February 8, 2017

 

Tourette’s syndrome is a neurological disorder that effects certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells.  The disorder is named for Dr. Georges Gilles de la Tourette, the neurologist who in 1885 first described the condition in an 86-year-old woman. He summarized it as a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics.  The exact cause of Tourette’s is unknown, but it is well known that both genetic and environmental factors are involved. Genetic epidemiology studies have shown that the majority of cases of Tourette’s are inherited, although the exact mode of inheritance is not yet known as no gene has been identified. In other cases, tics are associated with disorders other than Tourette’s, a phenomenon known as tourettism, such as OCD (obsessive Compulsive Disorder) and ADHD (Attention Defeicit Hyperactive Disorder).

Signs and symptoms of Tourette syndrome typically show up between ages 2 and 12.  Males are about three to four times more likely than females to develop Tourette syndrome. It involves unusual repetitive movements or unwanted sounds that can’t be controlled (tics).  You may repeatedly blink your eyes, shrug your shoulders or jerk your head, or you might unintentionally blurt out offensive words.

You can live a normal life span with Tourette’s syndrome, and many people don’t need treatment when symptoms aren’t troublesome. Symptoms often lessen or become quiet and controlled after the teen years.

While there is no known cure for Tourette’s Syndrome here at COEM we treat using multiple techniques.

  1. Reduce the allergic load
  2. Look for mineral depletion
  3. Eradicate over growth of yeast from the body
  4. Look for a bacterial infection or over growth

To prepare for your appointment you will want to come off any antihistamines 48 hours before your visit, to allow for accurate allergy testing.  Also make sure to bring with you copies of any recent tests and bloodwork performed, along with your new patient packet.

 

References

www.tsa-usa.org

National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov

 

 

Posted in NEUROVASCULAR
February 8, 2017

Sarcoidosis is an inflammatory disease that affects one or more organs but most commonly affects the lungs and lymph glands. As a result of the inflammation, abnormal lumps or nodules (called granulomas) form in one or more organs of the body. These granulomas may change the normal structure and possibly the function of the affected organ(s).

Sarcoidosis usually starts in the lungs or lymph nodes in the chest. It is thought that inflammation of the alveoli (tiny sac like air spaces in lungs where carbon dioxide and oxygen are exchanged) is the start of the disease process in the lungs. This may either clear up on its own or lead to granuloma formation and fibrosis (scarring). Over 90% patients have some type of lung problem. Once considered a rare disease, sarcoidosis is now the most common of the fibrotic lung disorders.

Many people with sarcoidosis have no symptoms at all. But in others, the condition can cause long-term organ damage. For example, some people have fiber-like scar tissue in the lungs, which can cause breathing problems. Sarcoidosis may develop over time and cause symptoms that last for years, or it may show up and go away quickly.

People who have a variation of sarcoidosis, called Lofgren’s syndrome, may have symptoms that include swollen lymph nodes, fever, painful, reddened nodules, and joint pain. Lofgren’s syndrome generally tends to clear up on its own within 1 to 2 years.

Who is at Risk?

Sarcoidosis affects people of all ages and races. However, it’s more common among African Americans and Northern Europeans. In the United States, the disease affects African Americans somewhat more often and more severely than Whites.

Sarcoidosis is somewhat more common in women than in men. The disease usually develops between the ages of 20 and 50. People who have a family history of sarcoidosis also are at higher risk for the disease.

Causes

No one knows exactly what causes sarcoidosis, but it is probably due to a combination of factors. Some research suggests that bacteria, viruses or chemicals might trigger the disease. Although such triggers might not bother most people, it is possible that in someone with the right genetic predisposition they provoke the immune system to develop the inflammation associated with sarcoidosis.

The fact that a person is more likely to develop the disease if someone in his or her close family has the disease strongly suggests that genetics plays a role. Researchers have not discovered the genes for sarcoidosis yet, but it seems likely that more than one gene is involved.

It’s still uncertain which foreign substance “triggers” the body’s abnormal response. Some researchers suggest that fungi, viruses, or bacteria are likely triggers. In fact, cases of sarcoidosis have occurred in groups of people who had close contact with each other, as well as in recipients of heart, lung and bone marrow transplants. But, so far, no data have been able to convincingly and consistently establish this “infectious” connection as the cause of the disease. However, some types of bacteria have recently emerged as possible candidates and continue to be closely studied.

Symptoms

Many people with sarcoidosis do not have any symptoms. Others have only vague symptoms that can be seen in many other illnesses, such as weight loss, fever, loss of appetite, depression, night sweats, and sleep problems. Symptoms that may come from problems with a specific organ include –

  • Lungs – Shortness of breath, wheezing or dry cough that may disappear over time.
  • Lymph nodes – Enlarged and sometimes tender lymph nodes, most often in the neck and chest, but sometimes under the chin, arm pits or groin.
  • Eyes – Burning, itching, tearing, redness, sensitivity to light, dryness, seeing black spots, blurred vision, reduced color vision, and, in rare cases, blindness.
  • Skin – Bumps, ulcers, or rarely, flat areas of discolored skin that appear mostly near the nose or eyes or on the back, arms, legs and scalp. Painful and tender bumps can also appear on the ankles and shins.
  • Bones and Joints – Bone lumps (nodules), causing pain in the hands and feet and sometimes pain and swelling in the ankles or other joints.
  • Spleen and Liver – Fever, fatigue or itching. There can be pain in the upper right part of the abdomen, under the rib.
  • Heart – Shortness of breath, swelling in the legs, wheezing, coughing, and chest pain. One may have a feeling of an irregular or fast heart beat at times, or even pass out without warning.
  • Salivary Glands – Swelling (which may make the cheeks look puffy) and an overly dry mouth and throat.
  • The Nervous System – Headaches, vision problems, weakness or numbness of an arm or leg, drooping of one side of the face, loss of movement in the arms or legs, weakness, pain or a “pins and needles” feeling.

Treatment

Medications

Corticosteroids, such as prednisone are considered the first-line treatment for lowering inflammation from sarcoidosis. Corticosteroid pills can have some serious side effects if taken in high doses for long periods. Side effects may include –

  • High blood pressure
  • Diabetes
  • Stomach ulcers
  • Tuberculosis
  • Osteoporosis

Other medications sometimes used for sarcoidosis include those that suppress the immune system, such as –

  • Methotrexate
  • Azathioprine (Imuran)
  • Infliximab (Remicade)

Other medications that may be used include –

  • Antimalarial drugs: such as hydroxychloroquine, used when the skin is affected. It may be toxic to the eyes.
  • Thalidomide: being studied for sarcoidosis, used to improve lung function and treat skin problems.
  • Topical therapies: including steroid creams, eye drops, nasal corticosteroids, and steroid inhalers.

Alternative Treatment

A daily multivitamin – Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Omega-3 fatty acids – Such as fish oil, 1 to 2 capsules or 1 to 3 tbsp of oil, 1 to 3 times daily. Fish oil seems to help reduce inflammation throughout the body. Cold-water fish, such as salmon or halibut, are good choices to eat.

Bromelain – A mixture of enzymes derived from pineapple, 500 mg per day. Bromelain may also help reduce inflammation in the body.

Probiotic supplement (containing Lactobacillus acidophilus) – These “friendly” bacteria help maintain gastrointestinal health.

Turmeric & Cat’s claw   – This may help reduce inflammation.

 

Reference –

http://www.medicinenet.com/sarcoidosis/article.htm

https://www.blf.org.uk/Page/What-is-sarcoidosis

https://www.thoracic.org/patients/patient-resources/resources/what-is-sarcoidosis.pdf

http://www.wasog.org/pdfs/sharma.pdf

http://www.nejm.org/doi/pdf/10.1056/NEJMra071714

http://www.sarcoidosisonlinesites.com/cardiac_sarcoidosis.pdf

http://www.mayoclinic.org/diseases-conditions/sarcoidosis/basics/causes/con-20022569

 

Posted in NEUROVASCULAR
February 8, 2017

Raynaud’s Disease, also known as Raynaud’s Phenomenon (RP), refers to reversible spasm of peripheral arterioles in response to cold or stress. It is a disorder characterized by one or more fingers becoming blanched, cyanotic, and red (often in that order), upon an individual’s exposure to cold stimuli or emotional stress. These color changes are attributable to several factors; however, they mainly result from vasospasms of the digital arteries.

RP is named after the French physician, Maurice Raynaud, who first described it. Although the fingers of healthy individuals may become pale in response to severe cold, the effect is exaggerated in individuals with Raynaud’s symptoms. Even mild cold exposures can cause significant symptoms. 8 percent of the sufferers are women, and as many 5 percent population of the U.S. are affected by RP.

