Parkinson’s Disease: What To Expect

Parkinson’s disease is a progressive and incurable disorder of the nervous system. It affects movement and is characterised by tremors, stiffness and slowing down of movement.

Early symptoms may be barely noticeable. The condition often starts with a slight tremor in one hand and a feeling of stiffness in the body, but as the disease develops the symptoms become more pronounced.

Symptoms of Parkinson’s disease

Symptoms of Parkinson’s disease may vary from person to person. Some of the early signs include:

  • Tremors or shaking – this often begins in the hands or fingers and you may notice tremors in the hand even when it is resting.
  • Slowed movement (bradykinesia) – Parkinson’s disease causes a slowing of movement which may make even everyday tasks, such as walking or getting up out of a chair, more difficult and time-consuming.
  • Speech changes – you may start to slur or hesitate before speaking. Your speech may lose its normal inflections and become more monotone.
  • Muscle stiffness – muscles may become stiff and painful, limiting your range of movement.
  • Changes in posture – you may start to stoop or have problems balancing.
  • Loss of automatic movement – movements that you perform without thinking about them, such as swinging your arms when you walk or smiling, may become more difficult.
  • Writing changes – you may find it more difficult to write and your writing may become illegible.

In addition, you may also develop:

  • Depression, anxiety or loss of motivation.
  • Problems chewing, eating or swallowing – these tend to occur as the condition develops.
  • Sleep problems.
  • Bladder problems.
  • Constipation due to a slower digestive tract.
  • Problems with your sense of smell including difficulty distinguishing between different odours.
  • Pain.

What are the 5 stages of Parkinson’s disease?

Doctors have identified five stages to Parkinson’s disease, known as the Hoehn and Yahr Scale. This scale is used to classify patients in research studies.

  • Stage 1: the earliest stage with mild symptoms only on one side of the body and little or no functional impairment.
  • Stage 2: Symptoms have spread to both sides of the body and may now include loss of facial expression and speech abnormalities. This may come months or years after stage 1.
  • Stage 3: By this stage you may have loss of balance and slowness of movement. However, you will still be able to dress, eat and wash by yourself.
  • Stage 4: You may be able to walk and stand unassisted, but you have become increasingly disabled and can no longer perform daily activities without assistance.
  • Stage 5: The most advanced stage of the disease. You can no longer get out of a chair or bed without help. You may fall frequently when standing and stumble when walking. You need round the clock assistance and you may have hallucinations.

Causes of Parkinson’s disease

Scientists are not absolutely sure what causes Parkinson’s disease, but it is linked to the death of nerve cells in the brain and a fall in level of dopamine levels which causes abnormal brain activity. If it is accompanied by changes in the Lewy bodies of the brain, dementia may also develop.

Certain factors seem to be associated with an increased risk of developing Parkinson’s disease. These include:

  • Age – the disease is most common in people aged 60 and over.
  • Hereditary – if you have a close family member with the disease, you are more likely to develop it.
  • Sex – A French study in 2015 found that men are 50% more likely to develop Parkinson’s disease than women. However, the risk for women increases with age.
  • Environmental factors – studies suggest ongoing exposure to certain pesticides may slightly increase your risk of Parkinson’s.

Dr David Choluj discusses more about the causes of Parkinson’s disease.

Diagnosis of Parkinson’s disease

There is no specific test for Parkinson’s disease, and it may take some time to establish a definitive diagnosis. A neurologist will assess your medical history and review your signs and symptoms. You may be given an MRI, CT or ultrasound scan and/or blood tests to rule out other disorders. A dose of Parkinson’s disease medication may be administered to see if it improves your symptoms. This may help to confirm a diagnosis of Parkinson’s.

Parkinson’s disease treatment

  • Medication: There is no cure for Parkinson’s disease but there is a wide range of medications that have been shown to be effective in controlling symptoms, including medication to increase or provide a substitute for lost dopamine. Medication can improve problems with movement, tremoring and walking.
  • Surgery: People with advanced Parkinson’s disease who are no longer responding well to medication may be offered deep brain stimulation surgery. This implants electrodes into different parts of the brain that send pulses into the brain and may reduce symptoms.
  • Lifestyle changes: Certain lifestyle changes have been shown to reduce the symptoms of Parkinson’s disease. These include eating high fibre foods and drinking plenty of fluids to prevent constipation; eating a diet rich in omega-3 fatty acids; exercising to improve balance, flexibility and strength.

