilateral ptosis as the presentation of midbrain tuberculoma. Neurol India 2008; 56:212-3.
109. S Kumar, G Rajshekher, S Prabhakar. Platelet glycoprotein IIb/IIIa inhibitors in acute ischemic stroke. Neurol India 2008;56:399-404.

2009
110. S Kumar, R Reddy, S Prabhakar. Contralateral diaphragmatic palsy in acute stroke: An interesting observation. Ind J Crit Care Med 2009; 13:28-30.

2010
111. S kumar, G Rajshekher, C R Reddy, J Venkateswarlu, S Prabhakar. Intra-sinus thrombolysis in cerebral venous sinus thrombosis: single center experience in 19 cases. Neurol India 2010;58:225-9.
112. R Lath, S Kumar, R Reddy, G R Boola, A Ray, S Prabhakar, A Ranjan. Decompressive surgery for severe cerebral venous sinus thrombosis. Neurol India 2010;58:392-7.

2012
113. S Bhuvaneshwari, Sujith Chandy, Sudhir Kumar. A prospective, double-blinded, crossover study to determine the equivalence of the serum levels and the peak level toxicity of diphenylhydantoin (Eptoin ER). Journal of Clinical and Diagnostic Research. 2012;6:783-786.

2013
114. Varghese GM, Mathew A, Kumar Sudhir, Abraham OC, Trowbridge P, Mathai Differential diagnosis of scrub typhus meningitis from bacterial meningitis using clinical and laboratory features. Neurol India 2013;61:17-20
115. Sudhir Kumar, Chenna Rajesh Reddy, Subhashini Prabhakar. Striatal toe. Ann Ind Acad Neurol. 2013;16:304-5
116. S Bhuvaneshwari, Sujith Chandy, Sudhir Kumar. Equivalence of the steady state concentrations of two dosage regimens of phenytoin using computer optimisation programme OPT6. International Journal of Pharmaceuticals and Biological Archives.2013;4:899-902. 

2016
117. Kumar S. Hypertension and ischemic stroke. Hypertens J. 2016;2:39-43.
118. Kumar S, Reddy CR, Prabhakar S. Bilateral putaminal necrosis in a comatose patient with metabolic acidosis. Indian J Crit Care Med. 2016;20:745-8.

2017
119. Kumar S. Hypertension and hemorrhagic stroke. Hypertens J. 2017; 3:89-93.

2018
120. Kumar S, Rohatgi A, Chaudhari H, Thakor P. Evolving landscapes of multiple sclerosis in India: Challenges in the management. Ann Ind Acad Neurol 2018;21:107-15.



Books, Chapters, monographs
1. Elizabeth Chandy, Sudhir Kumar. Atlas of Electroencephalography in Adult & Child. Mattethra Group Publications, Cochin, India, 2004.
2. Sudhir Kumar. Cerebrovascular diseases in the elderly. In Progressive General Practice- Geriatrics issue. Ed, Alka Ganesh. CME series of Christian Medical College, Vellore, India, 2002.
3. Soumitra S. Datta, Sudhir Kumar, K.S. Jacob. Clinical approach to dementia. In Textbook of Psychiatry, Bangalore.
4. Sudhir Kumar. Muscular dystrophies in children and adolescents. In Update in Pediatrics Volume 1, 1st edition, Mathur & Mathur Eds, 2005.
5. Sudhir Kumar. Neonatal Meningitis. In Textbook of Neonatal Emergencies. Ed Prof Suraj Gupte, Peepee Publishers and Distributors, New Delhi, 2006
6. Sudhir Kumar, Subhash Kaul. Approach to a patient with hemiplegia and monoplegia. Progress in Medicine 2017. Published by Association of Physicians of India (API) (Can be accessed at http://www.apiindia.org/pdf/progress_in_medicine_2017/mu_27.pdf)