The disease mostly affects the fingers, toes, tip of the nose and the ears. The problem is in the blood vessels that supply the skin. Smaller arteries narrow and limit blood circulation to affected areas. Areas of the body subsequently become cold and very pale. Patients typically feel pins and needles, numbness, and even burning. The sensation can be unpleasant and painful.

The disease is classified as following –

  • Primary Raynaud’s – This is the most common form, there is no apparent cause (idiopathic). It is possible for the primary form to move to the secondary form.
  • Secondary Raynaud’s – It is associated with an underlying disease, such as rheumatoid arthritis. In extreme cases this form can progress to necrosis or gangrene of the fingertips.

Raynaud’s phenomenon doesn’t usually cause permanent damage. However, it can be a symptom of more serious underlying illnesses, so it is important to see the doctor if anyone experiences it.

Causes

  • Blood vessels in spasm With Raynaud’s, arteries to the fingers and toes go into vasospasm when exposed to cold or stress, narrowing the vessels and temporarily limiting blood supply. Over time, these small arteries may thicken slightly, further limiting blood flow. Cold temperatures are most likely to trigger an attack. Exposure to cold, such as putting the hands in cold water, taking something from a freezer or encountering cold air, is the most likely trigger. For some people, emotional stress can cause an episode of Raynaud’s.
  • Connective tissue diseases – Most people who have a rare disease that leads to hardening and scarring of the skin (scleroderma) have Raynaud’s. Other diseases that increase the risk of Raynaud’s include lupus, rheumatoid arthritis and Sjogren’s syndrome.
  • Diseases of the arteries – Raynaud’s phenomenon can be associated with various diseases that affect arteries, such as the buildup of plaques in blood vessels that feed the heart (atherosclerosis) or a disorder in which the blood vessels of the hands and feet become inflamed (Buerger’s disease). A type of high blood pressure that affects the arteries of the lungs (primary pulmonary hypertension) can be linked to Raynaud’s.
  • Carpal tunnel syndrome – This condition involves pressure on a major nerve to the hand (median nerve) producing numbness and pain in the affected hand. The hand may become more susceptible to cold temperatures and episodes of Raynaud’s.
  • Repetitive action or vibration – Typing, playing piano or doing similar movements for long periods and operating vibrating tools, such as jackhammers, can increase the risk of developing Raynaud’s.
  • Smoking – Smoking constricts blood vessels and is a potential cause of Raynaud’s.
  • Injuries – Injuries to the hands or feet, such as wrist fracture, surgery or frostbite, can lead to Raynaud’s phenomenon.
  • Certain medications – Some drugs — including beta blockers, which are used to treat high blood pressure; migraine medications that contain ergotamine or sumatriptan; attention-deficit/hyperactivity disorder medications; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter cold medications — have been linked to Raynaud’s.
  • Cancers – Some types of cancer can cause secondary Raynaud’s. These are usually cancers that develop inside the blood, bone marrow or immune system, such as –
    • Acute lymphoblastic leukaemia – a cancer of the white blood cells that mainly affects children
    • Lymphoma – a cancer that develops inside one or more of the glands that are part of the immune system
    • Multiple myeloma – a cancer that develops inside bone marrow 

Risk Factors

Risk factors for primary Raynaud’s include –

  • Sex – Primary Raynaud’s affects women more than men.
  • Age – Although anyone can develop the condition, primary Raynaud’s often begins between the ages of 15 and 30.
  • Climate – The disorder is also more common in people who live in colder climates.
  • Family history – A family history appears to increase the risk of primary Raynaud’s. About one-third of people with primary Raynaud’s have a first-degree relative — a parent, sibling or child — with the disorder.

Risk factors for secondary Raynaud’s include –

  • Associated diseases – These include conditions such as scleroderma and lupus.
  • Certain occupations – People in occupations that cause repetitive trauma, such as operating tools that vibrate, may be more vulnerable to secondary Raynaud’s.
  • Exposure to certain substances – Smoking, medications that affect the blood vessels, and exposure to certain chemicals, such as vinyl chloride, are associated with an increased risk of Raynaud’s.

Symptoms

Generally, primary Reynaud’s disease symptoms are mild, while the secondary form’s may be more severe. In the primary form both hands are affected simultaneously, usually all fingers at the same time. In the secondary form the development and appearance of symptoms is more patchy, with perhaps a couple of fingers on one side being affected.

The affected areas will become very pale (pallor), and then take on a bluish color (cyanosis) due to hypoxia (lack of oxygen to that area). They will feel very cold and numb. If all fingers are affected, trying to rummage in your pockets for specific coins becomes much more difficult. This can sometimes be distressing.

  • Cold fingers and toes
  • Color changes in your skin in response to cold or stress
  • Numbness or tingling in the fingers and toes (can be on the ears or nose)
  • Stinging or throbbing pain upon warming or stress relief
  • Ulcers in the tips of fingers and/or toes
  • Raynaud’s-type symptoms may occur during breastfeeding; the nipples will turn white and become extremely painful.

Treatment

Conventional Treatment

Calcium channel blockers – These are prescription medications that help to dilate or enlarge the blood vessels, thereby increasing circulation to the extremities. These medications are helpful in reducing the severity and frequency of attacks. Some medications used are – nifedipine and diltiazem.

Vasodilators – Topical prescription medications like nitroglycerin which relax the walls of the blood vessels can provide relief. This type of drug can be used to help heal painful skin ulcers caused by the condition of Raynaud’s. Vasodilators that are typically used to treat other conditions are also prescribed to those with Raynaud’s.  Such drugs as: Cozaar (used for treatment of high blood pressure), antidepressants like Prozac and Sarafem, and as odd as it may sound, Viagra (sildenafil) is also prescribed for Raynaud’s.

Alpha Blockers – These drugs typically counteract the actions of the hormone that constricts the blood vessels, norepinephrine. Some examples of this type of medication are Minipress (prasolin) and Cardura (doxazosin).

Surgeries or medical procedures – Nerve surgery to cut the sympathetic nerves in your hands and feet can help to interrupt their exaggerated response to temperature shifts, etc. This surgery is called a sympathectomy and may reduce the frequency or severity of attacks, but has not always been successful.

Chemical Injections – Physicians use chemicals injected into the sympathetic nerves to block the nerves. This procedure needs to be repeated if symptoms persist.

Surgical intervention – In very rare cases where the blood flow has been completely blocked, gangrene can set in, requiring amputation of the affected tissue.

Alternative Treatment

Omega-3 fatty acids, found in fish oil, may reduce symptoms in people with primary Raynaud’s, according to one study. High doses of fish oil can increase your risk of bleeding.

Evening primrose oil contains a different type of fatty acid that stops the body from making chemicals that narrow blood vessels. In one study, people with Raynaud’s who took EPO had fewer and less severe attacks compared to those who took placebo. More research is needed, however. People who have a history of seizures should not take EPO. EPO can increase your risk of bleeding.

Inositol hexaniacinate, a form of vitamin B3 or niacin, may reduce frequency of Raynaud’s attacks. In studies, people took high doses of inositol hexaniacinate, which can be dangerous if not monitored by a doctor.

Magnesium opens up blood vessels. Some doctors suggest taking a magnesium supplement, although there are no scientific studies to show it works. Magnesium can interact with a number of medications, including antibiotics, drugs used to treat high blood pressure, and drugs used to treat osteoporosis.

Alpha Lipoic Acid to ease the circulatory issues with Raynaud’s.

Vitamin E enhances blood flow. Vitamin E may potentiate the effect of anticoagulant drugs

Ginkgo (Ginkgo biloba) can open up blood vessels and increase circulation in the fingers. One preliminary study found that people with Raynaud’s who took 160 mg of ginkgo per day had less pain.

Flavonoids are found in a variety of herbs and produce. Vegetable juice and eating a variety of fruits is an option. Flavonoids help dilate blood vessels.

 

Reference

https://umm.edu/health/medical/altmed/condition/raynauds-phenomenon

http://www.medicinenet.com/raynauds_phenomenon/article.htm

http://www.mayoclinic.org/diseases-conditions/raynauds-disease/basics/risk-factors/con-20022916

http://www.nhs.uk/Conditions/Raynauds-phenomenon/Pages/Causes.aspx

http://www.thelancet.com/pdfs/journals/lancet/PIIS014067360313646X.pdf

http://www.turner-white.com/pdf/hp_sep01_raynaud.pdf

http://www.medicalnewstoday.com/articles/176713.php

http://www.medicalnewstoday.com/articles/176713.php

 

Posted in NEUROVASCULAR
February 8, 2017

Parkinson’s Disease is a chronic and progressive neurodegenerative brain disorder. Parkinson’s disease (PD) was first described by Dr. James Parkinson. Earlier, the condition was known popularly as the shaking palsy and in the medical community by its Latin equivalent, paralysis agitans. These terms are misleading, however, implying that people are paralyzed with this disorder, which is not the case. It is sometimes called idiopathic parkinsonism (the term idiopathic means that the cause is unknown), but more commonly today it is simply called Parkinson’s disease, to honor the physician who first described it.

