LOM Neurology Notes

NEUROLOGY

INTRODUCTION

The nervous system is one of the most complex of all human body systems. More
than 100 billion nerve cells operate constantly all over the body to coordinate the
activities we do consciously and voluntarily, as well as those that occur unconsciously or
involuntarily. We speak, move muscles, hear, taste, see, and think. Our glands secrete
hormones, and we respond to danger, pain, temperature, and touch. All of these functions
comprise only a small number of the many activities controlled by the nervous system.

Fibers exiting from microscopic nerve cells (neurons) are collected into macroscopic
bundles called nerves, which carry electrical messages all over the body. External stimuli,
as well as internal chemicals such as acetylcholine, activate the cell membranes of nerve
cells, which results in electrical discharges of these cells. These electrical discharges,
nervous impulses, may then traverse the length of the associated nerves. External
receptors (sense organs) as well as internal receptors in muscles and blood vessels receive
these impulses and may in turn transmit impulses to the complex network of nerve cells in
the brain and spinal cord. Within this central part of the nervous system, impulses are
recognized, interpreted, and finally relayed to other nerve cells that extend out to all
parts of the body, such as muscles, glands, and internal organs.

GENERAL STRUCTURE OF THE NERVOUS SYSTEM

The nervous system is classified into two major divisions: the central nervous
system (CNS) and the peripheral nervous system (PNS). The central nervous system
consists of the brain and spinal cord. The peripheral nervous system consists of 12 pairs of
cranial nerves and 31 pairs of spinal nerves, plexuses, and peripheral nerves throughout
the body. Cranial nerves carry impulses between the brain and the head and neck. The one
exception is the 10th cranial nerve, called the vagus nerve. It carries messages to and
from the neck, chest, and abdomen. Cranial nerves functions, and the parts of the body
that they carry messages to and from. Spinal nerves carry messages between the spinal
cord and the chest, abdomen, and extremities.

A plexus is a large network of nerves in the peripheral nervous system. The

cervical, brachial (brachi/o means arm), and lumbosacral plexuses are examples that
include cervical, lumbar, and sacral nerves.

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The spinal and cranial nerves are composed of nerves that help the body respond to
changes in the outside world. They include sense receptors for sight (eye), hearing and
balance (ear), smell (olfactory), and touch (skin sensation) and sensory (afferent) nerves
that carry messages related to changes in the environment toward the spinal cord and
brain. In addition, motor (efferent) nerves travel from the spinal cord and brain to
muscles of the body, telling them how to respond. For example, when you touch a hot
stove, temperature and pain receptors in the skin stimulate afferent nerves, which carry
messages toward the spinal cord and brain. Instantaneously, the message is conveyed to
efferent nerve cells in the spinal cord, which then activate voluntary muscles to pull your
hand away from the stove.

In addition to the spinal and cranial nerves (whose functions are mainly voluntary and
involved with sensations of smell, taste, sight, hearing, and muscle movements), the
peripheral nervous system also contains a large group of nerves that function involuntarily
or automatically, without conscious control. These peripheral nerves belong to the
autonomic nervous system. This system of nerve fibers carries impulses away from the
CNS to the glands, heart, blood vessels, and involuntary muscles found in the walls of
tubes like the intestines and hollow organs like the stomach and urinary bladder.
Some autonomic nerves are sympathetic nerves and others are parasympathetic nerves.
The sympathetic nerves stimulate the body in times of stress and crisis. They increase
heart rate and forcefulness, dilate (relax) airways so more oxygen can enter, and increase
blood pressure. In addition, sympathetic neurons stimulate the adrenal glands to secrete
epinephrine (adrenaline), while also inhibiting intestinal contractions to slow digestion.
The parasympathetic nerves normally act as a balance for the sympathetic nerves.
Parasympathetic nerves slow down heart rate, lower blood pressure, and stimulate
intestinal contractions to clear the rectum.

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CRANIAL NERVES AND THEIR FUNCTIONS

A nerve is sensory when it carries messages toward the brain and from sense organs and
motor when it carries messages from the brain to muscles and internal organs. Mixed
nerves carry both sensory and motor fibers.

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NEURONS, NERVES, AND GLIAL CELLS

A neuron is an individual nerve cell, a microscopic structure. Impulses pass along

the parts of a nerve cell in a definite manner and direction.

