13. Nervous System I - Pathologies Flashcards
Carpal Tunnel Syndrome: definition
Compression of the median nerve in the carpal tunnel
What does the median nerve do?
Provides sensory information to the hand
Controls movements in the hand and fingers
Carpal Tunnel Syndrome: aetiology
Fluid retention - pregnancy
Overuse - vibrating tools, desk posture
Other pathologies - RA, hypothyroidism, acromegaly
Trauma (swelling), tumour or fracture in wrist
Carpal Tunnel Syndrome: signs and symptoms
Tingling, numbness, pain in median nerve distribution
Worse at night
Weakness of grip and weak thumb opposition
Carpal Tunnel Syndrome: diagnostics
Tinel’s test
Phalen’s test
Nerve conduction studies
Carpal Tunnel Syndrome: complications
In chronic/untreated cases, muscles around base of thumb may degenerate
Carpal Tunnel Syndrome: allopathic treatment
Anti-inflammatory drugs Corticosteroid injection Physiotherapy Wrist splinting Surgery
Carpal Tunnel Syndrome: natural treatments
Treat the cause.
Herbs and nutrition for pain and inflammation.
Acupuncture,
homeopathy (arnica, ruta)
Vitamin B6 helps in pain pathway
Osteopathy - ‘biscuit breaking’ exercise
Bell’s Palsy: definition
Inflammation or compression of the facial nerve
Specifically compressed in facial canal
Bell’s Palsy: aetiology
Viral (Herpes simplex*)
Surgery (secondary to a procedure)
Injury
*same as for cold sores
Bell’s Palsy: signs and symptoms
Sudden, unilateral weakness or paralysis of the facial muscles
Cannot close affected eye*
Loss of taste
Intolerance to loud noise
*patients advised to protect cornea with eye patch
Bell’s Palsy: allopathic treatment
Cortisone (steroid)
Acyclovir (antiviral)
Bell’s Palsy: natural treatment
Acupuncture most effective at early stage
Herbs and nutrients (antiviral, support for nerve function)
Anti-inflammatory diet
Homeopathy.
Guillain-Barre Syndrome: definition
Acute, ascending, progressive inflammation and demyelination of peripheral nerves
Guillain-Barre Syndrome: aetiology
Autoimmune
75% triggered by a recent infection
(1-3 wks after respiratory/GIT infection eg. Flu or EBV)
Associated with post-vaccination (linked to Flu and HPV vaccines
Guillain-Barre Syndrome: pathophysiology
Starting with the most peripheral neurons
Feet, lower limbs and progressive ascending paralysis
Causes neuritis (inflammation of the nerve cells)
Guillain-Barre Syndrome: signs and symptoms
Sudden, progressive, bilateral, ascending paralysis (starts in the feet)
Paraesthesia (‘pins and needles’) and sensory changes
Neuropathic pain into legs
Guillain-Barre Syndrome: complications
Death by heart or respiratory failure
Guillain-Barre Syndrome: diagnostics
Nerve conduction studies
Lumbar puncture
Guillain-Barre Syndrome: allopathic treatment
Emergency care (respirator, intensive care)
Plasma exchange
Intravenous antibodies
Corticosteroids
Multiple Sclerosis (MS): definition
Autoimmune inflammatory diseases causing demyelination of axons in CNS neurons
Multiple Sclerosis (MS): aetiology
Vitamin D deficiency* Vitamin B12 deficiency Genetic susceptibility Environmental triggers: > Dietary risk factors > Viruses - EBV, measles etc
*Vit D activates oligodendrocytes
Multiple Sclerosis (MS): signs and symptoms
Blindness, loss of vision in one eye and occasional pain (neuritis) Double vision and nystagmus (jerking of eyeball) Deafness Loss of balance Spinal tract symptoms: > Burning pain, pulling sensations > Tingling, loss of sensation Bladder urgency, incontinence Cognitive changes, depression Weakness
Multiple Sclerosis (MS): pathophysiology
T-lymphocytes attack antigens in the myelin sheath
Multiple areas of sclerosis (scar tissue)
Creates leisons of damaged myelin along axons disrupting conduction
Multiple Sclerosis (MS): diagnostics
No definitive test - based on clinical findings
MRI
Ophthalmoscopy (retinal examination of optic nerve)
CSF analysis
At what age is multiple sclerosis likely to occur?