PD is a disorder of the central nervous system, involving primarily a degeneration of certain nerve cells in deep parts of the brain called the basal ganglia, and in particular a loss of nerve cells (or neurons) in a part of the brainstem called the substantia nigra. These cells make the neuro-chemical messenger dopamine, which is partly responsible for starting a circuit of messages that coordinate normal movement. In the absence (or with substantial reduction, more than 80% of the normal level) of dopamine, the neurons in the receiving area (called dopamine receptors) in the next part of the basal ganglia circuit called the striatum are not adequately stimulated, and the result is impairment of movement with tremor, slowness, stiffness, or balance problems, among other symptoms, which will be discussed in the later section.

Nearly one million people in the US are living with Parkinson’s disease. PD occurs in roughly the same proportions in men and women, although there may be a slight preponderance of affected men throughout the world. Initial symptoms may appear at any age, although under 40 is uncommon and under 20 is very rare (but it happens!). Most commonly, the first symptoms are noted in the 60’s or 70’s. The average age of onset of PD is about 59.

Causes

The exact causes of PD remain unknown, despite decades of intensive study. Many experts suggest that the disease is caused by a combination of genetic and environmental factors, which may vary from person to person.

In some people, genetic factors may play a role; in others, illness, an environmental toxin or other event may contribute to PD.

  • Genetic Factors – The vast majority of Parkinson’s cases are not directly inherited. About 15 to 25 percent of people with Parkinson’s report having a relative with the disease.

Researchers have discovered several gene mutations that can cause the disease directly, but these affect only a small number of families. Some of these mutations involve genes that play a role in dopamine cell functions. Parkinson’s has developed at an early age in individuals with mutations in genes for parkin, PINK1, LRRK2, DJ-1, and glucocerebrosidase, among others. 

  • Environmental Factors – Several studies suggest that Parkinson’s disease may result from exposure to an environmental toxin or injury. Several factors can be linked to Parkinson’s, including rural living, well water, manganese and pesticides.

Prolonged occupational exposure to certain chemicals is associated with an elevated risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb.

It is to be noted that, a simple exposure to an environmental toxin is never enough to cause Parkinson’s. Most people exposed to a toxin do not develop the disease. In fact, there is no conclusive evidence that any environmental factor, alone, can be considered a cause of the disease.

  • Less common causes include poisoning by carbon monoxide or manganese (a type of mineral), lesions and tumors in the brainstem, and a rare illicit drug called N-MPTP.
  • Drugs & Medications – Medications that can cause secondary Parkinsonism include:
    • Haloperidol* and other medications used to treat hallucinations
    • Metoclopramide (an anti-nausea medication)
  • Lewy bodies – Clumps of specific substances within brain cells are microscopic markers of Parkinson’s disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson’s disease.
  • Alpha-synuclein is found within Lewy bodies – Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (A-synuclein). It’s found in all Lewy bodies in a clumped form that cells can’t break down. This is currently an important focus among Parkinson’s disease researchers.
  • Food Allergies – Hidden food allergies and chemical sensitivities contribute to most degenerative diseases. However, in Parkinson’s disease the body generally is insensitive and does not readily react even when specifically testing for hidden allergies. Nevertheless, it has been shown that the intestinal barrier becomes increasingly inefficient with advancing age and degenerative diseases. This allows only partly digested protein fragments or peptides to enter the bloodstream and reach the brain, causing chronic Inflammation and long-term degeneration of brain cells.
  • Heavy Metals – Brain deterioration can be caused by accumulations of the heavy metals cadmium, lead and mercury. Of these, mercury is generally the greatest brain hazard, coming mainly from amalgam tooth fillings. Organic mercury compounds are strong nerve poisons, which may kill nerve cells, cause tremors and reportedly also symptoms of multiple sclerosis. Finally, iron overload, especially in inorganic form, can intensify Parkinson problems.
  • Aluminium – A contributing factor greatly facilitating the passage of toxic chemicals into the brain is aluminium. The brain is normally protected from undesirable chemicals in the bloodstream by a filter barrier. High aluminium levels have been shown to allow toxic chemicals to cross this barrier, which would otherwise be kept out.
  • Gastrointestinal Involvement – Endotoxins are toxic chemicals produced by harmful intestinal bacteria. Undesirable changes in the composition of the intestinal flora and resulting overgrowth of the small intestine with undesirable bacteria and fungi commonly results from antibiotics and other immune-suppressive drugs, from low gastric acidity and from frequently drinking alcohol.

Symptoms

Each person is affected differently by Parkinson’s disease and no two people will experience exactly the same symptoms. The impact of Parkinson’s disease can be unpredictable and it is common for people to have good days and bad days.

The main symptoms of Parkinson’s disease are:

  • tremor (involuntary trembling or shaking movements; the most common symptom)
  • rigidity (stiffness)
  • slowness of movement (bradykinesia)
  • balance problems
  • problems with posture (particularly a tendency to stoop forwards)

Other symptoms include –

  • Freezing
  • Micrographia – shrinkage in handwriting
  • Less Expressive Face
  • Unwanted Acceleration
  • Stooped posture, a tendency to lean forward
  • Dystonia
  • Impaired fine motor dexterity and motor coordination
  • Impaired gross motor coordination
  • Poverty of movement (decreased arm swing)
  • Akathisia
  • Speech problems, such as softness of voice or slurred speech caused by lack of muscle control
  • Difficulty swallowing
  • Sexual dysfunction
  • Cramping
  • Drooling

There are 5 stages of Parkinson’s Disease –

  • Stage 1 – Unilateral involvement only, usually with mini9mal or no functional impairment.
  • Stage 2 – Bilateral or midline involvement, without impairment of balance.
  • Stage 3 – First signs of impaired righting reflexes. This is evident as the patient turns or is demonstrated when he or she is pushed from standing equilibrium with the feet together and eyes closed.
  • Stage 4 – Fully developed, severely disabling disease; the patient is still able to walk and stand unassisted but is markedly incapacitated.
  • Stage 5 – Confinement to bed or wheelchair unless aided.

Treatment

Medications

There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease.

It is common for people with PD to take a variety of these medications – all at different doses and at different times of day – in order to manage the symptoms of the disease.

These include –

  • Carbidopa/Levodopa (Sinemet) – The most potent medication for Parkinson’s is levodopa. Its development in the late 1960s represents one of the most important breakthroughs in the history of medicine. Plain levodopa produces nausea and vomiting. It is now combined with carbidopa to prevent this side effect. The well-known combined carbidopa/levodopa formulation is called Sinemet.
  • Dopamine agonists – These are the drugs that stimulate the parts of the human brain influenced by dopamine. In effect, the brain is tricked into thinking it is receiving the dopamine it needs. The two most commonly prescribed oral pill agonists in the US are pramipexole (Mirapex) and ropinirole (Requip). A third, rotigotine transdermal system (Neupro), was recently re-approved after several years of being off the market. Bromocriptine (Parlodel® ) is available, but is less commonly used.
  • Anticholinergics – Anticholinergics can be helpful for tremor and may ease dystonia associated with wearing-off or peak-dose effect. They have little effect on other symptoms of Parkinson’s. The drugs in this class include trihexyphenidyl (Artane), benztropine mesylate (Cogentin) and procyclidine (no longer available in the US), among others.
  • MAO-B inhibitors — Selegiline also called deprenyl, with trade names Eldepryl and Zelapar and rasagiline (Azilect) — block an enzyme in the brain that breaks down levodopa. These drugs have a modest effect in suppressing the symptoms of Parkinson’s.

