失眠的定義

醫學上對失眠的定義是：難以入睡、持續睡眠、隔天清晨醒來汲有睡飽的感覺。失眠是一種症狀而非疾病，必需先找出潛在的病因加以治療，而不是只有治療失眠的症狀而已。

美國國家健康組織﹝National Institute of Health﹞ 把失眠症依病程時間分為短暫性失眠﹝短於一星期﹞、短期性失眠﹝1-3星期﹞及長期性失眠﹝超過3星期﹞。

1.      短暫性失眠：

遇到重大壓力﹝如考試或競賽﹞、情緒上的激動﹝如興奮或憤怒﹞等都可能會失眠。而跨越時區旅行造成的時差反應也會對睡眠有所影響。

2.      短期性失眠：

病因和短暫性失眠有些雷同，但時間較長。有人在喪偶、離婚、生命中出現重大變數時，會造成情緒上的衝擊，平復所需要的時間可能長達數星期。

3.      長期性失眠：

這類失眠患者必須到失眠門診求診才行，病史有些達數年或數十年之久，必須找出潛在病因才有治療的希望。

參考資料 : www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向醫生查詢，而不應單倚賴以上提供的資料。

控制或消除失眠因素的方法

1.      到醫院掛精神科或神經內科了解病因。

2.      補充維生素B、Niacin 、鈣、鎂等。

3.      解除壓力，運動、打坐、深呼吸是很好的舒壓方法。

4.      避免服用含咖啡因的飲料。

5.      避免晚間運動。

6.      改變環境，如臥室、床舖、光線、聲音、環境氣氛等。

7.      排除身體疾病，如發燒、疼痛、搔癢、焦慮、憂鬱等。

8.      控制精神疾病，80%的失眠和精神疾病有關。

9.      避免可能造成失眠的藥物或飲料，如提神藥物或咖啡、茶等飲料。

10.  控制酒精的使用量，少量酒精可能幫助睡眠，經常喝則容易導致睡眠週期不規律，停喝後反而睡不著。

使用安眠與鎮靜劑的副作用

∎        精神及生理依賴性及藥物成癮性。

∎        白天精神萎糜、隔天藥效殘留作用相關後遺症。

∎        經常服用容易引起抗藥性或劑量必須不斷加重。

∎        長期使用會造成腦神經傷害或神經衰弱。

∎        行為異常。

藥物的副作用包括：視力模糊、低血壓、精神紊亂、記憶力衰退、語言不清、震顫、倦怠、尿失禁、便秘、健忘等。

參考資料 : www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向醫生查詢，而不應單倚賴以上提供的資料。

三叉神經痛, Trigeminal Neuralgia

香港的痛症病人中，近三成屬神經痛，僅次於背部的肌肉及骨骼痛症。

神經痛病徵三叉神經痛會出現如電擊的針刺痛楚，多數只影響半邊面，連刷牙、咀嚼都會加劇痛楚。
神經痛成因三叉神經痛多半成因是因腦血管壓住神經線。有少數是因病毒感染引至發炎，如流感病毒及梅毒。
神經痛預防方法保持身體良好， 減少發炎機會。患者應放鬆心情， 減少痛症對自己的影響。
神經痛治療

若病情較輕微，可選擇以專門醫治神經痛的藥物控制, 但藥物並沒有根治功效。如藥物未能控制病情，亦有多種微創治療的方法，包括刺針電熱治療, radio Frequency、神經線減壓術, micro-vascular decompression, 和放射外科治療, radiosurgery。各種治療的成效和副作用不同，病人可以與神經外科醫生一起制定最適合自己身體狀況和目標的醫治方法。

参考资料 : www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

Symptoms of stroke

Stroke is sudden onset of neurological disability. It happens because of sudden blockage of blood vessel in the brain or sudden bleeding in the brain. Within minutes, the affect part of the brain dies. On average, every year, 26,000 new patients suffer from stroke in Hong Kong. The peak time for onset of stroke is when temperature suddenly drops, e.g. around November to December.

Symptoms of stroke

The symptoms of stroke include (1) weakness or numbness of the face, arm or leg, (2)  confusion and drowsiness, (3) difficult to speak, (4) dizziness, (5) blurring of vision, (6) severe headache, (7) incontinenece, (8) vomiting, and (9) coma. Mini-stroke means patients suffered for one or more of the above named symptoms, but only temporarily.

Risk factors

Stroke can be caused by diseases such as, diabetes mellitus, atrial fibrillations, high blood pressure, high blood cholesterol level.

Patient with following diseases would have higher risk of stroke.

1.          Patients with coronary artery disease, cardiac & peripheral vascular disorders

2.          Cigarette smoker

3.          Obesity

4.          Lack of physical activity

Some patients have hidden time bomb in the brain, e.g. cerebral aneurysm or arteriovenous malformation, which may cause bleeding in the brain.

Prevention

Primary prevention is more important than treatment after stroke. More than half of the strokes are preventable. Persons with regular physical activities, balance diet, not smoking have a much lower chance of stroke. Good control of blood pressure, blood glucose and lipid are very effective way of preventing stroke. Person with family history of stroke, should have detailed body check up to see if there are risk factors for stroke.