Between 20-50 years
Who is more likely to be affected by multiple sclerosis?
Women (2:1 to men)
What patterns can MS follow?
Relapsing-remitting pattern (85% of cases) Other patterns are progressive Primary (progressive from onset) Secondary (relapse-remitting > progressive)
What is the prognosis for MS?
Depends on disease pattern - 15% only suffer one episode
Progressive types have a poor prognosis
Multiple Sclerosis (MS): allopathic treatment
Immunomodulatory therapies:
* corticosteroids
* interferon-beta
Physiotherapy
Symptom management
Multiple Sclerosis (MS): natural treatment
Lifestyle and diet are important in prolonging remission Anti-inflammatory diet Ketogenic diet (increasing ketones) Herbal medicine for autoimmune and antiviral conditions Low-grade exercise Alpha-lipoic acid (antioxidant) Vitamin D and Vitamin B12
Motor Neuron Disease (MND): definition
Progressive degeneration of motor neurons in the spinal cord, motor cortex and brain stem
Degeneration of any motor pathway of CNS
At what age does MND usually occur?
> 40 yrs (50-70 yrs)
Who does MND usually affect?
More commonly affects men
Motor Neuron Disease (MND): pathophysiology
Abnormal mitochondrial function causing oxidative stress in motor neurons
Motor Neuron Disease (MND): aetiology
Unknown - suspected link with genetics, environmental toxins, oxidative stress
Motor Neuron Disease (MND): signs and symptoms
Weakness in upper limbs* Weak grip, dropping/difficulty manipulating objects Wasting of hand muscles Tremor of limbs at rest Later stages can affect legs (tripping) Slurred speech Dyspnoea, difficulty swallowing
Deterioration begins in upper limbs
Motor Neuron Disease (MND): complications
Death by respiratory failure Typically 3-5 yrs after diagnosis*
Stephen Hawking exception (very young at diagnosis)
Motor Neuron Disease (MND): allopathic treatment
No cure
Specialist care
Motor Neuron Disease (MND): natural treatment
An anti-inflammatory diet
Herbs and nutrients to support nerve function
Homeopathy and acupuncture.
Dementia: definition
Syndrome caused by a number of brain disorders which cause
* Memory loss
* Decline in other aspects of cognition
* Difficulty performing daily activities
What are the two main categories of dementia?
Alzheimer’s disease (50%)
Vascular dementia (25%)
What is vascular dementia?
Due to cerebrovascular disease e.g. stroke/strokes and poor oxygen delivery
Alzheimer’s Disease: definition
Neurodegenerative disease of the cerebral cortex
Alzheimer’s Disease: pathophysiology
Abnormal protein plaque deposition (beta amyloid plaques*)
Atrophy of neurons
Estimated loss of 1000 synapses/day
Less acetylcholine
*Key diagnostic feature
Which area of the brain is usually first affected by Alzheimer’s?
Hippocampus
Short term memories affected
What is the hippocampus important for developing?
Memories
Which area of the brain is usually affected later by Alzheimer’s?
Amygdala
What is the amygdala important for?
