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CHRONIC NEUROLOGICAL DISORDERS in Nepal

CHRONIC NEUROLOGICAL DISORDERS

Neurological disorders are diseases of the central and peripheral nervous system. In other words, the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles. These disorders include epilepsy, Alzheimer disease and other dementias, cerebrovascular diseases including stroke, migraine and other headache disorders, multiple sclerosis, Parkinson's disease, neuroinfections, brain tumours, traumatic disorders of the nervous system due to head trauma, and neurological disorders as a result of malnutrition.

Many bacterial (i.e. Mycobacterial tuberculosis, Neisseria meningitides), viral (i.e. Human Immunodeficiency Virus (HIV), Enteroviruses, West Nile Virus, Zika), fungal (i.e. Cryptococcus, Aspergillus), and parasitic (i.e. malaria, Chagas) infections can affect the nervous system. Neurological symptoms may occur due to the infection itself, or due to an immune response.

CERTAIN TYPES: -

  • Dementia
  • Alzheimer's disease
  • Parkinson's disease
  • Dystonia
  • Amyotrophic lateral sclerosis (ALS)
  • Epilepsy
  • Multiple Sclerosis
  • Neurological disorders due to nutrient deficiency.

BELL'S PALSY:-

Bell's palsy is an unexplained episode of facial muscle weakness or paralysis. It begins suddenly and worsens over 48 hours. This condition results from damage to the facial nerve (the 7th cranial nerve). Pain and discomfort usually occur on one side of the face or head.

Bell’s palsy can strike anyone at any age. It occurs most often in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell's palsy affects men and woman equally. It is less common before age 15 or after age 60.

Bell's palsy is not considered permanent, but in rare cases, it does not disappear. Currently, there is no known cure for Bell's palsy; however, recovery usually begins 2 weeks to 6 months from the onset of the symptoms. Most people with Bell's palsy recover full facial strength and expression.

CAUSES OF BELL'S PALSY:-

The cause of Bell's palsy is not known. It is thought that it may be due to inflammation that is directed by the body's immune system against the nerve controlling movement of the face. Bell's palsy is sometimes associated with the following:

  • Diabetes
  • High blood pressure
  • Injury
  • Toxins
  • Lyme disease
  • Guillain-Barré syndrome
  • Sarcoidosis
  • Myasthenia gravis
  • Multiple sclerosis

Infection, especially following a viral infection with Herpes simplex virus (a virus that is related to the cause of the common "cold sores" of the mouth).

SYMPTOMS OF BELL'S PALSY: -

These are the most common symptoms of Bell's palsy:

  • Disordered movement of the muscles that control facial expressions, such as smiling, squinting, blinking, or closing the eyelid
  • Loss of feeling in the face
  • Headache
  • Tearing
  • Drooling
  • Loss of the sense of taste on the front two-thirds of the tongue
  • Hypersensitivity to sound in the affected ear (hyperacusis)
  • Inability to close the eye on the affected side of the face
  • The symptoms of Bell's palsy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

DIAGNOSIS:-

 There are no specific tests used to diagnose Bell’s palsy. However, your healthcare provider may order tests to rule out other conditions that can cause similar symptoms and to determine the extent of nerve involvement or damage. These tests may include:

Electromyography (EMG) to determine the extent of the nerve involvement

Blood tests to determine if another condition such as diabetes or Lyme disease is present

Magnetic resonance imaging (MRI) or computed tomography (CT) to determine if there is a structural cause for your symptoms.

It is important that the healthcare provider rule out the presence of a stroke or tumor that may cause symptoms similar to Bell’s palsy.

COMPLICATIONS OF BELL'S PALSY: -

Bell’s palsy usually resolves in time and causes no long-term complications. However, during the illness most people with Bell’s palsy are unable to close their eye on the affected side of their face. It is, therefore, important to protect the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched.

Living with Bell's palsy:-

Bell’s palsy usually resolves in time and causes no long-term complications. It is important, however, to take medicines as directed. It is also crucial that you protect the affected eye from drying.

BRAIN ANEURYSM:-

A brain aneurysm (also called a cerebral aneurysm or an intracranial aneurysm) is a ballooning arising from a weakened area in the wall of a blood vessel in the brain.