Interested to know more about how Parkinson’s disease can be treated?

Dementech specialise in diagnosing and treating neurological disorders like Parkinson’s disease. For more information contact our experienced and friendly team.

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In The News: Dementech hosting AI trials with Medopad and Tencent

One of the world’s largest technology firms, Tencent, is partnering with London based start-up Medopad on clinical trials of artificial intelligence (AI) programs which aim to diagnose patients with Parkinson’s disease, multiple sclerosis and psoriasis.

The Parkinson’s disease clinical trials will involve around 40 patients over the next few months and will take place at Dementech Neurosciences, state of the art private mental health clinic in central London. Clinical trials for multiple sclerosis and psoriasis will follow.

The move comes after Tencent were asked by the Chinese government to help facilitate and develop AI technology for diagnosing complex health conditions.

At Dementech we have always been at the forefront of neurological diagnosis and treatment and we are excited by the current project with Medopad and Tencent.

Keep up to date with the latest news and information from our projects on our website or social channels.

You can read more about project on the Financial Times website.

 

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The dementech team’s multidisciplinary approach to patient care

People with neurological disorders, such as Parkinson’s disease, Alzheimer’s and multiple sclerosis, benefit from a multidisciplinary approach combining pharmacological therapies with psychological interventions.

These are complex and frequently incurable conditions that present a range of different symptoms, both physical and psychological. In order to make the greatest difference, patients need an accurate diagnosis and holistic treatment plan that addresses the many different aspects of each disease.

Dementech Neurosciences – a private memory clinic based in London – was founded in August 2016 to provide just this. Our team includes healthcare experts and world-renowned scientific advisers who specialise in the diagnosis and treatment of particular neurological conditions. 

 

Our Scientific Advisers include:

Professor K. Ray Chauduri who specialises in Parkinson’s disease and neurology and is Professor of Neurology/Movement Disorders at King’s College London. He is Medical Director of the National Parkinson Foundation International Centre of Excellence, Co-chairman of the appointments committee of the Movement Disorders Society and Chairman of the MDS Non-motor Study Group. Prof. Chauduri is co-editor in chief of Nature Parkinson’s Journal and chief editor of the first textbook on the non-motor aspects of Parkinson’s. In 2018, he received the Van Andel award for outstanding research contribution in the field of non-motor Parkinson’s.

Professor Dag Aarsland who is world-renowned in the field of Lewy Body Dementia and Parkinson’s disease and has contributed vastly to our understanding of old age psychiatry, Prof. Aarsland was professor of clinical dementia research at the Karolinska Intitutet before joining the Institute of Psychiatry, Psychology and Neuroscience in January 2016. As well as leading international research, Prof Aarsland sees patients and helps to train old age psychiatrists. He is a professor of geriatric psychiatry at the University of Oslo and director of research at the University of Stavanger’s Centre for Age-Related Medicine.

 

Specialist Healthcare Team

Dr Lucio D’Anna, Lead Neurologist who is a consultant in stroke medicine with a PhD in clinical neuroscience from King’s College London. He gained the Best PhD Award from the college in 2016 and featured on the front cover of Neurology magazine. Dr D’Anna is an associate member of the Royal College of Physicians with a particular interest in stroke, cryptogenetic stroke and atrial fibrillation. He has published numerous papers and been featured in a number of leading scientific journals.

 

Dr Areti Pavlidou, Lead Psychiatric Services who specialises in adult and liaison psychiatry. Dr Pavlidou works as lead consultant for inpatient and community mental health services within the NHS and has a particular interest in stress-related conditions and the mind/body connection, as well as chronic fatigue syndrome and fibromyalgia. She is experienced in treating all types of adult mental health problems, such as depression, bipolar affective disorder and psychotic illnesses.