Emotions
Memories
Alzheimer’s: Beta-amaloid hypothesis
|Verbal, not on slide
The subject of extensive research and drug development efforts with little to no effect
Suggests that the accumulation of beta-amyloid plaques plays a central role in the development and progression of Alzheimer’s disease
Alzheimer’s Disease: aetiology
Heavy metal toxicity (degeneration of the blood brain barrier) * Mercury * Excessive copper * Aluminium toxicity (vaccines, cans, foil) Genetic links (<1%) - ApoE4 gene Chronic inflammation * Sugar (insulin resistance), dairy * Gluten and leaky gut (molecules/bacteria entering blood which can travel to brain) Pathogens (micro-organisms) * Oral bacteria e.g. P. gingivalis * Herpes simplex virus Increased risk if cardiovascular disease (CVD) present and with high homocysteine. High levels of oxidative stress High cortisol Nutritional deficiency * B1, B3, B6, B12, folate* * Omega 3 fatty acids Hormonal deficiencies * Oestrogen, testosterone * Thyroid hormone
*Help with conversion of homocysteine to methionine
Alzheimer’s Disease: signs and symptoms - early stages
Slight memory loss (especially short term - forgetting recent conversations)
Repeated questions and confusion
Decreased initiative - reduction in hobbies/hygiene
Alzheimer’s Disease: signs and symptoms - later stages
Significant memory loss (long term, forget who people are)
Subtle changes in higher order functions i.e. not understanding jokes
Mood disturbances - agitation, aggression
Loss of sense of self
Difficulty with language
Unsteady, disorientated
Depression
Alzheimer’s Disease: diagnostics
Mini mental state exam (MMSE)
MRI/CT scans
Alzheimer’s Disease: allopathic treatment
Drugs - acetylcholinesterase inhibitors (to encourage Ach to increase) - ineffective
Psychological treatments - cognitive behavioural therapy (usually not offered)
Alzheimer’s Disease: natural treatment
Nutrition is essential in prevention and
disease management
Ketogenic diet
Deficiencies to be addressed: antioxidants, anti-inflammatory and other
nerve supporting nutrients:
- Beta-carotene
- Omega-3 fatty acids
- Medium-chain triglycerides (MCTs support neuron functions)
- B vitamins
Herbs such as ginkgo and turmeric
Regular exercise and good quality sleep
Addressing metal toxicity
Managing stress
MEND protocol
What is the prognosis for Alzheimer’s?
People typically live for anywhere between 5 and 20 yrs after the onset of symptoms
What is the most common cause of death in people with Alzheimer’s?
Infection
Parkinson’s Disease: definition
Progressive neurological disorder affecting movement
What is the prevalence of Parkinson’s
Affects 1% of individuals over 60
Parkinson’s Disease: aetiology
Mitochondrial dysfunction (oxidative stress)
Constipation and diet low in polyunsaturated fats
Genetics
Toxic environmental factors :
industrial chemicals
carbon monoxide
manganese poisoning
exposure to pesticides and herbicides
Parkinson’s Disease: pathophysiology
Degeneration of the dopaminergic neurons in the *substantia nigra** (area of brain that regulates movement)
Causes dopamine deficiency, leaving patients less able to direct or control their movement
Accumulation of abnormal protein (Lewy bodies) within neurons
*‘black substance’, darker appearance due to high levels of neuromelanin
Parkinson’s Disease: signs and symptoms
Bradykinesia - short shuffling steps, difficulty stopping/starting
Resting tremor (pill rolling)
Stopped/flexed posture
Lack of normal subconscious movements - swinging arms
Muscle rigidity, mask like face, low voice
Parkinson’s Disease: allopathic treatment
Dopamine replacement - Levodopa (L-dopa)
Deep brain stimulation - electrodes in brain
Parkinson’s Disease: natural treatment
Anti-inflammatory, anti-oxidant and
mitochondrial support through diet (i.e.
Mediterranean), herbs. B vitamins.
Exercise (30–45 mins of aerobic 3–5 x per week).
- Cycling: reduces symptoms
- Dance: music and colours are stimulatory
Dietary protein intake at dinner to prevent competitive uptake between amino acids and L-dopa.
Huntington’s Disease: definition
Inherited neurodegenerative disorder affecting the basal ganglia
Huntington’s Disease: pathophysiology
A genetic (autosomal dominant) disease with a defect on chromosome 4
Huntington’s Disease: signs and symptoms
Loss of muscle co-ordination (chorea) Cognitive impairment Loss of intellect Depression Aggression
What are the involuntary jerky movements seen in Huntington’s disease called?
Chorea
