General Neurology

Alzheimer’s disease is a progressive, neurodegenerative disease that occurs when nerve cells in the brain die and often results in the following:

• Impaired memory, thinking and behavior
• Confusion
• Restlessness
• Personality and behavior changes
• Impaired judgment
• Impaired communication
• Inability to follow directions
• Language deterioration
• Impaired thought processes that involve visual and spatial awareness
• Emotional apathy

Motor function is often preserved with Alzheimer’s disease.

An estimated 5.3 million Americans have Alzheimer’s disease and this number includes 5.1 million people who are over the age of 65. It also includes 200,000 to 500,000 people younger than 65 who have early-onset Alzheimer’s and other types of dementias.

Brains affected by Alzheimer’s disease often show presence of fiber tangles within nerve cells (neurofibrillary tangles) and clusters of degenerating nerve ending (neuritic plaques).

Alzheimer’s disease also causes the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin and somatostatin.

Causes of Alzheimer’s Disease

The cause of Alzheimer’s is not entirely known. But, suspected causes often include the following:

• Age and family history
• Certain genes
• Abnormal protein deposits in the brain
• Other risk and environmental factors
• Immune system problems

Symptoms of Alzheimer’s Disease

Although each individual may experience them differently there are warning signs or symptoms of the disease.

• Memory loss that affects job skills
• Difficult performing familiar tasks
• Problems with language
• Disorientation to time and place
• Poor or deceased judgment
• Problems with abstract thinking
• Misplacing things
• Changes in mood or behavior
• Changes in personality
• Loss of initiative

Treatment of Alzheimer’s Disease

Treatment for Alzheimer’s will be based on such factors as age, overall health, extent of the condition, medical history, etc. There is no cure and no way of slowing down the progression of the disease, nor any treatment available to reverse the deterioration of Alzheimer’s disease. However, there is new research findings and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease or improve memory of a period of time.

There are some medications available to help manage some of the most troubling symptoms of the disease:

• Depression
• Behavioral disturbance
• Sleeplessness

Rehabilitation for Alzheimer’s Disease

Every rehabilitation plan for Alzheimer’s will be specific to the individual and therefore different depending upon the patient’s symptoms, expression, and progression of the disease. Making a diagnosis of the disease is also very difficult.

It is important to remember that, although any skills lost will not be regained, the caregiving team must keep in mind the following considerations:

• In managing the disease, physical exercise and social activity are important, as are proper nutrition and health maintenance
• Plan daily activities that help to provide structure, meaning, and accomplishment for the individual
• As functions are lost, adapt activities and routines to allow the individual to participate as much as possible
• Keep activities familiar and satisfying
• Allow the individual to complete as many things by himself/herself as possible. The caregiver may need to initiate an activity, but allow the individual to complete it as much as he/she can
• Provide "cues" for desired behavior (i.e., label drawers/cabinets/closets according to their contents)
• Keep the individual out of harm's way by removing all safety risks (i.e., car keys, matches)
• As a caregiver (full-time or part-time), it is important to understand your own physical and emotional limitations

Amyotrophic lateral sclerosis, or ALS, is a terminal neurological disorder characterized by progressive degeneration of nerve cells in the spinal cord and brain. It is often referred to as “Lou Gehrig’s Disease" after the famous baseball player who died from it. It is one of the most devastating of the disorders that affects the function of nerves and muscles.

There are different types of ALS:

• Sporadic ALS is the most common, involving 90 to 95 percent of all cases, which occur randomly without any known cause or family connection
• Familial ALS occurs when the disease is inherited, which accounts for a very small number of cases in the U.S
• Guamanian ALS was observed in an extremely high incidence in Guam and the Trust Territories of the Pacific in the 1950s

Symptoms of ALS

Every individual may experience symptoms differently, but the following are some common signs of the disease:

• Twitching and cramping of muscles, especially those in the hands and feet
• Loss of motor control in the hands and arms
• Impairment in the use of arms and legs
• Tripping and falling
• Dropping things
• Persistent fatigue
• Uncontrollable periods of laughing or crying
• Slurred or thick speech and difficulty in projecting the voice
• If the disease progresses it exhibits the following:
  • Difficulty breathing
  • Difficulty swallowing
  • Paralysis

Treatment for ALS

Your particular treatment for ALS will depend on certain factors specific to you including your age, overall health, medical history, extent of the illness, etc. There is no proven treatment for ALS. It is more a matter of managing the symptoms, which may include physical, occupational, speech, respiratory and nutritional therapies. The U.S. Food and Drug Administration has approved Rilutek®, which is the first drug that has prolonged the survival of persons with ALS.

