« Dr Harrish Reesaul - Consultant Neurologist »

28/04/2025

Mo fatiguer, ki pou fer?
Fatigue, what to do?

Fatigue treatment focuses on addressing the underlying causes and implementing lifestyle changes to improve energy levels. This may involve addressing medical conditions, making dietary adjustments, and incorporating regular exercise and stress-reducing techniques.

1. Identify and Treat Underlying Causes:

Medical Conditions:
Fatigue can be a symptom of various medical conditions, such as anaemia, sleep apnoea, thyroid issues, or infections. Addressing these conditions through medication, supplements, or other therapies is crucial.

Mental Health:
Anxiety and depression can significantly contribute to fatigue. Seek professional help from a psychologist or psychiatrist to address these conditions.

2. Lifestyle Modifications:
Sleep:
Prioritize a regular sleep schedule, aiming for 7-9 hours of quality sleep per night. Avoid caffeine and alcohol before bed and create a relaxing bedtime routine.

Diet:
Eat a balanced diet rich in fruits, vegetables, and whole grains. Avoid excessive processed foods, sugary drinks, and excessive caffeine and alcohol, which can disrupt sleep and energy levels.

Exercise:
Regular physical activity, even moderate exercise, can improve energy levels and sleep quality. Consult with a doctor or therapist to determine an appropriate exercise plan.

Stress Management:
Practice relaxation techniques like yoga, mindfulness, or meditation to reduce stress, which can contribute to fatigue.

3. Specific Considerations:
Medications:
Some medications can cause or worsen fatigue. Consult with your healthcare provider to discuss potential side effects and adjust medications if necessary.

Chronic Fatigue Syndrome (CFS):
For individuals with CFS, treatment may involve a combination of lifestyle changes, medications, and therapies.

Muscle Fatigue:
Rest, massage, and foam rolling can help alleviate muscle fatigue, especially after exercise.

31/03/2025

Burning sensation. Mo gagne briler.

A burning sensation in the body can stem from various causes, including nerve damage, infections, inflammation, or even anxiety, and can manifest in different areas like the skin, chest, or extremities.

Potential reasons:
Nerve-Related Causes:
Peripheral Neuropathy: Nerve damage, often due to diabetes, can cause burning, tingling, or numbness, especially in the hands and feet.

Nerve Compression: Conditions like carpal tunnel syndrome or cubital tunnel syndrome can lead to nerve compression and burning sensations.

Neuralgia: Nerve pain, which can feel like a burning sensation, can occur after nerve damage or infection.

Multiple Sclerosis (MS): This autoimmune disorder can cause burning, tingling, or muscle spasms.

Shingles: A reactivation of the chickenpox virus can cause a painful, burning rash.

Other Medical Conditions:
Infections: Infections like cellulitis or urinary tract infections (UTIs) can cause burning sensations.

Skin Conditions: Allergic reactions, eczema, or dry skin can contribute to a burning sensation.

Diabetes: High blood sugar levels can damage nerves, leading to burning sensations.

Kidney or Liver Disease: These conditions can cause nerve damage and burning sensations.

Vitamin Deficiencies: Deficiencies in certain vitamins, like B12, can lead to nerve damage and burning sensations.

Anxiety or Stress: Anxiety can cause a burning sensation, as the body directs more blood to vital organs and muscles.

Acid Reflux/GERD: Backflow of stomach acid into the oesophagus can cause a burning sensation in the chest.

Heartburn: A burning sensation in the chest that can be caused by acid reflux.