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A stimulus begins an impulse in the branching fibers of the neuron, which are called
dendrites. A change in the electrical charge of the dendrite membranes is thus begun, and
the nervous impulse moves along the dendrites like the movement of falling dominoes.
The impulse, traveling in only one direction, next reaches the cell body, which contains the
cell nucleus. Small collections of nerve cell bodies outside the brain and spinal cord are
called ganglia (singular: ganglion). Extending from the cell body is the axon, which carries
the impulse away from the cell body. Axons can be covered with a fatty tissue called
myelin. The purpose of this myelin sheath is to insulate the axon and speed transmission of
the electrical impulse. Demyelination is loss of the myelin insulating the nerve fiber andis
characteristic of multiple sclerosis, an acquired illness affecting the CNS.
The myelin sheath gives a white appearance to the nerve fiber—hence the term white
matter, as in parts of the spinal cord and the white matter of the brain and most
peripheral nerves. The gray matter of the brain and spinal cord is composed of the cell
bodies of neurons that appear gray because they are not covered by a myelin sheath. The
nervous impulse passes through the axon to leave the cell via the terminal end fibers of
the neuron. The space where the nervous impulse jumps from one neuron to another is
called the synapse. The transfer of the impulse across the synapse depends on the release
of a chemical substance, called a neurotransmitter, by the neuron that brings the impulse
to the synapse. Tiny sacs (vesicles) containing the neurotransmitter are located at the
ends of neurons, and they release the neurotransmitter into the synapse. Acetylcholine,
norepinephrine, epinephrine (adrenaline), dopamine, serotonin, and endorphins are examples
of neurotransmitters. Whereas a neuron is a microscopic structure within the nervous
system, a nerve is macroscopic, able to be seen with the naked eye. A nerve consists of a
bundle of dendrites and axons that travel together like strands of rope. Peripheral nerves
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that carry impulses to the brain and spinal cord from stimulus receptors like the skin, eye,
ear, and nose are afferent or sensory nerves; those that carry impulses from the CNS to
organs that produce responses, such as muscles and glands, are efferent or motor
nerves.Neurons and nerves are the parenchyma of the nervous system. Parenchyma is the
essential distinguishing tissue of an organ. In the brain and spinal cord, neurons, which
conduct electrical impulses, are the parenchymal tissue. Stroma of an organ is the
connective and supportive tissue of an organ. The stromal tissue of the nervous system
consists of the glial (neuroglial) cells, which make up its supportive framework and help it
ward off infection. Glial cells do not transmit impulses. They are far more numerous than
neurons and can reproduce.
There are four types of supporting or glial cells. Astrocytes (astroglial cells) are star-like
in appearance (astr/o means star) and transport water and salts between capillaries and
neurons. Microglial cells are small cells with many branching processes (dendrites). As
phagocytes, they protect neurons in response to inflammation. Oligodendroglial cells
(oligodendrocytes) have few (olig/o means few or scanty) dendrites. These cells form the
myelin sheath in the CNS. By contrast, ependymal cells (Greek ependyma means upper
garment) line membranes within the brain and spinal cord where CSF is produced and
circulates. Glial cells, particularly the astrocytes, are associated with blood vessels and
regulate the passage of potentially harmful substances from the blood into the nerve cells
of the brain.
This protective barrier between the blood and brain cells is called the blood-brain barrier
(BBB). This barrier consists of special lining (endothelial) cells, which along with astrocytes
separate capillaries from nerve cells. Delivery of chemotherapeutic drugs to treat brain
tumors is thus difficult, because the BBB blocks drug access to brain tissues.

THE BRAIN

The brain controls body activities. In the human adult, it weighs about 3 pounds
and has many different parts, all of which control different aspects of body functions.
The largest part of the brain is the “thinking” area, or cerebrum. On the surface
of the cerebrum, nerve cells lie in sheets, which make up the cerebral cortex. These
sheets, arranged in folds called gyri, are separated from each other by grooves known as
sulci. The brain is divided in half, a right side and a left side, which are called cerebral
hemispheres. Each hemisphere is subdivided into four major lobes named for the cranial
(skull) bones that overlie them. These lobes—frontal, parietal, occipital, and temporal—as
well as gyri and sulci.

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The cerebrum has many functions. Thought, judgment, memory, association, and
discrimination take place within it. In addition, sensory impulses are received through
afferent cranial nerves, and when registered in the cortex, they are the basis for
perception. Cranial nerves carry motor impulses from the cerebrum to muscles and glands,
and these produce movement and activity In the middle of the cerebrum are spaces, or
canals, called ventricles. They contain a watery fluid that flows throughout the brain and
around the spinal cord. This fluid is cerebrospinal fluid (CSF), and it protects the brain
and spinal cord from shock by acting like a cushion. CSF usually is clear and colorless and
contains lymphocytes, sugar, and proteins. Spinal fluid can be withdrawn for diagnosis or
relief of pressure on the brain; this is called a lumbar puncture (LP). For this procedure, a
hollow needle is inserted into the lumbar region of the spinal column below the region
where the nervous tissue of the spinal cord ends, and CSF is withdrawn.

Two other important parts of the brain are the thalamus and the hypothalamus.
The thalamus acts like a triage center. It decides what is important and what is not,
selectively processing and relaying sensory information to the cerebral cortex. The
thalamus also plays a major role in maintaining levels of awareness and consciousness. The
hypothalamus (below the thalamus) contains neurons that control body temperature, sleep,
appetite, sexual desire, and emotions such as fear and pleasure. The hypothalamus also
regulates the release of hormones from the pituitary gland at the base of the brain and
integrates the activities of the sympathetic and parasympathetic nervous systems.

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The following structures within the brain lie in the back and below the cerebrum and
connect the cerebrum with the spinal cord: cerebellum, pons, and medulla oblongata. The
pons and medulla are part of the brainstem.

The cerebellum functions to coordinate voluntary movements and to maintain

balance and posture.

The pons is a part of the brainstem that literally means bridge. It contains nerve
fiber tracts that connect the cerebellum and cerebrum with the rest of the brain. Nerves
to the eyes and face lie here.

The medulla oblongata, also in the brainstem, connects the spinal cord with the rest
of the brain. Nerve tracts cross from right to left and left to right in the medulla
oblongata. For example, nerve cells that control movement of the left side of the body are
found in the right half of the cerebrum. These cells send out axons that cross over
(decussate) to the opposite side of the brain in the medulla oblongata and then travel down
the spinal cord.

In addition, the medulla oblongata contains three important vital centers that regulate
internal activities of the body:
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1. Respiratory center—controls muscles of respiration in response to chemicals or other

stimuli

2. Cardiac center—slows the heart rate when the heart is beating too rapidly

3. Vasomotor center—affects (constricts or dilates) the muscles in the walls of blood

vessels, thus influencing blood pressure

SPINAL CORD

The spinal cord is a column of nervous tissue extending from the medulla oblongata to the
second lumbar vertebra within the vertebral column. Below the end of the spinal cord is
the cauda equina (Latin for “horse’s tail”), a fan of nerve fibers. The spinal cord carries all
the nerves to and from the limbs and lower part of the body, and it is the pathway for
impulses going to and from the brain. A cross-sectional view of the spinal cord reveals an
inner region of gray matter (containing cell bodies and dendrites) and an outer region of
white matter (containing the nerve fiber tracts with myelin sheaths) conducting impulses
to and from the brain.