Carpal tunnel syndrome is a condition where the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. This tunnel is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. This affects the thumb and three middle fingers. Women are more likely to get it than men and it usually occurs in adults.

Causes of Carpal Tunnel Syndrome

For most, there is no specific cause of the condition; however the following may serve as a contributing factor:

• Frequent, repetitive, small movements with the hands (such as typing or suing a keyboard)
• Frequent, repetitive, grasping movements with the hands (such as with sports and certain physical activities)
• Joint or bone disease (i.e. arthritis, osteoarthritis, rheumatoid arthritis)
• Hormonal or metabolic changes (i.e. menopause, pregnancy, thyroid imbalance)
• Changes in blood-sugar levels (may be seen with type 2 diabetes)
• Other conditions or injuries of the wrist (i.e. strain, sprain, dislocation, break or swelling and inflammation)

Symptoms of Carpal Tunnel Syndrome

Everyone may experience carpal tunnel syndrome differently, but the following are a list of common signs:

• Difficulty making a fist
• Difficulty gripping objects with the hand
• Pain and/or numbness in the hands
• “Pins and needles” feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and index and middle fingers
• Pain and/or numbness that is worse at night, interrupting sleep

Always consult your doctor for a proper diagnosis as these symptoms may resemble other conditions.

Treatment of Carpal Tunnel Syndrome

Your particular treatment for carpal tunnel syndrome will depend on a number of factors specific to you including your age, overall health, medical history, extent of the condition etc. Aside from those factors there are some common treatments for the condition which may include:

• Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
• Oral or injected (into the carpal tunnel space) anti-inflammatory medications (to reduce the swelling)
• Surgery (to relieve compression on the nerves in the carpal tunnel)
• Changing position of a computer keyboard, or other ergonomic changes

The National Institute of Neurological Disorders and Stroke finds that the carpal tunnel release is one of the most common surgical procedures performed in the U.S. It is generally performed in an outpatient location under local or general anesthesia.

Multiple Sclerosis, or MS, is a chronic disease of the central nervous system and is thought to be an autoimmune disorder. It affects individuals differently. Some may be mildly affected while others my lose their ability to write, speak, or walk- when communication between the brain and other parts of the body becomes disrupted.

MS is when the fatty tissue, called myelin, that surrounds and protects nerve fibers is lost in multiple areas and forms scar tissue called sclerosis. These areas are also called plaques or lesions. When they are damaged in this way, the nerves are unable to conduct electrical impulses to and from the brain.

Causes of Multiple Sclerosis

There are many possible causes including:

• Viruses
• Autoimmune disorders
• Environmental factors
• Genetic factors

Symptoms of Multiple Sclerosis

MS symptoms are erratic. They can be mild or severe, of long duration or short. They may appear in various combinations, depending on the area of the nervous system affected. Although individuals may experience symptoms differently, common symptoms include:

The following are often initial symptoms of MS:

• Blurred or double vision
• Red-green color distortion
• Pain and loss of vision due to optic neuritis, an inflammation of the optic nerve
• Difficulty walking
• Paresthesia - abnormal sensation, or pain, such as numbness, prickling, or "pins and needles."