Alternative Treatment

  • Vitamin E – Vitamin E can fight damage in the brain caused by free radicals, and has been suggested to lower the risk of PD. But taking vitamin E alone did not seem to have the same effect. More studies are needed to know whether there is any real benefit. Vitamin E supplements can increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Selenium is an antioxidant that works with vitamin E. It also helps to increase circulation and tissue oxygenation, thereby limiting damage to nerve cells.
  • Gamma-aminobutyric acid (GABA) is an amino acid that acts as a neurotransmitter. It helps both to strengthen and relax the nervous system.
  • Acidophilus and bifidobacteria are friendly bacteria that ensure a healthy gastrointestinal tract. Probiotics are especially helpful for preventing constipation, which is often a problem for people with Parkinson’s disease.
  • Alpha-lipoic acid is an antioxidant that also helps to “recharge” other antioxidants in the body.
  • Calcium and magnesium are imperative for maintaining a healthy nervous system.
  • Coenzyme Q10 is an oxygenating antioxidant that helps prevent free-radical damage and important for cell renewal.
  • Evening primrose oil and flaxseed oil contain valuable essential fatty acids (EFAs), which are often deficient in people with Parkinson’s disease.
  • Green-foods supplements supply chlorophyll and important trace minerals.
  • Marine alginate concentrate and N-acetylcysteine may help in the process of chelating (binding to) heavy metals in the body so that they can be excreted.
  • Nicotinamide adenine dinucleotide hydrogren (NADH) is an enzyme that helps to improve neurotransmitter function.
  • Phosphatidylserine is a type of lipid important for normal brain function and the effective transmission of nerve impulses. Low levels of phosphatidylserine are associated with Parkinson’s disease.
  • Soy Lecithin is rich in phosphatidylcholine. Choline is a vital building block for acetylcholine.
  • Pine-bark and grape-seed extracts fight free-radical damage and have anti-inflammatory properties. Many people consider Parkinson’s disease to be a consequence of degeneration of nerve cells due to free-radical damage.
  • The B vitamins are very important for brain and nerve function.
  • Vitamin C and the bioflavonoids are powerful antioxidants that fight free radicals.
  • Creatine – Some studies suggest that taking creatine, an amino acid that helps supply energy to muscles, may help slow progression of Parkinson’s among people who are in the early stages, and who do not need medication to control symptoms.
  • Exercise – Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety.
    • Massage. Massage therapy can reduce muscle tension and promote relaxation. These services, however, are rarely covered by health insurance.
    • Acupuncture. During an acupuncture session, a trained practitioner inserts tiny needles into many specific points on the body, which may reduce the pain.
    • Tai chi. An ancient form of Chinese exercise, tai chi employs slow, flowing motions that may improve flexibility, balance and muscle strength. Tai chi may also prevent falls. Several forms of tai chi are tailored for people of any age or physical condition.
    • Yoga. In yoga, gentle stretching movements and poses may increase theflexibility and balance.
    • Alexander technique. This technique — which focuses on muscle posture, balance and thinking about how you use muscles — may reduce muscle tension and pain.
    • Meditation. In meditation, body quietly reflects and focuses on mind, on an idea or image. Meditation may reduce stress and pain and improve the sense of well-being.
    • Music or art therapy. Music or art therapy may help to relax. Music therapy helps some people with Parkinson’s disease to improve their walking and speech. Participating in art therapy, such as painting or ceramics, may improve the mood.

As Parkinson’s disease is a long-term condition and symptoms worsen over time, it is important to treat it on time.

 

References –

www.parkinson.org

http://www.pdf.org/en/parkinson_otc_meds

http://www.parkinson.org/understanding-parkinsons/treatment/complementary-treatment

http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/causes/con-20028488

http://bodyandhealth.canada.com/channel_condition_info_details.asp?channel_id=2046&disease_id=102&relation_id=33685

http://www.brainandspine.org.uk/parkinsons-disease

http://parkinsonsresource.org/wp-content/uploads/2012/01/The-FIVE-Stages-of-Parkinsons-Disease.pdf

https://ethnomed.org/patient-education/neurological-conditions/parkinsons/Parkinsons%20Disease%20Overview.pdf

 

 

 

 

 

 

Posted in NEUROVASCULAR
February 8, 2017

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (CNS). CNS is made up of brain, spinal cord and optic nerves.

Multiple Sclerosis is caused by a disturbance of immune function. Generally, the antibodies produced by the immune system help protect the body against invaders of the human body (viruses, bacteria etc). In this condition, the disturbance allows cells of the immune system to attack myelin, the insulating sheath surrounding the nerve fibers (axons) located in the CNS which helps messages (electrical impulses) travel quickly and smoothly between the brain and the rest of the body. When the myelin is damaged, electrical impulses cannot travel quickly along the never fiber pathways in the brain and spinal cord. The loss of myelin is called demyelination. The disruption caused to electrical conductivity results in fatigue and disturbances of vision, strength, co-ordination, balance, sensation and bladder & bowel functions.

The situation produced my demyelination can be better understood by taking an example of an electrical lamp. When the insulating surface, surrounding an electric lamp cord, is disrupted by cracks or tears on it, the lamp will short circuit and the light bulb will flicker or no longer illuminate. Similarly, loss of myelin sheath surrounding the nerve fibers results in short circuits in nerves traversing the brain and spinal cord, hence resulting in the symptoms of MS. As oppose to a single wire pathway in a lamp cord, there are numerous nerve pathways in the brain and the spinal cord .i.e. CNS. The damage to myelin – resulting in dense, scar like tissue, occur in many places throughout CNS, hence the name ‘Multiple Sclerosis’ or many scars.

There are 4 types of MS. Their names are according to the way the disease acts on the body over time. They are:

  • Relapsing Remitting MS (RRMS) – It is the most common disease course, characterized by clearly defined attacks of worsening neurological function. People with RRMS have temporary periods called relapses, flare-ups or exacerbations- are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely and there is no apparent progression of disease. About 85% of people with MS are initially diagnosed with RRMS.
  • Secondary Progressive MS (SPMS) – SPMS follows after the relapsing-remitting course. In SPMS, symptoms worsen steadily over time, with or without the occurrence of relapses or remissions. Most people who are initially diagnosed with RRMS will eventually transition to SPMS.
  • Primary Progressive MS (PPMS) – This type of MS is not very common. It is characterized by slowly worsening the symptoms from the beginning with no relapses or remissions. About 10 percent of people with MS are diagnosed with PPMS.
  • Progressive Relapsing MS (PRMS) – It is the least common of the four disease course and is characterized by steadily progressing disease from the beginning and occasional exacerbations along the way. People with this form of MS may or may not experience some recovery following these attacks; the disease continues to progress without remissions. About 5% of people with MS are diagnosed with PRMS.

Causes

Multiple Sclerosis is most commonly diagnosed between 20 to 50 years of age, although onset may be earlier. While anyone can get MS, it is 2 to 3 times more common in women than in men. In the US, approximately 10,000 to 15,000 new cases of MS are diagnosed every year. Around 2.5 million people have been diagnosed with MS, worldwide.

Although the exact cause of MS may remain unknown, but studies suggest that a combination of several factors may be involved.

  • Environmental & Immunological Factor

The environmental theory proposes that an environmental factor triggers the immune system to cause the symptoms of MS. Studies have explored the possibility that exposure to viral or bacterial infections, environmental toxins, duration of sunlight, changes in temperature and humidity, or diet might in some way produce or aggravate MS.

The immune system appears to go out of control and attack the myelin sheath. Mainstream medicine usually sees this as an immune system malfunction, but actually the immune system is working just fine. The immune system’s job is to distinguish self – that which belongs in the human body – from non-self; the immune system then does its best to destroy that which is non-self and doesn’t belong and can cause harm.

The problem occurs when the body’s own cells combine with something else, forming a self/non-self hybrid that the immune system goes after. If these outside toxins combine with nerve cells and the immune system attacks the damaged cells, lesions or damage occur on the myelin and MS symptoms can result.

  • Exposure to Heavy Metals – One of the biggest culprits is the toxic metal mercury, which is especially attracted to the brain and to nerve cells. Its greatest source is usually right in your own mouth, in the form of those silver to black metal fillings. Studies suggest that dental workers have a much higher incidence of MS than the general population due to their greater mercury exposure.
  • Harmful Chemicals – Chemicals present in pesticides and solvents are oil-soluble, and the myelin sheath is mostly fat and hence these chemicals are attracted to it. These chemicals combine with the myelin, causing the kind of immune system attack as described earlier.
  • Dental Cause – Mercury poisoning is not the only problem that can be caused by metal fillings. Metal in the mouth can cause the Battery Effect, in which a mixture of metals combined with saliva can put out measurable electrical charges. Since the nervous system is electrical, these opposing, random charges can stimulate and disrupt nervous system signals. Fluoride found in most water supplies and added deliberately for the unproven purpose of preventing cavities, is a nerve poison. It is best to drink filtered water and to not use fluoride toothpaste, supplements, or dental treatments.
  • Viral and Other Infectious Agents – Research and studies show that common virus or other infectious agent may play a role in the cause of MS. Environmental studies suggest that some factor – probably infectious – must be encountered before the age of 15 in order for MS to develop later in life. Several viruses and bacteria, including Epstein-Barr, Chlamydia, pneumonia, measles, canine distemper, and human herpes virus-6 have been or are being studied to determine if they may trigger MS.
  • Vitamin D Deficiency – Vitamin D plays a role in the body’s immune and nervous systems and how they work. Studies suggest that children who are exposed to s of sun are less likely to develop MS than someone who grows up in a place where there is little sun.
  • Mycotoxins – Patients with autoimmune disease are actually living or working in environments that have toxic mold. Toxic molds produce mycotoxins, which are volatile organic compounds (VOC), which can be toxic to genetically susceptible people.
  • Leaky Gut – In order to absorb nutrients, the gut is somewhat permeable to very small molecules. Many things including, gluten, infections, medications and stress can damage the gut, allowing toxins, microbes and undigested food particles – among other things – directly into your bloodstream. Leaky gut is the gateway for these infections, toxins and foods like gluten to begin to cause systemic inflammation that leads to autoimmunity.
  • Gluten – Gluten is a huge problem for most people these days because we hybridized it, modified it and it’s in everything. The most severe of all is that, it can wreak havoc on the gut and set the body up for a leaky gut. Once the gut is leaky, gluten can get into the bloodstream and confuse the body’s immune system. When the proteins in the consumed food resemble the proteins that make up myelin, the immune system can get confused and accidentally attack the myelin coating your nerves. This process is called molecular mimicry and can occur with inflammatory foods like gluten and dairy.
  • Genetic Factors

Though MS is not hereditary, having a first degree relative i.e. parent or sibling with MS condition may significantly increase an individual’s chances of developing MS. Studies suggest that there is a higher prevalence of certain genes in populations with higher rates of MS. Similar genetic factors have been found in some families where there is more than one patient with MS.

