Nervous system 1 pathologies Flashcards
Carpal Tunnel Syndrome
The median nerve becomes compressed in carpal tunnel syndrome
- The carpal tunnel is a narrow passageway in the anterior wrist that contains tendons & the median nerve
- The median nerve provides sensory information to the hand and controls movements in the hand and fingers
Causes:
* Fluid retention; pregnancy
* Overuse; vibrating tools, desk posture
* Due to R.A., hypothyroidism, acromegaly
* Trauma (swelling), tumour or fracture in wrist.
* Small carpal tunnel (congenital)
Signs and Symptoms:
* Tingling, numbness or pain in the median nerve distribution
* Symptoms are often worse at night and can wake a patient
* Weakness of grip and weak thumb opposition
* Muscle wasting at base of the thumb (sensory symptoms first)
Diagnosis:
* Tinel’s test and Phalen’s test (+ve if reproduces hand symptoms)
* Nerve conduction studies
Allopathic treatment:
* Anti-inflammatory drugs
* Corticosteroid injection
* Splinting the wrist
* Physiotherapy
* Surgery (cutting transverse carpal ligament)
Alternative treatment:
* Treat the cause
* Herbs and nutrition for pain and inflammation
* Acupuncture, homeopathy (arnica, ruta), vit. B6, osteopathy
Complications:
* In chronic and / or untreated cases, the muscles at the base of the thumb may degenerate
Bell’s Palsy
The nerve that controls the facial muscles (facial nerve) becomes inflamed or compressed
Causes:
* Viral e.g. herpes simplex, surgery, injury
Signs and symptoms:
* Sudden unilateral weakness or paralysis of the facial muscles
* Cannot close affected eye (can damage cornea)
* Loss of taste and intolerance to loud noise if severe
Allopathic treatment:
* Acyclovir
* Cortisone
Alternative treatment:
* Treat cause
* Herbs and nutrients to support nerve function
* Antiviral, anti-inflammatory diet
* Acupuncture
* Homeopathy
Guillain-Barre Syndrome
A form of post-infectious de-myelinating disease with ‘neuritis’ (Autoimmune)
(neuro = nerve, it is = inflamed, de = removal, -myelinating = myelin)
- Associated with acute, ascending (moving upwards), progressive inflammation and demyelination of peripheral nerves
Causes:
* Auto-immune. 75% are triggered by a recent infection (1-3 weeks after respiratory / GIT infection of post vaccination e.g. flu/HPV, EBV). Antibodies formed against virus cross react with lipids in myelin – molecular mimicry
Signs and symptoms:
• Sudden, progressive, bilateral, ascending paralysis
• Paraesthesia and sensory changes
• Neuropathic pain into legs
Diagnosis:
• Nerve conduction studies
• Lumbar puncture
Allopathic treatment:
• Emergency care – respirator, intensive care
• Plasma exchange, intravenous antibodies
• Corticosteroids
Complications:
• Death by heart or respiratory failure
Multiple Sclerosis (ME)
An autoimmune inflammatory disease causing demyelination of axons in CNS neurons with damage
Pathophysiology:
* T-lymphocytes attack myelin antigens. Multiple areas of sclerosis (scar tissue) along axons which disrupts conduction.
- Usually occurs between 20-50 years of age, affecting women (2:1) to men
- Most MS follows a relapsing-remitting pattern (85%). Other patterns are progressive
Prognosis:
* Depends on disease pattern. 15% only suffer one episode. Progressive types have a poor prognosis
Causes:
* Vitamin D deficiency – higher prevalence further away from the equator. Vitamin D has been shown to increase oligodendrocyte production of myelin
* Vitamin B12 deficiency – normally acts as a co-factor in myelin formation and also has immunomodulatory effects
* Genetic susceptibility and environmental trigger, dietary risk with family history
* Viruses e.g. Epstein-Barr virus (EBV), measles, etc.
* Visual symptoms are common; blindness, loss of vision of one eye and occasional pain (neuritis). Double vision and nystagmus (jerking of eyeball)
* Deafness and loss of balance
* Burning, pulling sensations
* Tingling and loss of sensation
* Bladder urgency and incontinence
* Cognitive changes and depression
* Weakness
MS affects nerves that are highly myelinated, such as the optic nerve
Diagnosis:
* No definite test: based on clinical findings, MRI ophthalmoscopy and CSF analysis
Allopathic treatment:
* Immunomodulatory therapies; corticosteroids, interferon-beta, physiotherapy, symptom management
Alternative treatment:
* Lifestyle and diet are important in prolonging remission. Anti-inflammatory and ketogenic diet.
