Brain & CNS Diseases
ADHD - CAUSE
Most substantiated causes appear to fall in the realm of neurobiology and genetics. This is not to say that environmental factors may not influence the severity of the disorder, but such factors do not seem to give rise to the condition by themselves.
ADHD - SIGNS AND SYMPTOMS
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child's life. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begin to affect performance in school, social relationships with other children, or behavior at home, ADHD may be suspected. But because the symptoms vary so much across settings, ADHD is not easy to diagnose. This is especially true when inattentiveness is the primary symptom.
There are three subtypes of ADHD recognized by professionals. These are the predominantly hyperactive-impulsive type (that does not show significant inattention); the predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms).
HOW DIAGNOSIS IS DONE for ADHD?
Because everyone shows some of these behaviors at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person's age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person's life such as in the schoolroom, on the playground, at home, in the community, or in social settings. So someone who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.
To assess whether a child has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? That is, do they occur more often than in other children the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or in the schoolroom? The person's pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the DSM-IV-TR.
Signs and symptoms of Autism
Autism is the common term for a range of disabilities medically classified
as Pervasive Developmental Disorders (PDD). Autism/PDD is characterized by
qualitative differences in the development of cognitive, language, social or
motor skills, and these are usually apparent before age three. Research
evidence suggests that autism may result from an underlying difficulty with
expressive movement and its regulation, severely challenging the individual
to keep body movements, including sensory responses, in control. These
sensorimotor problems can make it difficult to respond consistently and
productively to other individuals and to the environment.
Autism/PDD occurs in approximately fifteen out of every 10,000 births and is
four times more common among males than females
Signs and symptoms of Brain Affections
Migraine Headache: Migraine headaches are severe headaches that usually occur with other symptoms such as visual disturbances or nausea. The pain may be described as throbbing, pounding, or pulsating. It tends to begin on one side of the head, although it may spread to both sides. There may be an "aura" (a group of warning symptoms that start before your headache). The pain usually gets worse when the person tries to move around.
Other types of headaches: Sinus headaches cause pain in the front of the head and face. They are due to inflammation in the sinus passages that lie behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning. Postnasal drip, sore throat, and nasal discharge usually occur with these headaches.
Signs and symptoms of Delirium
Mental Confusion: Delirium is a state of mental confusion, which develops quickly and usually fluctuates in intensity. A state in which the thoughts, expressions, and actions are wild, irregular, and incoherent; mental aberration; a roving or wandering of the mind, -- usually dependent on a fever or some other disease, and so distinguished from mania, or madness.
Signs and symptoms of Epilepsy
Epilepsy is a disorder in which nerve cells of the brain from time to time release abnormal electrical impulses. These cause a temporary malfunction of the other nerve cells of the brain, resulting in alteration of, or complete loss of consciousness. There are several forms of epilepsy. Most people will have seen someone suffer a major epileptic seizure, suddenly losing consciousness, jerking the arms and legs, etc. But there are other types of epilepsy - for example, one common form of epilepsy in children merely consists of staring blankly and losing contact with the surroundings for a few seconds.
Signs and symptoms of Hydrocephalus
Hydrocephalus is a condition in which excess fluid builds up in your brain. The word hydrocephalus comes from the roots hydro meaning "water" and cephalus meaning "head." The fluid that accumulates is cerebrospinal fluid (CSF), a fluid that normally surrounds your brain and spinal cord.
In hydrocephalus, too much fluid builds up, causing abnormal enlargement of the cavities in the brain (ventricles) that contain CSF. Too much CSF in the ventricles can put too much pressure on the brain, potentially damaging the brain.
A blood pressure of 140/90 or higher is considered high blood pressure. Both numbers are important. If one or both numbers are usually high, you have high blood pressure.
Hypertension / High Blood Pressure Causes
Hypertension occurs when arterioles, small blood vessels that branch off from the arteries, become constricted making it difficult for blood to pass through them. As a result, blood pressure rises causing your heart to work harder. If your blood pressure at rest stays at 140/90 or more, you may have hypertension.
