A Folic Acid a day...

Dr. Chhavi Gupta


Keeps the Stroke Away…


Folic acid is a vitamin found naturally in green vegetables, fruits, poultry, meats, and grains. Asparagus, Spinach and Brussels are particularly rich in Folic Acid. Folic acid is a key constituent of prenatal vitamins. It is well known that folic acid is protective against neural tube defects in the growing fetus when given to pregnant women. Folic acid supplementation lowers elevated homocysteine levels, considered an important risk factor for vascular disease. It has also been found to be helpful in curbing depression and mild cognitive impairment or memory problems.  , More excitingly a recent study has shown Folic Acid may be protective against strokes.


Strokes or brain attacks commonly lead to brain damage, paralysis and loss of neurologic functions contributing to significant morbidity and mortality and are the second leading cause of death and disability in the world. Till date Folic Acid had not been considered for stroke prevention. In a large Chinese study with over 20,000 participants,  strokes and other cardiovascular diseases were found to be reduced with daily folic acid intake of at least 800 micrograms. Those on Folic acid had an approximately 21% lower risk of stroke than those not on folic acid. The China Stroke PrimaryPrevention Trial or CSPPT was recently published in the Journal of American Medical Association JAMA and provides evidence that daily Folic Acid may be a helpful addition to the regular medications used in the elderly and those at risk for stroke such as those with high blood pressure, diabetes, high cholesterol levels, or those who are obese or have history of smoking.


Other tips to reduce stroke would include taking a baby aspirin on a daily basis, considering healthy physical activity, weight loss, and curbing risk factors such as diabetes, high blood pressure, high cholesterol, atrial fibrillation, smoking and obesity. Atrial fibrillation is strongly associated with strokes and is serious condition that necessitates life long anticoagulation. For more information on stroke please read more… 



The American Heart Association has recently revised their recommendations on exercise. Previously 20 min of exercise three times a week was felt to be adequate for meeting requirements of healthy activity however more recent research suggests 30 minutes of moderate exercise 5 days a week is the right approach. This helps lower blood pressures and helps decrease the risk of stroke and heart attacks.

Please read on for tips on healthy activity. Click Here

Epilepsy Surgery:




Seizures occur in upto 10% of the population. Epilepsy or recurrent unprovoked seizures occur in 1%. Of the newly diagnosed epilepsy patients 30-35% will be refractory to medications either single or in combination. For these individuals epilepsy surgery may be an option.




This consists of inpatient admission for long term Video EEG monitoring in an epilepsy monitoring unit (EMU) for capturing 4-6 seizures on video and EEG recording and assessing if this arising from a single area of the brain ( focal) or from initial simultaneous whole brain involvement (generalized ). If focal in onset then epilepsy resective surgery may be an option. Otherwise vagal nerve stimulation may be considered in the appropriate setting. If respective surgery is an option the chances of cure are quite high and can be as high as an 80% chance of cure in temporal lobe epilepsy and upto 50% chance of cure in extra temporal or non temporal lobe epilepsy. If you or anyone you know has refractory seizures or epilepsy then referral to an epileptologist or an epilepsy center may be life changing.



CT Scan


There is a rising concern that CT scans may be associated with radiation-induced cancer. The amount of radiation associated with a routine CT scan is usually low at 2-10mS (millisieverts). Sieverts is an international unit for measuring different kinds of radiation. Radiation associated with CT scans are usually x-rays and often times equivalent to over a 200 conventional xrays. Read More...

 Most studies link radiation induced cancer to the gamma radiation exposure from the 1945 atomic bombing. The jury is still out. No direct studies are present to help confirm the actual risk. A single case of cancer may arise from 1000 routine chest CTs  by the above data estimates. This however has not been confirmed. Further studies are required to prospectively evaluate the risks overtime.


In the interim it may be wise to decrease the dose of radiation from CT scans by using special modified imaging techniques.  Massachussets General Hospital has been developing techniques that may decrease the exposure of radiation by approximately 75% without compromising the diagnostic quality of CT scans. Judicious use of CT scanning is also recommended.


More and more physicians are now requesting MRIs instead of CT scans to avoid the risk of CT scan related radiation exposure.  The risk of CT induced cancer is estimated to be as low at 0.05% (in comparison to a lifetime prevalence of 20%). However as many will agree,  the bottom line is one cancer is a cancer too many.

That said, it is important to follow through with your physicians advice and have the required CT testing to avoid diagnostic delays in the absence of confirmatory reports of CT induced issues. The risks of not having the CT may be far higher than having the test given the information at hand. We'll keep you abreast of any developing details.




Headaches, be gone: New Devices help. New medical FDA approved devices for headache and pain on the horizon.




As we race through the 21st century the world of medicine continues to make breakthroughs. For those who have have not yet heard about the neurological devices -DBS Deep Brain Stimulation and VNS Vagal Nerve Stimulation please read more by clicking the devices. The devices soon to be available are:  









Cefaly- A device providing supraorbital transcutaneous stimulation used for migraine headaches using electrical impulses to the surface of the forehead through an electrode patch has shown promise when used daily for 20 min. It was reported to decrease headaches in as many as 38% of patients using the device vs 12% of those not using the device or a gain of 26%  which is similar to that achieved by the use of medications.  Read More.








Eneura – A transcranial magnetic stimulator which has shown promise in treating acute migraine attacks. The device delivers magnetic pulse stimulation that is applied via a hand held device to disrupt the usual spread of migraine in the superficial neurons. In studies it was shown to help patients become migraine free at 2hrs and 24hrs more frequently than those not using the device. (38% vs 17% and 34 % vs 10% respectively) Read More.




Gammacore  A transcutaneous vagal nerve stimulation device has shown promise in helping relieve cluster headaches. The electrical impulses stimulates the vagal nerve through an electrode patch applied to the skin. Upto 44% of migraine attacks responded to a single application per an open label study reported in the journal of headache and pain. Read More.


quell device  


Quell – Similar to TENS transcutaneous Electrical Stimulation, this device acts by blocking the ascent of pain signals by delivering an electrical impulse to the shin through an applied electrode patch round the clock and utilizing the famed gating theory to limit pain impulse passage to the brain. Read More.