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HOW IMPORTANT ARE THE MARKS IN AN EXAMINATION?
Anuja’s suicide
When I was 10 year old, I remember once, there was a crowd gathered around Anuja’s (name changed) house, who lived about 100 meters away from our house. I too wanted to go there to find out what was happening, but was not allowed by my parents. Later on in the evening, I came to know that she committed suicide by hanging, as she scored only 81% marks in her tenth board examinations, which was well below her parents’ and her expectations. We hear several similar stories from different parts of our country. Depression, stress and anxiety are common before & during examinations. If one does not score high marks, they feel worthless, unfortunately leading to suicide in some cases.
Mental problems among students
I have been increasingly seeing young students with various psychological problems, such as sleep disturbance, anxiety, headaches, poor memory, body pains, decreased energy and depression. Fear of exam or fear of scoring low marks in an exam are the main reasons for these symptoms.
But is scoring high marks so important?
Marks have limited importance:
1. One needs to score “pass” marks in order to get promoted to the next class, which ranges from 35-50% in various classes/schools/colleges. 
2. One needs to score “qualifying” marks in order to become eligible to write competitive exams for UPSC, engineering, medical, etc (which ranges from 50-75% in various exams).
3. Class XII marks are taken into account for admissions into graduate courses of a few good colleges (which can be as high as 99% in some cases).
Drawbacks and demerits of marks:
1. There is no perfect correlation between marks and knowledge. A student with good knowledge may score lesser marks and someone with lesser knowledge may get very high marks. 
2. Examinations, unfortunately, do not assess the practical knowledge, intelligence, judgment and application of a student; they mainly assess the retention, recall and memory abilities. Communication skills, ability to deal with difficult situations, and interpersonal skills, which are so important in real life, are also not assessed by the “marks” system.
3. Marks obtained in 10th and 12th board exams do not have any meaning in the job/occupation one chooses later. For example, no patient of mine has ever asked me my marks from school or college days (however, I would be proud to tell those figures, as I scored high in most of the exams).
So, what should students do?
1. One should study to gain and acquire knowledge. Understanding the concepts is more important than just memorizing them. 
2. Marks do not matter much and obtaining high marks in an exam should not be the sole goal. 
3. Studies would be a pleasure, if it is taken as a means of gaining knowledge, rather than a means to score high marks in an exam. 
4. One should study “round-the-year” and not just before the exams. This would reduce the pressure prior to the exams. 
5. There is no need to feel bad, if one gets” low” marks in an examination. Most of the great men & women in the world were not class toppers in their school or college days.
I would be pleased to have your comments on this article.

DR SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/
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WHAT IS AILING THE HEALTH OF OUR YOUNG GENERATION?
Mr Parvesh (name changed), a 33-year old, was rushed into emergency department last night with sudden onset of chest pain and breathlessness. He was at his office at 11 PM, when he felt uneasy. He lied down on the sofa outside his office to take some rest. His friends found him unconscious and rushed him to the hospital. On arrival in ER, his pulse and BP were un-recordable. ECG showed features of massive heart attack. He was given the best cardio-pulmonary resuscitation, followed by the best medical care. All in vain, he passed away within four hours. 

Mr Parvesh is not alone. In my practice over the past 25 years, I have seen many young people (mostly men) in their 30s and 40s coming to the hospital with features of heart attack and brain stroke. This is unusual, as during my medical school training in early 90s, we were taught that heart attacks and brain strokes affect only older people in their 60s and 70s or even later. Now, about 40% of people suffering from heart attacks and brain strokes are young people (<50 years of age). 

