Neurology in Tunisia

Neurology is a branch of medicine that focuses on the diagnosis and the treatment of diseases of the nervous system. The nervous system is a complex and sophisticated system that regulates and coordinates our body activities. It is divided into two major parts:

• The central nervous system: the brain and spinal cord
• The peripheral nervous system: all nerves branching out from the brain and spinal cord, and extend to other parts of the body, including organs and muscles.

Since the nervous system is complex, there are numerous subspecialties within the field of neurology, including:

• Neurodevelopmental disabilities
• Pediatric or child neurology
• Neuromuscular medicine
• Pain medicine
• Hospice and palliative care neurology
• Headache medicine
• Vascular Neurology (stroke care)
• Sleep medicine
• Autonomic disorders
• Brain injury medicine
• Neuropsychiatry
• Epilepsy
• Neurointensive care

A doctor who specializes in treating diseases of the nervous system is called a neurologist. Symptoms that often require a neurologist help may include coordination problems, muscle weakness, confusion, dizziness, and a change in sensation. People who are having problems with their senses, such as vision, touch, or smell, may also require to see a neurologist since problems with senses are sometimes caused by disorders of the nervous system.

A neurologist may also treat patients with:

• Stroke
• Seizure disorders, such as epilepsy
• Migraines and headaches
• Brain aneurysms
• Brain tumors
• Peripheral neuropathy
• Multiple sclerosis
• Infections of the nervous systems, such as meningitis, encephalitis, or brain abscesses
• Neuromuscular disorders, such as myasthenia gravis
• Neurodegenerative disorders, such as Alzheimer’s disease and Lou Gehrig’s disease
• Sleep disorders
• Spinal cord disorders, such as autoimmune and inflammatory disorders
• Speech and language disorders

Keep in mind that neurologist does not perform surgery. If you need surgery, you will be referred to a neurosurgeon.

What does Neurology Involve?

A wide variety of different tests and procedures are used to diagnose and treat neurological conditions. On your first appointment with a neurologist, a physical and neurological exam is likely to be performed. A neurological exam is done to test muscle strength, coordination, and reflexes.

Because different diseases can have similar symptoms, more than one testing may be required for your neurologist to make a diagnosis.

Some of the procedures that fall into the field of neurology may include:

Electromyography

Electromyography (EMG) is used to measure how well your muscles react to electrical stimulation from motor neurons, which are specific nerves controlling muscle movement. It can help neurologists diagnose general muscle or nerve dysfunction, as well as spinal cord disease.

During an EMG, small needles called electrodes are inserted into the muscle by a specially trained technician. The electrodes can measure the different electrical activity occurring in muscle tissue during periods of movement and rest.

Electroencephalogram

Electroencephalogram (EEG) is performed to assess and record electrical activity in your brain. Neurons in our brain communicate with other neurons through electrical impulses, which an EEG can record. Brain wave patterns can also be tracked by an EEG. It is used to help diagnose conditions of the brain, including tumors, inflammation, injuries, as well as psychiatric disorders, epilepsy, and seizures.

During an EEG, electrodes are placed on your head. The electrodes are connected to a computer, which converts electrical signals into patterns that can be seen from a screen or printed on a piece of paper.

Lumbar puncture

Lumbar puncture is done to test your spinal fluid. It involves inserting a needle into your spine after numbing it with an anesthetic. Using the needle, a sample of your spinal fluid is taken.

A lumbar puncture can help diagnose the following conditions:

• Meningitis
• Encephalitis
• Leukemia
• Myelitis
• Dementia
• Autoimmune diseases, such as multiple sclerosis (MS)
• Bleeding in the brain

The procedure can also be used to treat conditions affecting the spinal cord. Your neurologist may inject anesthetics, cancer treatments, or antibiotics using a lumbar puncture needle.

Tensilon test

To help diagnose myasthenia gravis, your neurologist may perform a tensilon test. It involves the injection of a medicine called Tensilon. Then, your neurologist observes how medicine affects your muscle movements.

Sleep study

Chronic sleep problems are diagnosed in a Sleep Study. Also known as a Polysomnogram (PSG), this procedure involves monitoring patients during sleep and physiological data is recorded electronically.

Other tests

Other types of tests may be used by your neurologist to make a diagnosis. These may include:

• Magnetic resonance imaging (MRI scan)
• Computed tomography (CT scan)
• Positron emission tomography (PET scan)
• Biopsy
• Genetic testing
• Angiography

Botox injections

Botox injections can be done to treat some neurological conditions, such as cerebral palsy, that can cause your limbs to pull in toward your center. Sometimes, these contracted muscles can be relaxed with Botox injections.