Blood pressure is determined by the amount of blood pumped by the heart, and the size and condition of the arteries. Many other factors can affect blood pressure, including volume of water in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and levels of various hormones in the body.
Essential hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all high blood pressure.
Secondary hypertension is high blood pressure caused by another disorder. This may include:
adrenal gland tumors
glomerulonephritis (inflammation of kidneys)
renal vascular obstruction or narrowing
use of medications, drugs, or other chemicals
Signs and symptoms of Hypertension / High Blood Pressure
Usually, no symptoms are present. Occasionally, you may experience a mild headache. If your headache is severe, or if you experience any of the symptoms below, you must be seen by a doctor right away. These may be a sign of dangerously high blood pressure (called malignant hypertension) or a complication from high blood pressure.
- vision changes
- angina-like chest pain (crushing chest pain)
- heart failure
- blood in urine
- irregular heartbeat
- ear noise or buzzing
A neurotic disorder characterized by a wide variety of somatic and mental symptoms resulting from dissociation, typically beginning during adolescence or early adulthood and occurring more commonly in women than men.
Symptoms and Signs of Hysterical Neurosis
Conversion symptoms: Almost any organ disease symptom can be simulated on an hysterical basis. A variety of sensorimotor symptoms have been considered to be specific to and characteristic of hysterical neurosis. Weakness and paralysis of muscular groups are common; spasms and abnormal movements, less frequent. Especially characteristic are the "glove and stocking" distribution of the motor and sensory disturbances when these affect the limbs; ie, the distribution is determined by the body-image concept of a functional arm and leg rather than the dermatome innervation of the area affected. Less frequently, special senses and functions may be affected, such as in hysterical blindness, deafness, and aphonia; both visual and auditory hallucinations may occur.
Dissociative phenomena: A variety of altered states of consciousness may result from the dissociative process. In the most common form of dissociative hysteria, the patient typically has a complete loss of memory for all past events covering a period of several hours to several weeks. Anterograde amnesia may occur, wherein the amnesia covers the memory of events as they are experienced, the patient forgetting continuously from moment to moment what he has just been thinking, feeling, and doing.
Symptoms and Signs of Vertigo
Vertigo is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in balance (equilibrium). It also may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.
Vertigo usually occurs as a result of a disorder in the vestibular system (i.e., structures of the inner ear, the vestibular nerve, brainstem, and cerebellum). The vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves.
|Insomnia / Sleeplessness
Symptoms and Signs of Insomnia / Sleepessness
Difficulty in sleeping or inability to fall asleep or to remain asleep long enough to feel rested, especially when this is a problem that continues over time.
It may be defined as:
• Inability to sleep,
• Over a period of time;
• Difficulty initiating sleep;
• Difficulty maintaining sleep;
• Early morning awakening;
• Non Restorative sleep.
Types of Insomnia:
- Transient Insomnia (short term)
- Intermittent Insomnia (on and off)
- Chronic Insomnia (constant).
What are the causes of Insomnia?
Advanced age (insomnia occurs more frequently in those over age 60); the melatonin - a chemical that is needed in order to induce sleep, decreases and, at the age of sixty, very little is produced by our bodies. Without the presence of this chemical, the amount of sleep that the body receives diminishes. This may either mean rising earlier in the morning or the inability to sleep at night.
Female gender affected most; often than their male counterparts. This is partially due to the fact that hormonal changes which are intrinsic to females can bring about this particular condition. These changes may include PMS, menstruation, pregnancy and menopause. Any number of things can happen when an influx or decrease of hormones takes place in the body, and insomnia is one of the more common side effects
A history of depression
Various medical conditions such as high blood pressure, heart disease, asthma, arthritis, allergies, hyperthyroidism and Parkinson’s disease.