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MENINGES

The meninges are three layers of connective tissue membranes that surround the brain
and spinal cord. The outermost membrane of the meninges is the dura mater. This thick,
tough membrane contains channels (dural sinuses) that contain blood. The subdural space is
below the dural membrane. The second layer surrounding the brain and spinal cord is the
arachnoid membrane. The arachnoid (spider-like) membrane is loosely attached to the
other meninges by web-like fibers, so there is a space for fluid between the fibers and
the third membrane. This is the subarachnoid space, containing CSF. The third layer of
the meninges, closest to the brain and spinal cord, is the pia mater. It contains delicate
(Latin pia) connective tissue with a rich supply of blood vessels. Most physicians refer to
the pia and arachnoid membranes together as the pia-arachnoid.

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SYMPTOMS

The following are the possible symptoms of neurological disorders, but discretion and
medical help should be sought in case of doubt.

1. Weakness or paralysis of muscles in an arm, leg, part of the face, or eyes.

2. Problems with balance, coordination, vision, hearing, speech, communication, or
swallowing.
3. Loss of smell.
4. Dizziness: It is the feeling of being lightheaded, woozy, or unbalanced.
5. Numbness in a part of the body.
6. Confusion.
7. Personality changes.
8. Fatigue.
9. Sleeping difficulties, insomnia, hypersomnia.
10. Myalgia.
11. Memory loss.
12. Disorientation.
13. Poor concentration.
14. Failing intellect.
15. Personality changes and mood swings.
16. Fever.
17. Stiff neck.
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18. Vomiting.
19. Loss or blurring of vision.
20. Difficulty with speaking.
21. Slowness of movement (bradykinesia).
22. Stiffness of muscles (rigidity).
23. Shaking (tremor).
24. Hallucination: It is a perception in the absence of external stimulus that has qualities
of real perception.
25. Vertigo: False sensation of moving or spinning of objects usually accompanied by nausea
and loss of balance.
26. Narcolepsy: Uncommon sleep disorder with irrepressible attacks of sleep during normal
waking hours.
27. Sleep apnea: Group of sleep disorders in which a sleeping person repeatedly stops
breathing long enough to decrease the amount of oxygen in the blood and brain and to
increase the amount of carbon dioxide.
28. Parasomnia: Vivid dreams and physical activities that occur during sleep.
29. Syncope: Partial or complete loss of consciousness with interruption of awareness of
oneself and one's surroundings.

VOCABULARY

Absence seizure: Minor (petit mal) form of seizure consisting of momentary clouding of
consciousness and loss of contact with the environment.

Acetylcholine: Neurotransmitter chemical released at the ends of some nerve cells.

Afferent nerves: Nerves that carry impulses toward the brain and the spinal cord;
sensory nerve.

Agnosia: A rare disorder in which a person can see and feel objects but cannot associate
them with their usual role or function.

Agraphia: Loss of ability to write due to lesion in the brain.

Akinesia: Absence or loss of the power of voluntary movement.

Amnesia: Total or partial inability to recall recent or remote experiences.

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Aneurysm: Abnormal widening of a blood vessel; can lead to hemorrhage and stroke.

Aphasia: Loss of ability to use language because of an injury to the language area of the
brain.

Apraxia: Inability to perform tasks that require remembering patterns or sequences of

movements.

Arachnoid membrane: Middle layer of the three membranes (meninges) that surround the
brain and spinal cord; means spider-like.

Astereognosia: Inability to recognize objects or forms by touch.

Astrocyte: A type of neuroglial cell; connective, supporting cell of the nervous system.
Astrocytes transport water and salts between capillaries and nerve cells.

Astrocytoma: Malignant tumor of neuroglial brain cells (astrocytes).

Ataxia: An inability to coordinate muscle activity during voluntary movement; most often
due to disorders of the cerebellum or the posterior columns of the spinal cord; may involve
the limbs, head, or trunk.
Athetosis: This is a continuous stream of slow writhing movements generally of the hands
and feet.

Aura: Peculiar sensation appearing before more definite symptoms.

Autonomic nervous system: Nerves that control involuntary body functions; automatically
carry impulses from the brain and spinal cord to muscles, glands and internal organs.

Axon: Microscopic fiber that carries the nervous impulse along a nerve cell.

Basal ganglia: Originally, all of the large masses of gray matter at the base of the
cerebral hemisphere; currently, the striate body (caudate and lentiform nuclei) and cell
groups functionally associated with the striate body

Blood-brain barrier: Blood vessels (capillaries) that selectively let certain substances
enter the brain tissue and keep other substances out.

Brain stem: Lower portion of the brain that connects the cerebrum with the spinal cord.
The pons and the medulla oblongata are part of the brain stem.

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Cauda equina: Horse’s tail – a collection of spinal nerves below the end of the spinal cord
at the level of the second lumbar vertebra.

Cell body: Part of a nerve cell that contains the nucleus.

Central nervous system (CNS): The brain and the spinal cord.

Cerebellum: Posterior part of the brain. It is responsible for coordinating voluntary

muscle movements and maintaining balance.

Cerebral cortex: Outer region of the cerebrum; also called the gray matter of the brain.

Cerebrospinal fluid: Liquid that circulates throughout the brain and spinal cord.

Cerebrum: Largest part of the brain; responsible for voluntary muscular activity, vision,
speech, taste, hearing, thought, memory, and many other functions.

Coma: A state of unconsciousness. It can result from a variety of causes.

Convolution: Elevated portion of the cerebral cortex; gyrus.

Delirium: This is a potentially reversible condition that usually comes on suddenly. The
person has diminished ability to pay attention and is confused, disoriented and unable to
think clearly.

Dementia: Mental decline and deterioration.

Demyelination: Destruction of myelin on the axons of nerves (seen in multiple sclerosis).

Dendrite: Microscopic branching fiber of a nerve cell that is the first part to receive the
nervous impulse.

Dopamine: A neurotransmitter that is deficient in Parkinson's disease.

Dura mater: Outermost layer of the meninges surrounding the brain and spinal cord.

Dysarthria: A speech disorder that often affects people with cerebral palsy, caused by a
weakness in the muscles that produce speech.

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Dysdiadochokinesia: Decreased ability to do rapid alternating movements such as flipping

one’s hand over repetitively)

Dysmetria: An inability to judge the distance, power, or speed of a movement.

Dysphagia: Difficulty in swallowing.

