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Introduction

 

 

 

Department of Neurology

Current Director: Associate Prof. Pai, Ming-Chyi (2009 to present)

Former Directors: Prof. Tsai, Jing-Jane (1988-1994)

                          Prof. Lai, Ming-Liang (1994-1999)

                          Associate Prof. Tsai, Tzu-Tung (1999-2002)

                          Associate Prof. Lin, Thy-Sheng (2002 to 2005) 

                          Associate Prof. Hwang, Wen-Juh (2005 to 2009)

 

History: Since the foundation stage of the hospital, this department has been designated as an independent one. Dr. Tsai, Tzu-Tung was the first doctor joining the department in 1985, after completing his clinical training of general neurology in the department of neurology at the National Taiwan University Hospital. In 1988, Dr. Tsai, Jing-Jane and Dr. Lai, Ming-Liang also finished studying abroad and came back to our country, becoming the establisher of this department. The hospital was formerly in work and the department founded in June of the same year.

 

Organization

●    There is one director who is responsible for the development and promotion of this department.

●    Apart from general neurology, there are five divisions in the department – Division of Epilepsy, Cerebrovascular Diseases, Movement Disorders, Behavioral Neurology, and Neurophysiology.

●    Up to 2004, we have 10 attending physicians (one professor, five associate professors, and two assistant professors), 10 resident physicians, five electrophysiological technicians, and one concurrent neuropsychological examiner.

●    The general wards are in the 6C area, including 32 beds in 4 single rooms and 14 double rooms. There are still one special ward for 24-hour electroencephalography (EEG) examinations, 3 intensive care unit beds, and several research rooms.

●    The examination equipments include ordinary and portable EEG recorders, evoked potential studies, nerve conduction velocity (NCV) and electromyography (EMG) studies, duplex Doppler, electronystagmography (ENG), and cognitive function tests.

 

General Neurology

        The Department of Neurology is also called the Department of Internal Medicine of Neurology. The human nervous system is very complicated and each of its components is mutually related. Serious problems are caused when a small part of the system is out of order, either from a major damage to the brain or spinal cord or a minor injury to the 12 cranial nerves or the peripheral neuromuscular structures. The human nervous system is also a very delicate and well-differentiated organization; permanent dysfunction is often seen if the diseases are not diagnosed in early stages. Therefore, the job of a neurologist is to locate the lesions precisely, like a professional detective, and to facilitate early managements. Under the circumstances that medication is not the treatment of choice, consultations for neurosurgeons or cooperation with the department of rehabilitation for physical or occupational therapy are mandatory. Neurologists are supposed to check on avoiding unnecessary operations and determining the most appropriate treatments for the patients with neurological disorders.

 

Common neurological symptoms

1.      Motor dysfunction: hemiplegia caused by stroke, paralysis, limbs weakness, gait disturbance, limbs stiffness, tremors, muscle twitching, involuntary movements, Parkinson’s disease, myopathy or muscular dystrophy, motor neuron disease (amyotrophic lateral sclerosis), myasthenia gravis, facial palsy, ophthalmoplegia, and diplopia.

2.      Sensory dysfunction: various kinds of neuropathic pain, dysesthesia, and limbs numbness.

3.      Cerebral dysfunction: headache, vertigo, seizure, disturbance of consciousness, aphasia, cognitive impairments, memory deficits, delirium, and personality changes.

4.      Nervous system infection: encephalitis, meningitis, and myelitis.

 

All the physicians in our outpatients units are capable of diagnosing and treating the diseases listed above. Blood examinations, imaging studies, and electrophysiological studies are arranged whenever needed. Certain special examinations or treatments can only be done during hospitalizations, such as lumbar puncture and cerebrospinal fluids (CSF) studies for the central nervous system infection, biopsies of the muscle, nerve, or brain parenchyma, and plasma exchanges or intravenous immunoglobulin therapy for severe acute inflammatory polyneuropathy or myasthenia gravies. Patients with complicated or unstable condition are admitted for close observations and thorough investigations. If there is a necessity, the doctors in general outpatients units can refer the patients to our special clinics for further managements.

 

Division of Epilepsy

Epilepsy is a disease of paroxysmal abnormal electric discharges of the brain. There are many kinds of seizure presentations, including grand mal seizures, absence seizures, complex partial seizures, and so on, characterized by different location and severity of the electric discharges. In making a diagnosis, detailed history takings and neurological examinations are imperative. EEG, brain imaging, cerebral perfusion scans, and even 24-hour continuous EEG recordings can also be arranged depending on various clinical situations. Treatments of epilepsy are mainly from medications. A comprehensive communication between the physicians and the patients and their families ensures the optimal therapy effects. Novel antiepileptic drugs are generated on and on, and it is no longer a dream having good controls of the epilepsy. The intractable epilepsy can be managed by surgical interventions.