Painful or uncomfortable syndromes- toothache, arthritis and restless legs syndrome.
Drugs withdrawals such as caffeine, antidepressant, beta blockers, alcohol, sympathomimetics and hypnotics.
Nocturnal enuresis [bed wetting in the children], sleep walking, taking while asleep and night terrors can cause sleep disturbance in children.
Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following- stress, environmental noise, extreme temperatures, a change in the surrounding environment, sleep/wake schedule problems such as those due to jet lag, or medication side effects.
What are symptoms of insomnia?
Inadequate or poor-quality sleep.
Difficulty falling asleep; early wakening, waking frequently during the night, un-refreshing sleep, or a combination of these.
Waking up frequently during the night with difficulty returning to sleep.
Waking up too early in the morning.
Persons without adequate sleep can experience tiredness, lack of energy, and concentration problems.
|Mood Disorders - Depression, Mania, Bipolar Disorder
The fundamental abnormality of an affective disorder is a disturbance of mood, either depression or mania. Depression is by far the commoner; most patients who have manic symptoms are also prone to depressive episodes but the reverse does not apply. In a few cases depressive and manic symptoms occur simultaneously or in rapid succession (mixed affective state/ bipolar disorder)
Cause of Mood Disorders / Affective Disorders -- Depression, Mania, Bipolar Disorder
Genetic Factors have some role in bipolar disorder.
Environmental factors like
• Loss of mother before age 11
• 3 or more children under 14 living at home
• Lack of confiding relationship
• Lack of employment etc
are known to play a significant role in mood disorders.
Physical Illness: A physical illness can be followed by depression, esp. those like cancer, AIDS, and heart diseases etc which carry serious implications. Also mood changes can occur after infectious mononucleosis or influenza and other viral illness.
Depression or mania could be the presenting feature of cerbrovascular disease, neurological disorders such as multiple sclerosis, Parkinsonism and endocrine diseases such as Cushing's syndrome, Addison's Disease, and hypothyroidism.
Mood changes can also be associated with drug therapy, for eg. corticosteroids, beta-adrenoceptor antagonists and other anti-hypertensive drugs. When mood disorder results directly from physical causes they are known as organc affective disorders.
Personality - Some depressives have personality characteristics which are thought to predispose to the illness. this involves a negative attitude to oneself, the outside world and the future; the term 'cognitive triad' ha been applied to these attitudes.
Symptoms and Signs of Depression
• Depression of mood is the primary symptom. There may be a diurnal variation of mood, depression being most distressing early in the morning or at the end of the day.
• Loss of pleasure in life (anhedonia)
• Loss of interest in oneself and others
• Low self esteem
• Self blame
• Suicidal thinking
• Feeling of guilt and worthlessness
• Sleep disturbance (initial insomnia, early morning wakening or hypersomnia)
• Poor concentration
• Headache and other pains
• Anorexia (loss of appetite)
• Weight changes
• Reduced libido
All these symptoms may not be present in any single person and the level of intensity of symptoms vary from person to person.
Multiple Sclerosis (abbreviated MS, also known as disseminated sclerosis or encephalomyelitis disseminata) is a chronic inflammotory demyelinating disease. that affects the central nervous system(CNS).
Multiple sclerosis (MS) is a nervous system disease that affects your brain and spinal cord. It damages the myelin sheath, the material that surrounds and protects your nerve cells.
Signs and Symptoms of Multiple Sclerosis
This damage slows down or blocks messages between the brain and body, leading to the symptoms of MS. MS can cause a variety of symptoms including-
• Changes in sensation (in arms, legs or face). Sensations such as numbness, prickling, or "pins and needles"
• Visual problems (complete or partial vision loss and double vision)—optic neuritis, nystagmus or diplopia.
• Muscle weakness.
• Depression,thinking and memory disturbances.
• Difficulties with coordination and speech.
• Severe fatigue.
• Cognitive impairment.
• Problems with balance (ataxia).