 If the brain aneurysm expands and the blood vessel wall becomes too thin, the aneurysm will rupture and bleed into the space around the brain. This event is called a subarachnoid hemorrhage (SAH) and may cause a hemorrhagic (bleeding) stroke.

 Rupturing brain aneurysm and SAH are life-threatening events.

SYMPTOMS OF BRAIN ANEURYSM: -

The presence of a brain aneurysm may not be known until it ruptures. Most brain aneurysms have no symptoms and are small in size (less than 10 millimeters, or less than four-tenths of an inch, in diameter). Smaller aneurysms may have a lower risk of rupture.

However, occasionally there may be symptoms that happen before a rupture due to a small amount of blood that may leak. This is called "sentinel hemorrhage" into the brain. Some aneurysms are symptomatic because they press on adjacent structures, such as nerves to the eye. They can cause visual loss or diminished eye movements, even if the aneurysm has not ruptured.

THE SYMPTOMS OF AN UNRUPTURED BRAIN ANEURYSM INCLUDE THE FOLLOWING:

  • Headaches (rare, if unruptured)
  • Eye pain
  • Vision changes
  • Diminished eye movement.
  • The first evidence of a brain aneurysm is most often a subarachnoid hemorrhage (SAH), due to rupture of the aneurysm. This may cause symptoms such as:
  • Rapid onset of "worst headache of my life"
  • Stiff neck
  • Nausea and vomiting
  • Changes in mental status, such as drowsiness
  • Pain in specific areas, such as the eyes
  • Dilated pupils
  • Loss of consciousness
  • High blood pressure
  • Loss of balance or coordination
  • Sensitivity to light
  • Back or leg pain
  • Problems with certain functions of the eyes, nose, tongue, and/or ears that are controlled by one or more of the 12 cranial nerves.
  • Coma and death
  • The symptoms of a brain aneurysm may resemble other problems or medical conditions.

RISK FACTORS FOR BRAIN ANEURYSM: -

Inherited risk factors associated with aneurysm formation may include the following:

Alpha-glucosidase deficiency. A complete or partial deficiency of the enzyme needed to break down glycogen and to convert it into glucose.

Alpha 1-antitrypsin deficiency:- A hereditary disease that may lead to hepatitis and cirrhosis of the liver or emphysema of the lungs.

Arteriovenous malformation (AVM):- An abnormal connection between an artery and a vein.

Coarctation of the aorta:- A narrowing of the aorta. This is the main artery coming from the heart.

Ehlers-Danlos syndrome:-  A connective tissue disorder (less common).

Family history of aneurysms.

Female gender.

 

Fibromuscular dysplasia:-An arterial disease, cause unknown, that most often affects the medium and large arteries of young to middle-aged women.

Hereditary hemorrhagic telangiectasia:- A genetic disorder of the blood vessels in which there is a tendency to form blood vessels that lack capillaries between an artery and vein.

Klinefelter syndrome. A genetic condition in men in which an extra X sex chromosome is present.

Noonan's syndrome. A genetic disorder that causes abnormal development of many parts and systems of the body.

Polycystic kidney disease (PCKD). A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys. PCKD is the most common medical disease associated with saccular aneurysms.

Tuberous sclerosis. A type of neurocutaneous syndrome that can cause tumors to grow inside the brain, spinal cord, organs, skin, and skeletal bones.

Acquired risk factors associated with aneurysm formation may include the following:

Advancing age

Alcohol consumption (especially binge drinking)

Atherosclerosis. A buildup of plaque (made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin) in the inner lining of an artery

Cigarette smoking

Use of illicit drugs, such as cocaine or amphetamine.

High blood pressure.

Head injury.

Infection.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions. These include changing behaviors and being monitored for the disease.

Brain Aneurysm

 DIAGNOSIS: -

A brain aneurysm is often discovered after it has ruptured or by chance during diagnostic exam, such as computed tomography (CT scan), magnetic resonance imaging (MRI), or angiography that are being done for other reasons.

In addition to a complete medical history and physical exam, diagnostic procedures for a brain aneurysm may include:

Cerebral angiography. This provides an image of the blood vessels in the brain to detect a problem with vessels and blood flow. The procedure involves inserting a catheter (a small, thin tube) into an artery in the leg and passing it up to the blood vessels in the brain. Contrast dye is injected through the catheter and X-ray images are taken of the blood vessels.