Trauma: Injuries to the skin or underlying tissues can cause a burning sensation

Sunburn: Exposure to the sun can cause a burning sensation on the skin

Insect bites and stings: These can cause a burning sensation on the skin

When to Seek Medical Advice:
If the burning sensation is severe, persistent, or accompanied by other symptoms like fever, numbness, or weakness.
If you suspect you have an infection or other serious medical condition.
If the burning sensation is interfering with your daily activities or sleep

13/10/2024

Tips to stay healthy:

Avoid salty foods.
Avoid sugary and sweet foods.
Avoid greasy/fatty foods.
Decrease your protein intake to 50 to 100g daily.
Increase your water intake to more than 2 litres daily.
Increase your dietary fibre intake.
Limit your net calories intake to approximately 2500 Kcal for men and 2000 Kcal for women.
Daily exercise for a minimum of 30 minutes.
Sleep adequately - 8 hours on average.
Eat small meals giving preference to fruits and salads.
If you have diabetes, control it stringently.
If you have hypertension, monitor and control your blood pressure carefully.
If you have cardiac problems, get it sorted out.
Visit your doctor regularly for the necessary check-ups.
Meditation helps.
Thanks, please share to avoid falling sick.
Being healthy is hard, but being unhealthy is harder.

15/08/2024

What to do in case of headaches?

Some people think that headaches are symptoms to worry. However, most of the headaches you shall ever experience are harmless.
Only up to 6% of headaches are of concern.
Unfortunately, most of the people fail to recognise it, this is why it is always good to have yourself be seen by a neurologist/doctor in case of doubt.
Sudden onset headaches are of concern because they could be hiding intracranial haemorrhages.
Headaches after 50 years of age should definitely be investigated.
Persistent dull headaches are sign of worry too.
Sporadic/episodic headaches are benign causes like tension type headaches, migraine, etc.
In my work, I see headaches nearly every day and most of the patients are worried and they want to have a brain imaging done which is totally understandable. Even very experienced doctors sometimes find it difficult to manage headaches properly.
However, the golden rule is always to reassure the patient and adapt the management to the requirements of the patient. Abstain from over treating and under treating, both being challenging in refractory headaches.
Headaches are mostly provoked. E.g. lack of hydration can cause headaches, too much screen time can cause headaches, prolonged exposure to sunshine can cause headaches, stress can provoke headaches, oily foods/Chinese foods can cause headaches, and the list goes on. Avoiding these trigger factors can decrease the frequency of headaches.
What will your neurologist/doctor do when you go see him/her? He/she will listen to you and try to understand what kind of headaches you are experiencing. He/she may ask for a scan of the brain to exclude intracranial pathologies. He/she will determine the best treatment modality for you. He/she will reassure you so that you can live your life headache free.
Hope you have found the above informative and share to create awareness.
Happy a happy holiday!

Consultant Neurologist. Manages Headaches, Dizziness/Vertigo, Stroke, Epilepsy, Dementia, Parkinson'

22/06/2024

Tremors - Tremblements (Part 1)
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder.

Tremor is most classified by clinical features and cause or origin. Some of the better-known forms of tremor, with their symptoms, include the following:

Cerebellar tremor (also known as intention tremor) is a slow, broad tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one's nose. In classic cerebellar tremor, a lesion on one side of the brain produces a tremor in that same side of the body that worsens with directed movement. Cerebellar damage can also produce a "wing-beating" type of tremor called rubral or Holmes' tremor — a combination of rest, action, and postural tremors. The tremor is often most prominent when the affected person is active or is maintaining a particular posture. Cerebellar tremor may be accompanied by other manifestations of ataxia, including dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck. Titubation is tremor of the head, hands, and torso and is of cerebellar origin.

Dystonic tremor occurs in individuals of all ages who are affected by dystonia, a movement disorder in which sustained involuntary muscle contractions cause twisting and repetitive motions or painful and abnormal postures or positions. Dystonic tremor may affect any muscle in the body and is seen most often when the patient is in a certain position or moves a certain way. The pattern of dystonic tremor may differ from essential tremor. Dystonic tremors occur irregularly and can often be relieved by complete rest. Touching the affected body part or muscle may reduce tremor severity. The tremor may be the initial sign of dystonia localized to a particular part of the body. The dystonic tremor has usually a frequency of about 7 Hz.