• Overheating, and pain.
• Bladder and bowel difficulties.
• Impaired mobility and disability in more severe cases.
Myasthenia gravis is a chronic disorder characterized by weakness and rapid fatigue of any of the muscles under your voluntary control. It's caused by a breakdown in the normal communication between nerves and muscles.
Myasthenia gravis (MG) is a chronic autoimmune disorder that results in progressive skeletal muscle weakness. MG causes rapid fatigue (fatigability) and loss of strength upon exertion that improves after rest. Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. In myasthenia gravis, antibodies produced by the body's own immune system block, alter, or destroy the receptors for acetylcholine.
Types of Myasthenia gravis:
Myasthenia gravis can be classified according to which skeletal muscles are affected. Within a year of onset, approximately 85–90% of patients develop generalized myasthenia gravis, which is characterized by weakness in the trunk, arms, and legs.
About 10–15% of patients have weakness only in muscles that control eye movement. This type is called ocular myasthenia gravis.
Other types of MG include congenital, which is an inherited condition caused by genetic defect, and transient neonatal, which occurs in infants born to mothers who have MG. Congenital MG develops at or shortly after birth and causes generalized symptoms.
Transient neonatal MG is a temporary condition that develops in 10–20% of infants born to mothers who have MG. Transient neonatal MG is caused by circulation of the mother’s antibodies through the placenta and it lasts as long as the mother’s antibodies remain in the infant (usually a few weeks after birth).
Incidence and Prevalence of Myasthenia gravis:
Myasthenia gravis affects approximately 2 out of every 100,000 people and can occur at any age. It is most common in women between the ages of 18 and 25. In men, the condition usually develops between 60 and 80 years of age.
Signs and Symptoms of Myasthenia gravis
Initially, people with myasthenia gravis may complain about specific muscle weakness, particularly in the eyes, face and neck. They may have difficulty swallowing, chewing or speaking, and may have double vision. They also may feel fatigue, especially later in the day. Symptoms can be aggravated by emotional stress, systemic illness such as a viral respiratory infection, menstrual cycle, pregnancy, hypothyroidism or hyperthyroidism, and other factors.
Myasthenia gravis Treatment:
Myasthenia gravis can be controlled. Some medications (Cholinesterase inhibitors, such as pyridostigmine (Mestinon) and corticosteroids) improve neuromuscular transmission and increase muscle strength, and some suppress the production of abnormal antibodies. These medications must be used with careful medical followup because they may cause major side effects. Thymectomy, the surgical removal of the thymus gland (which often is abnormal in myasthenia gravis patients), improves symptoms in certain patients and may cure some individuals, possibly by re-balancing the immune system. Other therapies include plasmapheresis, a procedure in which abnormal antibodies are removed from the blood, and high-dose intravenous immune globulin, which temporarily modifies the immune system and provides the body with normal antibodies from donated blood.
Paralysis or palsy (pôl'ze) , complete loss or impairment of the ability to use voluntary muscles, usually as the result of a disorder of the nervous system. The nervous tissue that is injured may be in the brain, the spinal cord, or in the muscles themselves. Accordingly there may be general paralysis, involvement of only one side (hemiplegia), paralysis on both sides at one level (paraplegia or quadriplegia), or localized paralysis in a small group of nerves or muscles.
The cause of paralysis may be any injury that tears or compresses the nerves; it may be hemorrhage, tumor, infection, or substances toxic to nerve tissue. One of the most frequent causes of paralysis is stroke, in which hemorrhage, thrombosis, or obstruction of a cerebral vessel interferes with nerve function. Another disorder in which a resting tremor is one of the main symptoms, accompanied by slowness and poverty of movement, muscular rigidity, and postural instability is Parkinson's disease. Cerebral palsy is due to an injury to the brain motor tissue before or during birth. However, this disorder is nonprogressive. Partial or complete paralysis often accompanies multiple sclerosis.
