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Can You Have A Healthy Pregnancy If You Are Suffering From MS?

November 1, 2018 0 2 minutes, 41 seconds read

Also known as MS, Multiple Sclerosis is an autoimmune disorder that affects the brain and spinal cord. Unfortunately, in cases of many women, the diagnosis comes at a stage when they are about to plan a pregnancy. Several studies have shown that pregnancy, delivery, and rate of congenital disabilities are no different in women with MS when equated to those without MS. The good part is that there are no substantial evidence of MS causing infertility.

In the past, women with MS were advised not to start a family as the condition may keep them away from giving proper care to their newborn baby. In addition, it was also presumed that pregnancy might worsen the symptoms. 

So, if someone is fighting hard with MS and wishes to plan a pregnancy, the advice is to seek consultation from the best neurologist in Gurgaon to better understand the chances of having a healthy pregnancy. 

Living with MS While Pregnant

Luckily, the picture today is somewhat different. Multiple studies have shown that pregnancy reduces the chances of relapse and this mainly happens in the third trimester. However, if someone has unrecognized MS, they are more likely to start having symptoms during pregnancy. The incapacitating effects of MS may make it substantially hard to carry a pregnancy without any complications. Coordination problems and muscle weakness may surge the likelihood for falls. Furthermore, fatigue may worsen. With fatigue, wheelchair dependence may increase and so the risk of encountering UTIs. 

Keeping the above things in mind, during pregnancy, women need regular and close monitoring to keep track of the condition and overall health of the baby. They may also require recurrent prenatal visits. Though, no standard treatment modifies the course of MS; there are medicines such as steroids and anti-inflammatory drugs that may help. 

During pregnancy, rehabilitation and supportive treatment become especially important. Rehabilitation differs depending on the symptoms, but may help in: 

  • Performing everyday activities
  • Getting the family involved
  • Being independent
  • Using canes, walkers and other assistive devices
  • Enhancing motor skills
  • Refining communication skills in those having trouble speaking caused by weakness or lack of coordination between face and tongue muscles
  • Dealing with bowel or bladder incontinence

Will There Be Any Complications in Breastfeeding?

Multiple Sclerosis does not carry any obstacle in breastfeeding. However, because it is still not clear whether disease-modifying drugs are passed in breast milk, most neurologists advise not to resume therapy until the time someone is breastfeeding. However, there is always an option to resume therapy and formula-feed the baby. Neither of them is right or wrong, as in the end only the mother can decide what is best for them and the baby.

The Role of Neurologist While Pregnant

The neurologist plays a significant role when someone is trying to conceive and that during pregnancy. They also have an opinion about therapy options that will work well in having a smooth pregnancy and prevent relapse after the delivery. Thus, the need of seeking consultation from the best neurologist in Gurgaon. Furthermore, some neurologists also prescribe intravenous immunoglobulin (IVIG) immediately after childbirth to significantly reduce the risk of postpartum relapse. On the other hand, some neurologists may recommend one or several doses of intravenous corticosteroids for the same purpose. 


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Dr. Himanshu Agarwal

Dr. Himanshu Agarwal
Consultant – Interventional Neurology
Dr. Himanshu Agarwal - Max Hospital
  • Society of Therapeutic Neurointervention (STNI)
  • Indian Society of Neuroradiology (ISNR)
  • Indian Radiological and Imaging Association (IRIA)
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Work Experience: 
  • Consultant, Interventional Neurology, Max Saket
  • Ex. Associate Consultant, INR, Max Saket
  • Ex. Assistant Professor, INR, AIIMS, New Delhi
  • Ex. Senior Resident, INR, AIIMS, New Delhi
Education & Training: 
  • DM, AIIMS, New Delhi
  • MD, GSVM Medical College
  • MBBS, SN Medical College
Awards Information: 
  • Gold Medal from President of India for best student in post graduation
  • PGME topper in entire state
  • First prize in health awareness video competition
  • Honors in various subjects in MBBS
  • Published multiple papers in International and National journals, including largest series of Vein of Galen Aneurysmal Malformation from India
Speciality Interest: 
  • Diagnostic cerebral and spinal angiography
  • Acute stroke  Mechanical Thrombectomy
  • Intracranial Aneurysms
  • Cranial and Spinal AVM;s
  • Cranial and Spinal DAVF
  • Carotico-cavernous fistulas
  • Parent vessel occlusion
  • Carotid Stenting
  • Head and Neck Tumor embolisation
  • Balloon test occlusion
  • Petrosal sinus sampling
  • Venous sinus thrombectomy
  • Intra-arterial chemotherapy for Retinoblastomas
  • Brain and Spine Imaging 
  • CT guided Spinal Interventions
Duration Of OPD: 

