EN1 Neuro Services Pvt Ltd

Good morning everybody.

Mai Dr. Neeta Naik bol rahi hoon aur mai pediatric neurologist or developmental pediatrician hoon. Aaj main aapse baat karne wali hoon drug resistant epilepsy ke treatment ke bare mein. So, drug-resistant epilepsy kya hoti hai iske bare mein maine mere pehle video mein baat kar chuki hoon. Main aapko aaj bataungi iski treatment kis tareeke se kii jati hai aur jo jankari aapke liye relevant hai uske bare mein mai baat karungi. Drug resistant epilepsy means epilepsy jiski dava se treatment sahi tarike se ya completely nahi hoti ya jaha bacho ke seizures drugs ya medications se control nahi hote hai vaha hum alag tareeke ke treatment use karte hai usme se 1 jo pehla tareeka jyadatar use kiya jata hai usko dietary treatment bolte hain, Dietary treatment of epilepsy. Dusra hai use bolte hai vagal nerve stimulation aur teesra hai epilepsy surgery.

So abi dietary treatment kya hai? So, dietary treatment ye hai ki isme hum bache ka khana badalte hai. Bacha normally jo khana khata hai ya hamara jo Indian diet hai vo bahut carbohydrate intensive hota hai aur usme protein aur fats ki matra kafi kam hoti hai. Drug resistant epilepsy mein 2 ya 3 tareeke ke alag diets istemal kiye jate hai. Usme jo commonly ya oldest tareeka hai use ketogenic diet assay kehte hai. Shayad apne ketogenic diet ye word suna hoga kyunki ye jo dietary treatment hai ye aajkal ki bahut sari utilisation weight loss ke liye bhi ki jaati hai. To isme bache ka jo khana hai jo carbohydrate intense hai jaise ki rice hua, chapati, vegetables, fruits ya jo bhi hum Indian khate hai upma, idli, dosa isko switch karke hum high hume carbohydrate ekdum kam karna hai isme so carbohydrate content is below 5%, 80% approximately fat content hota hai aur 15% approximately protein hota hai. Toh isme isko 4:1, 3:1 ya 2:1 fat to protein + carbohydrate ratio me kiya jata hai. Ye diet is tareeka ka nahi hai ke jo hum ghar mein kar sakte hai ise doctor ki aur dietecian ki supervision ki, pre test ki aur follow-up ki ye charo cheez ki zarurat hai. To jab ketogenic diet ye kyu karte hai kyunki ketogenic diet mein jab fat istemal kiya jata hai energy production ke liye to ketones jo shareer mein paida hote hai vo blood brain barrier cross karke brain pe effect uska hota hai aur uska effect antiepileptic drug ke tarike se hi hota hai jismein brain ki electrical activity kam hojati hai aur 100 me se 30-40% patients mein isme 40-90% seizures control karne ki shamta hai. But the difficulty is ki ketogenic diet kabhi-kabhi bahut jyada mushkil ho sakta hai.

Kabhi kabhi ketogenic diet karna bade bacchon ke liye aasan nahin hai kyunki usme bahut jyada fat khana padta hai jaise ghee, butter, cheeze ye main oil ye cheeze bahut jyada content badh jata hai aur baki content bahut kam ho jata hai isilye iska ek 2nd type of diet hai jisko modified Atkins diet kehte hain. To modified Atkins diet mein protein or fat hum unlimited kha sakte hain aur sirf carbohydrate kaam karna padta hai. Yeh thoda aasan hai, isme measurements kam hai, isme unlimited protein hai so non vegetarian families ke liye bahut jyada aasan ho sakta hai, isme Soya products vegetarian family ke liye use hota hai aur isme bhi the principal is same but this diet is easier to do. Agar dietary treatment karna hai to again I would like to repeat ke supervision ke under hi karna hai aur isme kafi bacchon mein bahut jyada tarike se isme refractive drug-resistant epilepsy mein faida ho sakta hai. Dusri treatment hai use kehte hain VNS ya Vagal nerve stimulation.