Introduction - Also called: Paralysis agitans, Shaking palsy
Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the central nervous system that often impairs the sufferer's motor skills and speech.
Symptoms of Parkinson's disease have been known and treated since ancient times. However, it was not formally recognized and its symptoms were not documented until 1817, in An Essay on the Shaking Palsy. by the British physician James Parkinson. Parkinson's disease was then known as paralysis agitans, the term "Parkinson's disease" being coined later by Jean Martin Charcot. The underlying biochemical changes in the brain were identified in the 1950's, due largely to the work of Swedish scientist Arwid Carlsson, who later went on to win a Nobel prize.
Parkinson's disease is a disorder that affects nerve cells, or neurons, in a part of the brain that controls muscle movement. In Parkinson's, neurons that make a chemical called dopamine die or do not work properly. Dopamine normally sends signals that help coordinate your movements. Parkinson's is a disease that causes a progressive loss of nerve cell function in the part of the brain that controls muscle movement. Progressive means that this disease's effects get worse over time.
Signs and Symptoms of Parkinson's Disease
Parkinson's disease belongs to a group of conditions called movement disorders. The primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine ,which is produced in the dopaminergic neurons of the brain. Secondary symptoms may include high level cognitive dysfunction and subtle language problems. PD is both chronic and progressive.
PD is the most common cause of parkinsonism a group of similar symptoms. PD is also called "primary parkinsonism" or "idiopathic PD" (having no known cause). While most forms of parkinsonism are idiopathic, there are some cases where the symptoms may result from toxicity, drugs, genetic mutation, head trauma, or other medical disorders.
Early symptoms of PD are subtle and occur gradually. Affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly or that their handwriting is slow and looks cramped or small. They may lose track of a word or thought, or they may feel tired, irritable, or depressed for no apparent reason. This very early period may last a long time before the more classic and obvious symptoms appear.
Friends or family members may be the first to notice changes in someone with early PD. They may see that the person's face lacks expression and animation (known as "masked face") or that the person does not move an arm or leg normally. They also may notice that the person seems stiff, unsteady, or unusually slow.
As the disease progresses, the shaking or tremor that affects the majority of Parkinson's patients may begin to interfere with daily activities. Patients may not be able to hold utensils steady or they may find that the shaking makes reading a newspaper difficult. Tremor is usually the symptom that causes people to seek medical help.
People with PD often develop a so-called Parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward (called festination), and reduced swinging of the arms. They also may have trouble initiating movement (start hesitation), and they may stop suddenly as they walk (freezing).
PD does not affect everyone the same way, and the rate of progression differs among patients. Tremor is the major symptom for some patients, while for others; tremor is nonexistent or very minor.
PD symptoms often begin on one side of the body. However, as it progresses, the disease eventually affects both sides. Even after the disease involves both sides of the body, the symptoms are often less severe on one side than on the other.
The four primary symptoms of PD are:
Tremor. The tremor associated with PD has a characteristic appearance. Typically, the tremor takes the form of a rhythmic back-and-forth motion at a rate of 4-6 beats per second. It may involve the thumb and forefinger and appear as a "pill rolling" tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. For example, the shaking may become more pronounced a few seconds after the hands are rested on a table. Tremor usually disappears during sleep or improves with intentional movement.
Rigidity-. Rigidity, or a resistance to movement, affects most people with PD. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible not just because one muscle becomes more active, but because the opposing muscle relaxes. In PD, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the patient's arm, which will move only in ratchet-like or short, jerky movements known as "cogwheel" rigidity.
Bradykinesia. - Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is particularly frustrating because it may make simple tasks somewhat difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easily — such as washing or dressing — may take several hours.
Postural instability.- Postural instability, or impaired balance, causes patients to fall easily. Affected people also may develop a stooped posture in which the head is bowed and the shoulders are drooped.
A number of other symptoms may accompany PD. Some are minor; others are not. Many can be treated with medication or physical therapy. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms varies from person to person.