Dystonia: Involuntary, slow, repetitive sustained muscle contractions may cause freezing
in the middle of an action as well as twisting, turning or torsion movement of the trunk, the
entire body or segments of the body.

Efferent nerves: Nerves that carry impulses away from the brain and spinal cord to the
muscles, glands, and organs; motor nerves.

Embolus: A mass (clot) of material travels through the bloodstream and suddenly blocks a
vessel.

Fissure: Depression or groove in the surface of the cerebral cortex; sulcus.

Gait: Manner of walking.

Gyrus: Elevation in the surface of the cerebral cortex; convolution.

Hemiballismus: Involuntary violent movement of a large body part.

Herpes zoster: Type of herpes virus that causes shingles.

Homogenous hemianopia: Loss of right or left half of the field of vision in both eyes.

Hypothalamus: Portion of the brain beneath the thalamus; controls sleep, appetite, body
temperature and the secretions from the pituitary gland.

Intervertebral disc: A cartilaginous joint that consists of a pad of fibrocartilage located

between two adjacent vertebrae.

Lamina: The flattened or arched part of the vertebral arch, forming the roof of the
spinal canal. The posterior part of the spinal ring that covers the spinal cord or nerves.

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Medulla oblongata: Part of the brain just above the spinal cord; controls breathing,
heartbeat and the size of the blood vessels; nerve fibers cross over here.

Meninges: Three protective membranes that surround the brain and the spinal cord.

Microglial cell: One type of neuroglial cell.

Motor nerves: Nerves (controlling motion) that carry messages away from the brain and
spinal cord to muscles and organs.

Myelin sheath: Fatty tissue that surrounds and protects the axon of a nerve cell.

Neglect: Can be produced by a lesion of the right frontal lobe where there is an inability
to interpret stimuli on left side of the body.

Nerve: Macroscopic structure consisting of axons and dendrites in bundles like strands of
rope.

Neuroglia: Cells in the nervous system that do not carry impulses but are supportive and
connective in function. Examples are astrocytes, microglial cells and oligodendroglia. There
are about 100 billion neuroglial cells.

Neuron: A nerve cell; carries impulses throughout the body. There are about 10 billion
neurons.

Neurotransmitter: Chemical messenger, released at the end of a nerve cell that

stimulates or inhibits another cell. The second cell affected may be another nerve cell, a
muscle cell or a gland cell. Examples of neurotransmitters are acetylcholine, epinephrine,
and dopamine.

Occlusion: Blockage.

Oligodendroglia: A neuroglial cell that produces myelin, which is the fatty tissue that
forms a sheath covering the axons.

Parasympathetic nerves: Involuntary, autonomic nerves that help regulate body functions
like heart rate and respiration.

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Perseveration: Repeatedly performing the same segment of a task repeatedly saying the
same word/phrase without purpose.

Peripheral nervous system: Nerves outside the brain and spinal cord; cranial, spinal and
autonomic nerves.

Pia mater: Thin delicate inner membrane of the meninges.

Plexus: A large, interlacing network of nerves. Examples are cervical, lumbar and brachial
plexuses.

Pons: Bridge – part of the brain anterior to the cerebellum and between the medulla and
the rest of the brain.

Receptor: An organ that receives a nervous stimulation and passes it on to nerves within
the body. The skin, ears, eyes, and taste buds are receptors.

Reflexes: An involuntary reaction in response to a stimulus applied to the periphery and

transmitted to the nervous centers in the brain or spinal cord. There are many kinds of
reflexes.

Sensory nerves: Nerves that carry messages to the brain and spinal cord from a receptor.

Stimulus: A change in the internal or external environment that can evoke a response.

Stupor: A condition where a person is immobile, mute, and unresponsive, but appears to be
fully conscious because the eyes are open and follow the movement of external objects.

Sulcus: Depression in the surface of the cerebral cortex; fissure.

Sympathetic nerves: Autonomic nerves that influence body functions involuntarily in

times of stress.

Synapse: The space through which a nervous impulse is transmitted from one neuron to
another or from a neuron to another cell such as a muscle of gland cell.

Synergies: Mass movement patterns that are primitive in nature coupled with spasticity
usually as a result of brain damage.

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Thalamus: Main relay center of the brain. It conducts impulses between the spinal cord
and the cerebrum; incoming sensory messages are relayed through the thalamus to
appropriate centers in the cerebrum.

Thymectomy: Removal of the thymus gland, a lymphocyte-producing gland in the chest).

Tremor: This is an involuntary, rhythmic shaking movement produced when muscles

repeatedly contract and relax. Action tremors occur when muscles are active. Resting
tremors occur when the muscles are resting. Intention tremor occurs when a person makes
a purposeful movement. Essential tremors are tremors that usually begin in early
adulthood, slowly become more obvious and have no known cause. Senile tremors are
essential tremors that begin in older people.

Ventricles of the brain: Reservoirs in the interior of the brain that are filed with
cerebrospinal fluid.

CONGENITAL
Topic Description
Disease SPINA BIFIDA
Definition A major birth defect and a type of neural tube defect that
involves an opening in the vertebral column caused by the
failure of the neural tube to close properly during embryonic
development.(The neural tube is the structure in the developing
embryo that gives rise to the brain and spinal cord.)
Cause  Idiopathic/ unknown
Risk Factors  Folate deficiency
 Family history of neural tube defects
 Some medications
 Diabetes
 Obesity
 Increased body temperature.
Types  Spina bifida occulta
 Spina bifida meningocele
 Myelomeningocele
Signs and symptoms Spina bifida occulta
 This mildest form results in a small separation or gap in
one or more of the bones (vertebrae) of the spine.
Because the spinal nerves usually aren't involved, most
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children with this form of spina bifida have no signs or

symptoms and experience no neurological problems.
 Visible indications of spina bifida occulta can sometimes
be seen on the newborn's skin above the spinal defect,
including:
 An abnormal tuft of hair
 A collection of fat
 A small dimple or birthmark
Meningocele

In this rare form, the protective membranes around the spinal

cord (meninges) push out through the opening in the vertebrae.
Because the spinal cord develops normally, these membranes
can be removed by surgery with little or no damage to nerve
pathways.
Myelomeningocele,

 Also known as open spina bifida, myelomeningocele is the

most severe form — and the form people usually mean
when they use the term "spina bifida."
 In this condition spinal canal remains open along several
vertebrae in the lower or middle back. Because of this
opening, both the membranes and the spinal cord
protrude at birth, forming a sac on the baby's back.