Yaha ek equipment hota hai jaise ke aap heart mein pacemaker dalte hai usi tareeke se ek pacemaker jaisa equipment hota hai aur ye equipment chest mein skin ke under surgically dala jata hai. Ye equipment se hamare yaha nas hoti hai jise vagal nerve kehte hai, vagal nerve mein stimulation diya jata hai electrical stimulation aur vagal nerve ye impulses brain ko carry karti hai aur brain ko stimulate karke brain ke jo abnormal electrical activity pe affect karke vo bhi kam hosakta hai. Though ye surgical procedure hai, bahut choti surgery isme hoti hai aur iska bhi bahut jyada hadd tak faida refractory epilepsy mein ho sakta hai. Teesri jo treatment hai use epilepsy surgery kehte hai. Usme 2 type ki surgery hoti hai: lesional ya non-lesional surgery. Agar MRI mein bacchon ke koi ghanth ya koi agar lesion dikhayi deta hai to use nikalna use lesional surgery kehte hai aur jaha lesion nahi dikhta usme non-lesional surgery kehte hai. Isme ek palliative surgery bhi hoti hai, ye surgery diet aur VNS ya vagal nerve stimulant ke hisab se bahut jyada complicated hoti hai lekin jo bacchon ke akdi baki cheezo se control nahi hoti usme iska faida ho sakta hai. To aaj maine apse bat ki iske bare mein ki drug resistant epilepsy kis tareeke se control karni chahye. Aapko aapke paediatric neurologist ke pass jana zaroori hai aur yeh treatment options vo aapke sath discuss karenge.

Agar aapko iske bare mein aur koi jankari chahye to aap lybrate hamare page pe visit kar sakte hai.

Thank you.

Good morning everybody.

I am Dr. Neeta Naik, I am a paediatric neurologist. Main ek paediatric neurologist hoon aur main developmental pediatrician bhi hoon. Jyadatar bacchon mein main jab bacchon ke dimag ke problem hote hain jaise ki epilepsy hai ya developmental disorders hai jaise ki autism hai ya koi bacche jinki growth ya jiski development umar ke hisab se nahin hoti hai aise bacchon ki main treatment karti hoon. So, I am gonna speak a little bit in English, little bit in Hindi depending on the terminology that I have to use. So, aaj ka topic hamare liye hai childhood epilepsy yane bacchon ke mirgi ki bimari.

So childhood epilepsy ye bahut common neurological disorder hai aur isme iska jo characteristic feature hai vo hai bar bar bacche ko akdi aana ya mirgi ke daure padna means basically when the child gets repeated, recurrent seizures or it is also known as recurrent unprovoked seizure yani ki koi aur vajah nahi hai jaise ki fever hua ya calcium kam huya ye vajah nahi hai lekin fir bhi koi vajah na hone ke bawjood bhi bacche ko agar bar bar akdi ke fit ke ya seizure ke daure aate hain ya English mein jise seizures kehte hai seizures aate hai to use childhood epilepsy kaha jata hai. Ab sawal ye hai ki iski treatment kaun karta hai ya kis tareeke se hoti hai, who treats childhood epilepsy.

So, typically childhood epilepsy is treated by a paediatric or a child neurologist jo bacchon ke dimag ke doctor hote hain ya bacchon ke dimag ke specialist hote hain but sometimes in some areas child neurologist may not be available and in that case a pediatrician or child specialist who having experience in treatment of childhood epilepsy will treat this disorder. Why it happens, ye kyu hota hai? This is because of excessive electrical activity in the brain, hamare brain mein jo Vidyut lohria ya electrical activity hoti hai kabhi kisi vajah se ye electrical activity badh jaati hai, so when there is an excessive electrical activity and this excessive electrical activity synchronises wo itni jyada hoti hai ki uska effect hamare movement pe ya consciousness pe hota hai to bacche ko ya hume ya jise bhi jo affected hai use fit ya mirgi aati hai. To agar ye aati hai to parents kya kare? The first thing, the most important thing is that the child needs treatment, iski treatment available hai, there is a very good childhood epilepsy is treatable and in 60 to 70% of the patients it can be considered as curable also. Agar curable means medicine se agar hum long term this seizures ko control mein rakh sakte hain to epilepsy cure bhi ho sakti hai. So, whenever there is a child who has repeated seizures, the parents have to seek opinion of an expert. Vo expert kya karte hai the first thing is aapko detail mein unhe history batani hai, jab aap history bataenge uske bad expert EEG, MRI ya koi blood test order karenge. Iske bad bacche ki bimari ka nidan hoga, a diagnosis of epilepsy is made. The diagnosis of epilepsy is a complex stepwise process aur isme diagnosis ye kis tarah ki epilepsy hai, kis vajah se huyi hai, iska prognosis yane ye kis tarah se theek ho sakti hai ki ni, iske bare mein doctor jankari payenge through the test and through the history aur ye jab unhe jankari hogi uske hisab se bacche ke treatment chalu hogi. Ab ye treatment usually medication se hi hoti hai aur jo drugs iske liye istemal kiye jate hai usko antiepileptic drugs kaha jata hai. So, Antiepileptic drugs are a group of drugs which are used for children with epilepsy. Jyadatar bacchon mein ek dawa chalu ki jati hai. When you start first medicine is started and the medicine is titrated. Titrated ka matlab ye hai ki agar humne 1 dawa chalu ki bacche ko aur agar ek particular dose mein hum jab dawai ki shuruaat ya medication ki shuruaat karte hain aur bacche ki iski vajah se akdi control mein nahi aati to dhire dhire dose badhaya jaata hai but ye supervised process honi chahye jisme parents vapas neurologist ke pass regular follow-up ko jake bataye ki agar bacche ki akdi control nahi ho rahi to kis tarah se akdi aa rahi hai, kitni bar akdi aa rahi hai. Therefore ye jo bimari hai iski treatment long term hai kyunki childhood epilepsy is a chronic disorder, iski kam se kam treatment 2 se 3 sal chalti hai aur koi koi yane 20-30% baccho mein iske treatment 5 sal ya 10 sal bhi chal sakti hai, aur ye kyu itni lambi chalti hai iski vajah bhi hoti hai yane konse tarah ki epilepsy hai iske hisab se ye define hota hai ki ye epilepsy respond karegi ya epilepsy benign hai jo turant dawa se theek hogi ya ye complicated ya encephalopathy jise bolte hain.