Other symptoms of multiple sclerosis:

Throughout the course of the illness, an individual may experience any/all of the following symptoms, to a varying degree:

• Muscle weakness in the extremities
• Difficulty with coordination (impaired walking or standing may result; partial or complete paralysis is possible)
• Spasticity - the involuntary increased tone of muscles leading to stiffness and spasms.
• Fatigue (this may be triggered by physical activity, but may subside with rest; constant, persistent fatigue is possible)
• Loss of sensation
• Speech impediments
• Tremor
• Dizziness
• Hearing loss
• Bowel and bladder disturbances
• Depression
• Changes in sexual function

Approximately 50 percent of all people with MS experience cognitive impairments related to their disease. The effects of these impairments may be mild, often detectable only after comprehensive testing, and may include difficulty with any/all of the following:

• Concentration
• Attention
• Memory
• Poor judgment

Myasthenia gravis (neuromuscular junctions) is a complex, autoimmune disorder in which antibodies destroy neuromuscular connections. This results in weakness of the skeletal muscles. MG affects the voluntary muscles of the body like the eyes, mouth, throat and limbs.

About 20 people in 100,000 are affected by MG in the United States, with women seeing an onset by age 20 to 30 and men most commonly by age 50. Males, more than females, are affected by the disorder.

Causes of Myasthenia Gravis

The disorder is acquired through immune proteins/antibodies to babies born to mothers with MG or it may develop spontaneously later in life. It is not inherited as a rare genetic disease nor is it contagious.

There are several types of MG:

• Congenital MG is a very rare, non-immune form of MG that is inherited as an autosomal recessive disease. This means males and females are equally affected and two copies of the gene, one inherited from each parent, are necessary to have the condition. Symptoms of congenital MG usually begin in the baby’s first year and are life-long
• Transient neonatal MG affects between 12 to 20 percent of babies born to mothers with MG have this temporary form. It occurs when antibodies common in MG cross the placenta to the developing fetus. It usually only lasts a few weeks and babies are not at greater risk for developing MG later in life
• Juvenile MG is an auto-immune disorder that develops typically in female adolescents – especially Caucasian females. It is a life-long condition that may go in and out of remission. About 10 percent of MG cases are juvenile-onset
• MG may occur in adults at any age, although symptoms begin to appear more often between the ages of 20 to 30 in women and 50 to 60 in men

Symptoms of Myasthenia Gravis

Although each individual may experience MG differently, the following are common symptoms:

• Visual problems, including drooping eyelids (ptosis) and double vision (diplopia). About two-thirds of people with MG exhibit these symptoms first.
• Severe muscle weakness and fatigue that may vary rapidly in intensity over days or even hours
• Facial muscle involvement causing a mask-like appearance; smile may appear more like a snarl
• Difficulty in swallowing and/or pronouncing words
• Weakness of the neck and/or limbs

For a proper diagnosis always consult your doctor. Exacerbations and remissions may occur periodically during the course of MG, however remissions are only rarely permanent or complete.

Treatment of Myasthenia Gravis

Your particular treatment for MG will depend on a number of factors like your age, overall health, medical history, extent of the condition, etc. There is no cure for MG, but the symptoms can sometimes be controlled. It is a life-long condition with the key being to manage early detection. Treatment seeks to prevent respiratory problems and provide adequate nutritional care since the swallowing and breathing muscles are affected by MG.

Some common treatment may include:

• Medications: anticholinesterase medications, such as Prostigmin or Tensilon ; steroids; and/or immunosuppressive (suppress the immune system’s response) medications may be used
• Thymectomy: surgical removal of the thymus gland. What the thymus gland does in MG is not fully understood, and the thymectomy may or may not improve symptoms
• However, thymectomy reduces symptoms in more than 70 percent of patients who do not have cancer of the thymus, possibly by altering the immune system response, according to the National Institute of Neurologic Disorders
• Plasmapheresis: a procedure that remove abnormal antibodies from the blood and replaces the blood with normal antibodies through donated blood
• Immunoglobulin: a blood product that helps to decrease the immune systems’s attack on the nervous system, given intravenously (IV)

MG Crisis

The severity of the condition can vary and some may require a breathing machine to help the person breathe easier. Your Valley team of experts will help educate the family after hospitalization on how best to care for the person at home and will outline the problems that require immediate medical attention by the person’s physician.

MG crisis is a condition of extreme muscle weakness, particularly of the diaphragm and chest muscle that support breathing. MG crisis may be caused by a lack of medication or by other factors, such as a respiratory infection, emotional stress, surgery, or some other type of stressor. In a worst case scenario, a person might have to be put on a ventilator to assist breathing until muscle strength returns with treatment.