The most significant genetic link to MS has been identified in the major histocompatability complex (MHC), a cluster of genes on chromosome 6 that are essential for immune system function. Rare MS cases may be due to variations in interleukin-7 (IL-7) and interleukin-2 (IL-2) gene receptors, which are also related to immune system regulation.

Symptoms

The symptoms of multiple sclerosis depend largely on which particular nerve fiber pathway is involved in the CNS. Tingling, numbness, sensations of tightness, or weakness may result when loss of myelin occurs in the spinal cord. If the nerve fibers to the bladder are affected, urinary incontinence may follow. If the cerebellum of the brain is affected, imbalance or incoordination may result. Since the plaques of MS can arise in any location of the CNS, it is easy to understand why no two MS patients have exactly the same symptoms.

The symptoms are divided into 3 following parts:

  1. More Common Symptoms
    • Fatigue
    • Numbness or Tingling
    • Weakness
    • Dizziness & Vertigo
    • Walking Difficulties
    • Spasticity – Refers to feelings of stiffness and a wide range of involuntary muscle spasms; can occur in any limb, but it is much more common in the legs.
    • Vision Problems
    • Bladder & Bowel Problems
    • Cognitive Changes – Refers to a range of high-level brain functions affected in 50% of people with MS, including the ability to learn and remember information, organize and problem-solve, focus attention and accurately perceive the environment.
    • Depression
    • Sexual Problems
    • Emotional Changes 
  1. Less Common Symptoms
    • Speech Problems
    • Swallowing Problems
    • Tremor – Respiration problems occur in people whose chest muscles have been severely weakened by damage to the nerves that control those muscles.
    • Itching
    • Headache
    • Hearing loss
  1. Secondary & Tertiary Symptoms
    • Bladder dysfunction can cause repeated urinary tract infections.
    • Inactivity can result in loss of muscle tone and disuse weakness (not related to demyelination), poor postural alignment and trunk control, decreased bone density (and resulting increased risk of fracture), and shallow, inefficient breathing
    • Immobility can lead to pressure sores.
    • Social, Vocational and Psychological complications

Treatment for MS 

  • Conventional Medicine

Conventional medication focuses only on treating the symptoms and not on getting out the root cause of the disease.            Most drugs available in the market are designed to slow down the development of the disease and reduce the number of relapses rather than treating the root cause.

  • Interferons – Avonex, Betaseron, Extavia, and Rebif are all interferon beta products. The interferon drugs seal off the blood brain barrier and inhibit the T-lymphocytes (T cells) – type of white blood cell that circulate around our bodies, scanning for cellular abnormalities and infections, from being activated. This prevents the T cells from entering the central nervous system and destroying myelin, and ultimately the nerve axons.
  • Capaxone – The struacture of capaxone is similar to that of myelin protein. The effects of this drug are usually less dramatic than the interferon, but the side effects only include chest pain, shortness of breath, and flushing.
  • Tysabri – Tysabri was the first humanized monoclonal antibody approved for the treatment of MS. Tysabri works by blocking the receptors on white blood cells that allow them to enter the brain and spinal cord.
  • Lemtrada – Lemtrada is administered as intravenous infusions – for five consecutive days initially and for three consecutive days one year later. Because of its safety profile, Lemtrada should generally be reserved for people who have had an inadequate response to two or more MS therapies.
  • Aubagio – Aubagio (teriflunomide) is a pyrimidine synthesis inhibitor that inhibits the function of specific immune cells that have been implicated in MS. The prescribing information contains a boxed warning about the potential for liver damage in the parent compound (leflunomide). Also, Aubagio should not be used during pregnancy.

These drugs have different mechanisms of action and unique side effect profiles.

Functional Treatment

At our center, we study the patient’s entire medical history and perform Comprehensive Diagnostic workup which gives us the root cause of the disease.

  • Chelation Therapy – We are exposed to heavy metals in a number of different ways: amalgams, fish consumption, and the environment. It is one of the causes of MS. The Center for Occupational and Environmental Medicine specializes in safely treating toxicity from heavy metals such as lead and mercury. It involves detoxifying our body from all the heavy harmful metals.
  • Removing Gluten from the diet – People with MS should completely remove gluten from their diet as its simply an inflammatory food.
  • Total Body Stress Load – The body’s total stress load is derived from multiple sources including allergies, exposure to toxins, infections, and emotional stresses. It is important to evaluate and manage all factors of the total stress load if we are to regain and maintain our health.  The old saying “the straw that broke the camel’s back” appropriately illustrates this concept, as we envision the camel as the body and the straw as the stresses.
  • Healing the Gut – Healing the gut is very essential for healing the disease.
  • Immune System Support – Supplements like vitamin D, omega-3 fish oils, and glutathione are powerful immune modulators, which means that they can help support the immune system. Vitamin D has been shown to help regulate the immune system. Omega 3 fish oils help to reduce inflammation in the entire body. Glutathione is the most powerful antioxidant in the body which can help reduce inflammation and improve detoxification in the body.

The treatment method also includes the following:

  • Acupuncture and acupressure
  • Alexander Technique
  • Aromatherapy
  • Chiropractic
  • Cannabis and cannabis extracts
  • Herbal medicine
  • Honey bee venom
  • Hyperbaric oxygen therapy
  • Homeopathy
  • Massage
  • Reiki
  • Relaxation and meditation
  • Shiatsu
  • T’ai chi

At our center, we find the root cause of your illness and reverse your disease. You say Multiple Sclerosis, we say It can be cured…

Posted in NEUROVASCULAR
February 8, 2017

Movement, although seemingly simple like picking up a bit of paper, is actually a complex process that requires activities of several different parts of the brain working in tandem with muscles and nerves.

The term “movement disorders” refers to a group of nervous system (neurological) conditions that cause you to have abnormal voluntary or involuntary movements, or slow, reduced movements.

Different types of movement disorders can develop, depending on the nature and location of the damage or malfunction, as in the following –

  • Damage to the parts of the brain that control voluntary (intended) movement or the connections between the brain and spinal cord – Weakness or paralysis of the muscles involved in voluntary movements and exaggerated reflexes
  • Damage to the basal ganglia (collections of nerve cells located at the base of the cerebrum, deep within the brain) – Involuntary (unintended) or decreased movements, but not weakness or changes in reflexesc
  • Damage to the cerebellum – Loss of coordination

Some movement disorders, such as hiccups, are temporary, usually causing little inconvenience. Others, such as Parkinson disease, are serious and progressive, impairing the ability to speak, use the hands, walk, and maintain balance when standing.

Every body movement, from raising a hand to smiling, involves a complex interaction between the central nervous system (brain and spinal cord), nerves, and muscles. Damage to or malfunction of any of these components may result in a movement disorder.

Treatment varies by disorder. Medicine can cure some disorders. Others get better when an underlying disease is treated. Often, however, there is no cure. In that case, the goal of treatment is to improve symptoms and relieve pain.

Causes

Most movement disorders are associated with pathological changes in the brain especially in an area of the brain called the basal ganglia. This region is part of the grey matter that lies deep within the brain.

The defects may also lie in the base of the brain or cerebellum. This leads to difficulty in walking, locomotion or maintenance of posture and normal body balance.

Movement disorders are widely prevalent and many of them have genetics as the common cause.

Movement disorders occur as a result of damage or disease in a region located at the base of the brain (basal ganglia). The basal ganglia is comprised of clusters of nerve cells (neurons) that send and receive electrical signals and are responsible for involuntary movement. Movement disorders can result from the following –

  • Age-related changes
  • Environmental toxins
  • Genetic disorders (e.g., Huntington’s disease, Wilson disease)
  • Medications (e.g., antipsychotic drugs)
  • Metabolic disorders (e.g., hyperthyroidism)
  • Parkinson’s disease
  • Stroke

Symptoms

Symptoms of movement disorders vary and depend on the type and severity of the condition. The severity of movement disorder symptoms can be affected by factors such as anxiety, fatigue, medication, and stress.