Find out about what makes Dementech different, according to Dr Areti Pavlidou

Mr. Stelios Kiosses, Lead Psychological Services who is an experienced consultant psychotherapist who works with adults and adolescents to help them to overcome personal issues. Mr Kiosses is a consultant psychotherapist who studied psychodynamic counselling and clinical supervision at the University of Oxford. He is a member of the British Association for Counselling & Psychotherapy and the British Psychological Society and will be a familiar household name to many, having appeared as a TV psychologist on Channel 4. He is involved in data review and decision-making, as well as training and supervising associate therapists and managing a team of experienced psychologists.

Find out more about Mr Stelios Kiosses’s role at Dementech

Dr David Choluj, Lead Neurologist for MS who is a consultant neurologist with a particular interest in stroke medicine and neurological rehabilitation. Dr Choluj trained and worked at one of the most prestigious teaching hospitals in middle Europe, the Motol University Hospital in Prague. He worked in the areas of neurological rehabilitation and disability management at Addenbrooke’s Hospital in Cambridge and the Royal Hospital for Neuro-disability in London. His specialist areas are neurology – MS, headache, dementia and Parkinson’s – and neurorehabilitation – prolonged disorders of consciousness, spasticity/complex neuro-disability management. 

Find out about why Dr David Choluj thinks patients should choose Dementech

Joanna Rodrigues, Health Psychologist and Cognitive Behavioural Therapist who has more than 13 years’ experience working in the NHS and private settings. Among the conditions she treats are depression, anxiety, OCD, trauma and stress. She is part of a holistic condition management approach for people experiencing chronic health conditions and long-term pain.

Find out about what makes Dementech unique, according to Joanna Rodrigues

The Dementech team all understand why this holistic, multidisciplinary approach is so successful when it comes to diagnosing and treating neurological disorders, which is what makes us different and enables us to provide the highest level of personalised patient care in our field.

 

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Diagnosing complex neurological conditions with tech

Accurate diagnosis is critical for people with suspected neurological disorders in order to manage the condition appropriately. While, sadly, many neurological disorders are incurable, if sufferers are given the right medication and other forms of treatment, it can slow the progress of the disease and significantly improve quality of life.

But such conditions are complex and getting an accurate diagnosis can sometimes be challenging.

Diagnosing Neurological and Psychological Conditions

Dementech is a private clinic in the heart of London. Our internationally renowned team of healthcare experts, who cover a wide range of specialisms from neurology to speech therapy, provide diagnosis and treatment for patients with neurological and psychological conditions. 

We particularly specialise in complex or intensive interventions for people who may not have benefitted from more usual approaches.

To support our diagnoses and improve accuracy we use a range of leading-edge technologies, including:

Parkinson’s KinetiGraph

The Parkinson’s KinetiGraph is a small device that is worn on the wrist by a patient with Parkinson’s Disease. It is used to collect data over a period of six to 10 days, which is then compiled into a report for the doctor. 

This report reveals variations throughout the day in motor symptoms and complications of Parkinson’s Disease (such as tremors, stiffness and dyskinesias). Using this information, a doctor will be able to see how well people are functioning at home and whether the current medication dose needs to be altered or the medication itself needs to be changed. 

The technology is also used to remind people when to take their prescribed medication and to capture information about daytime sleepiness and night-time disturbances.

Cantab

Cantab is an analytical computerised assessment software programme that is used to measure brain function and cognitive health in five key areas:

    • Executive function (central control, planning, strategy, flexible thinking)
    • Processing speed (the ability to perform mental tasks quickly and efficiently)
    • Attention (the ability to concentrate and actively process information)
    • Working memory (how we hold information while processing or acting on it)
    • Episodic memory (memory of events and experiences, what happened, where and when)

An assessment using the software normally takes around 30 minutes and the results are adjusted for age, gender and education. They provide an accurate evaluation of a person’s cognitive performance and can be compared over time to assess for any decline.

Computerised Cognitive Rehabilitation and Psychotherapy

Computerised Cognitive Rehabilitation and Psychotherapy is a 12-session computer package of 12 challenging tasks designed to exercise specific cognitive functions in people with dementia. The skills learned can be transferred into real life situations with the support of a therapist. 

The package is designed to build cognitive, emotional and societal skills as well as increasing awareness and understanding of their new self. Therapists use such computer-based interventions to help people develop skills for day-to-day living and to learn strategies to compensate for the loss of cognitive function.  The technology uses a combined psychological and cognitive approach which addresses the interaction between people’s thoughts, feelings and behaviour.