 In some cases, skin covers the sac. Usually, however,

tissues and nerves are exposed, making the baby prone
to life-threatening infections.

 Neurological impairment is common, including:

 Muscle weakness of the legs, sometimes involving

paralysis
 Bowel and bladder problems
 Seizures, especially if the child requires a shunt
 Orthopedic problems — such as deformed feet, uneven
hips and a curved spine (scoliosis)
Diagnosis/ Investigation  Blood tests
 Maternal serum alpha-fetoprotein (MSAFP) test. For
the MSAFP test, a sample of the mother's blood is
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drawn and tested for alpha-fetoprotein (AFP) — a

protein produced by the baby. It's normal for a small
amount of AFP to cross the placenta and enter the
mother's bloodstream. But abnormally high levels
of AFP suggest that the baby has a neural tube defect,
such as spina bifida, though high levels of AFP don't
always occur in spina bifida.
 Test to confirm high AFP levels. Varying levels
of AFP can be caused by other factors — including a
miscalculation in fetal age or multiple babies — so may
be a follow-up blood test is needed for confirmation. If
the results are still high, need further evaluation,
including an ultrasound exam.
 Other blood tests. Your doctor may perform
the MSAFP test with two or three other blood tests.
These tests are commonly done with the MSAFP test,
but their objective is to screen for other abnormalities,
such as trisomy 21 (Down syndrome), not neural tube
defects.
 Fetal ultrasound
 Amniocentesis
Treatment Treatment depends on several factors, mainly how severe the
signs and symptoms are
Surgical options
 Surgery to repair the spine: This can be done within 2
days of birth. The surgeon replaces the spinal cord and
any exposed tissues or nerves back into the newborn's
body. The gap in the vertebrae is then closed and the
spinal cord sealed with muscle and skin.
 If bone development problems occur later, such
as scoliosis or dislocated joints, further corrective
surgery may be needed. A back brace can help correct
scoliosis.
 Prenatal surgery: The surgeon opens the uterus and
repairs the spinal cord of the fetus, usually during week
19 to 25 of pregnancy. This type of surgery may be
recommended to reduce the risk of spina bifida
worsening after delivery.
 Cesarian-section birth: If spina bifida is present in the
fetus, delivery will probably be by cesarean section. This
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is safer for the exposed nerves.

 Hydrocephalus: Surgery can treat a buildup of
cerebrospinal fluid in the brain. The surgeon implants a
thin tube, or shunt, in the baby's brain. The shunt drains
away excess fluid, usually to the abdomen. A permanent
shunt is usually necessary.
 Further surgery may be needed if the shunt becomes
blocked or infected, or to install a larger one as the
child grows.
 Physical and occupational therapy
 Physical therapy: This is vital, as it helps the individual
become more independent and prevents the lower limb
muscles from weakening. Special leg braces may help
keep the muscles strong.
 Assistive technologies: A patient with total paralysis of
the legs will need a wheelchair. Electric wheelchairs are
convenient, but manual ones help maintain upper-body
strength and general fitness.
 Leg braces can help those with partial paralysis.
 Computers and specialized software may help those with
learning problems.
 Occupational therapy: This can help the child perform
everyday activities more effectively, such as getting
dressed. It can encourage self-esteem and
independence.
Complication  Traumatic birth and difficult delivery of the baby.
 Frequent urinary tract infections.
 Fluid buildup on the brain (hydrocephalus)

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Topic Description
Disease HYDROCEPHALUS

Definition Hydrocephalus is a condition that occurs when fluid builds up in

the skull and causes the brain to swell.
Cause Under certain conditions, the amount of CSF in brain increases.
The amount of CSF can increase when:
 a blockage develops that prevents CSF from flowing
normally
 there is a decrease in the ability of blood vessels to
absorb it
 brain produces an excess amount of it
Underlying causes
In some cases, hydrocephalus starts before a baby is born.
This can result from:
 a birth defect in which the spinal column doesn’t close
 a genetic abnormality
 certain infections that occur during pregnancy, such
as rubella
This condition can also occur in infants, toddlers, and older
children due to:
 central nervous system infections such as meningitis,
especially in babies
 bleeding in the brain during or shortly after delivery,
especially in babies born prematurely
 injuries that occur before, during, or after delivery
 head trauma

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 central nervous system tumors

Risk Factors  brain-related infections such as meningitis
 head injuries
 bleeding from a blood vessel in your brain
 brain surgery
Signs and symptoms Infants
 Early signs of hydrocephalus in infants include:
 bulging fontanel, which is the soft spot on the surface
of the skull
 a rapid increase in head circumference
 eyes that are fixed downward
 seizures
 extreme fussiness
 vomiting
 excessive sleepiness
 poor feeding
 low muscle tone and strength
 Toddlers and older children
Toddlers and older children include:
 short, high-pitched cries
 personality changes
 changes in facial structure
 crossed eyes
 headaches
 muscle spasms
 delayed growth
 trouble eating
 extreme sleepiness
 irritability
 loss of coordination
 loss of bladder control
 larger than normal head
 trouble staying awake or waking up
 vomiting or nausea
 seizures
 problems concentrating
 Young and middle-aged adults
Young and middle-aged adults include:
 chronic headaches
 loss of coordination
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 difficulty walking
 bladder problems
 vision problems
 poor memory
 difficulty concentrating
Diagnosis/ Investigation  neurological exam
 ultrasound
 Magnetic resonance imaging (MRI) scans can be used to
look for signs of excess CSF.
 CT scans
Treatment Hydrocephalus can be fatal if it’s left untreated. Treatment
may not reverse brain damage that’s already occurred. The goal
is to prevent further brain damage. This involves restoring the
normal flow of CSF.
Surgical options:
 Shunt insertion: In most cases, a shunt is surgically
inserted. The shunt is a drainage system made of a long
tube with a valve. The valve helps CSF flow at a normal
rate and in the right direction. Inserts one end of the
tube in your brain and the other end into your chest or
abdominal cavity. Excess fluid then drains from the
brain and out the other end of the tube, where it can be
more easily absorbed. A shunt implant is typically
permanent and has to be monitored regularly.
 Ventriculostomy: A procedure called a ventriculostomy
can be performed as an alternative to having a shunt
inserted. This involves making a hole at the bottom of a
ventricle or in between ventricles. This allows CSF to
leave the brain.
Complication Babies with congenital hydrocephalus may experience some
permanent brain damage, which can result in long-term
complications. It include:
 a limited attention span
 autism
 learning difficulties
 physical coordination problems
 problems with memory
 speech problems
 vision problems