Essential tremor (sometimes inaccurately called benign essential tremor) is the most common of the more than 20 types of tremors. Although the tremor may be mild and nonprogressive in some people, in others, the tremor is slowly progressive, starting on one side of the body but affecting both sides within 3 years. The hands are most often affected but the head, voice, tongue, legs, and trunk may also be involved. Head tremor may be seen as a vertical or horizontal motion. Essential tremor may be accompanied by mild gait disturbance. Tremor frequency may decrease as the person ages, but the severity may increase, affecting the person's ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremors or increase their severity. Onset is most common after age 40, although symptoms can appear at any age. It may occur in more than one family member. Children of a parent who has essential tremor have a 50 percent chance of inheriting the condition. Essential tremor is not associated with any known pathology. Its frequency is between 4 and 8 Hz.

Orthostatic tremor is characterized by fast (>12 Hz) rhythmic muscle contractions that occur in the legs and trunk immediately after standing up. Cramps are felt in the thighs and legs and the patient may shake uncontrollably when asked to stand in one spot. No other clinical signs or symptoms are present and the shaking ceases when the patient sits or is lifted off the ground. The high frequency of the tremor often makes the tremor look like rippling of leg muscles while standing. Orthostatic tremor may also occur in patients who have essential tremor, and there might be an overlap between these categories of tremor.

Parkinsonian tremor is caused by damage to structures within the brain that control movement. This resting tremor, which can occur as an isolated symptom or be seen in other disorders, is often a precursor to Parkinson's disease (more than 25 percent of patients with Parkinson's disease have an associated action tremor). A classic symptom is a characteristic fine tremor in the hands, which is traditionally described as a "pill-rolling" action of the hands, but Parkinsonian tremor may also affect the arms, chin, lips, legs, and trunk, and can be markedly increased by stress or emotion. Onset is generally after age 60. Movement starts in one limb or on one side of the body and usually progresses to include the other side. The tremor's frequency is between 4 and 6 Hz.

Physiological tremor occurs in every normal individual and has no clinical significance. It is rarely visible and may be heightened by strong emotion (such as anxiety or fear), physical exhaustion, hypoglycaemia, hyperthyroidism, heavy metal poisoning, stimulants, alcohol withdrawal or fever. It can be seen in all voluntary muscle groups and can be detected by extending the arms and placing a piece of paper on top of the hands. Enhanced physiological tremor is a strengthening of physiological tremor to more visible levels. It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycaemia. It is usually reversible once the cause is corrected. This tremor classically has a frequency of about 10 Hz.

Psychogenic tremor (also called hysterical tremor and functional tremor) can occur at rest or during postural or kinetic movement. The characteristics of this kind of tremor may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction or body part affected, and greatly decreased or disappearing tremor activity when the patient is distracted. Many patients with psychogenic tremor have a conversion disorder (see Post traumatic stress disorder) or another psychiatric disease.

Rubral tremor is characterized by coarse slow tremor, which is present at rest, at posture and with intention. This tremor is associated with conditions which affect the red nucleus in the midbrain, classically unusual strokes.

Neuropathic tremor may occur in patients with peripheral neuropathies, when the nerves that supply the body's muscles are traumatized by injury, disease, abnormality in the central nervous system, or as the result of systemic illnesses. It is most observed in patients with an immunoglobulin M paraproteinemic neuropathy (IgMNP), but also in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). The tremor is predominantly exhibited as an action or postural tremor with a frequency of 3 to 10 Hz. Peripheral neuropathy can affect the whole body or certain areas, such as the hands, and may be progressive. Resulting sensory loss may be seen as a tremor or ataxia (inability to coordinate voluntary muscle movement) of the affected limbs and problems with gait and balance. Clinical characteristics may be like those seen in patients with essential tremor.

Neurogenic tremor is a self-induced tremor that is activated in humans. The mechanism is activated passive supine position, bringing the knees up and splitting them apart. The tremor is akin to the natural shaking mechanism in mammals to discharge stress and trauma. The type of tremor is also known as "self-induced therapeutic tremor". It is considered a kind of "spontaneous movement".