The following precautions can be taken to minimize the occurrence of MG crisis:

• Taking anticholinesterase medications 30 to 45 minutes prior to meals to reduce the risk of aspiration (food entering the lung passages)
• Taking anticholinesterase medications precisely as ordered by the physician to help maintain the strength of breathing muscles
• Avoid crowds and contact with people with respiratory infections, such as the cold or the flu
• Take in proper nutrition to maintain optimal weight and muscle strength
• Alternate performance of physical activities with periods of rest
• Use stress-reduction techniques and avoid emotional extremes
• Notify any healthcare provider of your condition when any medications are being prescribed, as certain medications may interfere either with the disease or the action of the medications your take for MG

Parkinson’s is a motor system disorder that is a slowly progressing, degenerative disease that is usually associated with the following symptoms. All of these result from the loss of dopamine-producing brain cells:

• Tremor or trembling of the arms, jaw, legs and face
• Stiffness or rigidity of the limbs and trunk
• Bradykinesia (slowness of movement)
• Postural instability, or impaired balance and coordination

The substance dopamine is produced in the body which has many effects, including smooth and coordinated muscle movement.

About 60,000 Americans are newly diagnosed with Parkinson’s disease each year, with more than 1 million American affected at any one time. More people suffer from Parkinson’s disease than multiple sclerosis, muscular dystrophy and amyotrophic lateral disease combined.

Causes of Parkinson’s Disease

The cause is yet unknown, however medical experts think the symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson’s is chronic and progressive disease. The disease may appear in young patients, but usually affects people in late middle age. It is not contagious.

The average age for the advancing onset is 60 years. Also, 50 percent more men are affected than women, according to the National Institute of Neurological Disorders and Stroke, but the reason is unclear.

Another important risk factor is family history. If you have a parent of sibling with the disease, you are two times as likely of developing Parkinson’s. Environmental and genetic factors are the cause of this increased risk most likely.

Being researched are environmental causes and the strong consistent findings are that rural living, exposure to well water, and exposure to agricultural pesticides and herbicides are related to Parkinson’s. However, these factors do not guarantee the development of Parkinson’s, nor does the absence prevent it. Having one or more relatives with Parkinson’s increases one’s rick of developing the disease, however, unless there is a known genetic mutation for PD present, the increased risk is only 2 to 5 percent.

Researchers currently believe that in most individuals the cause of Parkinson’s is a combination of genetics and environmental exposure.

Symptoms of Parkinson’s Disease

Although each individual may experience them differently, the following are common symptoms of Parkinson’s disease:

• Muscle rigidity – stiffness when the arm, leg, or neck is moved back and forth
• Resting tremor- tremor (involuntary movement from contracting muscles) that is most prominent at rest
• Bradykinesia – slowness in initiating movement
• Postural instability – poor posture and balance that may cause falls; gait or balance problems

Symptoms may appear slowly and in no particular order and early symptoms may be subtle and progress over many years before reaching a point where they interfere with normal daily activities.

The four major symptoms are Parkinson’s are listed above; other symptoms are divided into motor (movement related) and nonmotor symptoms.

Motor symptoms:

• Tremor
• Bradykinesia (slow movement)
• Rigidity and freezing in place
• Stooped posture
• Shuffling gait
• Decreased arm swing when walking
• Difficulty rising from a chair
• Micrographia (small, cramped handwriting)
• Lack of facial expression
• Slowed activities of daily living (e.g. eating, dressing, bathing, etc.)
• Difficulty turning in bed
• Remaining in a certain position for a long period of time
• Nonmotor symptoms
• Diminished sense of smell
• Low voice volume
• Difficulty speaking
• Painful foot cramps
• Sleep disturbance
• Depression
• Emotional changes (fearful and insecure)
• Skin problems
• Constipation
• Drooling
• Increased sweating
• Urinary frequency/urgency
• Male erectile dysfunction
• Walking may become affected as the disease progresses causing the patient to stop in mid-stride or “freeze” in place and maybe even fall over. Patients may also exhibit festination, or walking with a series of quick, small steps as if hurrying forward to keep balance.