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DEGENERATIVE MOVEMENT & SEIZURE DISORDERS

Topic Description
Disease ALZHEMERS DISEASE
Definition Alzheimer's disease is an irreversible, progressive brain
disorder that slowly destroys memory and thinking skills and,
eventually, the ability to carry out the simplest tasks.
Cause  It is not known exactly what causes this process to
begin, but people with Alzheimer’s disease have been
found to have abnormal clumps of protein (called amyloid
plaques) and bundles of protein fibres (called tau
tangles) in the brain.
Risk factors  Age - Risk for Alzheimer's goes up as you get older. For
most people, it starts going up after age 65.
 Gender - Women get the disease more often than men.
 Family history - People who have a parent or sibling with
Alzheimer’s are more likely to get it themselves.
 Down syndrome - It’s not clear why, but people with this
disorder often get Alzheimer's disease in their 30s and
40s.
 Head injury -Some studies have shown a link between
Alzheimer's disease and a major head injury.
 Other factors - High cholesterol levels and high blood
pressure may also raise your risk.
Signs and symptoms  Confusion
 Memory failure
 Disorientation,
 Restlessness
 Speech disturbances.
 Anxiety
 Depression
 emotional disturbances
Diagnosis/ Investigation  neurological exam
 ultrasound
 Magnetic resonance imaging (MRI) scans
 CT scans
Treatment Drugs
 Current Alzheimer's medications can help for a time
with memory symptoms and other cognitive changes.

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Two types of drugs are currently used to treat cognitive

symptoms:
 Cholinesterase inhibitors. These drugs work by boosting
levels of cell-to-cell communication by preserving a
chemical messenger that is depleted in the brain by
Alzheimer's disease. The improvement is modest.
 Cholinesterase inhibitors may also improve
neuropsychiatric symptoms, such as agitation or
depression. Commonly prescribed cholinesterase
inhibitors include donepezil (Aricept), galantamine
(Razadyne) and rivastigmine (Exelon).
 Memantine (Namenda). This drug works in another brain
cell communication network and slows the progression of
symptoms with moderate to severe Alzheimer's disease.
It's sometimes used in combination with a
cholinesterase inhibitor.
 Sometimes other medications such as antidepressants
may be prescribed to help control the behavioral
symptoms associated with Alzheimer's disease.
Creating a safe and supportive environment
 Adapting the living situation to the needs of a person
with Alzheimer's disease is an important part of any
treatment plan. For someone with Alzheimer's,
establishing and strengthening routine habits and
minimizing memory-demanding tasks can make life much
easier.
Complication  Restlessness and agitation. People diagnosed with AD
commonly have periods of agitation and anxiousness.
 Bladder and bowel problems. Bladder and bowel
problems are other complications of AD.
 Depression.
 Falls.
 Infections.
 Wandering.
 Malnutrition
 Dehydration.

AMAYOTROPHIC LATERAL SCLEROSIS

Topic Description
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Disease AMAYOTROPHIC LATERAL SCLEROSIS/ Lou Gehrig Disease.

Definition Amyotrophic lateral sclerosis is a type of motor neuron disease.

It refers to a group of progressive, neurological diseases that
cause dysfunction in the nerves that control muscle movement.
A famous baseball player, Lou Gehrig, became a victim of this
disease in the
mid-1900s, so the condition became known as Lou Gehrig
disease.
Types
Cause unknown
Risk Factors 
Signs and symptoms  Weakness and atrophy of muscles in the hands,
forearms, and legs
 Difficulty in swallowing and talking dyspnea develop as
the throat and respiratory muscles become affected.
 difficulty carrying out daily activities, including walking
 increased clumsiness
 cramping and twitching in the arms, shoulders, or tongue
 difficulty maintaining good posture and holding the head
up
 uncontrolled outbursts of laughing or crying, known as
emotional lability
 cognitive changes
 slurring of speech and difficulty with voice projection
 pain
 fatigue
 problems with saliva, and mucus
 difficulty breathing and swallowing, in the later stages
Diagnosis/ Investigation  electromyography (EMG), which detects electrical
energy in muscles
 nerve conduction study (NCS), which tests how well the
nerves send signals
 MRI
Treatment  There is no cure for ALS, so treatment aims to alleviate
symptoms, prevent unnecessary complications, and slow
the rate of disease progression.
Complication  Breathing in food or fluid (aspiration)
 Loss of ability to care for self.
 Lung failure.
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 Pneumonia.
 Pressure sores.
 Weight loss.