Tremor can result from other conditions as well

Alcoholism, excessive alcohol consumption, or alcohol withdrawal can kill certain nerve cells, resulting in a tremor known as asterixis. Conversely, small amounts of alcohol may help to decrease familial and essential tremor, but the mechanism behind it is unknown. Alcohol potentiates GABAergic transmission and might act at the level of the inferior olive.

To***co withdrawal symptoms include tremor.

Most of the symptoms can also occur randomly when panicked.

Part 2 coming soon – causes of tremors.

Please share

Consultant Neurologist. Manages Headaches, Dizziness/Vertigo, Stroke, Epilepsy, Dementia, Parkinson'

26/05/2024

Autism, it's not the end of the world. Help your loved one to lead an as independent life as possible.
Autism spectrum disorder (ASD) is a developmental disorder. It affects how children interact and communicate with others. The disorder is called a spectrum disorder because of the wide range (spectrum) of severity. Some children on the spectrum may be able to talk. Eventually they may be able to eventually live on their own. Others may not.

Children with ASD start to show symptoms at an early age. The symptoms continue during childhood and adulthood. Healthcare providers don’t know why some children develop ASD. It may be a combination of genes they are born with and something in their environment that sets off those genes.

Children with ASD have trouble relating to other people. They have trouble making eye contact. They often withdraw into themselves. They may seem uninterested in relating to family members.

Other children with ASD may be very focused on a topic they are interested in. They may only want to talk about that topic in conversation. The problem is that they may talk about it too long. Or they may talk only about that one subject. This can push other people away.

If you are a parent or grandparent of a child with ASD, it can be heartbreaking if you feel like you just can't c***ect with them. But learning more about these disorders and what has helped others can help you and your relationship.

ASD has no cure. But there is hope through treatment. Many children with ASD can learn to communicate and interact. Healthcare providers and mental health experts have learned a lot about how to break through to these children.

Here are some things we know about children with an ASD:

They may not be able to understand your nonverbal communications. They may not react to your smile or frown.

They take things literally. You need to be careful to say exactly what you mean. If you hurry the child by saying "Step on it," don't be surprised if they ask what to step on.

They may only be able to handle one thought or idea at a time. Keep conversations focused and simple.

They may want to only talk about the one thing they are really interested in at a given time. And they may want to talk about it over and over again.

They may see things differently than you do. You may not even notice ordinary sounds, tastes, touches, smells, and sights. But these may be physically painful to the child.

There are no hard-and-fast rules on how to communicate with a child with ASD. But many family members have had success with these tips:

Be patient. It often takes a child with ASD longer to process information. You may need to slow down your conversation to their speed. Long pauses can be helpful.

Teach the child how to express anger without being too aggressive. Children with ASD should know that they don't have to hold their anger and frustration inside.

Be persistent but resilient. Don't let your feelings get hurt if the child does not respond to you as you'd like. Children with ASD may have trouble both showing and controlling their emotions. They can be blunt in their responses. Don't take this personally.

Always stay positive. Children with ASD respond best to positive reinforcement. Be sure to talk about or reward good behaviour often. Be generous with compliments for good behaviour.

Ignore irritating attention-getting behaviour. A child with ASD may act badly at times to get you to focus on them. Ignoring this behaviour is often the best way to prevent it. Also talk about and reward the child's good behaviour often.

Interact through physical activity. Children with ASD tend to have short attention spans. This is especially true when it comes to communicating. Running around and playing outside may be a better way of sharing time together. It will also let them relax and feel calmer.

Be affectionate and respectful. Children with ASD often need a hug, just like other children. Sometimes they need this much more than other children. But some children don't like to be touched at all. Even light contact can distress them. Ask the child or caretaker before making any physical contact. Respect their personal space. Never force physical affection on an unwilling child.

Show your love and interest. Children with ASD may have trouble showing their feelings. But they still need to know that you love them. Go out of your way to express your interest, caring, and support.