Botox injections involve injecting tiny amounts of botulinum toxin into your skin of muscles using a thin needle.

Brain tumor treatment

A range of treatments can be done to treat a brain tumor. If your neurologist believes that you need surgery, you will be referred to a neurosurgeon who will remove as much of the brain tumor as possible through surgery.

A brain tumor may also be treated with radiation therapy, which uses high-energy beams to kill tumor cells.

Brain tumor treatment may be integrated between the departments of neurology and oncology.

Brain rehabilitation therapy

Brain rehabilitation therapy is used to help you relearn functions that are lost as a result of a brain injury. Brain rehabilitation therapy is usually integrated between specialty teams in the departments of neurology, sports medicine, psychiatry and psychology, neuroradiology, and the vestibular/balance laboratory.

Deep brain stimulation

During deep brain stimulation, electrodes are implanted within certain areas of the brain. The electrodes generate electrical impulses that can regulate abnormal impulses. These electrical impulses may also affect certain chemicals and cells within the brain.

Deep brain stimulation can be done to treat numerous conditions, including dystonia, essential tremor, epilepsy, and Parkinson’s disease. It is also being studied as a potential treatment for multiple sclerosis and stroke recovery.

Spinal stenosis treatment

Spinal stenosis is a condition that occurs when the spinal canal narrows and pinches the nerves, leading to back and leg pain. Spinal stenosis may be treated with pain medications, physical therapy, steroid injections, decompression procedure, or surgery. Surgery is usually performed if other treatments have not helped.

How Long Should I Stay in Tunisia?

Your length of stay depends on the type of procedure you have, you may be allowed to leave the hospital on the same day or you will stay for several days. For diagnostic procedures, you should be allowed to leave the hospital on the same day. However, you should wait until the results of the test are ready before you can fly home, which may take as long as 7 days, sometimes even longer. If you undergo brain tumor treatments or other types of treatment, especially treatments that involve surgical intervention, you should aim to stay in Tunisia at least for 10 days.

What's the Recovery Time?

The recovery time can be different for each procedure. It may also depend on the reason why you are having the procedure and your overall health. Your neurologist and neurosurgeon will give you a recovery timeline for each procedure. The recovery period for diagnostic procedures is typically short and you may be able to resume your normal activities within a week or so. For surgical procedures, you may need to wait 4 weeks or months until you can go back to your daily routine, including work and exercise.

What About Aftercare?

A detailed aftercare instruction will be given to you following your procedure. While the instructions will be different for each procedure, they typically include a diet plan, exercise, restrictions, and wound care (if any surgical intervention is involved). You should follow these instructions carefully in order to have a speedy and smooth recovery.

You may also need to attend follow-up checkups to monitor your overall condition and healing. For brain tumors, you may need to attend regular checkups to ensure the tumor has not come back.

What's the Success Rate?

The field of neurology is constantly advancing. The success rate of each procedure is typically high, particularly when performed by highly skilled and experienced medical professionals. Still, some procedures may carry some risks, such as bleeding, infection, and nerve injury.

Are there Alternatives to Neurology?

Since neurology is the branch of medicine to diagnose and treat problems of the nervous system, there are no other alternatives. However, if your doctor found that your disease or illness is found to be caused by other problems unrelated to the nervous system, your doctor will recommend you to see the relevant doctor.

Neurology in and around Tunisia

About Tunisia

Tunisia is one of the few countries which can cater to everyone and it manages to combine climate, golden beaches, history, and shopping for an “all-around” experience. It has a high standard of healthcare and an excellent reputation for cosmetic surgery. Cosmetic and plastic surgeons are regulated by the Tunisian Ministry of Health and the private clinics have state-of-the-art equipment and English-speaking staff. Tunisia welcomes an ever-increasing number of medical tourists each year, many of whom travel for Neurology procedures. Medical Tourists travel from all across the globe, particularly from Europe and neighboring African countries with an inferior healthcare system. Popular medical tourism destinations outside of the capital, Tunis, include Sousse and Mahdia

