Epilepsy

Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases. Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as a group of syndromes with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.

The diagnosis of epilepsy requires the presence of recurrent, unprovoked seizures; accordingly, it is usually made based on the medical history, EEG, MRI of the brain and long term video-EEG monitoring to discover an etiology for the epilepsy, discover the affected brain region, or classify the epileptic syndrome, but these studies are not useful in making the initial diagnosis.

Movement Disorders

Even a simple action such as picking up a pencil engages several different parts of the brain. The conscious thought areas of the brain trigger the motor area to send signals to the muscles of the arm. As the movement begins, sensors in the arm are activated, sending signals back into different areas of the brain that interpret them and then send further messages to the motor area to fine tune power, speed, co-ordination and balance.

With such complexity, problems with the control of movement are understandably widespread. Essential tremor - the most common movement disorder - affects one in 20 people under the age of 40 and one in five people aged over 65, while 25 per cent of older people have restless legs syndrome.
Other conditions such as Parkinson's disease (which affects one in 500 people) are less common but, because they destroy the independence of those affected, wreak havoc.

Dyskinesia simply means abnormal ('dys') movement ('kinesia'). Tics, spasm, athetosis (slow, writhing motions), chorea (rapid, randomly irregular jerky movements) and dystonia are all different types of dyskinesia. The term 'paroxysmal' is also often used, to indicate that the abnormal movements are sudden and unpredictable, with a fairly rapid return to normal.

Dyskinesia is often used to describe the movement difficulties of Parkinson's disease and similar disorders. They're also a common side-effect of certain drugs, such as L-Dopa and antipsychotic medication.

In dystonia there are sustained or persistent contractions of one or more muscles. This leads to abnormal postures or writhing, twisting movements of part of the body. There are many different types, with various muscles involved. Writer's cramp is an example of focal dystonia (limited to one group of muscles), causing bizarre postures in one arm when writing or typing and disappearing at rest.

Blepharospasm is a focal dystonia involving muscles that control closure of the eyelids. This leads to increased blinking and involuntary closing of the eyes. Dystonias tend to be aggravated by tiredness, stress, anxiety and emotion.
Tics are involuntary rapid and repeated contractions of a group of muscles. This may cause movement, such as blinking, shrugging or grimacing, or the production of a sound.

A tremor is an involuntary, rhythmic oscillation of a body part due to contractions of opposing muscles. There may be many causes. Everybody has a physiological tremor - that is, a very faint tremor in response to signals from the part of the brain called the cerebellum. Certain factors, such as exercise, emotional stress, or an overactive thyroid gland, can make this 'normal' tremor more prominent.

Essential tremor is as common as angina or stroke. It usually causes a tremor of the hands and feet, but the head and voice may also be affected. Very little is known about what goes on in the brain to cause essential tremor. It's often dismissed as insignificant, especially in elderly people, or misdiagnosed as Parkinson's disease. But although it isn't fatal, it can cause severe disability. Essential tremor can be treated with drugs, including beta-blockers, or brain surgery in severe cases.

Strokes

Early treatment can help minimize damage to brain tissue and improve the outcome (prognosis). Treatment depends on whether the stroke is ischemic or hemorrhagic and on the underlying cause of the condition. The long-term goals of treatment include rehabilitation and prevention of additional strokes.

Headaches/Migraines

Migraine headache pain is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head. The headache is often so severe that it interferes with daily activity and may awaken the person. The attack is debilitating, and migraine sufferers are often left feeling tired and weak once the headache has passed.

A migraine headache typically begins in a specific area on one side of the head, then spreads and builds in intensity over 1 to 2 hours and then gradually subsides. It can last up to 24 hours, and in some cases, several days.

There may be accompanying symptoms such as nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). Hands and feet may feel cold and sweaty and unusual odors may be intolerable.

Diagnosis of migraine is based on the history of symptoms, physical examination, and neurological tests. The tests are performed to rule out other neurological and cerebrovascular conditions.

The physician analyzes the patient's migraine history to devise an appropriate treatment program. The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine (called abortive treatment)

Dizziness

Vertigo, or dizziness, is a symptom, not a disease. The term vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in balance (equilibrium). It also may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

Treatment for vertigo, or dizziness, depends on identifying and eliminating the underlying cause. If a particular medication is responsible for the condition, lowering the dosage or discontinuing the drug may eliminate vertigo.
Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to treat vertigo. The goal of treatment is to minimize dizziness, improve balance, and prevent falls by restoring normal function of the vestibular system.

ADD/ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder and, more specifically, a chronic neurobehavioral syndrome. ADHD manifests as inattention, impulsivity, and hyperactivity. The term attention-deficit disorder (ADD) refers to the condition without hyperactivity.

A thorough medical examination is important to identify other conditions that may be responsible for symptoms or that coexist with ADHD and require treatment. Hearing and vision assessments should be included in the examination. The most important diagnostic tool is the clinical interview.

The first step in the treatment of ADHD is education, which includes providing clear information about what the disorder is, its possible causes, and how medication and behavioral therapy can help. The following are important to remember:

• Fifty percent of children with ADHD show improvement with psychostimulant medication and behavioral therapy.
• A number of national resources provide support and information.

The goal of behavioral therapy in children with ADHD is to reduce symptoms and improve function. Chances of conquering ADHD are better when parents participate in the treatment of their children.