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  1. 1. Neurological disorders
  2. 2. Closed Head Injury: Coup and Contrecoup
  3. 3. Glasgow Coma Score (GCS) <ul><li>Three parameters, higher is better (less impaired) 3 to 15 </li></ul><ul><ul><li>Best Eye Response. (4) </li></ul></ul><ul><ul><ul><ul><li>1 No eye opening. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2 Eye opening to pain. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3 Eye opening to verbal command. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>4 Eyes open spontaneously. </li></ul></ul></ul></ul><ul><ul><li>Best Verbal Response. (5) </li></ul></ul><ul><ul><ul><ul><li>1 No verbal response </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2 Incomprehensible sounds. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3 Inappropriate words. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>4 Confused </li></ul></ul></ul></ul><ul><ul><ul><ul><li>5 Orientated </li></ul></ul></ul></ul><ul><ul><li>Best Motor Response. (6) </li></ul></ul><ul><ul><ul><ul><li>1 No motor response. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2 Extension to pain. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3 Flexion to pain. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>4 Withdrawal from pain. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>5 Localizing pain. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>6 Obeys Commands. </li></ul></ul></ul></ul><ul><li>A Coma Score of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury. E3V3M5 = GCS 11. </li></ul>
  4. 4. Multiple Sclerosis (MS) <ul><li>Loss of myelin </li></ul>
  5. 5. Multiple Sclerosis (MS) <ul><li>People usually develop Sx of MS between 20 to 40y </li></ul><ul><li>2-3 x more common in women than in men. </li></ul><ul><li>Relapsing-Remitting MS (most common form): people show symptoms of the disease, but then seem to recover. After a period of time, the symptoms reappear; which continues over time. </li></ul><ul><li>Primary Progressive MS: gradual worsening of Sx without recovery. </li></ul><ul><li>Secondary Progressive MS: first show periods of recovery, but later enter a stage of gradual worsening of symptoms without recovery. </li></ul>
  6. 6. Alzheimer's Disease (AD) <ul><li>In 1986, Pres. Ronald Reagan's &quot;I don't recall&quot; responses to Iran-Contra affair seemed evasive. </li></ul><ul><li>However in 1994 he was dx’d with Alzheimer's. </li></ul><ul><li>Not a normal part of aging. </li></ul><ul><li>gradual memory loss & difficulties with language and emotions. </li></ul><ul><li>progressive loss of intellectual abilities (dementia) </li></ul><ul><li>As disease advances, need help in all aspects of life: bathing, eating, and using the restroom. </li></ul><ul><li>Plaques around neurons; currently no cure. </li></ul>
  7. 7. Attention Disorder Hyperactivity Disorder (ADHD) <ul><li>Attention Disorder Hyperactivity Disorder (ADHD) affects 5% of all boys and 2% of all girls (2 million in USA). </li></ul><ul><li>Up to 60% of these children will continue to have symptoms into adulthood. </li></ul><ul><li>A million children take prescription medicines to control hyperactive behavior. </li></ul><ul><li>ADHD appears to have a genetic component. MZ concordance is 75-91% </li></ul><ul><li>EEG reveals frontal slowing due to immature frontal lobe </li></ul>
  8. 8. Patterns of behavior indicative of ADHD <ul><li>Inattentive </li></ul><ul><ul><li>Being easily distracted </li></ul></ul><ul><ul><li>Failing to pay attention to details and making careless mistakes </li></ul></ul><ul><ul><li>Forgetting things, such as pencils, that are needed to complete tasks </li></ul></ul><ul><ul><li>Rarely following directions completely or properly </li></ul></ul><ul><li>Hyperactive </li></ul><ul><ul><li>Not being able to sit still </li></ul></ul><ul><ul><li>Talking non-stop </li></ul></ul><ul><ul><li>Leaving seat when sitting is expected/instructed </li></ul></ul><ul><li>Impulsive </li></ul><ul><ul><li>unable to suppress impulses such as making inappropriate comments </li></ul></ul><ul><ul><li>Shouting out answers before a question is finished </li></ul></ul><ul><ul><li>Hitting other people </li></ul></ul><ul><ul><li>Behavior which puts one in danger, such as dashing into the street </li></ul></ul>
  9. 9. Ritalin <ul><li>Controversy </li></ul><ul><li>Ritalin is one of the most commonly prescribed drugs for children , but there are worries about its long-term effects. </li></ul><ul><li>No studies on children who have taken Ritalin for more than 14 months. </li></ul><ul><li>Very similar to cocaine in composition and affect on brain </li></ul>