For a proper diagnosis consult your doctor, as symptoms of Parkinson’s may resemble other medical conditions.

Treatment of Parkinson’s Disease

Your treatment for Parkinson’s disease will be based on a number of factors including your age, overall health, medical history, extent of the disease, etc. There is as of yet no cure for Parkinson’s. However, physicians will establish an appropriate treatment protocol based on the severity of the symptoms and medical profile. That may include:

• Medications
• Surgery
• Complementary and supportive therapies, such as diet, exercise, physical therapy, occupational therapy and speech therapy
• The decision to give the patient medication once a diagnosis has been made depends on the following:
  • The degree of functional impairment
  • The degree of cognitive impairment
  • Ability to tolerate antiparkinsonian medication
  • The advice of the attending physician
• If surgery is selected, there are several types that can help patients with Parkinson’s disease:
  • Lesion surgery (burning of tissue)
  • Deep brain stimulation
  • Neural grafting or tissue transplants

Surgery may help with Parkinson’s symptoms, but it does not cure the disease or stop the progression of the disease.

Sciatica is also called lumbar radiculopathy and is a pain that originates along the sciatic nerve which runs from the back of the pelvis down the back of the thigh. It is the primary nerve of the leg and also the larges nerve in the body.

Causes of Sciatica

It is mostly caused by a herniated disk in the spine that presses on the sciatic nerve. There are other causes that may put pressure on the sciatic nerve. They include:

• Tumor
• Abscess
• Blood clot
• Awkward sitting position
• Any nerve disorders
• Other times a cause cannot be identified

How do I know I have sciatica?

These are common symptoms; however each person may experience them differently:

• Lower back pain that radiates down the buttock and back on one thigh
• Pain that extends from the buttock down to the foot
• Numbness in severe cases
• Weakness in severe cases

These symptoms may resemble other conditions, so consult your doctor for a proper diagnosis.

Treatment of Sciatica

Your treatment plan for sciatica will depend on a number of factors specific to you like your age, overall health, medical history, the extent of the injury, etc. Some common treatment options are as follows:

• Nonsteroidal anti-inflammatory medications
• Heat or cold applications to the sore muscle
• Keep your body in motion to minimize inflammation
• Surgery to repair the herniated disk if the condition persists

Tennis elbow is characterized by pain on the outside (lateral side) of the elbow.

Causes of Tennis Elbow

As the name implies, it is often cause by the force of the tennis racket hitting balls in the backhand position. In this case, the forearm muscles, which attach to the outside of the elbow, may become sore from excessive strain. In tennis, when making a backhand stroke, the tendons that roll over the end of the elbow can become damaged. The condition may be caused by the following:

• Improper backhand stroke
• Weak shoulder and wrist muscles
• Using too tightly strung or too short tennis racket, such as racquetball or squash
• Using repeated hand motions in various professions – meat cutters, musicians, dentists and carpenters
• Hitting the ball off center of n the racket or hitting heavy, wet balls
• Painting with a brush or roller
• Operating a chain saw
• Frequent use of other hand tools on a continuous basis

Symptoms of Tennis Elbow

Each individual may experience them differently, but the following are common symptoms of tennis elbow:

• Pain may be felt along the outside of the forearm and elbow
• Pain may increase down to the wrist, even at rest if the person continues the activity that causes the condition
• Pain may also persist when the arm and hand are placed palm-down on a table and the person tries to raise the hand against resistance

Treatment of Tennis Elbow

Your specific treatment for tennis elbow will depend on a number of factors specific to you including your age, overall heath, medical history, extent of the condition etc. Treatment for the condition includes stopping the activity that produces the symptoms and also:

• Ice pack application to reduce inflammation
• Strengthening exercises
• Anti-inflammatory medications
• Bracing
• Corticosteroid injections
• Surgery

• The Official Journal of the American Academy of Neurology
• Nature.com ClinicalPractice Neurology
• Medscape Neurology & Neurosurgery from WebMD
• The American Academy of Neurology
• National Multiple Sclerosis Society