   Max Super Speciality Hospital, Saket

  • Mon to Fri : 11 am – 4 pm


June 13, 2018 0 83 3 minutes, 55 seconds read

Summer is here, and Delhi will get hot and dusty.  Alongside mangoes, this season brings with it the risk of heat-related illness. Sweating heavily without replacing enough fluids can lead to dehydration or heat cramps. If the body cannot shed enough heat for any reason, there is a risk of heat exhaustion and, in extreme cases, heat stroke - a medical emergency.


Children are particularly vulnerable to heat-related illnesses, because their bodies have a greater surface area-to-body mass (which causes a greater heat gain). They tend to produce more metabolic heat per mass and their sweating capacity is considerably lower in children than in adults.


Heat injuries can be viewed as a continuum of illnesses relating to the body's inability to cope with an increase in heat load. They can be heat cramps, heat exhaustion and the feared heat stroke.


  1. Heat Cramps are acute, painful and involuntary muscle contractions that occur during or after intense exercise sessions in the heat. Heat cramps are associated with fluid deficiencies (that can lead to dehydration), electrolyte imbalances and neuromuscular fatigue. They can be earliest indications of heat injuries and may occur independently or with other symptoms of heat exhaustion.
  2. Heat exhaustion: Heat exhaustion is caused by loss of water and salt, often as a result of exercise in hot weather. If it is not treated, it may progress to heat stroke. Symptoms of heat exhaustion include (but are not limited to)   normal or elevated body temperature, although not as high as 40°C (104°F),   profuse sweating, pale skin, fast, shallow breathing, fast, weak pulse, headache, nausea, vomiting, dizziness, weakness, or fainting, heat cramps and   exhaustion .If his symptoms are severe, or if your child seems confused or disoriented or is behaving oddly, it is imperative to take him to a doctor right away.


It is an acute, life-threatening emergency, which results from an overload or impairment of heat-dissipating mechanisms. It is defined as a core temperature ≥40 to 41°C (104 to 105.8°F) accompanied by central nervous system dysfunction in patients with environmental heat exposure.


At risk are the elderly, infants, the obese, people with hyperthyroidism, and those taking certain drugs.


The main signs that indicate heat stroke are increase in core body temperature, usually above 40° C (104° F) ,  central nervous system dysfunction, which may take the form of altered consciousness, seizures, confusion, emotional instability( including irritability, aggressiveness, apathy) or irrational behaviour .It can progress to  seizures and even coma.

Other possible signs of heat stroke include(but are not limited to)   nausea, vomiting,  diarrhoea ,headache,  dizziness or weakness ,  hot and wet or dry skin ,  increased heart rate alongside  fast breathing .


If child is not treated promptly, it can result in multi-organ failure. This process may include muscle breakdown, renal impairment, difficulty in breathing and requirement of ventilation (ARDS). It can also cause impairment in clotting (DIC), injury to organs as heart, intestines, liver, pancreas among others. In such a case, your child will need admission to PICU, and will need rapid cooling, dialysis among other treatments.



  • Children should wear clothing that is light-coloured and lightweight to facilitate body cooling.
  • Plan their physical activities and rest breaks in accordance with the intensity of activity and environmental conditions, if possible limit outdoor activities.
  • Try activities such that they stay out of direct sunlight and crowded areas.
  • Make sure they drink non-alcoholic, non-diuretic fluids. Water is a good option, but children may drink more of a flavoured beverage such as juice .
  • Cool the body with water.
  • NEVER leave children or pets alone in a car, even for a few minutes. Cars can heat up to dangerous temperatures very quickly. Children who are left unattended in parked cars are at very high risk for heat stroke, and possibly death.