Computed tomography scan (CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays and may be used to detect abnormalities and help identify the location of the aneurysm and if it has burst or is leaking. A CT angiogram (CTA) can also be obtained on a CT scan to look at the vessels.

Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRI uses magnetic fields to detect small changes in brain tissue that help to locate and diagnose an aneurysm.

Magnetic resonance angiography (MRA). A noninvasive diagnostic procedure that uses a combination of magnetic resonance technology (MRI) and intravenous (IV) contrast dye to visualize blood vessels. Contrast dye causes blood vessels to appear opaque on the MRI image, allowing the doctor to visualize the blood vessels being evaluated.

GUILLAIN-BARRÉ SYNDROME: -

Guillain-Barré syndrome (GBS) is also called acute inflammatory demyelinating polyradiculoneuropathy (AIDP). It is a neurological disorder in which the body's immune system attacks the peripheral nervous system, the part of the nervous system outside the brain and spinal cord. The onset of GBS can be quite sudden and unexpected and requires immediate hospitalization. It can develop over a few days, or it may take up to several weeks with the greatest weakness occurring within the first couple of weeks after symptoms appear.

GBS is rare, affecting about 3,000 people in the U.S. It can affect people at any age and both men and women equally. GBS often develops after a respiratory or gastrointestinal viral infection.

CAUSES OF GUILLAIN-BARRÉ SYNDROME: -

It’s not clear why some people get GBS. What is known is that the body's immune system begins to attack the body itself.

Normally, the cells of the immune system attack only foreign material and invading organisms, but in GBS, the immune system starts to destroy the myelin sheath that surrounds the axons of many nerve cells, and, sometimes, the axons themselves.

When this occurs, the nerves can’t send signals efficiently, the muscles lose their ability to respond to the commands of the brain, and the brain receives fewer sensory signals from the rest of the body. The result is an inability to feel heat, pain, and other sensations.

GBS can occur after a viral infection, surgery, injury, or a reaction to an immunization.

SYMPTOMS OF GUILLAIN-BARRÉ SYNDROME: -

These are the most common symptoms of GBS. But each person may have slightly different symptoms.

The first symptom includes weakness or tingling sensations in the legs. This sometimes spreads to the arms and upper body. A neurological exam usually reveals a loss of all deep tendon reflexes. The symptoms may get worse. In some cases, you may not be able to use your muscles at all. You become paralyzed, and breathing is hard. Your blood pressure and heart function are affected. GBS is a medical emergency and needs to be treated promptly.

Although symptoms can become life-threatening, partial recovery is possible from even the most severe cases of GBS. But you may always have some degree of weakness.

The symptoms of GBS may look like other health conditions. Always talk with your healthcare provider for a diagnosis.

DIAGNOSIS OF GUILLAIN-BARRE SYNDROME:-

The signs and symptoms of GBS vary. It can be difficult to diagnose in its earliest stages.

THESE SIGNS AND SYMPTOMS ARE UNIQUE TO GBS:

Symptoms on both sides of the body:-

  • Symptoms appear quickly--days or weeks instead of months
  • Loss of reflexes
  • High protein level in cerebral spinal fluid. This is the fluid that surrounds the spinal cord and brain.

To diagnose GBS, you may have the following tests:

Spinal tap (lumbar puncture). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to find out if there is an infection or other problems.

Electrodiagnostic tests, such as electromyography (EMG) and nerve conduction velocity (NCV). These studies are done to evaluate and diagnose disorders of the muscles and motor neurons. Electrodes are inserted into the muscle, or placed on the skin overlying a muscle or muscle group, and electrical activity and muscle response are recorded.

Neurocutaneous syndromes in children Neurocutaneous:- syndromes are disorders that affect the brain, spinal cord, organs, skin, and bones. The diseases are lifelong conditions that can cause tumors to grow in these areas. They can also cause other problems such as hearing loss, seizures, and developmental problems. Each disorder has different symptoms. The most common disorders in children cause skin growths.