Topic Description
Disease EPILEPSY
Definition  Epilepsy is a condition in which a person has
recurrent seizures. A seizure is defined as an abnormal,
disorderly discharging of the brain's nerve cells,
resulting in a temporary disturbance of motor, sensory,
or mental function.
Types Focal seizures start on one side of your brain.
 Focal aware seizures mean you're awake and you can
respond to others
 Focal impaired seizures mean you're not completely
aware
 Focal motor seizures cause your body to jerk, twitch, or
move in other ways
 Focal non-motor seizures affect how you feel or think
Generalized seizures start on both sides of your brain.
 Generalized motor seizures make your body move or
twitch
 Generalized non-motor seizures don't cause movement

Cause  Tumor
 Chemical imbalance such as low blood sugar or sodium
 Head injuries
 Certain toxic chemicals or drugs of abuse
 Alcohol withdrawal
 Stroke, including hemorrhage
 Birth injuries
Risk Factors  Age
 Family history
 Head injuries
 Stroke and other vascular diseases
 Dementia
 Brain infections
 Seizures in childhood
Signs and symptoms 
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Diagnosis/ Investigation  A neurological exam.

 Blood tests.
 Electroencephalogram (EEG).
 High-density EEG
 Computerized tomography (CT) scan
 Magnetic resonance imaging (MRI).
 Functional MRI (fMRI).
 Positron emission tomography (PET
 Single-photon emission computerized tomography
(SPECT).
 Neuropsychological tests.
Treatment  Anti-seizure drugs. They're the main way to control
epilepsy. Your doctor may recommend one of these
medicines:
 Cannabidiol (Epidiolex)
 Carbamazepine (Tegretol)
 Clonazepam (Klonopin)
 Diazepam (Valium)
 Surgery
Complication  Falling
 Drowning
 Accidents
 Pregnancy complications. Seizures during pregnancy pose
dangers to both mother and baby, and certain anti-
epileptic medications increase the risk of birth defects.
 Emotional health issues
 Status epilepticus. This condition occurs if you're in a
state of continuous seizure activity lasting more than
five minutes or if you have frequent recurrent seizures
without regaining full consciousness in between them.
People with status epilepticus have an increased risk of
permanent brain damage and death.
 Sudden unexpected death in epilepsy (SUDEP)

Topic Description
Disease HUNTINGTON'S CHOREA
Definition Huntington's disease is an inherited disease that causes the
progressive breakdown (degeneration) of nerve cells in the
brain. Huntington's disease has a broad impact on a person's
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functional abilities and usually results in movement, thinking

(cognitive) and psychiatric disorders.
Cause  HD is caused by a faulty gene (mhTT) on chromosome
number 4.
 A normal copy of the gene produces huntingtin, a
protein. The faulty gene is larger than it should be. This
leads to excessive production of cytosine, adenine, and
guanine (CAG), the building blocks of DNA.
Signs and symptoms Movement disorders

 The movement disorders associated with Huntington's

disease can include both involuntary movement problems
and impairments in voluntary movements, such as:
 Involuntary jerking or writhing movements (chorea)
 Muscle problems, such as rigidity or muscle contracture
(dystonia)
 Slow or abnormal eye movements
 Impaired gait, posture and balance
 Difficulty with the physical production of speech or
swallowing
 Impairments in voluntary movements — rather than the
involuntary movements — may have a greater impact on a
person's ability to work, perform daily activities,
communicate and remain independent.

Cognitive disorders

 Cognitive impairments often associated with

Huntington's disease include:
 Difficulty organizing, prioritizing or focusing on tasks
 Lack of flexibility or the tendency to get stuck on a
thought, behavior or action (perseveration)
 Lack of impulse control that can result in outbursts,
acting without thinking and sexual promiscuity
 Lack of awareness of one's own behaviors and abilities
 Slowness in processing thoughts or ''finding'' words
 Difficulty in learning new information
 Psychiatric disorders
 The most common psychiatric disorder associated with
Huntington's disease is depression. This isn't simply a
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reaction to receiving a diagnosis of Huntington's

disease. Instead, depression appears to occur because
of injury to the brain and subsequent changes in brain
function. Signs and symptoms may include:
 Feelings of irritability, sadness or apathy
 Social withdrawal
 Insomnia
 Fatigue and loss of energy
 Frequent thoughts of death, dying or suicide
 Other common psychiatric disorders include:
 Obsessive-compulsive disorder — a condition marked by
recurrent, intrusive thoughts and repetitive behaviors
 Mania, which can cause elevated mood, overactivity,
impulsive behavior and inflated self-esteem
 Bipolar disorder — a condition with alternating episodes
of depression and mania
 In addition to the above symptoms, weight loss is
common in people with Huntington's disease, especially
as the disease progresses.
Symptoms of juvenile Huntington's disease
 The start and progression of Huntington's disease in
younger people may be slightly different from that in
adults. Problems that often present themselves early in
the course of the disease include:
 Behavioral changes
 Loss of previously learned academic or physical skills
 Rapid, significant drop in overall school performance
 Behavioral problems
 Physical changes
 Contracted and rigid muscles that affect gait (especially
in young children)
 Changes in fine motor skills that might be noticeable in
skills such as handwriting
 Tremors or slight involuntary movements
 Seizures
Diagnosis/ Investigation  Neurological examination

The neurologist will ask you questions and conduct relatively

simple tests in the office to judge:

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Motor symptoms

 Reflexes
 Muscle strength
 Muscle tone
 Coordination
 Balance

Sensory symptoms

 Sense of touch
 Vision and eye movement
 Hearing

Psychiatric symptoms

 Mental status
 Mood

 Neuropsychological testing

The neurologist may also perform standardized tests to assess:

 Memory
 Reasoning
 Mental agility
 Language function
 Spatial reasoning

Psychiatric evaluation

You'll likely be referred to a psychiatrist for an examination to

judge a number of factors that could contribute to your
diagnosis, including:
 Emotional state
 Patterns of behaviors
 Quality of judgment
 Coping skills
 Signs of disordered thinking
 Evidence of substance abuse
 Magnetic resonance imaging (MRI)
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 Computerised tomography (CT) scans

Treatment  Medications
 Tetrabenazine (Xenazine)
 AntiPsycotic
 Antidepressants
 Mood-stabilizing drugs
Complication  Pneumonia
 Heart disease

Topic Description
Disease MULTIPLE SCLEROSIS
Definition A chronic inflammatory disease of the central nervous
system (CNS), which results in sclerotic lesions in the
brain that gradually lead to motor and sensory deficits.