Encephalopathy hai jo long term chal sakti hai aur jiska asar bacche ke padhaai per ya development pe ho sakta hai. To jab shuruaat ki jaati hai treatment ki to ye treatment ki shuruaat jyadatar ideal antiepileptic drugs select karke hi ki jaati hai. Aap jab neurologist ke pass jaate hain to uske experience ke hisab se, bacche ki epilepsy kis tarah ke ki hai, kis type ki hai iske hisab se, bacche ki personality kis tarah ke ki hai, uska weight kya hai, age kya hai ye sab factors consider kiye jate hai aur ye sab factor consider karke, parents ke sath discuss karke, uske side effects parents ko bata ke drug chose kiya jata hai. Itna sab sochne ki jarurat isliye hai ki ye jo dawa hum bacche ko dete hain ye jyadatar bacchon mein 2 sal ya 3 sal chalegi. Jab long-term dawa di jaati hai to uske side effect kaise hote hain ye bhi parents ko janna zaroori hai taki agar side effects of ho to parents turant doctor ko report kare. Agar ek dawa choose kar ke bacche ki akdi control nahi hoti hai ya agar ye dawa ki vajah se bacche ko side effects hote hai to zaroori hai ki doctor usko second drug add kare aur ek dawa ise add karne ki zarurat pad sakti hai aur kabhi kabhi aise bhi so sakta hai ki ye dawa switch karne ki zarurat pad sakti hai yane ki ye dawa band karke koi aur dawa shuru karne ki jarurat pad sakti hai. Jab iss tareeke se hum bacche ki treatment karte hai aur uske bad mein 2 ya isse jyada 3 ya 4 dawayi dene ke bawjood agar bacche ki akdi control mein nahi aati hai to fir is drug resistant epilepsy kaha jata hai. So ye jo drug-resistant epilepsy hoti hai isme kabhi kabhi aisa hota hai jyadatar uski jo definition hai ki usko kya kaha jata hai ki 2 saal kam se kam ye drugs try karna chahiye aur uske bad usko drug-resistant epilepsy kaha jata hai but ye definition adults mein hai. Ise bacchon mein hum sochte hain ki agar 6 mahine mein ya 1 saal mein bhi theek tareeke se dawa dene ke bawjood agar control hota ni hai to hum use drug resistant epilepsy keh sakte hain. To fir agar hume pata hai samjho hum doctor neurologist ko pata hai ki ye drug resistant epilepsy hai fir hume aage kya karna chahiye.

