Ask a Neurologist: Dr Lysandra Katelaris

Your first appointment is really about building a clear picture of what you have been experiencing, how long it has been happening, and how it is affecting your day-to-day life. We will usually talk through:

• Your symptoms and when they started
• Your medical and family history
• Any medications you are taking, including supplements
• Previous tests, scans or specialist appointments

There are a few onboarding forms to fill in, either beforehand or when you arrive. If you can, bring previous scans/test results along, whether in digital or hardcopy format. (Although nowadays we can access the majority of scans via online databases, it is always sensible to have a back up). If your symptoms have involved blacking out, confusion or unusual movements, do bring someone who has seen them happen, their account is often very useful.

We will also go through a neurological examination, which assesses certain clinical signs such as your reflexes, strength, coordination, sensation and balance.

From there we will talk about whether further investigations are needed. Sometimes that means imaging straight away; sometimes another test first, or simply seeing how things go. Either way, we will explain the reasons why and in what order the investigations should occur. 

I always encourage patients to bring their questions along. Your first appointment is just as much a chance for you to understand what might be going on and to feel clear and comfortable about where we go from here.

If something has been worrying you, please do not put it off. You do not need to wait until symptoms become severe, or to have it all worked out before you come, working it out together is exactly what the appointment is for. You will be listened to, and you will leave knowing what happens next.

Question 2. What can a break from alcohol do for the brain?

Taking a break or even significantly cutting back your alcohol intake, whether for weeks, months or years, is one of the simplest things you can do for your brain health.

Alcohol affects the brain in a number of ways, including sleep, mood, concentration and memory. Taking a break from alcohol gives you the chance to notice whether anything changes in areas such as:

• Sleep quality
• Concentration and mental clarity
• Energy levels
• Mood and emotional wellbeing
• Sensations in the hands and feet, such as pins and needles or numbness

What alcohol is actually doing

There are two things going on. The first is direct: alcohol and acetaldehyde, the compound your body breaks it down into, are toxic to nerve cells, and the resulting oxidative stress gradually damages them. The second is nutritional. Alcohol interferes with how the body absorbs and uses thiamine (vitamin B1) and other B vitamins, which brain cells and nerves rely on to produce energy. Nerve tissue is unusually demanding in this respect, so it feels the shortfall early.

In the brain, some regions are more vulnerable than others — particularly the frontal lobes, which handle planning, attention and impulse control, and the cerebellum, which looks after balance and coordination. Heavy long-term drinking produces measurable loss of brain volume in these areas. Encouragingly, imaging studies show that some of this is recoverable with sustained abstinence.

Nerves as well as brain

The peripheral nerves, which are the nerves outside the brain, innervating your hands and feet, are affected by the same processes, and the longest nerves tend to be affected first. That is why alcohol-related nerve damage usually begins symmetrically in the feet, with burning, tingling, numbness or unsteadiness, before it is noticed anywhere else.  

This leads to peripheral neuropathy, which is worth taking seriously because nerves regenerate slowly. Stopping or cutting back usually halts the progression, and symptoms often improve, but recovery is measured in months rather than weeks and can be incomplete if the damage is long-standing. The earlier it is detected and managed, the better the long-term outcome. 

What to expect from a break

The effects will be different for everyone and depend on things like how much and how often you usually drink. Some people notice a clear difference within a fortnight; others notice very little, which is useful information too. Either way, even a temporary break is a good way to become more aware of how alcohol affects your brain and body.

One practical note: if you drink heavily most days, it is worth scheduling an appointment with your GP before stopping suddenly rather than going it alone. It is a straightforward conversation, and there are good ways to make the process safe and comfortable.

Longer term, reducing how much you drink is one of the more achievable things you can do to support your brain health as you age. Small, sustainable changes tend to matter more than short bursts of willpower.

And if you have been noticing changes in your memory, sleep or concentration, or tingling and numbness in your feet, and are not sure whether alcohol is part of the picture, please do not sit on it. Like with everything, early investigation and intervention improve outcomes.

Question 3. How do neurological conditions affect mental health?

Our brain controls much more than movement and memory. It also plays a major role in our mood, motivation, sleep, emotions and sense of self.

Yet we often separate neurological and mental health symptoms. Tremors, weakness, seizures and pain are seen as neurological, while anxiety, depression, low motivation or changes in behaviour can be seen simply as a reaction to what someone is going through.

In reality, the two are closely connected. Neurological conditions can directly affect the parts of the brain involved in mood and emotion. They can also affect mental health through ongoing pain, fatigue, poor sleep, changes to daily life and loss of independence. Often, it is a combination of both.

For example, depression affects around one in three stroke survivors. Around one in five people with epilepsy experiences anxiety, with a similar number experiencing depression. In Parkinson’s disease, low mood and apathy can sometimes appear before physical symptoms such as tremor.

Apathy is a good example of why understanding this connection matters. Someone may appear lazy or uninterested when they are actually finding it difficult to start an activity or find the motivation to do something.

Mental health symptoms can also be easy to miss. Someone with Parkinson’s may have reduced facial expression, making mood fluctuations harder to recognise. After a stroke, difficulty communicating may make it challenging for someone to explain how they are feeling.

That is why mental health should be considered in neurological care. A collaborative approach can be incredibly valuable, with neurologists, psychologists, psychiatrists and other health professionals working together to support both neurological and mental wellbeing. Regular check-ins, particularly after a diagnosis, relapse, hospital admission or medication change, can also help identify when someone may need additional support.

Sometimes, asking a patient “how are you coping?” can make a meaningful difference as opposed to only focusing on the physical symptoms. Holistic care provides a thorough, whole-person approach, which ultimately improves long-term outcomes.