Children who exercise in the heat are at higher risk than adults, because they produce more heat, sweat less, and may forget to drink enough.

  • Make sure the coach or supervisor is knowledgeable about exercising in the heat and that there is a plan for dealing with heat-related illnesses if they arise.
  • Reduce the intensity of exercise when it is very hot, humid, or sunny.
  • Make sure children take frequent breaks.
  • They should preferably wear lightweight, light-coloured clothing.
  • Make sure children are well hydrated before exercising, and regularly when exercising. 
  • IMPORTANTLY, seek medical care immediately if your child has symptoms of heat related illness.

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What Do You Need to Know About Locked-In Syndrome?

June 1, 2018 0 125 2 minutes, 56 seconds read

There are over 600 neurological disorders. Each one has its own shocking complications and symptoms that prove the fact that human mind is way more complex than what we conceive. Even a simple defect in the smallest of the nerves can result in challenging complications.

While you may have heard of common neurological conditions like brain tumor disease or may even know about brain stroke symptoms or brain tumor treatment, there are various other neurological conditions you might have never heard. One such rare neurological disorder is “Locked-In Syndrome”.

Also known as pseudocoma, Locked-In Syndrome (LIS) is a condition in which the patient loses the ability to move all voluntary muscles except for some like blinking of the eyes. To put it in simple words, the patients suffer from a complete paralysis where though they are aware of their surroundings, it is impossible for them to make any movement or use verbal communication. Another condition known as total locked-in syndrome causes paralyses even to the eyes; thus, barring communication.

Here is what you need to know about locked-in syndrome:

Signs and Symptoms

The syndrome is mainly characterized by the complete loss of movement in the voluntary muscles. However, there are some other signs and symptoms as well which may vary from one patient to another.

Patients suffering from locked-in syndrome are not able to speak or make any facial movement. The only way they can communicate is through blinking or eye movements. They can understand everything that happens around them and recognize people as their cognitive function remains unaffected during locked-in syndrome.


Locked-in syndrome is often caused by damage to a specific part of the brain known as pons which contains the important neuronal pathways between the cerebellum, spinal cord and cerebrum. A damage to this part interrupts the movement of motor fibers running from grey matter in the brain causing paralysis. Here are some of the causes and conditions that may lead to locked-in syndrome:

  • Amyotrophic Lateral Sclerosis (ALS)
  • Brainstem stroke
  • Traumatic brain injury
  • A stroke or brain hemorrhage
  • Lesion of the brain stem
  • Infection in the certain part of the brain
  • Poisoning from krait bite or other neurotoxic venoms


There are various other disorders like Akinetic mutism and a Guillain–Barré syndrome that exhibit symptoms similar to that of locked-in syndrome. This makes it difficult to recognize the occurrence of locked-in syndrome and hence the delay in treatment. Therefore, it is vital that one should seek medical consultation from hospitals that have an excellent neurological department.

We at Max Healthcare have highly experienced neurologists who have specializations in all type of neurological disorders and neurosurgery like brain tumor surgery. Some of the diagnostic tests that are performed for locked-in syndrome include Magnetic Resonance Imaging, Magnetic Resonance Angiography and Electromyography.


Though there is no specific treatment for locked-in syndrome, there are some therapies and supportive care methods that can increase the chances of recovery. In most of the cases, the doctors try to treat the underlying cause of the syndrome. They may also recommend tracheotomy to aid the patient in breathing.

Furthermore, to ensure that the patient gets enough nutrition, gastrostomy (where a feeding tube is inserted in the stomach) is performed as feeding and drinking via mouth is not possible. A special therapy called functional neuromuscular stimulation can also be used to stimulate muscle reflexes which can activate paralyzed muscles.

Another essential and effective treatment option is care, support and hope of the family members who can help the patient fight this unfortunate condition.

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What to Do When You Have Tremor?

May 18, 2018 0 93 3 minutes, 6 seconds read

Tremor is an involuntary, rhythmic muscle movement of one or more parts of the body. It is unintentional and can affect any part of the body such as arms, head, hands, trunk and legs. However, most tremors occur in the hands.