Dementech is not limited to the above technologies but can also call upon leading neurologists, with their own specialised teams, to assist with the diagnosis and treatment of neurological conditions.

If you would like more information about using leading edge technologies in the diagnosis and management of complex neurological conditions, contact us.

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Technology trial for Parkinson’s disease sufferers

A new clinical trial will assess the difference that a smartphone app could make to patients with Parkinson’s Disease by monitoring the development of their condition over time.

Forty Parkinson’s patients will participate in the 30-day trial, which is being conducted by Dementech Neurosciences clinical academic centre in collaboration with Medopad, an organisation that works with some of the world’s largest healthcare systems, research institutes and technology companies to solve problems in rare, chronic and complex disease monitoring.

The trial, which has been hailed by Dementech as a significant milestone, will allow researchers to assess the difference that high tech solutions like this could make to the management of the condition. 

If successful, the app could make a difference to the thousands of Parkinson’s Disease sufferers in the UK and further afield. It is just one of many technological advances in the diagnosis and treatment of neurological disorders.

About Parkinson’s Disease

Parkinson’s is a progressive neurological condition that causes problems in the brain which worsen as the disease progresses. One adult in every 350 in the UK – around 145,000 people – is diagnosed with the condition, which causes three main symptoms, tremors, slowness of movement and muscle symptoms.

The death of nerve cells in a particular part of the brain, called the substantial niagra, means that people with the condition don’t produce enough of the chemical Dopamine. This affects the body’s ability to control movement properly, everything from walking and talking to smiling. 

The symptoms can be subtle at first but as more cells are lost, they worsen, resulting in the characteristic shaking and muscle stiffness associated with Parkinson’s in its more advanced stages. 

There may be other symptoms, too, including restless legs, dizziness, fatigue and bowel problems. As the condition progresses, people can experience increasing disability and poor health, leaving them vulnerable to infection and significantly impacting their quality of life.

Latest research into Parkinson’s Disease: Why this trial is so important

Researchers don’t understand why some people get Parkinson’s, which is an irreversible condition with no current cure. The disease affects everyone differently. Symptoms may differ from person to person and the rate at which they progress is also highly individualised. This is why the smart app trial is so important as it could help provide insights into the evolution of Parkinson’s Disease in individuals.

Dementech is a private health clinic dedicated to understanding the nature and treatment of a wide range of neurological and psychological problems, including movement disorders like Parkinson’s Disease, dementia and other neurological problems, as well as mental health issues. 

An internationally renowned team of specialist consultants is engaged in the latest research into Parkinson’s Disease. 

The team at Dementech are delighted to be collaborating with an organisation of the calibre of Medopad and will publish the results of the trial in relevant academic journals as well as on the website.

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patient with Creutzfeldt-Jakob disease

CJD or ‘Mad Cow Disease’?

Both Creutzfeldt-Jakob Disease (CJD) and its close relative Variant Creutzfeldt-Jakob Disease (vCJD) are caused by Prions, incorrectly folded proteins, which destroy brain tissue. Neither are infectious but types of CJD can be spread by exposure to infected blood products, meat or medical instruments.

BSE (Bovine Spongiform Encephalopathy) or ‘Mad Cow Disease’ is a form of Transmissible Spongiform Encephalopathy (TSEs). The ‘spongiform’ in the name refers to the fact that the infected brain is filled with holes, resembling a sponge.

CJD is a degenerative brain disorder, estimated to affect one in a million people annually worldwide. Appearing in later life usually, the onset is rapid and fatal. Early symptoms include problems with vision, coordination problems, changes in behaviour, and memory problems, which lead to blindness, involuntary movements and coma.

vCJD was acquired by humans by exposure to meat infected with BSE. It is estimated that only 1% of CJD is ‘variant’. It was discovered in 1996 in the UK and, according to the government, 260 cases have been reported since then.