Treatment & Surgery

Stroke is an emergency.  If patients suffered from stroke attend hospital immediately and have accurate diagnosis of stroke within the golden hours of treatment, there are drugs that can stop further bleeding in the brain or unblock a blocked blood vessels.  In severe case, neurosurgical operation may be needed remove blood clot in the brain or blockage of bleeding vessels.  Nowadays, neurosurgeon can use cure cerebral aneurysm or arteriovenous malformation without open surgery.

After stroke, most patients need treatment of the cause of stroke with medications or neurosurgery. Surgical procedures includes (1) carotid endarterectomy or angioplasty to remove significant narrowing of the artery to the brain, (2) clipping of endovascular embolization of cerebral aneurysm. (3) Surgery or radiosurgery for arteriovenous malformation.

Many patients need to undergo a series of rehabilitation like physiotherapy, speech therapy, occupational therapy, etc…

Reference information: www.brain-spine.com.hk, http://www.back.com/

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Neurosurgeon for diagnosis and treatment.

孩童與青少年期常見的憂郁症症狀

如果家中青少年在短期內出現功課突然退步、突然坐立不安、身體動作突然變慢、講話音調變單調、沉默不語、不明原因的情緒激躁、無法解釋地哭泣、常顯得害怕或緊張、突然變得有攻擊性、出現反社會行為、使用酒精或成癮性物質、抱怨身體某部位疼痛不適卻又找不到病因等，可能是罹患憂郁症的前兆。

嚴重憂郁症患者可能伴隨的症狀：妄想與幻聽等症狀，常常容易使醫生誤診為精神分裂症。

不可不知的憂郁症問題

∎ 50%的憂郁症發病年齡在20-50歲。

∎ 老年憂郁症的盛行率為25-50%。

∎ 婦女罹患憂郁症的可能性是男性的兩倍。

∎ 任何年齡的人都可能患上憂郁症，但在育齡婦女中最為常見。

∎ 憂郁症與許多生理疾病有關。

∎ 患者有心胸病、中風、癌症及糖尿病的患者罹患憂郁症的比率更高。

∎ 自殺死亡的個案中，約90會在生前患有憂郁症，反之，憂郁症患者約15%最後會選擇自殺。

參考資料: www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

Hydrodiscetomy: Cutting with Water

Hydrodiscetomy is solving unmet needs and improving outcomes in spine surgery by providing fluidjet-driven medical devices for use in ‘open’ and ‘minimally invasive’ spine procedures.

The products empower neurosurgeons to simultaneously cut, ablate, and remove hard and soft tissue quickly, safely, and effectively— without the collateral thermal or mechanical trauma of other surgical modalities. Imagine being able to remove tissue during back surgery via an opening the size of a straw—with the aid of a hair-thin, 600-miles-per-hour stream of water, instead of a one- to two-inch incision from an ‘open’ surgery with a scalpel. Although high-pressure water jets have been employed for many years in industrial cutting applications, this technology is not easily adapted for use in medicine because of the unique technical requirements of surgery:

(1) the working fluid must be sterile;
(2) the tools must be tiny and easily maneuverable;
(3) the pump system must be small enough to fit in any operating room; and,
(4) the devices must be safe.

Hydrodiscetomy has overcome the major barriers to the transfer of fluidjet technology from industrial to surgical applications with significant technical innovations. As a result, a growing number of neurosurgeons are using Hydrodiscetomy to wash away patients’ pain in a variety of back procedures. Unique to Hydrodiscetomy’s devices is the use of a ‘collector’ tube, not only to capture the fluidjet stream, but also to create a powerful ‘Venturi’- and-morcellation effect at the active site—resulting in tissue being drawn into the collector tube and thus away from the operative site, without the need for an external suction connection. This also allows optimal visibility during operation of the device—particularly important in spine procedures, where the surgical site is surrounded by vital structures such as nerves and blood vessels.

A further major advantage of Hydrodiscetomy is the ability to achieve ‘selective’ tissue excision. The tissue selectivity benefit allows spine surgeons to quickly and safely remove appropriate tissue, such as disc nucleus, without damaging the surrounding harder tissue or vertebral endplates. These advantages illustrate the power and versatility of Hydrodiscetomy to provide solutions to the spine surgeon, enabling efficient surgical procedures and optimal patient outcomes.

Reference: http://www.minimally-invasive-centrehk.com

The above information serves as educational reference only, you should consult your neurosurgeon for diagnosis, treatments and surgeries.

