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A:  As a neurologist we cannot see every case of back pain or headache, but when the diagnosis and management of these condition becomes complicated, for example imaging is not showing the problem or traditional therapy has not been effective, we have more tools for diagnosis (as lumbar puncture) and detailed examination and we use somewhat more aggressive therapy that many family practitioners are not comfortable using.

A: There are many reasons for loss of balance as we age, but there are more causes that can be treated and prevented, such as vitamin b12 deficiency, neuropathy and cerebellar diseases that have to be considered.

A: Senility alone is not accepted as a reason for poor memory. Dementia is a broad term, which means long standing poor cognitive function. There are many causes or types of dementia as B 12 deficiency, multiple strokes, Parkinson disease, fronto-temporal dementia, tumors, medications, head trauma, normal pressure hydrocephalus NPH……but the most common type is Alzheimer type dementia

A:  Diabetic neuropathy is very common if you have diabetes, but now we even link it to the metabolic syndrome or pre-diabetes. There are many other causes that have to be considered in anyone with neuropathy …such as connective tissue disease, lupus, demyelinating neuropathy as acute Guillian Barre syndrome or a similar form but chronic, B 12 deficiency, heavy metals, toxins, vitamins B 6, autoimmune diseases, cancer, medications, Inherited disorders and many more.

Tremors of the hands is not always caused by Parkinson disease, there are some people with Parkinson disease who do not have shaking. Essential tremor is more of a familial condition, also some endocrine problems and common medications can cause shaking. Many other causes need to be rolled out.

A: Dizziness means many things to many people, but commonly means vertigo, which is not a disease by itself, it is a symptom which means abnormal sense of movement or spinning. Vertigo can be caused by disturbances in the inner ear which rarely get infected with bacteria unlike the middle ear which get infected a lot in children and at times adults. Inner ear problem can be caused by vestibular pathology, the most common of which is paroxysmal positional vertigo, which is treated by some maneuvers and less likely to be treated by medication as Antivert/Meclizine. Many other causes also exist.

A:  If strokes risk factors are under fair control and her brain image showed no acute stroke, complex partial epilepsy has to be considered. Details history and neurological evaluation is necessarily including an EEG (brain wave test), if it is epilepsy it can be treated even if she never had convulsion.

A: Treatment of epilepsy had advanced in the last 20 years by significant leaps and bounds. If you had one or 2 seizures and did not have another one for 4 years or more, you can be considered for medication weaning (gradually and after evaluation). If it is determined that you need seizure medication for life there are a lot more medications that have less side effects and do not require lab monitoring as the older group of medications. Please seek neurological evaluation.