What Causes Tremor?

The primary cause of tremor can be either an underlying neurological disorder or a side effect of a certain class of drugs. Typically, it is caused due to problems in the part of the brain that controls the muscles. Tremor is also one of the major symptoms of brain stroke, multiple sclerosis and other neurodegenerative diseases that affect the cerebellum. When tremor occurs on its own, it can be a symptom associated with various neurological disorders, such as:

  • Stroke
  • Parkinson’s disease
  • Multiple sclerosis
  • Traumatic brain injury

Other causes of tremor include:

  • Use of certain medications like corticosteroids and amphetamines
  • Drug and alcohol abuse or withdrawal
  • Mercury poisoning
  • Liver failure
  • Overactive thyroid

Furthermore, some forms of tremor are linked with genetic disorders and run in families without any known cause.

Tremor Resulting from Stroke

Cerebellar tremor is caused due to lesions or damage in the cerebellum; typically resulting from a stroke, a condition like multiple sclerosis, or even a tumour. These abnormal involuntary movements are common after an event of an ischemic or hemorrhagic stroke. Strokes in the pons or midbrain are linked to acute head tremors.

Holmes’ Tremor

A type of resting tremor, Holmes’ tremor involves the cerebellum, brainstem or the thalamus. It is a low-frequency tremor that typically affects the upper limbs. The tremors are slow and involve uncontrollable shaking that occurs when the muscles are at rest. This type of tremor worsens during voluntary muscle contractions.

Palatal Tremor

Palatal tremor occurs after a stroke and is characterised by rhythmic movements of the pharynx and soft palate, which typically persist during sleep.

When to See a Doctor?

Tremor can be one of the symptoms of brain stroke or can occur after one has had a stroke. Furthermore, several types of tremor can have different causes. However, the important thing is to consult our Institute of Brain and Spine in case of an occurrence of tremors. Immediately opting for brain stroke treatment in case of tremor can help in managing it better.

Here are things to keep in mind if you have a tremor:

       1. Beat the Stress

Anyone who is suffering from tremor should try and reduce stress from their daily life. It is one of the first things doctors’ advice to patients who have had a stroke or show the signs or symptoms. Furthermore, controlling anger is also necessary.

       2. Save Tough Tasks When You Are Most Active

Most people who get tremors because they had a stroke are advised to keep heavy tasks for the time of the day when they are most active. For instance, if you have tremor during the daytime, it is advisable to do essential things involving your hands in the later part of the day.

       3. Use Heavy Utensils

According to research, using heavy utensils to eat can help some people in ‘damping out’ their tremors. Moreover, utensils with larger handles are easier to control.

       4. Wear Comfortable Clothes and Shoes

Loose clothes with buttons are much more easy to wear. Shoes such as slip-on are advised to patients affected by tremors.

A neurologist from our Institute of Brain and Spine will suggest medications after thoroughly diagnosing the symptoms of brain stroke and tremors associated with it. However, there are treatment options like a deep brain stimulator that delivers electrical stimulation to the part of the brain responsible for tremors. In severe conditions, a neurosurgeon will perform a brain surgery only if the incision does not affect critical functions of the brain.

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Never Ignore These 5 Neurological DISORDER & DISEASES SYMPTOMS

May 11, 2018 0 306 3 minutes, 27 seconds read

What are neurological disorders & diseases?

The human body is no less than a miracle. Made up of complex yet incredible systems, its unbelievable functions can even leave doctors and scientists confounded. One such system is the neurological system of the human body. With billions of nerve cells or neurons, our body performs various voluntary and involuntary activities helping us in our daily tasks.

However, if there is any problem in the neurological system, a person can have difficulties in moving, speaking, swallowing, breathing, or learning. According to the doctors, there are over 600 neurologic diseases including Huntington's disease, Migraines, Degenerative diseases, epilepsy, brain tumours and meningitis to name a few.

Having a neurological disease can leave a deep impact not just on the patient’s life but on the life of others related to them as well. It is very crucial that one should seek medical assistance from the best neurologist in India as soon as possible when detected any neurological symptoms.