To aage ki treatment hoti hai usme vapis ek bar fir review karna chahiye, review yane kya ki bacche ke jo fit hai uska jo humne nidan kiya hai vo sahi hai ki nahi, kya hume aur koi test order karne ki jarurat hai hai kya, kabhi koi bacchon mein humne sirf EEG kiya hua rehta hai, kabhi usme video EEG ki jarurat pad sakti hai, jaise ki video EEG ye hota hai jaha pe video ka jo hota hai bacche ka seizure ya fit aur bacche ka EEG sath mein camera mein computer screen mein hum dekh sakte hain, taki hume ye jaan sakte hain ki ise fit aati hai vo kis tarah ke ki aati hai aur hum ye bhi jaan sakte hai ki jab fit aati hai us waqt bacche ke brain mein se kahan se aur kis tarah ki electrical abnormality ki nirmati ho rahi hai, to ise video EEG kehte hai. Kabhi hume MRI jo humne phle kiya nahi hota, hume MRI ki zarurat padh sakti hai, kabhi bacche ke brain mein structural lesion bolte hai jaise uska structure alag tarike se bana ho, kabhi aisa bhi ho sakta hai ki bacche ko genetic epilepsy ho ya metabolic epilepsy ho jisme metabolic means jo shareer mein jo hamare use chaya pachayan kriya bolte hai, jab chaya pachayan kriya chalti hai usme koi galti ya kami aane ki vajah se jo genetically determined ho, iski vajah se bhi kabhi kabhi fit ki shuruaat ho sakti hai aur usme kabhi kabhi alag tarike ki treatment sirf antiepileptic drugs nahi but koi alag tarike ki treatment hume milne ke bhi chance rehte hain. So ye sab iska jab review hota hai uske bad mein kabhi koi bacchon mein nayi treatment shuru ho sakti hai ya koi bacchon mein alag naye vale antiepileptic drug ki shuruaat ho sakti hai. But kabhi aisa bhi hota hai ki iske bawajood bhi fits control nahi hote, agar iske bawajood fits control nahi hote to hume aur tareeke hai treatment ke aur vo 3 tareeke hai us tareeke ke: 1 usko bolte hai diets, so bacchon ki jo treatment hoti hai resistant epilepsy ki usme 2-3 prakar ke common diets, popular diets use kiye jate hai. Diets means basically khana jo bacche ke bacchon ke khane mein badal karna to ise hum hamare pass ye book hai jise isko dietary treatment of neurological disorder aajkal dietary treatment of neurological disorders jo hai vo bahut jyada popular ho chuka hai lekin aisa nahi hai ki har ek bacche mein hum de sakte hai, hume vo doctor decide karega kaha ye diet istemal karna hai, kis tareeke ka diet istemal karna hai aur jabhi bhi hum diet istemal karte hai to vo under the supervision of a paediatric neurologist and a dietitian hi hoga, aap aise ghar mein nahi kar sakte mai padhle internet pe, Google search mara aur maine diet kar diya aise nahi hota kyunki usme kafi supervision ki jarurat hoti hai. To 2 tareeke ke diet hote hai: 1 ko kehte hai ketogenic diet aur ek ko kehte hai modified Atkins diet jo hum commonly istemal karte hain. So, ketogenic diet aapne shayad padha bhi hoga internet pe aur modified Atkins diet bhi aapne padha hoga vo commonly kafi log weight loss ke liye use karte hain. And diet vo hi hai par jab hum bacchon ke liye istemal karte hain, neurological disorder ke liye istemal karte hain to it has to be under supervision. So, isme principal kya hai ketogenic diet kya hai to thodi jankari mai aapko dungi ki ketogenic diet mein hum shareer mein ketones paida karte hain. Ketones ye ek metabolite hai jab fat istemal kiya jata hai energy produce karne ke liye.

Normally kya hota hai hum jab khana regular khate hain to hum glucose istemal karte hai, glucose particle, glucose istemal karte hain energy produce karne ke liye aur tabhi ketone paida nahi hote. Agar hum fats use karte hain energy production ke liye to ketones paida hote hain. To ye jo diet hai ketogenic diet isme basically hamara jo standard jo dietary intake hota hai hum jab khana khate hai to hum carbohydrate, protein or fats ye 3 tareeke ke cheeze hum hamari diets mein hota hai aur jo typical Indian diet hai usme carbohydrate bahut jyada hota hai, uske bad protein hota hai, uske bad fat hota hai. Ketogenic diet mein ye proportion ekdum ulta ho jata hai jaha hum jaise ke ek samjho aap 100% pakdoge to usme se 60-70 or sometimes 80% hum fats use karte hai aur baki 20% jo bachta hai usme proteins or carbohydrate use karte hain, to it's a very low carbohydrate and high fat diet. To isse kya hota hai jab hum high amount of fat bacche ko dete hain to bacche ke shareer mein ketones paida hote hain. Ye ketones blood brain barrier cross karke ek antiepileptic effect isme hai aur vo epilepsy control kar sakta hai. Lekin ye janna zaroori hai ki achanak se start karna, achanak se band karna ye hum nahi kar sakte isme hume start karna hai to doctor se discuss karke, fir doctor jo test bataenge ki ketogenic diet chalu karne ke pehle ya shuruaat karne ke pehle hume kayi sare blood test, video EEG etc karne hai, hume monthly ya two monthly monitoring karna hai aur agar diet successful hota hai to ho sakta hai diet 3-5 years ke liye aapko dena hai. 

Agar aapko iske bare mein aur koi jankari chahiye to aap lybrate hamare page pe visit kar skate.

Thank you.