 

The Different Types of CJD

When it comes Creutzfeldt-Jakob Disease, there are 4 types:

  1. Sporadic CJD
  • Sufferers have no known risk factors.
  • Most common type of CJD
  • 85% of all CJD cases

 

  1. Hereditary CJD
  • Family history of the disease
  • 10 to 15% of CJD cases

 

  1. Acquired or Iatrogenic CJD
  • Transmitted by exposure to bodily tissue during medical procedures
  • Improperly sterilised medical instruments are also thought to spread this
  • Before 1985, was spread by a treatment using glands from deceased humans

 

  1. Variant CJD (vCJD)
  • Caused by consuming meat from a cow infected with BSE AKA ‘Mad Cow Disease’
  • 1% of all CJD cases
  • Possible 10 year+ incubation period
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scan of a brain with young onset dementia

What is Young Onset Dementia?

A lot of young and middle-aged people joke when they forget something or miss an object that is right in front of them or say the wrong word, that they have dementia. Even though it is relatively rare, Young Onset Dementia is a serious concern.

Affecting people under 65 years of age, Young Onset Dementia, also known as early onset or working-age dementia, is so-called because of the old belief that dementia was an affliction that only affected the elderly.

Dementias that affect the young are seemingly rare but this may be because younger people cannot understand or are unwilling to believe that the malady affecting them is actually Dementia. They are much less likely to visit a doctor when they are presenting symptoms of dementia and, as sad as it is, doctors may be missing the signs too.

 

Who is likely to suffer from Young Onset Dementia?

Young Onset Dementia sufferers are more likely to have inherited a genetic form, for example, frontotemporal dementia presents in 40% with a family history of the disease.

Other groups at higher risk are people from BAME backgrounds, who are less likely to receive a timely diagnosis, and people with learning disabilities are also at greater risk of developing Young Onset.

Alzheimer’s disease accounts for about 1/3 of all Young Onset sufferers and vascular dementia affects 20% of Young Onset sufferers. 10% of Young Onset sufferers have Lewy Body dementia. 20% have something rarer, like Parkinson’s or Creutzfeldt Jakob.

Early Onset Dementia affects around 42,325 people in the UK, which is 5% of all dementia sufferers in the UK. The actual number may be as high as 6-9%. That is a pretty shocking statistic and a surprise for most people reading this. It is important that people, no matter their age, receive the correct diagnosis and are given the most up-to-date treatment.

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Close up of a dementia doctor

Dementia or another condition?

Some symptoms that the majority of people would ascribe to Dementia can be brought on by other conditions, so it is vitally important that this is taken into consideration during diagnosis. Here is our guide to help you tell the conditions apart.

Urinary Tract Infection

A Urinary Tract Infection can cause a sudden bout of confusion in an older person. Rapid changes in behaviour like agitation, inability to communicate properly and withdrawal are symptoms. If the person has complained of pelvic pain, a fever, a burning during urination or they use a catheter, UTI may be the culprit. The reason for the confusion symptom is due to the UTI overwhelming the kidneys and entering the bloodstream, causing blood poisoning which affects the brain. This is a serious condition and can be life-threatening.

Subdural Hematoma

The dura is the thin membrane that covers the brain. Blood trapped in between the membrane and the brain, caused by injury and bruising, can be mistaken for Alzheimer’s. The symptoms can emerge slowly, adding to the confusion and inhibiting a correct diagnosis. If the person has had a fall prior to the onset of symptoms, it may be a Subdural Hematoma.

Depression

Signs of depression can have the appearance of Dementia. The area of overlap is large including a lack of interest in subjects the person is usually passionate about, disrupted concentrating, forgetfulness, withdrawal and excessive sleeping. The main differences between the two are that those suffering from depression display less severe symptoms, ones that come and go, and do not reference suicide as much as Dementia sufferers. Obviously, that is not a lot to go on, so diagnosis is the only real way to differentiate.

Delirium

Although the symptoms of Delirium and Dementia are similar, the difference is that Dementia and other associated neurological conditions emerge over an extended period of time and Delirium starts suddenly. Things to look out for are an unusual amount of confusion, feelings of paranoia, hallucinations, rambling, behavioural changes, distraction, disorientation and excessive alertness problems – either drowsiness or agitation. Triggers can be clashes in medication or an underlying, untreated infection. Of course, people suffering from Dementia can also display these symptoms.