5 Neurological Disorder & Diseases Symptoms 

Now, if you are not aware of such symptoms then read the list carefully and never ignore these 5 Neurological symptoms:


It is one of the most common symptoms of neurological diseases. The individual may suffer from different types of pain such as back pain, neck pain, or the pain in the muscles and joint. Chronic headaches are also a part of neurological symptoms. There are cases where the chronic pain might be an age-related change. However, one cannot skip the fact that it may also be the sign directing the problem in the nervous system.

Difficulties with Memory

If there is a difficulty in memorizing information due to lack of concentration power, then a person might have a progressive neurological disease such as Agnosia. As the individual cannot concentrate on what is being said, he/she will not be able to process the information and hence will not remember anything. There are times when the long-term memory often remains intact, but the short-term memories fade away from the person’s mind.


Another symptom is numbness, i.e., partial or complete loss of sensation. In such a situation, the person is not able to feel any sensation whether it is related to touch, pain, vibration or temperature. They may not be able to use their body part properly and hence have difficulties in balance, coordination, walking, and driving or doing any other physical work.  If the numbness continues to affect the person for a long time, then one should immediately consult a doctor to prevent any other major problem.

Sleep Issues

Like numbness, sleep problems are also related to neurological symptoms. Insomnia and Hypersomnia are the two commonly known sleep disorders that can critically affect your health. While in insomnia, you will not be able to sleep, hypersomnia makes you sleep excessively. These disorders then give way to anxiety that again is another symptom of neurological disorders.

Partial or complete loss of vision

When there is some damage to the brain's occipital lobe that controls the vision, a person may get affected by the partial or complete loss of vision. This neurological vision impairment is associated with symptoms such as blurry or hazy vision, double vision, photophobia (a problem in bright light), etc. The person is also not able to perceive and interpret his/her surrounding making it difficult for him/her to interact with people.

If you have doubt that you or any of your acquaintance may be suffering from any of these symptoms, then you must visit the best neurologist in India to get proper medical assistance as early as possible. Many top hospitals like Max Healthcare have on-boarded the best neurologists from India to help and guide those suffering from neurological disorders.

Early detection and prevention is always the best option to cope with such disorders. The other thing that is most essential is the support and care. If people suffering from any of these symptoms get a strong support system and care from the people around them, it becomes easy for them to cope with their feeling of helplessness and depression that can make their healing effective and faster.


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What Do You Need to Know About Key Hole Spine Surgery?

April 25, 2018 0 89 2 minutes, 31 seconds read

It is also called Minimally Invasive Spine Surgery.

Our society has many myths about spine surgery.

Decision of spine surgery should be based on advice of experts in Spine surgery and not on incidences shared by non-medical people says DR. SANJEEV KUMAR GUPTA Director - Neurosurgery, Max Super Speciality Hospital, Shalimar Bagh.

1. Who will benefit from Key hole spine surgery?

  • Spine body stable fracture
  • Single level spine tumor

Not all patients for spine surgery will benefit with Key hole surgery. Key hole surgery just reduces the external size of the wound, the actual success of surgery depends on the nerve root decompression and adequate disc or bony removal.

2. What are the advantages of Key hole spine surgery?

  • Same day mobilization
  • Next day discharge
  • Muscle tissue is pushed aside rather than disrupted
  • Very less surgery site pain
  • Less blood loss
  • One inch incision
  • Stitch less surgery
  • No need for bed rest
  • Can climb stairs the next day
  • One can place multiple spine fixation screws through few small holes
  • Can be done under local anaesthesiae(not always)

Traditional open spine surgery requires a large muscle-tearing incision, longer hospital stay and a long recovery period.

3.  Why will spine surgery fail?

Delay In Surgery By The Patient due To Spine Surgery Fear. However, there have been significant developments in the spine surgery in the form of equipment like endoscope, miscroscope and surgical microtools.

4. What is the role of belt/brace after Key Hole Spine Surgery?

Although most patients are provided a brace, this is for comfort only. The use of minimally invasive techniques that preserve muscle function, along with specialized implants that act as an internal brace, allows one to avoid having to wear a brace. Most patients find that the brace improves their pain for about 1-2 weeks, and thereafter it is only worn occasionally.