Some movement disorders cause hyperkinesia—excessive spontaneous movement or abnormal involuntary movement—and others cause hypokinesia—absent or reduced ability to perform purposeful movement.

Abnormal movements may be rhythmical (e.g., essential tremor) or irregular, and may be rapid and jerky (e.g., tics) or slowed and sustained (e.g., Parkinson’s disease, dystonia). In most cases, irregular movement cannot be consciously controlled or suppressed.

Treatment

Treatment for movement disorders depends on the underlying cause. In most cases, the goal of treatment is to relieve symptoms. Treatment may include medication, botulinum toxin injection therapy (BOTOX therapy), and/or surgery.

Medications that may be used include the following:  –

  • Antiepileptics (e.g., carbamazepine [Tegretol], valproate [Depakote])
  • Antiseizure medications (e.g., primidone [Mysoline], gabapentin [Neurontin])
  • Beta-blockers (e.g., propranolol [Inderal])
  • Dopamine agonists (e.g., bromocriptine [Parlodel], pergolide [Permax])
  • Tranquilizers (benzodiazepines such as diazepam [Valium] and clonazepam [Klonopin])

Surgery – Ablative surgery locates, targets, and then destroys (ablates) the clearly defined area of the brain that produces chemical or electrical impulses that cause abnormal movements.

Globus Pallidus  – This type of surgery involves either ablation in the part of the brain called the globus pallidus (called pallidotomy) or ablation of brain tissue in the thalamus (called thalamotomy). A related procedure, cryothalamotomy, uses a supercooled probe that is inserted into the thalamus to freeze and destroy areas that produce tremors.

Deep Brain Stimulation (DBS), a surgically implanted, battery-operated medical device (neurostimulator) is used to deliver electrical stimulation to areas of the brain that control movement. The electrical charge blocks nerve signals that trigger abnormal movement.

Alternative Treatment

Vitamin C is a natural antioxidant that also aids in normal growth and development. When taken daily, vitamin C eliminates free radicals in the body that may be contributing to Movement disorders.

MSM is a naturally occurring chemical that is often used in treating a wide range of conditions. In relation to periodic limb movement disorder, the substance relieves inflammation as well as allergies that may be contributing to the disorder. MSM is also effective for improving circulation that may be related to the progression of the condition.

Glucosamine is a natural substance that contributes to the creation of cartilage. Taking a glucosamine supplement can relieve stress on the joints that may be contributing to the condition. The supplement also appears to work as a limited anti-inflammatory agent.

 

Reference –

http://www.news-medical.net/health/What-are-movement-disorders.aspx

http://www.ohsu.edu/xd/health/services/brain/getting-treatment/diagnosis/parkinsons/treatment-options/alternative-therapies.cfm

http://www.movementdisorders.org/MDS/Journals/Clinical-Practice-E-Journal-Overview/Movement-Disorders-Clinical-Practice-E-Journal-Volume-1-Issue-4/Treatment-Options-in-Degenerative-Cerebellar-Ataxia-A-Systematic-Review.htm

 

 

Posted in NEUROVASCULAR
February 8, 2017

Migraines are a type of recurring severe headache that can cause you to have time off work and need to rest in bed. They are often accompanied by feeling sick, vomiting or an increased sensitivity to light.

It’s estimated that about 36 million Americans suffer from migraine, but only 1 of every 3 people talk with a doctor about their headaches. Of those, only half get the right diagnosis.

Women are roughly three times more likely to get migraines than men. About four in every 20 women get migraines, while only about one in every 20 men do. You can get migraines for the first time at any age, but they commonly start during the teenage years.

In general, a migraine is a very bad headache that tends to come back. It may occur as often as several times a week or only once every few years. It can last anywhere from a few hours to 3 days. The pain usually begins in the morning, on one side of the head. (In fact, the word migraine is derived from a Greek word that means “half-head.”) Less frequently, the entire head is swallowed up by pain.

The amount of pain can vary. Some migraines can be fairly mild, while others seem almost unbearable. Obviously, the worse the pain, the more trouble you have carrying out daily activities, whether it’s going to work or simply getting out of bed. Of course, different people have different abilities to put up with pain. For some people, even a mild migraine can force them to lie down; others are able to work through a more severe migraine.

Two types of migraines

While there are many variations, there are two main types of migraines –

Migraine without aura (previously called common migraine) – Almost 80 percent of migraine sufferers have this type of migraine.

Migraine with aura (previously called classic migraine) – This type of migraine announces itself about a half-hour before the onset of head pain with an aura.

Aura is a term used to describe the visual or sensory symptoms that some people get when their migraine is starting. The following are less common types of migraine –

  • Retinal migraines are headaches associated with visual changes in one eye only.
  • Abdominal migraines are associated with stomach pains, and happen more often in children.
  • Menstrual migraines can happen in women two days before their period starts or finishes.
  • Status migrainosus are migraines that can last for a few weeks.

Migraine is a medical condition that can have a big effect on your life and others caring for you. It can affect your daily life and can mean taking time off work or school.

Causes

There are many theories that discuss the causes of migraine. The cortical spreading depression (CSD) theory suggests that migraine is a disease of the brain such as angina is a disease of the heart. Disruption of normal brain functioning is believed to be the underlying cause of the migraine pain and aura. Another theory is the vascular theory which suggests that migraines result from the widening of blood vessels surrounding the brain. The chemical serotonin is also thought to play an important role in migraine development. While the precise cause of migraines remains unknown, a number of potential migraine triggers (habits or conditions associated with the onset of a migraine) have been identified.

Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include –

  • Allergies and allergic reactions
  • Bright lights, loud noises, flickering lights, smoky rooms, temperature changes, strong smells and certain odors or perfumes
  • Physical or emotional stress, tension, anxiety, depression, excitement
  • Physical triggers such as tiredness, jet lag, exercise
  • Changes in sleep patterns or irregular sleep
  • Smoking or exposure to smoke
  • Skipping meals or fasting causing low blood sugar
  • Dehydration
  • Alcohol
  • Hormonal triggers such as menstrual cycle fluctuations, birth control pills, menopause
  • Tension headaches
  • Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs and salami)
  • Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products and fermented or pickled foods
  • Medication such as sleeping tablets, the contraceptive pill, hormone replacement therapy.
  • A higher percentage of obese people have episodic (occasional) migraines compared to individuals with a healthy body weight.
  • Sudden weather changes, including a drop in barometric pressure or changes in temperature, humidity, or wind
  • Loud noises
  • Perfumes or fumes
  • Secondhand smoke
  • Exposure to glare or flickering lights

Symptoms

Migraine symptoms may begin one to two days before the headache itself. This is known as the migraine’s prodrome stage. Symptoms include –

  • Food cravings
  • Depression
  • Fatigue or low energy
  • Frequent yawning
  • Hyperactivity
  • Irritability
  • Neck stiffness

Some people may also experience an aura after the prodrome stage. An aura causes visual, motor, and/or speech disturbances, such as –

  • Difficulty speaking clearly
  • Feeling a prickling or tingling sensation in the arms and legs
  • Flashes of light
  • Seeing shapes, light flashes or bright spots
  • Transient vision loss

The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine occurs. Attack phase symptoms can last anywhere from four hours to three days. Symptoms of a migraine can vary from person to person. Some symptoms may include –

  • Feeling dizzy or faint
  • Increased sensitivity to light and sound
  • Nausea
  • Pain on one side of the head
  • Pulsing and/or throbbing pain
  • Vomiting

Risk Factors

Family history – You are much more likely to have migraines if one or both of your parents had migraines.

Sex – Women are more likely than men to have migraines.

Age – Most people have their first migraine during adolescence, but migraines can start at any age, usually before age 40.

Treatment

Medications

Analgesia – Over-the-counter medications such as naproxen, ibuprofen, acetaminophen (paracetamol), and other analgesics like Excedrin (aspirin with caffeine) are often the first abortive therapies to eliminate the headache or substantially reduce pain.

Anti-emetics – Metoclopramide may also be used to control symptoms such as nausea and vomiting.

Serotonin agonists – Sumatriptan may also be prescribed for severe migraines or for migraines that are not responding to the over-the-counter medications. Antidepressants such as tricyclics – are prescribed to reduce migraine symptoms although they are not approved in all countries for this purpose.

Ergots – Another class of abortive treatments is called ergots, which are usually effective if administered at the first sign of a migraine.

Alternative Treatment

5-hydroxytryptophan – Body makes the amino acid 5-HTP and converts it into serotonin, an important brain chemical. Researchers think abnormal serotonin function in blood vessels may be related to migraines, and some of the drugs used to treat migraines work by affecting serotonin.