So, what factors are responsible for this “undesirable” change?
1. Expectations to achieve everything as early as possible: Achievement and success are good things, but not at the cost of health. Young people work long hours. In my interaction with people, I have observed that 13-15 hours work schedules are not uncommon. Add to this, 1-2 hours of commute time, where is the time to unwind? Where is the time to relax with family and friends? Our bodies are not machines (even machines break down, when overused). Heart and brain work best, when working hours are 8-9 hours, with good breaks in weekends.
2. Working from home, working on weekends and even during holidays: Breakthroughs in communication (internet, mobile phones, etc) have their advantages; however, there are drawbacks too. People are in “work-mode” 24X7, 7 days a week, and perpetually. There is no time, when a person totally disconnects from work. Constant work or thought of work takes a heavy toll on the body, especially the heart and brain.
3. Lack of sleep: We need at least 7-8 hours of sleep in order to refresh and recharge. However, younger people are not getting more than 4-5 hours of sleep per night. Demanding work schedules, use of gadgets and late night socializing are some of the reasons for lesser sleep duration. Lack of sleep is strongly associated with higher risk of diabetes, high BP and cholesterol; all of whom are risk factors for stroke and heart attacks.
4. High stress levels: I see many young people in my clinic, belonging to various industries such as IT & software, banking & finance, education, etc. More than 90% of them say they are under stress. Stress is related to jobs as well as personal lives. So, if one felt that not getting a job or not getting married are reasons to be under stress, think twice; those with good jobs and good spouses are also equally stressed, if not more. This cannot be real. Jobs and families need to be cared for and modeled to give joy & happiness.
5. Greed for material things beyond one’s means: Peer pressure is very high. One wants to own a good car and a good house in 30s and even in 20s. As the incomes are low, many end up taking huge loans to fund these dreams. People are also spending more than their means on education of children and vacations. Paying EMIs are no fun! Any unexpected expenditure and reduction in income takes a toll on health and stress levels rise. One must live within their means and avoid taking loans to fulfill the “desires”. We need to be satisfied with what we have and avoid competing with “neighbours or friends” in acquiring materialistic things.
6. Unhealthy diet and habits: Fast foods, irregular food habits and "eating out" have become common. We need to remember, home food is the best and healthiest. “Outside” food is high on taste (due to high amount of salt, sugar and oil) but low on nutrition. 
Most people are not exercising. Moreover, they use vehicles for travelling short distances. Walking as a habit is dying. Most people use lifts and staircases are “hidden” (only to be used in case of emergency or fire)! People sit for long duration (at work, while watching TV, etc). Sitting is as dangerous as smoking, if not more. 
Pollution is increasing- both air and water. Their negative impact on health is well known.
7. Poor financial planning: Younger people do not invest wisely. Either the savings are kept idle in the banks (for a meager interest of 3-4%, which is taxable at the highest slab) or they invest most of their savings in real estate (bought at high prices, with no scope of growth in the near future). The best investment asset class is equity. For someone with less time, investing in equity mutual funds via SIP (systematic investment plans) are the best. You can expect a return of 10-12 % per year (with current tax rate of 10% on the profits, if redeemed after one year).
8. Ignoring health checkups: Our body does give warnings. Any abnormal symptom such as headache, dizziness, tiredness, breathing difficulty, chest pain, etc should be seriously taken and a doctor should be consulted. Even if there are no symptoms, preventive health checkups can help in detecting diseases in early stage, which can be treated well.
So, what can younger people do to live longer and healthier?
1. Find a job that you like (which may not be with the biggest pay cheque).
2. Work for reasonable hours (8-9 hours on average).
3. Cut-off from work when out of office, on weekends and while on vacation (except for occasional emergencies.
4. Take regular vacations with family and friends.
5. Sleep well (on an average 7-8 hours per night). Avoid doing regular night shift duties.
6. Exercise- it can be anything you like, such as walking, jogging, cycling, etc. At least 30 minutes per day and 5 days per week.
7. Prefer home food as much as possible.
8. Keep expenses as per your income. Avoid taking loans as much as possible.
9. Start investing early after analyzing your financial needs and goals.
10. Don’t ignore small warnings about health. Consult a doctor and have preventive health checkups.

Dr Sudhir Kumar MD DM
Consultant Neurologist
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/
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FREQUENTLY ASKED QUESTIONS ABOUT HEADACHES



Headache is a common disorder. A large number of people suffer from headaches. Migraine and tension headaches are the commonest causes of headaches. They are not life-threatening, however, they cause significant disability, as pain impairs the quality of life. In some cases, headaches can be caused by serious causes, such as brain tumor, brain hemorrhage, brain fever, etc. 

The current interview focuses on the common causes of headache. How should we diagnose migraine? It can be diagnosed based on symptoms in most cases. When should one consult a doctor for headache? When should one do a brain scan? How do we treat headaches? To get answers to these and other questions, please watch this interview. The link of the youtube video with the interview is:

https://youtu.be/VgBvamY5kS0

Feel free to post your comments or ask any queries.


Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist,
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/
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