Popular Parts of Tunisia

• Tunis, the country’s capital, is overflowing with a history that dates from the 4th Century BC. The city is divided into two parts, the old city known as the medina and the new city (or Ville nouvelle in French). Many tourists visit Tunis to see the Archaeological Site of Carthage which is also a UNESCO World Heritage Site. The beautiful Islamic architecture in medina also attracts many tourists to the city.
• Tozeur is known as a home to an enchanting desert oasis, which was a place to rest and refuel for caravans crossing the Sahara. Another main attraction in the city is the medina, where tourists can find lines of beautiful brick-patterned traditional dessert houses. Chott el Djerid, Sahara’s largest salt pan, is a popular day-trip destination.
• Sousse is located on the coast of the Mediterranean Sea. It offers good beaches with a clear blue sea. The city has been fought over by the Romans, Arabs, and Europeans, giving it a colorful history and culture. Sousse Archeological Museum is one of the most visited sites in the country; it has the second largest collection of mosaics in the world.
• Hammamet is the country’s original tourism resort. The city has beautiful gardens filled with oranges, lemons, and other citrus plants. It also has wonderful sandy beaches with crystal clear water. Just like any other city in Tunisia, this city is also brimming with interesting histories. Sites such as The Gafsa Museum and Bardo Museum will give insights about the Islamic faith and culture.
• Douz, also known as “the gateway to the Sahara.” Tourists who want to experience the Sahara Desert come to this city. Take a camel trip or a 4-wheel-drive into the Sahara or see the Museum of the Sahara that has an interesting collection portraying traditional Saharan life.

Weather and Climate in Tunisia

The North of Tunisia has a subtropical Mediterranean climate with mild rainy winters and hot summers. The South and inland areas have a tropical desert climate.

The weather is relatively comfortable throughout the year. Summer starts in June and lasts until August. The average temperature is between 28 °C to 32 °C with July and August being the hottest months. The heat is not as bad on the coast because of the seaside breeze. Be aware that July to September is the jellyfish season.

The heat decreases in autumn and the weather is somewhat more comfortable. There are occasional rain showers in September. The temperature in October can be like summer during day time, but cold at night. October has more rain than September. The season lasts for three months from September to November with an average temperature of around 19 °C to 29 °C.

The weather in winter can be uncertain. The average temperature is between 16 °C and 18 °C, but it can drop to 7 °C at night and below 0 °C in highlands and deserts and a clear sky is rare during this season.

Spring comes in March and the temperature can rise to 20 °C. Mornings and nights are cold; there is still a high probability of rains and thunderstorms at the end of this season.  

Getting Around in Tunisia

Tunisia has several international airports. The main airport is Tunic-Carthage International Airport. It has international connections with major European countries and the Middle East. The airport is the hub for Tunisair, Tunisair Express, and Nouvelair. Other airports that have international flights are Enfidha-Hammamet, Monastir Habib Bourguiba, Djerba-Zarzis, and Tabarka-Aïn Draham.

Taxis and buses are available to get to the city center from Tunis Airport. The SNT bus line departs every 30 minutes from the airport, the ticket costs less than 1 TND. There is also the TUT bus which departs every 15 minutes and is more luxurious and expensive.

Airport taxis are available at the airport taxi stand and are usually metered. Always make sure that the driver turns the meter on before riding the taxis. A journey to the city should cost around 5 TND. An extra cost will be added if you have baggage.

Getting around in Tunisia can be done by several transportation modes. Tunisair Express provides domestic flights between Tunis, Tozeur, Djerba, and Gabes. The Train is also available and the national train company in the country is SNCFT that runs modern and comfortable trains from Tunis to Sousse, Sfax, and Monastir. There are three classes of service that tourists can choose. The fare from Tunis to Sousse is between 6 to 10 TND. The long-distance bus is an economical option to travel between big cities such as Tunis, Hammamet, and Nabeul. The buses usually depart every 30 minutes.

Tourist Visas in Tunisia

Citizens of 97 countries (including Australia, China Singapore, the United States, and Russia) can visit and stay in Tunisia for up to 90 days without a visa. Other nationalities are advised to check with their local Tunisia embassy. Tunisia provides an online visa application for nationalities that needs a visa to enter. The eVisa will simplify the process of obtaining travel authorization to enter the country.

Additional Information

1. Local Currency: the local currency is the Tunisian dinar (TND). 1 USD converts to 2.61 TND.

2. Money & Payments: ATMs can be found in most cities and in all tourist areas. Many ATMs have withdrawal limits of 400 TND. Credit cards (MasterCard and Visa) are accepted in major cities and tourist areas. They can be used for shops, car hire, or top-end accommodation. Always make sure to carry cash if you want to travel outside major cities. Tipping is not necessary but will be appreciated.

3. Local Language: Arabic is the official language of Tunisia. French is very common due to the country’s former status as a French protectorate. English is still very limited except in the tourist areas and expensive hotels.

4. Local Culture and Religion: Islam is the major religion with 98% of the population identified as Muslim. There is a small group of Christian and Jews. Since most of the population is Muslim, always remember that the dress code is important in Tunisia.

5. Public Holidays: Tunisia celebrates major Islam holidays. The country hosts several annual festivals throughout the year such as The International Festival of the Sahara, Yasmine Hammamet Festival, and the International Festival of Carthage.