Magnesium – People with migraines often have lower levels of magnesium than people who do not have migraines, and several studies suggest that magnesium may reduce the frequency of migraine attacks in people with low levels of magnesium.

Vitamin B2 – A few studies indicate that riboflavin may reduce the frequency and duration of migraines. In one study, people who took riboflavin had more than a 50% decrease in the number of attacks.

Coenzyme Q10 – CoQ10 can interact with several medications including blood thinners such as warfarin (Coumadin), some cancer medications, and medications for high blood pressure.

Melatonin – Melatonin can interact with a number of medications, so ask your doctor before taking it.

Butterbur – A few studies suggest that butterbur may help reduce both the frequency and duration of migraine attacks when taken on a regular basis for up to 4 months. More research is needed to see whether butterbur is really effective at preventing migraines.

Feverfew – Feverfew has been used traditionally to treat headaches, and several well-designed studies have found that it may help prevent and treat migraines.

Acupuncture has been studied as a treatment for migraine headache for more than 20 years. While not all studies have shown it helps, researchers agree that acupuncture appears safe, and may work for some people.

Chiropractic – In another study, people with migraine headaches were randomly assigned to receive spinal manipulation, a daily medication (Elavil), or a combination of both. Spinal manipulation worked as well as Elavil in reducing migraines and had fewer side effects. Combining the 2 therapies didn’t work any better.

Reflexology is a technique that places pressure on specific “reflex points” on the hands and feet that are believed to correspond to areas throughout the body. Some early studies suggest it may relieve pain and allow people with migraines to take less pain medication.

 

Reference –

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/treatment/con-20026358

http://www.medicinenet.com/migraine/article.htm

http://www.migraine.org.uk/get-involved/events

https://www.acponline.org/patients_families/pdfs/health/migraine.pdf

http://familydoctor.org/familydoctor/en/diseases-conditions/migraines.html

http://www.migraines.org/myth/mythreal.htm

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine

 

 

 

Posted in NEUROVASCULAR
February 8, 2017

Metachromatic leukodystrophy (MLD) is a rare inherited disorder affecting mainly the ‘white matter’ of the brain, causing a progressive loss of physical and, later, mental skills. MLD is the most common in a group of diseases known as leukodystrophies. These diseases affect the myelin sheath, a fatty covering that insulates and protects nerve cells.

Symptoms may include spasticity, seizures, personality changes, and progressive dementia. As the disease progresses, the person loses the ability to walk, talk, see, and hear. Eventually he or she become paralyzed and unresponsive.

MLD results from a deficiency in an enzyme called arylsulfatase A. The lack of arylsulfatase A causes a fatty substance called sulfatide to build up to toxic levels in the body. This gradually destroys the myelin sheath, without which brain cells die and nerves in the body cannot function properly.

Metachromatic leukodystrophy can be divided into early-onset and late-onset forms. The early-onset form is also called the infantile form, and the late-onset form can be further divided into juvenile or adult forms. The course of the disease is similar, but the age at which symptoms appear varies, as does the rate at which symptoms progress. The age at which symptoms begin is usually similar among family members.

Most children with the infantile form die by the age of 10. Those with the juvenile form typically develop symptoms between the ages of 3 and 14 and can live 10 to 20 years after the onset of symptoms. The adult form of the disease is more variable, but affected adults may not develop symptoms until their 40s or 50s and can live 20 to 30 years after symptoms begin. Death most commonly occurs from pneumonia or other infections

Types

Generally, there are considered to be three main types of MLD that have different ages of onset

  • Infantile form, occurring between ages 6 months and 2 years
  • Juvenile form, occurring between ages 3 and 6 (early juvenile) or between ages 6 and 16 (late juvenile)
  • Adult form, occurring at age 17 or older

Causes

MLD is inherited in an autosomal recessive manner, and is most commonly caused by a mutation in a gene called arylsulfatase A (ASA), also called sulfatide sulfatase. The protein produced by ASA is present in the lysosome, a compartment of the cell that specializes in general “cleanup” of the cell. You may hear MLD referred to as a lysosomal storage disorder, since ASA is a lysosomal enzyme.  MLD can also be caused by a defect in Saposin B (also referred to as the cerebroside sulfate activator), which is a protein required for ASA to work properly.

ASA is required for the breakdown of sulfatides, also called glycolipid- cerebroside sulfates, which are fats present in myelin. When ASA is deficient, the sulfatides build up in the myelin to high levels, disrupting the myelin structure and causing demyelination to occur in both the central nervous system and in the peripheral nervous system. The sulfatides will also build up in the visceral organs (such as the kidneys), and will be excreted at high levels in the urine.

Previously, a disorder known as multiple sulfatase deficiency (MSD) was sometimes considered a subset of MLD. While many symptoms of MSD are similar to those of MLD, we have chosen to classify it as a separate disorder. To learn more about MSD, please see our MSD fact sheet.

Risk Factors

Metachromatic leukodystrophy is a rare disorder that affects males and females in equal numbers. People of all ethnic backgrounds may be affected by this disease. More than 160 cases have been reported in the medical literature. The prevalence of the late infantile form is 1 in 40,000. The prevalence of the juvenile form is 1 in 150,000.

Metachromatic leukodystrophy is reported to occur in 1 in 40,000 to 160,000 individuals worldwide. The condition is more common in certain genetically isolated populations: 1 in 75 in a small group of Jews who immigrated to Israel from southern Arabia (Habbanites), 1 in 2,500 in the western portion of the Navajo Nation, and 1 in 8,000 among Arab groups in Israel.

Symptoms

The symptoms for MLD are –

  • Abnormally high muscle tone, abnormal muscle movements
  • Behavior problems
  • Decreased mental function
  • Decreased muscle tone
  • Difficulty walking
  • Feeding difficulties
  • Frequent falls
  • Inability to perform normal tasks
  • Incontinence
  • Irritability
  • Loss of muscle control
  • Nerve function problems
  • Personality changes
  • Poor school performance
  • Seizures
  • Speech difficulties, slurring
  • Swallowing difficulty

Treatment

Umbilical Cord, blood or stem cell or Bone marrow transplantation – This means that cells that produce normal ASA are introduced into the patient, and the normal ASA protein is then taken up into the deficient cells, allowing sulfatides in those cells to be broken down. However, this is only useful for those who are pre-symptomatic or those with very mild neurological manifestations.

Drugs can be given to relieve muscle spasms, treat infections and try to control seizures (should they occur). Pain relief and sedative drugs can be given if required, and feeding can be assisted.

Physiotherapists and others can advise parents on positioning, seating and exercising the limbs to maintain comfort.

Specialist schooling will be required and it is important for the child to have this stimulating environment and social contact and, indeed, for the parents to have some time for themselves and other family members and friends.

Alternative Treatment

Enzyme Replacement Therapy – A therapeutic strategy useful in other metabolic storage diseases is direct enzyme replacement. The difficulty with this strategy has always been getting adequate enzyme activity into the Central Nervous System (CNS). Intravenous injections of a recombinant human Arylsulfatase-A in a mouse model of metachromatic leukodystrophy initially demonstrated no evidence of impact on CNS stores of sulfatide. However, with a significant increase in the injection frequency, researchers were able to demonstrate a reduction in CNS stores.

 

Reference –

http://www.ninds.nih.gov/disorders/metachromatic_leukodystrophy/metachromatic_leukodystrophy.htm

https://my.clevelandclinic.org/health/diseases_conditions/hic_Metachromatic_Leukodystropy

http://www.healthline.com/health/metachromatic-leukodystrophy#Overview1

http://www.webmd.com/brain/leukodystrophy-metachromatic

http://emedicine.medscape.com/article/951840-treatment

http://www.mldfoundation.org/

http://www.brains4brain.eu/developing-treatment-options-for-metachromatic-leukodystrophy-mld/

 

Posted in NEUROVASCULAR
February 8, 2017

Meralgia paresthetica, also called Bernhardt-Roth syndrome, is caused when one of the large sensory nerves (lateral femoral cutaneous nerve) to one of the legs is being compressed. This compression results in a terrible burning sensation felt in the outer thigh. It is characterized by tingling, numbness, and burning pain in the outer side of the thigh.

The femoral nerve is a part of the lumbar plexus nerve network. The femoral nerve works to provide nerve innervations to the flexor muscles of the hip and the extensor muscles of the leg. It provides sensation to the anterior (front) of the thigh.

The lateral femoral cutaneous nerve is part of the lumbar plexus nerve network. It provides sensation to the antero-lateral aspect of the thigh and has some overlap in sensation with the femoral nerve. As a pure sensory nerve, it does not operate any muscles.

Nerve compression can arise from swelling, injury, tight clothing, weight gain, and certain types of physical activity. In most cases, addressing the cause of the meralgia paresthetica will prevent any complications. Left untreated, however, meralgia paresthetica may lead to serious pain or paralysis.