The 3 most common types of neurocutaneous syndromes are:

  • Tuberous sclerosis (TS)
  • Neurofibromatosis (NF), including NF1, NF2, and Schwannomatosis
  • Sturge-Weber disease

CAUSES OF NEUROCUTANEOUS SYNDROME IN A CHILD:-

These diseases are all present at birth (congenital). They are caused by gene changes.

Tuberous sclerosis (TS) is an autosomal dominant disorder. Autosomal means that both boys and girls are affected. Dominant means that only 1 copy of the gene is needed to have the condition. A parent with TD or the gene for TD has a 50% chance to pass the gene on to each child. Many children born with TS are the first cases in a family. This is because most cases of TS are caused by a new gene change (mutation), and are not inherited. But the parents of a child with TS may have very mild symptoms of the disorder. The parents are believed to have a slightly increased risk of having another child with TS.

Neurofibromatosis Type 1 (NF1) occurs in about 1 in 3,000 to 4,000 babies in the U.S. NF1 is an autosomal dominant disorder. It’s caused by changes in a gene on chromosome 17. In 50% of cases, this is inherited from a parent with the disease.

Neurofibromatosis Type 2 (NF2) is less common. It affects about 1 in 25,000 babies in the U.S. The gene change that causes NF2 is on chromosome 22.

A parent with NF has a 50% chance of passing on the genetic mutation and disease to each child.  

NF may also be the result of a new gene change. From 3 in 10 to 1 in 2cases of NF are caused by a new mutation and not inherited. Boy and girls are equally affected.

Schwannomatosis is a form of NF. It is rare, and only 3 in 20 cases are inherited. There are 2 genetic forms of schwannomatosis:

Schwannomatosis 1. This is caused by mutations in a gene called SWNTS1. This condition is also known as congenital cutaneous neurilemmomatosis.

Scwannomatosis 2. This condition starts in adulthood. It causes schwannomas to grow throughout the body. But it has no other symptoms.

The cause of Sturge-Weber disease is not known. Researchers think it occurs by chance (sporadic). In some cases, other family members have hemangiomas. These are noncancer (benign) growths that are made of blood vessels. Some children with this condition may have mutations in a gene called GNAQ.

RISK FACTORS FOR A NEUROCUTANEOUS SYNDROME: -

A child is more at risk for a neurocutaneous syndrome if he or she has a family member with one of the syndromes.

 SYMPTOMS OF A NEUROCUTANEOUS SYNDROME IN A CHILD: -

Symptoms can occur a bit differently in each child. Below are the most common symptoms for each condition:

Tuberous sclerosis

This causes growths called tubers to grow in the brain and retina of the eye. Tuberous sclerosis also affects many other organs in the body. It can affect the brain, spinal cord, lungs, heart, kidneys, skin, and bones. It can also cause intellectual disability, developmental delays, seizures, and learning disabilities.

Neurofibromatosis Type 1 (NF1)

This is the more common of type of neurofibromatosis. It is also called Von Recklinghausen's disease. The classic symptom of NF1 is light brown patches of pigment on the skin. These are known as cafe-au-lait spots. A child may also have skin tumors that are not cancer (benign). These are called neurofibromas. Neurofibromas are often found growing on the nerves and in organs. There is a higher rate of brain tumors in people with NF. Less than 1 in 100 people with NF1 will have cancer (malignant) in the neurofibromas. An older child may also have Lisch nodules. These are small tumors on the colored part of the eye (iris). These usually do not cause problems. Other symptoms can include hearing loss, headaches, seizures, scoliosis, and facial pain or numbness. Intellectual disability of varying degree may be slightly more common in people with NF1. About half may have a variety of learning problems and attention deficit disorder. Renal artery stenosis and other vascular problems may occur with NF1.

Neurofibromatosis Type 2 (NF2):-

NF2 affects about 1 in 25,000 people. The symptoms usually appear between ages 18 and 22. The tumors called schwannomas grow on a vestibular nerve branch. These are known as bilateral vestibular schwannomas (BVS). These tumors on the 8th cranial nerve can lead to hearing loss, headaches, problems with facial movements, problems with balance, and trouble walking. A child may have hearing loss. Other signs of NF2 may include seizures, tumors of the membranes around the brain and spinal cord (meningiomas), skin nodules (neurofibromas), and cafe-au-lait spots. 