Depression: This is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Fortunately, depression usually can be successfully treated with antidepressant medications. Hallucinations,delusions and paranoia may develop.
Emotional changes: Some people with PD become fearful and insecure. Perhaps they fear they cannot cope with new situations. They may not want to travel, go to parties, or socialize with friends. Some lose their motivation and become dependent on family members. Others may become irritable or uncharacteristically pessimistic.
Difficulty with swallowing and chewing: Muscles used in swallowing may work less efficiently in later stages of the disease. In these cases, food and saliva may collect in the mouth and back of the throat, which can result in choking or drooling. These problems also may make it difficult to get adequate nutrition. Speech-language therapists, occupational therapists, and dieticians can often help with these problems.
Speech changes: About half of all PD patients have problems with speech. They may speak too softly or in a monotone, hesitate before speaking, slur or repeat their words, or speak too fast. A speech therapist may be able to help patients reduce some of these problems.
Urinary problems or constipation: In some patients, bladder and bowel problems can occur due to the improper functioning of the autonomic nervous system, which is responsible for regulating smooth muscle activity. Some people may become incontinent, while others have trouble urinating. In others, constipation may occur because the intestinal tract operates more slowly. Constipation can also be caused by inactivity, eating a poor diet, or drinking too little fluid. The medications used to treat PD also can contribute to constipation. It can be a persistent problem and, in rare cases, can be serious enough to require hospitalization.
Skin problems: In PD, it is common for the skin on the face to become very oily, particularly on the forehead and at the sides of the nose. The scalp may become oily too, resulting in dandruff. In other cases, the skin can become very dry. These problems are also the result of an improperly functioning autonomic nervous system. Standard treatments for skin problems can help. Excessive sweating, another common symptom, is usually controllable with medications used for PD.
Sleep problems: Sleep problems common in PD include difficulty staying asleep at night, restless sleep, nightmares and emotional dreams, and drowsiness or sudden sleep onset during the day. Patients with PD should never take over-the-counter sleep aids without consulting their physicians.
Dementia or other cognitive problems: Some, but not all, people with PD may develop memory problems and slow thinking. In some of these cases, cognitive problems become more severe, leading to a condition called Parkinson's dementia late in the course of the disease. This dementia may affect memory, social judgment, language, reasoning, or other mental skills.
Orthostatic hypotension: Orthostatic hypotension is a sudden drop in blood pressure when a person stands up from a lying-down position. This may cause dizziness, lightheadedness, and, in extreme cases, loss of balance or fainting. Studies have suggested that, in PD, this problem results from a loss of nerve endings in the sympathetic nervous system that controls heart rate, blood pressure, and other automatic functions in the body. The medications used to treat PD also may contribute to this symptom.
Muscle cramps and dystonia: The rigidity and lack of normal movement associated with PD often causes muscle cramps, especially in the legs and toes. Massage, stretching, and applying heat may help with these cramps. PD also can be associated with dystonia — sustained muscle contractions that cause forced or twisted positions. Dystonia in PD is often caused by fluctuations in the body's level of dopamine. It can usually be relieved or reduced by adjusting the person's medications.
Pain: Many people with PD develop aching muscles and joints because of the rigidity and abnormal postures often associated with the disease. Certain exercises also may help. People with PD also may develop pain due to compression of nerve roots or dystonia-related muscle spasms. In rare cases, people with PD may develop unexplained burning, stabbing sensations. This type of pain, called "central pain," originates in the brain. Dopaminergic drugs, opiates, antidepressants, and other types of drugs may all be used to treat this type of pain.
Fatigue and loss of energy: The unusual demands of living with PD often lead to problems with fatigue, especially late in the day. Fatigue may be associated with depression or sleep disorders, but it also may result from muscle stress or from overdoing activity when the person feels well. Fatigue also may result from akinesia – trouble initiating or carrying out movement. Exercise, good sleep habits, staying mentally active, and not forcing too many activities in a short time may help to alleviate fatigue.