  10. 10. Tourette Syndrome (TS) <ul><li>Inherited neurological movement disorder characterized by motor or vocal tics. </li></ul><ul><li>Early onset (~ 7y); first Sx usually facial tics, such as eye blinks. </li></ul><ul><li>No cure but treatments available; Sx generally decline in severity after puberty. </li></ul><ul><li>3-4x males are </li></ul><ul><li>1 million mild cases, 200,000 severe </li></ul><ul><li>Types of tics </li></ul><ul><li>SIMPLE v COMPLEX; MOTOR v VOCAL </li></ul><ul><ul><li>(echopraxia; copralalia or echolalia) </li></ul></ul><ul><li>Likely problem in basal ganglia (caudate R) </li></ul><ul><li>Brain injury, stimulants (e.g.,, Ritalin) and other conditions may cause tics. </li></ul><ul><li>Tics worsen with fatigue or stress. </li></ul>
  11. 11. TS <ul><li>Involuntary or UNvoluntary? </li></ul><ul><li>Because tics are a response to an urge to perform a movement, some people refer to these movements as UNvoluntary, because the person does have some control over them. People with mild TS can partially or fully suppress tics for a short period of time. When tics are suppressed, it seems that tension builds inside the person, which is eventually released by a burst of tics. </li></ul><ul><ul><li>Disinhibition </li></ul></ul><ul><li>Mozart presumed to have TS (copralalia) </li></ul><ul><ul><li>wrote letters to his cousin Maria that contained many obscene words, especially words having to do with bodily functions. He was hyperactive, suffered mood swings, had tics, and loved made-up words. </li></ul></ul>
  12. 12. Types of Epilepsy <ul><li>Generalized seizures (most common) - uncontrollable discharge of neurons on both hemispheres. Seizure starts in one brain area and spreads across brain. Muscle twitches, convulsions and loss of consciousness. People with this type of epilepsy do not remember having a seizure. </li></ul><ul><ul><li>Tonic-clonic (&quot;grand mal&quot;) seizure - massive discharge in both hemispheres. Rigidity and violent jerking of body. &quot;Tonic-clonic&quot; = &quot;stiffness-violent.&quot; &quot;Grand mal&quot; = &quot;great sickness.&quot; </li></ul></ul><ul><ul><li>Absence (&quot;petit mal&quot;) seizure - nonconvulsive., a person may become unaware of his or her surroundings and may stare off in space or freeze for 5 to 30 seconds. </li></ul></ul><ul><ul><li>Myoclonic seizure - This seizure involves the motor cortex and causes twitching or jerking of certain parts of the body. </li></ul></ul><ul><ul><li>Status epilepticus - frequent, long-lasting seizures without regaining consciousness between attacks. Requires immediate medical attention. </li></ul></ul>
  13. 14. Types of Epilepsy <ul><li>Partial Seizures - characterized by abnormal electrical activity involving only a small part of the brain. Sometimes a partial seizure can spread to the whole brain. </li></ul><ul><ul><li>Simple partial seizures (also called &quot;Jacksonian&quot; or &quot;focal&quot; seizures) - Short-lasting seizures without loss of consciousness. People with these kinds of seizures often see, hear or smell something strange. Also, only part of the body may jerk. </li></ul></ul><ul><ul><li>Complex partial (psychomotor) seizures - A seizure with a change , not a loss, in consciousness. People may hear or see things or memories may resurface. Feelings of deja vu may also occur. </li></ul></ul>
  14. 15. Epilepsy Info <ul><li>1 in 200 people suffer epilepsy </li></ul><ul><li>Many (50-70%) cases of epilepsy have no known cause. </li></ul><ul><ul><li>Head injuries, such as a car accident or a fall. </li></ul></ul><ul><ul><li>Brain tumor or stroke </li></ul></ul><ul><ul><li>Arteriosclerosis (fatty plaque build-up in arteries) </li></ul></ul><ul><ul><li>Brain injury before birth caused by infection or lack of oxygen to the brain </li></ul></ul><ul><ul><li>Infection, such as meningitis or encephalitis </li></ul></ul><ul><li>Brain damage causes &quot;scar&quot; on brain. This is where a seizure starts. Unknown why a scar starts a seizure. </li></ul><ul><li>Seizure triggers: </li></ul><ul><ul><li>stress </li></ul></ul><ul><ul><li>lack of sleep </li></ul></ul><ul><ul><li>flashing lights or sounds (like from a video game or TV) </li></ul></ul><ul><ul><li>low blood sugar </li></ul></ul><ul><ul><li>i.e., Transitions </li></ul></ul>
  15. 16. <ul><li>TX </li></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Drugs </li></ul></ul><ul><ul><li>Neurofeedback </li></ul></ul><ul><ul><li>Diet, exercise, vasal stimulation, other novel therapies </li></ul></ul>