5. How long will I be in the hospital?

After a Key Hole disc surgery patient can go home in the evening or next day morning. In spine fusion  surgery , open procedure will need 5-7 days of stay whereas Key hole surgery will 2-3 days of stay.

6. When can I go back to work after Key Hole Spine Surgery?

The decision to return to work should be individualized to the patient, as well as the patient’s occupation.

For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks.
For a larger surgery such as a fusion, this may take 4-6 weeks.

7. Will I need Physiotherapy after Key Hole Surgery?

Physiotherapy helps in rapid recovery. After 1 week of surgery muscle strengthening exercises are started. It is advisable to continue these exercises at home as a part of routine to prevent recurrent episodes of low back pain.

You can also hire a physiotherapist at home from Maxathome.

8. How is Key Hole surgery performed?

Key hole surgery is performed through a serial dilator system which splits the muscle on one side rather than cutting the muscle







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Everything You Need to Know About Amyotrophic Lateral Sclerosis (ALS)

April 13, 2018 0 303 2 minutes, 52 seconds read

Amyotrophic lateral sclerosis, also known as ALS, is a nervous system disease in which the neurons in the brain, as well as spinal cord, are attacked. The function of the neurons is to transfer messages from the brain and spinal cord to the voluntary muscles. The voluntary muscles are the ones which can be controlled, like in the arms and legs. ALS being a progressive disease can get worse as time passes. As it affects the nerves in the brain and spinal cord that control the muscles, the muscles get weaker and, this creates difficulty in walking, talking, eating, and even breathing. One should visit a brain hospital as soon as these symptoms start to appear.

Symptoms of Amyotrophic Lateral Sclerosis (ALS)

Some of the earliest signs of ALS include:

  • Constant tripping and falling
  • Difficulty in walking or doing the normal daily activities
  • Weakness in hand or clumsiness
  • Difficulty holding the head up or maintaining a good posture
  • Weakness in leg, feet or ankles
  • Muscle cramps and twitching in arms, tongue, and shoulders
  • Trouble swallowing or slurred speech

Types of ALS

There exist two main types of ALS:

  • Sporadic ALS: This being the most common form of ALS, affects up to 9 percent of individuals diagnosed with the disease. Sporadic means it sometimes happens without an apparent cause.
  • Familial ALS (FALS): This type of ALS runs in families. However, only 5 to 10 percent of individuals with ALS have this type. A faulty gene passes to the children through their parents. If one parent has the ALS gene, each of their children will have a 50 percent chance of inheriting the gene and being diagnosed with the disease.

Causes of ALS

ALS is inherited in 5 to 10 percent of cases, while the remaining cases have no known cause. As per the researchers, these could be the several possible causes of ALS:

  • Chemical Imbalance: Individuals with ALS usually have higher than normal levels of glutamate, which can be toxic to some nerve cells. Glutamate is a chemical messenger present in the brain, near the nerve cells in their spinal fluid.
  • Gene Mutation: Many genetic mutations can lead to inherited ALS, which has almost similar symptoms as the non-inherited form.
  • Protein Mishandling: Mishandled proteins present inside the nerve cells may accumulate which can eventually destroy the nerve cells.
  • Disorganized Immune Response: At times an individual's immune system starts attacking some their normal cells, which may kill the nerve cells.

Risk Factors for ALS

Some of the established risk factors for ALS are:

  • Heredity: 5 to 10 percent of the individuals with ALS inherited it, which is known as familial ALS.
  • Age: The risk of ALS increases with age and people between the ages of 40 and 60 are more prone to be diagnosed with this disease.
  • Sex: Slightly more males than females develop ALS before the age of 65. This sex difference tends to disappear after age 70.
  • Genetics: There exist certain similarities in the genetic variations of individuals with familial ALS and some individuals with non-inherited ALS. These genetic variations might make individuals more vulnerable to ALS.

Treatment of ALS

Damage done by amyotrophic lateral sclerosis cannot be cured by treatments, however; medicines can slow the progression of symptoms, prevent complications and make an individual more independent as well as comfortable. One may require an integrated team of doctors skilled in multiple areas and other healthcare professionals to offer the right care. Doing this may prolong a patient’s survival and improve their quality of life.


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