 

Division of Cerebrovascular Diseases

        The best-known cerebrovascular disease by the public is stroke, which currently takes the second place of top ten causes of people death in Taiwan. Two different kinds of strokes are identified – hemorrhagic stroke and ischemic one. The other cerebrovascular diseases include vascular aneurysms, arteriovenous malformations, atherosclerosis, vessels dysplasia, arterial dissection, etc. The clinical symptoms of cerebrovascular diseases are hemiplegia, visual field defects, disturbance of consciousness, seizures, and headache. Common investigations consist of brain imaging studies, brain computer tomography (CT) or magnetic resonance imaging (MRI) being most frequently used, neck duplex Doppler, transcranial Doppler, and angiography.

Hemorrhagic strokes are treated by medication or surgical removal of the hematoma after consultation of the neurosurgeons. Beside of oral medication for ischemic strokes, we also provide intravenous thrombolytic agents for hyperacute ischemic strokes within three hours after stroke onset, according to the guidelines of Taiwan Stroke Society. In treating patients with severe extracranial carotid artery stenosis, cooperation with cardiovascular physicians to implant carotid stents or consultations of neurosurgeons to perform carotid endarterectomy can also be considered for secondary stroke prevention.

 

Division of Movement Disorders

        In this division, the major tasks are to treat the Parkinson’s disease, which is a degenerative disorder of the extrapyramidal system, resulting in limbs rigidity, tremors, bradykinesia, masked face, and instability. Parkinson’s disease has to be distinguished from secondary parkinsonism caused by other non-degenerative etiologies. The examinations include brain image studies, clarification of history of toxin exposures, and investigations of endocrine dysfunction. We currently perform special TRODAT examinations under the cooperation with the department of nuclear medicine, providing great benefits in making the differential diagnosis and decisions of medication therapy of the Parkinson’s disease.

        Moreover, managements of other rare involuntary movements are also our missions. These disorders include hemifacial spasms, dystonia, torticollis, chorea, and Tourette syndrome. We provide botulinum injection for hemifacial spasm, dystonia, or torticollis, under the National Health Insurance’s guidelines.

 

Division of Behavioral Neurology

        In this era, the lifespan of people in Taiwan has been increased continuously accompanying the improvements of medicine and the elevation of people intelligence. Dementia has become widely known to the public. It is a degenerative disease of the brain with recent memory impairments as the earliest manifestation. Patients with dementia may present with other cognitive dysfunction, confusion, disturbed daily activities, disorientation to people, hallucinations, and loss of self-care abilities. These impose a considerable suffering on families and caregivers. Early diagnosis and managements can postpone the deterioration of symptoms and reduce the burdens to the families and the society. What is more important is to identify and cure other treatable etiologies of cognitive impairments, such as brain tumors, nutritional deficiencies, thyroid dysfunction, central nervous system infection, and so on.

        We make the differential diagnosis and provide treatments and neuropsychological and cognitive evaluations of dementia. We also identify and treat other high cortical dysfunctions, such as agnosia, aphasia, and apraxia.

 

Division of Neurophysiology

        This division is primarily responsible for evaluating the relevant physiological performance of the human nervous system, providing information with regard to clinical diagnosis of the neurological diseases. All the examinations are extremely safe, as described below:

1.      Electroencephalography (EEG): It is an electrical recording of the neuron activities. This can be used to evaluate the focal or global neuronal dysfunction and to detect cerebral lesions, being an essential examination in the diagnosis of epilepsy.

2.      Nerve conduction velocity (NCV) studies: Several nerves are selected for transient electric stimulations. The nerve conduction velocity and its specific responses to the stimuli can help determine whether there is a compression injury to the nerve and differentiate the demyelinating and axonal degeneration of the neuropathy. The patients feel only mild and transient tingling sensation during examinations.

3.      Electromyography (EMG): The needle electrodes are inserted into the muscles to record the changes of physiological functions. Concomitant nerve conduction velocity studies yield more accurate localization and determination of the injury patterns and of the nerve lesions. This examination is undertaken by neurologists. The patients feel pain from insertion of the needles but have no sequela.

4.      Evoked potential: Visual, auditory, and somatosensory stimuli cause small electric signals to be produced by neural structures along the corresponding sensory pathways. Abnormalities identify dysfunction in specific sensory pathways and suggest the location of a responsible lesion.

5.      Duplex Doppler studies: This study is mainly to detect the degree of stenosis of carotid arteries. The transcranial Doppler devices can also be used to examine the velocity of intracranial blood flows and the vascular malformations.

6.      Electronystagmography (ENG): Patients with dizziness, vertigo, or balance dysfunction are evaluated. It is to assess the integrity of vestibular system.