Learn from your child. Your child's special need and abilities may show you a way to look at the world that you've never considered. As difficult as it may be on some days, relaxing, laughing, and enjoying the unique gift that is your child can provide both you and your family with many rewards.

Believe. A child with autism is first and foremost a child. They are a growing person with unknown possibilities. Believe in what the child can do. Don’t define the child by a diagnosis.

Take care of yourself. It’s OK to take a break. Join parent support groups. Or ask understanding family and friends to care for your child so you can recharge. School psychologists and counsellors can also provide resources to help you.

It can be challenging to interact with a child or grandchild with ASD. But it's one of the most important things you can do to help that child learn. Research shows that early, frequent, and loving involvement of family members is one of the best ways to help children with ASD.

Please share. And Happy Mother's Day, especially those who have children affected by ASD.

10/03/2024

Headaches!!
Douleur la tete!! La tete fer mal!!

Every day, I see a lot of patients having headaches. They seem worried that there could be something inside their heads giving them the headaches. They think that it may be a tumour, a malformation, a bleed, a cyst, something bad lurking in their heads. These patients want to have a scan done, which is understandable. Well, let me tell you that in nearly 95% of patients having headaches, the brain imaging/scan is normal. Nothing abnormal can be detected. More than 50% of patients have tension type headaches. More than 35% are having a migraine. Some are having sinusitis. Some are having raised intra-ocular pressure. Some are having benign intracranial hypertension. Some are having cluster headaches. Very few are having something serious!! However, it's always reassuring to have the brain imaging/scan done which is totally reasonable and understandable.

Headaches sometimes take time to subside, sometimes long-term medications are needed. Whatever treatment suits the patient is the best treatment. So, it may sometimes take your doctor some time to have the headache managed/controlled.

In order to have the headaches decrease in frequency, the trigger factors should be avoided, e.g. lengthy screen time, lack of sleep, dehydration, oily foods, etc.
Take your medicines regularly.
There are abortive treatment and preventive treatments, this should be discussed with your treating doctor.

Still confused. See your doctor/neurologist.
Please share.

18/02/2024

How to prevent stroke? Are there any tests that can help know the risk of having one?
Couman pou empeche fer ene attack/congestion? Eski enan kit tests ki capav dire ki risque enan pou gagne ene attack/congestion?

These are the two questions that a lot of people keep asking me.
Sa c'est deux questions ki bocoup dimounes demanne moi.

First question: Premier question:
1. Control your blood pressure. Controlle ou tension.
2. Control your blood sugar. Controlle ou diabete.
3. Stop smoking. Arette fimer.
4. Stop alcohol. Arette boire l'alcool.
5. Exercise. Fer l'exercise.
6. Monitor cardiac problems if any. Geutte ou problemes cardiac si enan.
7. Stop drugs. Pas touche la drogue.
8. Low salt, low sugar, low fat diet. Evite doux, gras, et saler.
9. Do your medical check-ups regularly. Fer ou check-up la santer regulierement.
10. Ask your doctor. Demanne ou docteur.

Second question: Deuxieme question:
There are plenty of tests that can be done to assess the risk of developing a stroke, however the tests cannot say for sure that you will develop a stroke. The tests can just say that your risk of having a stroke is higher or lower.
Enan bocoup tests ki capav fer pou c***e risque si ou pou develop ene attack/congestion, mais banne tests la pas capav dire sire sire si ou pou gagne attack ou pas. Banne tests zis capav dire ou si ou risque la li fort ou faible.

Examples of tests: Ene deux examples banne tests la:
1. ECG. ECG
2. Electrocardiography. Echo cardiac.
3. Cholesterol levels. Cholesterol.
4. Thrombophilia screen. Tests thrombophilie.
5. CT angiography of cerebral arteries. CT Angio banne vessaux sanguis cerveau.
6. Neurological examination. Examin neurologique.

If you are still confused, see your neurologist.
Si ou encore pas trop comprend, geutte ou neurologue.

02/02/2024

Rehabilitation

Rehabilitation is the action of restoring someone to health or normal life through training and therapy.