Usually, meralgia paresthetica will resolve itself spontaneously or with lifestyle modifications such as wearing loose clothing. In cases in which meralgia paresthetica is painful, antiseizure or antidepressant medications that target the nervous system may be used. In extreme cases of meralgia paresthetica, surgical intervention may be necessary to release the compressed nerve.

Causes

Meralgia paresthetica is caused by nerve entrapment. The lateral femoral cutaneous nerve running through your pelvis, groin and into the thighs becomes compressed. This can be caused by swelling, trauma, or pressure narrowing these openings and squeezing the nerve.

Common causes of meralgia paresthetica may include –

  • Repetitive motion of the legs
  • Recent injuries to the hip
  • Wearing tight clothing
  • Weight gain

Risk Factors

The following conditions may increase your risk of meralgia paresthetica –

  • Extra weight – Being overweight or obese may increase the pressure on the lateral femoral cutaneous nerve.
  • Pregnancy – A growing belly puts added pressure on the groin, through which the lateral femoral cutaneous nerve passes.
  • Diabetes – Diabetes-related nerve injury can lead to meralgia paresthetica.
  • Age – People between the ages of 30 and 60 are at a higher risk.

Symptoms

A painful, burning sensation on the outer side of the thigh may mean that one of the large sensory nerves to your legs–the lateral femoral cutaneous nerve is being compressed. This condition is known as meralgia paresthetica.

  • Pain on the outer side of the thigh, occasionally extending to the outer side of the knee
  • A burning sensation, tingling, or numbness in the same area
  • Occasionally, aching in the groin area or pain spreading across the buttocks
  • Usually only on one side of the body
  • Usually more sensitive to light touch than to firm pressure

Treatment

Conservative treatment is effective for most of the patients and helps in getting rid of the pain within a few weeks to months. Conservative measures include –

  • Wearing loose clothing
  • Losing excess weight

Over-the-counter pain killers such as acetaminophen (Tylenol) ibuprofen (Advil, Motrin) or aspirin help in relieving pain.

Corticosteroid injections are given in severe cases, where the symptoms persist despite conservative treatment. These injections help in reducing pain and inflammation. Side effects of corticosteroid injections include pain and whitening of skin around the site of injection, infection of the joint and nerve damage.

Tricyclic antidepressants also help in pain relief. Side effects include dry mouth, drowsiness, constipation and impaired sexual functioning.

Anti-seizure medications such as gabapentin (Neurontin) or pregabalin (Lyrica) also help in alleviating symptoms of pain. Side effects include nausea, dizziness, constipation, drowsiness and lightheadedness.

Surgery – Rarely surgery is required in severe cases where the patient has persistent symptoms for a long time. Surgery is done in order to decompress the nerve.

Lifestyle changes such as avoiding tight clothing, avoiding standing or walking for prolonged periods of time, maintaining a healthy weight and losing excess weight helps in preventing and relieving meralgia paresthetica.

Alternative Treatment

Vitamin B12 supplements help in reducing burning and tingling sensation. Increase the intake of meat, egg and poultry products.

Physical therapy is considered useful in relieving the nerve entrapment. Physical therapy attempts to strengthen the muscles of the thigh and inner hip region to reduce the entrapment.

Obese individuals are at a higher risk of developing this condition and hence weight management is considered very important. Regular exercise coupled with dietary modifications like reducing the intake of processed foods, oily and starchy foods and increasing the intake of dietary fiber is very useful.

Electrotherapy is also considered beneficial in reducing the nerve blockage and alleviating the symptoms. Electrotherapy focuses on stimulating the nerve tissue and alleviating the symptoms associated with the condition.

Alfalfa is a nerve tonic and helps in alleviating the symptoms associated with the condition.

 

Reference –

http://www.brainfacts.org/diseases-disorders/diseases-a-to-z-from-ninds/meralgia-paresthetica/

http://curingmeralgiaparesthetica.com/mp-book-long-landing-page

http://www.fpnotebook.com/ortho/neuro/MrlgPrsthtc.htm

http://www.healthline.com/health/fitness-exercise/meralgia-paresthetica-exercises

http://orthopedics.about.com/od/hipinjuries/a/meralgia.htm

http://emedicine.medscape.com/article/1141848-overview

 

Posted in NEUROVASCULAR
February 8, 2017

Megaloblastic anemia is a type of anemia characterized by very large red blood cells. In addition to the cells being large, the inner contents of each cell are not completely developed. This malformation causes the bone marrow to produce fewer cells, and sometimes the cells die earlier than the 120-day life expectancy. Instead of being round or disk-shaped, the red blood cells can be oval.

The term ‘megaloblastic anaemia’ incorporates two different types of anaemia – vitamin B12 deficiency anaemia and folate deficiency anaemia. Most people with either of these conditions will have underdeveloped, larger than normal red blood cells. These do not function properly and will crowd out the healthy cells, which leads to anaemia. Also, because they are underdeveloped, they will have a shorter than normal life expectancy.

Megaloblastic anaemia is typically diagnosed with a blood test and can be treated by a change in diet to feature foods high in vitamin B12 or folic acid (the artificial form of folate).

Causes

There are many causes of megaloblastic anemia, but the most common source in children occurs from a vitamin deficiency of folic acid or vitamin B12. Other sources of megaloblastic anemia include the following –

Digestive diseases – Certain diseases of the lower digestive tract can lead to megaloblastic anemia. These include celiac disease, chronic infectious enteritis, and enteroenteric fistulas. Pernicious anemia is a type of megaloblastic anemia caused by an inability to absorb vitamin B12 due to a lack of intrinsic factor in gastric (stomach) secretions. Intrinsic factor enables the absorption of vitamin B12.

Malabsorption – Inherited congenital folate malabsorption, a genetic problem in which infants cannot absorb folic acid in their intestines, can lead to megaloblastic anemia. This requires early intensive treatment to prevent long-term problems, such as intellectual disability.

Medication-induced folic acid deficiency – Certain medications, specifically ones that prevent seizures, such as phenytoin, primidone, and phenobarbital, can impair the absorption of folic acid. The deficiency can usually be treated with a dietary supplement.

Folic acid deficiency – Folic acid is a B vitamin required for the production of normal red blood cells. Folate, the naturally occurring form, is present in foods, such as green vegetables, liver, and yeast. Folic acid is produced synthetically and added to many food items, including breads and cereals.

Risk Factors

In adults, symptoms of pernicious anemia are usually not seen until after age 30. The average age of diagnosis is age 60.

People are more likely to get this disease if they –

  • Are Scandinavian or Northern European
  • Have a family history of the condition

Certain diseases can also raise the risk. They include –

  • Addison disease
  • Chronic thyroiditis
  • Graves disease
  • Hypoparathyroidism
  • Hypopituitarism
  • Myasthenia gravis
  • Secondary amenorrhea
  • Type 1 diabetes
  • Testicular dysfunction
  • Vitiligo

Symptoms

These are some of the symptoms of megaloblastic anemia –

  • Pale or yellow skin
  • Fast heart beat
  • Shortness of breath
  • Lack of energy, feeling tired
  • Decreased appetite
  • Irritability or fussiness
  • Hair color changes
  • Stomach upsets, nausea, diarrhea, gas, constipation
  • Trouble walking
  • Numbness or tingling in hands and feet
  • Smooth and sore tongue
  • Weak muscles

The symptoms of megaloblastic anemia may look like other conditions or medical problems. Always check with your child’s doctor for a diagnosis.

Complications

In general, anemia may cause –

  • Problems with growth and development
  • An enlarged heart, heart failure

Megaloblastic anemia can also cause problems with the nervous system.

Treatment

Vitamin B12 injections are usually given daily for 1 week, then weekly for 4 weeks, and then monthly until hematologic indices have stabilized. Patients with continued risk of deficiency should remain on monthly injections. Oral B12 may be substituted in highly compliant patients. At high intakes, the vitamin enters the body through diffusion. Vitamin B12 sublingual preparations and a nasal gel are also available for maintenance therapy when compliance is ensured.

Folate – Oral folate taken daily for several months usually corrects the deficiency.  Concomitant B12 deficiency must be ruled out, as folate supplementation can mask the hematologic signs of B12 deficiency, leading to irreversible neurological injury if not treated. This masking is more likely to occur in patients routinely prescribed folate for other medical reasons (eg, sickle cell anemia).

 

Reference –

http://www.healthline.com/health/megaloblastic-anemia

http://umm.edu/health/medical/ency/articles/pernicious-anemia

http://www.orpha.net/consor4.01/www/cgi-bin/OC_Exp.php?lng=EN&Expert=49827

http://www.msdmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/megaloblastic-macrocytic-anemias

https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=90&ContentID=P02325

http://emedicine.medscape.com/article/204066-overview

 

 

Posted in NEUROVASCULAR