* Herbal medicine for autoimmune and antiviral conditions
* Low grade exercise
* Alpha-lipoic acid (anti-oxidant)
* Vitamin D and Vitamin B12
Motor Neurone Disease (MND)
The progressive degeneration of motor neurons in the spinal cord, motor cortex and brain stem
- The current hypothesis focuses on abnormal mitochondrial function causing oxidative stress in motor neurons
- Sensory functions remain intact
Causes:
* Unknown. Suspected link with genetics and environmental toxins and oxidative stress
* Age of onset is typically 40 years (highest incidence 50-70 years)
* More commonly affects men
Signs and symptoms:
* Typically presents as weakness in upper limbs dropping objects or difficulty manipulating objects
* Wasting of hand muscles and tremor of limbs at rest
* Later stages can affect the legs (tripping), cause slurred speech, dyspnoea, difficulty swallowing
* Death by respiratory failure – typically within 3-5 years
Allopathic treatment:
* Currently no cure, specialist care
Alternative treatment:
* An anti-inflammatory diet
* Herbs and nutrients to support nerve function
* Homeopathy and acupuncture
Dementia
Dementia is a syndrome caused by a number of brain disorders, which cause:
* Memory loss
* Decline in other aspects of cognition
* Difficulty performing daily activities
Causes:
* Most common causes are:
1. Alzheimer’s disease (50%) – degeneration of the cerebral cortex and reduced acetylcholine production
2. Vascular dementia (25%) – due to cerebrovascular disease (e.g. due to stroke / strokes) and poor oxygen delivery
* The prevalence of dementia rises with age
Huntington’s Disease
Inherited neurodegenerative disorder affecting the basal ganglia
Causes:
* A genetic (autosomal dominant) disease – defect on chromosome 4
Signs and symptoms:
* Results in loss of muscle co-ordination (abnormal involuntary jerky movements called ‘chorea’)
* Cognitive impairment & loss of intellect
* Poor regulation of mood and emotions; psychiatric symptoms (depression, aggression etc.)
Alzheimer’s Disease
A neurodegenerative disease of the cerebral cortex
Pathophysiology:
* Associated pathologically with abnormal protein deposition (beta amyloid), atrophy of neurons and less acetylcholine
* The hippocampus is among the areas first affected, which is important for memories. The amygdala is often affected later and is the a key centre for emotions and memories.
* Whist progressing, additional regions of brain become affected
Causes:
* Heavy metal toxicity (degenerate the blood brain barrier)
- High copper and mercury
- Aluminum toxicity (e.g. vaccines, cans, foilds, etc.)
* Genetic links (account for <1%) – ApoE4 gene
* Chronic inflammation;
- such as sugar (and insulin resistance), dairy, gluten
- Leaky gut (promoting inflammation)
* Pathogens (micro-organisms):
- Oral bacteria such as P. gingivalis have been identified in tissue biopsies
- Herpes simplex virus
* Increased risk if have cardiovascular disease (CVD) and high homocysteine
* High levels of oxidative stress
* Higher cortisol levels (chronic stress)
* Nutritional deficiency e.g. B1, B3, B6, B12, folate, omega-3 fatty acids
* Hormonal factors:
- Oestrogen deficiency (effects mostly seen in women following full hysterectomy)
- Testosterone deficiency
- Thyroid hormone deficiency
Signs and symptoms:
Early stages:
* Slight memory loss (especiall short-term), i.e. forgetting recent conversations
* Repeated questions and confusion
* Decreased initiative (decreased hobbies, decreased hygiene)
Later stages:
* Significant memory loss (inc. long-term memory)
* Subtle changes in higher order functions i.e. understand jokes
* Mood disturbances; agitation and aggression
* ‘loss of sense of self’ – autobiography (left hippocampus)
* Difficulty with language, unsteady, depression
Diagnosis:
* Mini mental state exam
* MRI and CT scan
Allopathic treatment:
* Drugs; acetylcholinesterase inhibitors (ineffective)
* Psychological treatments such as cognitive behavioural therapy (CBT)
Alternative treatment:
* Nutrition is essential in prevention and disease management. Ketogenic (brain energy)
* Deficiencies need to be addressed, antioxidants, anti-inflammatory and other nerve supporting nutrients:
- Beta-carotene
- Omega-3 fatty acids and medium chain triglycerides (MCTs) which support neural functions)
- B vitamins
* Herbs such as gingko (vascularize areas of the brain) and turmeric
* Regular exercise and good quality sleep
* Addressing metal toxicity, managing stress
Other:
* It is the most common type of dementia (50%)
* 20% of the population affected by 80 years of age
* Brain deterioration is thought to begin decades before symptoms become evident
* Global neuron atrophy (and hence brain shrinkage) with disrupted cell communication (Ach)
* Prognosis: People typically live for anywhere between 5 and 20 years after the onset of Alzheimer’s symptoms. The most common cause of death is infection
Parkinson’s Disease
A progressive neurological movement disorder affecting movement
Pathophysiology:
* Two major neuropathological findings in the medical model:
1. Degeneration of dopaminergic neurons in the substantia nigra (midbrain) causing dopamine deficiency leaving patients less able to direct or control their movement
2. Accumulation of abnormal proteins (Lewy bodies) within neurons.
Causes:
* Caused by loss of dopaminergic neurons in the substantia nigra: an area of the midbrain that regulates movement (and reward).
* Affecting approx. 1% of individuals over 60
* Mitochondria dysfunction (oxidative stress)
* Constipation and diet low in polyunsaturated fats.
* Genetics
* Toxic environmental factors; i.e. carbon monoxide, manganese poisoning, exposure to pesticides and herbicides
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 (need dopamine for expressions)
* Low voice
Allopathic treatment:
* Dopamine replacement (levodopa / L-dopa); doesn’t cross blood brain barrier very well so high doses needed, and adverse effects can lead to abnormal movements
* Deep brain stimulation (electrodes in brain)
Alternative treatment:
* Anti-inflammatory, antioxidant and mitochondrial support through diet (i.e. Mediterranean)
* Herbs
* B vitamins
* Exercise (30-45 mins of aerobic 3-5 x per week)
* Dietary protein intake at dinner to prevent competitive uptake between amino acids and L-dopa
Other:
* Substantia nigra ‘black substance’ – has a darker appearance due to high levels of neuromelanin in dopaminergic neurons