When someone has a stroke, accident, trauma, neurodegenerative diseases like Parkinson's disease, multiple sclerosis and many others leaving them with disabilities; rehabilitation is necessary.

Together with a proper diet, medications; rehabilitation is required to regain functions that have been lost to disease.

However, rehabilitation is not a magic process, patience and dedication are necessary because it shall be very time consuming with little improvements. However, after a few sessions, improvements will be visible, though small but significant to recover slowly.

Feel free to ask for advice and share to create awareness.

Consultant Neurologist. Manages Headaches, Dizziness/Vertigo, Stroke, Epilepsy, Dementia, Parkinson'

01/02/2024

Vertigo!

In my last post, I was asked to write on vertigo. I will try to simplify vertigo so that everyone can understand.

Vertigo is a condition in which a person has the sensation of movement / or of surrounding objects moving when they are not.

The surrounding may be revolving according to the patient, or the patient may tell that he has a sensation of being on a boat being rocked by waves.

Thats how vertigo is mostly described.

Some patients say that their heads are spinning. Some may say they feel nauseated and a sensation of unsteadiness bothering them, etc.

The most common disorders that result in vertigo are benign paroxysmal positional vertigo (BPPV), Meniere's disease, and vestibular neuritis. Less common causes include stroke, brain tumours, brain injury, multiple sclerosis, migraines, trauma, and uneven pressures between the middle ears.

Vertigo is as simple as that.

Investigations that may be asked are MRI/CT scan of the brain, Audiometry, ECG, Evoked potentials, and some other ancillary tests.

Treatment is also very simple:
1. Anticholinergics such as hyoscine hydrobromide (scopolamine)
2. Anticonvulsants such as topiramate or valproic acid for vestibular migraines
3. Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties.
4. Beta blockers such as metoprolol for vestibular migraine
5. Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasone as a second-line agent for Meniere's disease.

Patients will also have to avoid trigger factors like high altitude, elevator, acidic foods, contact sports, etc.

Thats as simple as that. If you think you are suffering from vertigo, please see your doctor and have it followed. Sometimes vertigo takes time to resolve. So proper follow-up is very important.

Please share.

18/01/2024

Headaches, when to see the doctor?

Headaches happen.
For some people, unfortunately, they happen a lot.
But when are frequent headaches the result of a behaviour you can identify and correct on your own and when do they warrant a doctor's attention? It's important to know when to see a doctor about headaches because they're not always just a nuisance that disrupts an hour or two of your day and then goes away. In some cases, headaches can be chronic, debilitating and affect your quality of life, and they can also be a sign of an underlying health issue that needs attention.
Currently we do not have a complete understanding of why headaches happen exactly.
We know headaches are the result of interactions between the nerves, blood vessels and muscles in and around your head or neck and that these interactions cause the nerves to signal pain, but the exact mechanism for this is still not clear.
While the underlying reason behind them might be somewhat murky, we know that several factors can trigger the everyday headache, including:
Stress
Poor sleep
Dehydration
Alcohol
Too much screen time
Poor posture
Caffeine (too much or too little)
A headache can often be traced back to one of these triggers, but not always. Additionally, while headaches aren't typically a huge concern, they can sometimes be a sign of an underlying health issue. This is why it's important to talk to your doctor if you're getting headaches.
When to see your doctor????
1. Your headaches are affecting your sleep, activity level or work
2. You're getting frequent headaches and can't identify a trigger
3. Your headaches are occurring more often or becoming more severe
4. You need help managing your headaches
5. Your headaches are affecting your sleep, activity level or work

In some cases, a headache may even be a medical emergency.
1. Seek immediate medical attention if a headache:
2. Comes on suddenly and very quickly becomes severe
3. Feels like the worst headache in your life
4. Is accompanied by a stiff neck and/or fever
5. Is accompanied by a seizure, fainting, confusion or changes in personality
6. Begins right after an injury, particularly a head injury
7. Is accompanied by weakness, numbness or vision changes

Please share to create awareness. Thanks.