Sexual dysfunction: PD often causes erectile dysfunction because of its effects on nerve signals from the brain or because of poor blood circulation. PD-related depression or use of antidepressant medication also may cause decreased sex drive and other problems. These problems are often treatable.
Impaired visual contrast sensitivity , spatial reasoning, colour discrimination, convergence insufficiency (characterized by double vision ) and oculomotor disturbances.
Dizziness and fainting; usually attributable to orthostatic hypotension, a failure of the autonomous nervous system to adjust blood pressure in response to changes in body position
Impaired propriception (the awareness of bodily position in three-dimensional space)
Reduction or loss of sense of smell (microsmia or anosmia) - can occur years prior to diagnosis,
Pain: neuropathic, muscle, joints and tendons, attributable to tension, dystonia, rigidity, joint stiffness, and injuries associated with attempts at accommodation
What Causes Parkinson's Disease?
The main causes could be graded under four headings:
Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful movement. Loss of dopamine results in abnormal nerve firing patterns within the brain that cause impaired movement. Studies have shown that most Parkinson's patients have lost 60 to 80 percent or more of the dopamine-producing cells in the substantia nigra by the time symptoms appear. Recent studies have shown that people with PD also have loss of the nerve endings that produce the neurotransmitter nor epinephrine. Nor epinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system, the part of the nervous system that controls many automatic functions of the body, such as pulse and blood pressure. The loss of nor epinephrine might help explain several of the non-motor features seen in PD, including fatigue and abnormalities of blood pressure regulation.
Scientists have identified several genetic mutations associated with PD, and many more genes have been tentatively linked to the disorder. Studying the genes responsible for inherited cases of PD can help researchers understand both inherited and sporadic cases. The same genes and proteins that are altered in inherited cases may also be altered in sporadic cases by environmental toxins or other factors.
Although the importance of genetics in PD is increasingly recognized, most researchers believe environmental exposures increase a person's risk of developing the disease. Even in familial cases, exposure to toxins or other environmental factors may influence when symptoms of the disease appear or how the disease progresses. There are a number of toxins, such as 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine, or MPTP (found in some kinds of synthetic heroin), that can cause Parkinson Ian symptoms in humans. Other, still-unidentified environmental factors also may cause PD in genetically susceptible individuals.
Viruses are another possible environmental trigger for PD. People who developed encephalopathy after a 1918 influenza epidemic were later stricken with severe, progressive Parkinson's-like symptoms. A group of Taiwanese women developed similar symptoms after contracting herpes virus infections. In these women, the symptoms, which later disappeared, were linked to a temporary inflammation of the substantia nigra.
Several lines of research suggest that mitochondria may play a role in the development of PD. Mitochondria are the energy-producing components of the cell and are major sources of free radicals — molecules that damage membranes, proteins, DNA, and other parts of the cell. This damage is often referred to as oxidative stress. Oxidative stress-related changes, including free radical damage to DNA, proteins, and fats, have been detected in brains of PD patients.
Other research suggests that the cell's protein disposal system may fail in people with PD, causing proteins to build up to harmful levels and trigger cell death. Additional studies have found evidence that clumps of protein that develop inside brain cells of people with PD may contribute to the death of neurons, and that inflammation or over stimulation of cells (because of toxins or other factors) may play a role in the disease. However, the precise role of the protein deposits remains unknown. Some researchers even speculate that the protein buildup is part of an unsuccessful attempt to protect the cell. While mitochondrial dysfunction, oxidative stress, inflammation, and many other cellular processes may contribute to PD, the actual cause of the dopamine cell death is still undetermined.
How is Parkinson's Disease diagnosed?
