These are questions with answers that are most commonly asked. Many of these questions have been submitted through to and answered by Dr Simcock, a neurologist and the Neurological Foundation’s Medical Advisor.

  • I am 44 years old and I have just been diagnosed as having Parkinson's disease. Should I start treatment? What is the best medication?

    There is no advantage in either starting treatment early, or in delaying treatment. The appropriate time is when your symptoms are interfering with your life. The aim of medication is to improve the symptoms where you can manage with them, but not to get rid of the symptoms completely, that is, to use the smallest reasonable dose of medication.

    The type of medication to start on is controversial, between a dopamine agonist (eg, ropinirole) or a preparation contain L-Dopa (Madopar or Siminet) You need to discuss these options with your neurologist.

  • I am a 74-year-old retired farmer. For 2 years I have had numb feet and this is getting worse. I saw a neurologist who diagnosed peripheral sensory neuropathy. Can you explain this diagnosis.

    A neuropathy is a disorder in which there is damage to the nerve fibres encoding messages from the spinal cord to the muscles (motor nerve fibres) from the sense organs in the skin, joints and muscles to the spinal cord (sensory nerve fibres) and the fine nerve fibres controlling the circulation and sweating (autonomic nerve fibres). A peripheral neuropathy is a disorder in which the longest nerve fibre are generally affected first and most severely - so that the symptons start in the feet and both sides are usually affected to the same degree.

  • I am confused about the benefit of taking asprin to prevent a stroke. A recent newspaer articel quoted a report the asprin caused more harm than good.

    The report quoted results from a health group taking asprin - the deleterious side effects were greater than the benefits (prevention of heart attck or stroke) However, the situation when asprin is given after a stroke to prevent further stokes is different. Asprin has been shown to be of benefit after an ischamic stroke. The degree of benefit is difficult to assess. For example, asprin after a stroke may reduce the chance of a furhter stroke over the next 3 years from 15 % to 10%. This could be said to be a reduction of 33%. A 33% reduction sounds impressive.

  • I am going to be having a neurological assessment for migraine, what should I expect?

    The Neurologist will ask you details about your headaches - frequency, site, precipitating and relieving factors, associated symptoms and previous treatment. He will also ask about your past medical history and your family history and will also need to know your social situation. He will then examine you thoroughly and finally discuss his diagnosis and plan of management with you. This could take about 3/4 hour.

  • I am troubled by hot burning feet or in cold weather sometimes excessively cold. Degree varies without any obvious reason. Some pain also in balls of feet. No medication has been helpful except Ativan which has controlled symptoms a little. I am interested to know the neurological explanation of this condition for interests sake. I manage it OK and am not seeking a treatment just more information, thanks.

    Sometimes the distortion of sensation in the feet which you describe can be caused by damage to the sensory nerves. This damage may be due to any one of a number of causes such as diabetes, excess alcohol or other toxins, or some blood disorder; often no cause can be found. The feet are affected because the longest sensory nerves are the most easily damaged.