Schwannomatosis:- This type of neurofibromatosis causes schwannomas to grow through the body, but without other symptoms of NF1 or NF2. The main symptom is intense pain that occurs when a schwannoma grows larger or presses on a nerve or nearby tissue. Other symptoms may include numbness, tingling, or weakness in the fingers and toes.

 Sturge-Weber disease

The classic symptom of this disease is a mark on a child’s face called a port wine stain. A port wine stain is a flat area on the skin that varies in color from red to dark purple. It is present from birth. It is most often found near or around the eye and forehead. The birthmark is caused by too many tiny blood vessels forming under the skin. There may also be related brain abnormalities on the same side of the brain as the face lesion. A child may also have seizures, muscle weakness, changes in vision, and intellectual disability. A child may also have increased pressure in the eye (glaucoma) at birth. Sturge-Weber disease does not affect the other organs of the body.

The symptoms of neurocutaneous syndromes can be like other health conditions.

DIAGNOSIS: -

The healthcare provider will ask about your child’s symptoms, health history, and developmental milestones. He or she may also ask about your family’s health history. He or she will give your child a physical exam. Your child may also have tests, such as:

Genetic tests. These are blood tests.They check for health conditions that tend to run in families.

MRI. This test uses large magnets, radio waves, and a computer to make images of the inside of the body.

CT scan. This test uses a series of X-rays and a computer to create images of the inside of the body. A CT scan shows more detail than a regular X-ray.

Electroencephalogram (EEG). This test records the brain's electrical activity through sticky pads (electrodes) attached to the scalp.

Eye exam. This is done to check for growths on the retina and excess pressure in the eye.

Biopsy. A small sample of tissue from a tumor or skin lesion may be taken. This is checked with a microscope.

Dementia:- Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.

ALZHEIMER'S DISEASE - STAGES & SYMPTOMS

Alzheimer's disease is a progressive disorder that causes brain cells to waste away (degenerate) and die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that disrupts a person's ability to function independently.

PARKINSON'S DISEASE: -

Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

AMYOTROPHIC LATERAL SCLEROSIS (ALS):-

Amyotrophic lateral sclerosis (ALS), also known as motor neurone disease (MND) or Lou Gehrig's disease, is a disease that causes the death of neurons controlling voluntary muscles.

TYPES OF EPILEPTIC SEIZURES:-

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.

MULTIPLE SCLEROSIS: -

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.

APPROACH OF HOMOEOPATHIC REMEDIES IN MANAGING CHRONIC NEUROLOGICAL ILLNESSES: -

The medicines that can be thought of use are:-

CONIUM MACULATUM:- It is the remedy of bachelors and of old maid servants, the type that likes to be done and hates visitors, he hates people he does not know because he is shy . Hypochondriac indifferent, not interested in anything; averse to all intellectual work and also to all physical effort, weakness, decline, laziness. It is very difficult for him to come to the point of starting to do anything. He cannot walk quickly; he cannot hurry; and if you want to go with him, you will have to proceed at his pace, which is always slowly.

HELLEBORUS NIGER: this drug brings about sensorial depression with a bitter or insipid taste. Fetor oris. Movements of chewing food always tastes insipid or else bitter in all illnesses, absence of thirst, encephalic cry especially at night while sleeping.

Convulsions of nursing infants, melancholic subjects who are always slow to answer when spoken to, in voluntary sighing, dull, apathetic, indifferent, loss of hair and always rubbing his nose.

These patients always have diminished vitality and they have two things that one will notice anasarca and dropsy. Like Belladonna and Tubeculium, Helleborus always bores the head in to the pillow, and he rolls his head on the pillow day and night. The eyeballs always gaze upwards- Hemeralopia.

GELSEMIUM: - Gelsemium has always light colored urine, never dark, even when there is fever.

Frequent urination, abundant urination which relieves head ache.

VALERIANA OFFICINALIS: -  when it is dynamized , this plant has an affinity with subjects who have an extremely variable temperament . The height of impressionable, hypersensitive, very nervous, asthenic, hysterical complaints, pulse generally accelerated. Nervous system always rather exited. This remedy has the sensation as if there were a thread hanging in the throat excellent drug for babies who vomit great pieces of curdled milk after feeding.