A doctor may diagnose a person with Parkinson's disease based on the patient's symptoms, neurological examinations and medical history. No blood tests or x-rays can show whether a person has Parkinson's disease. However, some kinds of x-rays can help the doctor make sure nothing else is causing symptoms. If symptoms go away or get better when the person takes a medicine called levodopa, it's fairly certain that he or she has Parkinson's disease.
The disease can be difficult to diagnose accurately. The Unified disease rating scale is the primary clinical tool used to assist in diagnosis and determine severity of PD. Indeed, only 75% of clinical diagnoses of PD are confirmed at autopsy. Early signs and symptoms of PD may sometimes be dismissed as the effects of normal aging. The physician may need to observe the person for some time until it is apparent that the symptoms are consistently present. Usually doctors look for shuffling of feet and lack of swing in the arms. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases. However, CT and MRI brain scans of people with PD usually appear normal.
The Unified Parkinson's Disease Rating Scale (UPDRS) is a rating scale used to follow the longitudinal course of Parkinson’s disease. It is made up of the following sections:
Mentation, behavior, and mood;
Activities of daily living;
Complications of therapy;
Hoehn and Yahr Stage;
Hoehn and Yahr Staging of Parkinson's Disease
Stage one: Symptoms on one side of the body only.
Stage two: Symptoms on both sides of the body. No impairment of balance.
Stage three: Balance impairment. Mild to moderate disease. Physically independent.
Stage four: Severe disability, but still able to walk or stand unassisted.
Stage five: Wheelchair-bound or bedridden unless assisted.
Prognosis of Parkinson’s disease:
PD is not by itself a fatal disease, but it does get worse with time. The average life expectancy of a PD patient is generally the same as for people who do not have the disease. However, in the late stages of the disease, PD may cause complications such as choking, pneumonia, and falls that can lead to death. Fortunately, there are many treatment options available for people with PD.
The progression of symptoms in PD may take 20 years or more. In some people, however, the disease progresses more quickly. There is no way to predict what course the disease will take for an individual person.
Can medicines treat Parkinson's disease?
There is no cure for Parkinson's disease. But medicines can help control the symptoms of the disease. Some of the medicines used to treat Parkinson's disease include carbidopa-levodopa (one brand name: Sinemet), bromocriptine (brand name: Parlodel), selegiline (one brand name: Eldepryl), pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), and tolcapone (brand name: Tasmar).
Plantar Fasciitis is inflammation of the plantar fascia or arch tendon of the foot. It is an overuse injury causing heel pain which may radiate forward into the foot. Plantar fasciitis can also be known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can occur (with repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel can have no heel spur present.
The Plantar Fascia or arch tendon is a broad, thick band of tissue that runs from under the heel to the front of the foot. A rupture can sometimes occur at the origin of the arch ligament and result in inflammation and pain.
Plantar Fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes heel pain and disability.
Cause of Plantar Fascitis:
The cause of plantar fasciitis is unclear and may be multifactorial. Because of the high incidence in runners, it is best postulated to be caused by repetitive microtrauma. Possible risk factors include obesity, occupations requiring prolonged standing, heel spurs, pes planus (excessive pronation of the foot), and reduced dorsiflexion of the ankle.
Sex:The condition occurs equally in both sexes in young people. Some studies show a peak incidence may occur in women aged 40-60 years.
Age:The condition can occur at any age. As mentioned, a peak incidence may occur in women aged 40-60 years.
Clinical features of Plantar Fascitis
• Pain beneath heel.
• Pain extends medially into sole.
• Pain worse on standing, walking.
• Marked tenderness at site of attachment of planter fascia to calcaneum.
• Tenderness at heel pad.
INVESTIGATION for Plantar Fascitis
• Usually no abnormality.
• Occasionally calcaneal spur is evident but its significance in causing pain is doubtful.
GENERAL MANAGEMENT for Plantar Fascitis
• Avoid precipitating causes.
• Correct maintaining causes.
• Advise foot wears having soft rubber cushioned soles.
• Short wave diathermy helpful in relieving pain.