坐骨神經痛 (Sciatica)

坐骨神經是人體最長的神經線，從下腰一直延伸到腳掌。假如這束神經任何一處受損或受壓，都可引起坐骨神經痛。

嚴格來說，坐骨神經痛是一種症狀，最常見的病因是椎間盤脫位，壓住神經線所致。

坐骨神經痛相當普遍，很多時只影響身體的一邊，疼痛從臀部開始蔓延至大腿後面及小腿，並帶有麻痺感，如果情況嚴重，更會使下肢肌肉無力，影響病人行動。急性椎間盤脫位可引致小便失禁，必須立即施行手術。

坐骨神經痛發作時，下半身就好像有一條橡筋被硬拉到腿部般，而當要坐下、咳嗽、打噴嚏、用力甚至笑的時候，痛楚還會加劇。

參考資料: www.brainspine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的醫生查詢，而不應單倚賴以上提供的資料。

中風高危期

近來天氣忽冷忽熱，有神經科專家警告，氣溫由暖急劇轉冷，慢性病患者難以適應，血壓容易颯高，每年十一月及一至二月，均是中風高峰期。中風除了半身乏力及口齒不清等典型徵狀外，頸痛及視力短暫模糊亦是危險徵兆。曾有四十歲男教師突然頸痛及半身麻痺，入院檢驗方知頸動脈及腦血管栓塞，至今中風一個多月，仍未回復左手功能，需緊密康復治療才有望重拾教鞭。

中年應定期檢查心腦血管

仁安醫院神經外科專科醫生藍明權指，全港每年有二萬六千多人中風，每年十一月天氣轉冷，及一至二月氣溫驟降，均是中風高危期，「天氣由暖變凍，血壓會突然颯高，特別多中風爆血管個案。」

頸痛也是中風徵狀，一名四十歲男教師月前突然頸痛，及後左邊身麻痺及口齒不清，入院檢查發現右腦缺血性中風，右側頸動脈有血塊阻塞，要持續半年服抗凝血藥及做物理治療。左腳雖已活動正常，可以走路，但左手活動能力較差，無力拿水杯，也暫不能打字，預料有一半機會完全康復。患者沒有定期身體檢查，中風後才發現有高血壓、高膽固醇及糖尿病，這均是中風高危因素，建議中年人士應定期做心腦血管及頸動脈檢查。

此外，心房顫動病人有百分之七至一成機會併發中風。五十歲的陳先生健康一直良好，但近半年持續心跳不規則，至出現右邊身乏力才求診，入院後檢驗方發現左腦輕微血管栓塞。原來他病發前三個月其視力已短暫模糊，突然眼前一黑，一分鐘才回復正常。

參考資料: orientaldaily.on.cc

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的醫生查詢，而不應單倚賴以上提供的資料。

頭痛 (Headache)

頭痛─是一般人尋醫診治的常見症狀之一，但對於輕微的頭痛，很多人也會嘗試自行處理，例如：

1. 稍作休息、熱水浴及睡眠等，以作鬆弛神經

2. 多喝水或喝不含酒精的飲料

3. 服用無須醫生處方的止痛藥，例如(paracetamol \ acetaminophan及阿士匹寧,

頭痛的成因很多，常見的包括：緊張性頭痛、眼部疲勞或因長期費神集中工作、發燒、感冒、偏頭痛、醉酒、鼻竇炎，亦有些嚴重而有威脅生命的頭痛成因，例如：腦中風(出血性中風)、腦瘤、腦膜炎、創傷性撞擊

緊張性頭痛 Tension Headache

這類頭痛主要是由於過度疲勞或其他心理因素而引致頭、頸的肌肉收縮所形成的擠壓性痛症

病徵

頭部買週或局部的沉重或刺痛，頸部有時亦呈僵硬狀態。有些病者甚至會有其他精神緊張的病徵如心跳、氣促、失眠、精神不穩等

治療方法

1. 藥物治療

2. 物理治療及針炙治療

3. 矯正或改變生活方式，盡量減少壓力，多作休息，保持心境開朗

參考資料: www.brainspine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的醫生查詢，而不應單倚賴以上提供的資料。

Prevalence, Pathophysiology and Symptoms of Neuropathic Cancer PAIN – Hong Kong review

PAIN can be a persistent and incapacitating symptom of cancer. Although reports indicate only 15% of patients with nonmetastatic disease experience tumour-associated PAIN at the time of diagnosis, PAIN becomes more pervasive as disease progresses.1 In patients with recurrent or metastatic cancer, 67% complain of PAIN and 41% experience PAIN directly attributable to the disease. PAIN may be

chronic or acute, and patients with chronic PAIN commonly experience acute flares of PAIN.

One half to two thirds of patients with well-controlled chronic PAIN experience transitory ‘breakthrough’ PAIN. Cancer-associated PAIN may be secondary to antineoplastic therapy or an unrelated comorbid condition, but is commonly due to direct tumor involvement (ie, infiltration or compression of adjacent local structures, such as bone, soft tissue, nerves or the gastrointestinal tract).1,4 Hence, cancer PAIN syndromes can be somatic, visceral or neuropathic in origin.3 Understanding and recognizing these syndromes can help identify PAIN etiology and the need for additional evaluation, and target therapy more appropriately.

Reference source: http://www.neuropainhk.org, www.brainspione.com.hk

The above information is for educations only, if you have any related disease, please consult your neurosurgeon for more information.