Side Effects

Medicines can create a variety of side effects which can be confused with dementia. The list includes, but is not limited to, sedatives, antidepressants, anti-anxiety medication, anticonvulsants, corticosteroids and antihistamines.

Vitamin Deficiency

A lack of Vitamin B1, Vitamin B6, Folic Acid and Niacin have been linked to dementia-esque symptoms. Alcoholics can succumb to Wernicke-Korsakoff syndrome due to a long-term lack of vitamin B1. Deficiency of B12 can lead to pernicious anaemia which is also mistaken for Dementia, and as the liver stores B12 (as well as vitamins A, D and Iron), liver damage can precipitate dementia-like effects.

Hypothyroidism

Too much (hyperthyroidism) or too little (hypothyroidism) thyroid activity can mimic some of the symptoms of dementia.

Hypothyroidism happens when the gland can’t produce enough hormones. This may be due to many factors such as an autoimmune disease. Individuals experiencing hypothyroidism experience declining mental sharpness, depression, ‘foggy brain’, difficulty concentrating, mood swings, visual-spatial skills and memory loss amongst others. Other symptoms that could be clues as to whether you have hypothyroidism are difficulty losing weight/water retention, brittle fingernails, hair loss, sensitivity to cold, enlarged tongue and enlarged thyroid gland.

The most likely cause of hyperthyroidism is also autoimmune related. This causes the gland to secrete too much hormone. The symptoms which cause it to be confused with more serious neurological conditions are tremors, nervousness, agitation, anxiety, poor concentration, lack of spatial awareness, eye problems and slowed reactions.

These conditions can be reversed a lot of the time, so if you or someone you know is displaying these symptoms, seek a diagnosis.

Normal Pressure Hydrocephalus (NPH)

NPH is a brain disorder, affecting those in their 60s and 70s primarily, where excess cerebrospinal fluid enters the brain ventricles and destroys brain tissue, causing dysfunction which leads to dementia-like symptoms like reasoning problems and walking problems. It can be treated with surgery which improves the mobility aspects but has little positive effects on the sufferers reasoning.

Brain Tumour

Malignant or benign tumours can disrupt the flow of information around the brain in a similar fashion to that of dementia. Two of the most common are changes in personality and disruption of cognitive function. These can depend on the position of the tumour within the brain and there can be mimicry of many different symptoms of dementia. Symptoms of a brain tumour are increased pressure in the brain, seizures, headaches, vomiting, changes in senses. Brain tumours can be deadly and if you suspect you have one, seek treatment immediately.

Stroke

Strokes happen when the blood flow to the brain is interrupted. Cognitive abilities are suddenly disrupted. This may be the key to recognising the difference between Dementia and the stroke version known as Vascular Dementia. The similar symptoms between the two are memory loss, confusion, hallucinations and impaired motor skills. Strokes can be treated by lowering blood pressure or cholesterol with medication.

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doctor that knows what is the difference between Alzheimer's and Dementia?

What is the difference between Dementia and Alzheimer’s?

If you are unsure, do not worry. Some health professionals do not know the difference either, so you are not alone.

Dementia is an umbrella term for serious brain conditions that affect reasoning, focus, memory, communication and visual perception. Some types of serious brain conditions are named Dementia such as Vascular Dementia, Lewy Body Dementia and Frontotemporal Dementia. Alzheimer’s is a type of Dementia too.

Alzheimer’s is a degenerative brain disease that leads from difficulty remembering and apathy to difficulty speaking and walking.

To make things even more confusing for people finding out about Dementia, it is possible to have two types of Dementia at the same time. Getting the correct diagnosis is so important to aide the correct treatment.

Just remember: Alzheimer’s is a form of Dementia but Dementia is not a form of Alzheimer’s.

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Parkinson’s Patient Case Study – Dementech Neurosciences

The video is displaying the difference in life quality that can be achieved by correct diagnosis and appropriate medical treatments. The case study is based on a Parkinson’s patient that has been wheelchair-bound for over two years.

The patient achieved a very significant improvement after having a consultation with an expert neurologist in our team. That led to a change of diagnosis and change in medication. She can be seen later in the video now able to stand up and walk.

This case is one of the many that we come across. The great difficulties in managing the condition are usually due to the wrong initial diagnosis or incorrect course of treatment.

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