Cause  Unknown. It's considered an autoimmune disease

Signs and symptoms Multiple sclerosis signs and symptoms may differ greatly from
person to person and over the course of the disease depending
on the location of affected nerve fibers.
Symptoms often affect movement, such as:

 Numbness or weakness in one or more limbs that

typically occurs on one side of your body at a time, or
the legs and trunk
 Electric-shock sensations that occur with certain neck
movements, especially bending the neck forward
(Lhermitte sign)
 Tremor, lack of coordination or unsteady gait

Vision problems are also common, including:

 Partial or complete loss of vision, usually in one eye at a

time, often with pain during eye movement
 Prolonged double vision
 Blurry vision
 Multiple sclerosis symptoms may also include:
 Slurred speech
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 Fatigue
 Dizziness
 Tingling or pain in parts of your body
 Problems with sexual, bowel and bladder function
Diagnosis/ Investigation  Blood Test
 MRI
 Lumbar Puncture or Spinl tap
Treatment  Cortocosteroids
 Plasma exchange (plasmapheresis)
 Beta interferons
 Glatiramer acetate (Copaxone, Glatopa)
Complication  Muscle stiffness or spasms.
 Paralysis, typically in the legs.
 Problems with bladder, bowel or sexual function.
 Mental changes, such as forgetfulness or mood swings.
 Depression.
 Epilepsy.

Topic Description
Disease MYASTHENIA GRAVIS
Definition An autoimmune neuromuscular disorder that is characterized
by fatigue and exhaustion of muscles.
Cause It is caused by a mistaken immune response to the body's own
nicotinic acetylcholine receptors, which are found in junctions
between muscles and the nervous system. The body produces
antibodies that attack these receptors, preventing signals from
reaching the muscles.
Signs and symptoms  The main symptom of MG is weakness in the voluntary
skeletal muscles. Weakness associated with MG typically
gets worse with more activity and improves with rest.
 trouble talking
 problems walking up stairs or lifting objects
 facial paralysis
 difficulty breathing due to muscle weakness
 difficulty swallowing or chewing
 fatigue
 hoarse voice
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 drooping of eyelids
 double vision
Diagnosis/ Investigation  History Collection
 Physical examination
 Neurological examination
 Edrophonium test - Injection of the chemical
edrophonium chloride that results in a sudden,
temporary improvement in muscle strength might
indicate myasthenia gravis. Edrophonium chloride blocks
an enzyme that breaks down acetylcholine, the chemical
that transmits signals from nerve endings to muscle
receptor sites.
 Ice pack test - If the patient have a droopy eyelid,
might place a bag filled with ice on your eyelid. After
two minutes, removes the bag and analyzes droopy eyelid
for signs of improvement.
 Blood analysis - A blood test might reveal the presence
of abnormal antibodies that disrupt the receptor sites
where nerve impulses signal muscles to move.
 Repetitive nerve stimulation - In this nerve conduction
study, attach electrodes to skin over the muscles to be
tested and send small pulses of electricity through the
electrodes to measure the nerve's ability to send a
signal to muscle.
 Pulmonary Function Test
Treatment  There is no cure for myasthenia gravis, but treatment
with immunosuppressants or cholinesterase inhibitors
can help control symptoms.
 Cholinesterase inhibitors
 Corticosteroids
 Immunosuppressants
 Thymectomy
Complication  Myasthenic crisis - Myasthenic crisis is a life-
threatening condition that occurs when the muscles that
control breathing become too weak.
 Thymus gland tumors
 Underactive or overactive thyroid.
 Autoimmune conditions. P

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PALSY

Topic Description
Disease Cerebral palsy
Definition Cerebral palsy is partial paralysis and lack of muscular
coordination caused by loss of oxygen (hypoxia) or blood flow
to the cerebrum during pregnancy or in the perinatal period.
Cause  Asphyxia neonatorum, or a lack of oxygen to
the brain during labor and delivery.
 Gene mutations that result in
abnormal brain development.
 Severe jaundice in the infant.
 Maternal infections, such German measles and herpes
simplex.
 Brain infections, such as encephalitis and meningitis.

Signs and symptoms  Variations in muscle tone, such as being either too stiff
or too floppy
 Stiff muscles and exaggerated reflexes (spasticity)
 Stiff muscles with normal reflexes (rigidity)
 Lack of balance and muscle coordination (ataxia)
 Tremors or involuntary movements
 Slow, writhing movements
 Delays in reaching motor skills milestones, such as
pushing up on arms, sitting up or crawling
 Favoring one side of the body, such as reaching with one
hand or dragging a leg while crawling
 Difficulty walking, such as walking on toes, a crouched
gait, a scissors-like gait with knees crossing, a wide gait
or an asymmetrical gait
 Excessive drooling or problems with swallowing
 Difficulty with sucking or eating
 Delays in speech development or difficulty speaking
 Learning difficulties
 Difficulty with fine motor skills, such as buttoning
clothes or picking up utensils
 Seizures

Diagnosis/ Investigation  MRI
 Cranial Ultrasound
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 Electroencephalogram (EEG)

Treatment  Anticholinergics (uncontrolled body movements)
 Anticonvulsants (seizure medications)
 Antidepressants (depression medications)
 Antispastic (muscle relaxers)
 Anti-inflammatories (pain management)

Therapies - A variety of therapies play an important role in

treating cerebral palsy:
 Physical therapy. Physical therapy involves exercises and
activities that can maintain or improve muscle strength,
balance, and movement.A physical therapist helps the
child learn skills such as sitting, walking, or using a
wheelchair.
 Occupational therapy. Occupational therapists work to
help your child gain independence in daily activities and
routines in the home, the school and the community.
Adaptive equipment recommended for your child can
include walkers, quadrupedal canes, seating systems or
electric wheelchairs.
 Speech and language therapy. Speech-language
pathologists can help improve your child's ability to
speak clearly or to communicate using sign language.
They can also teach the use of communication devices,
such as a computer and voice synthesizer, if
communication is difficult. Speech therapists can also
address difficulties with eating and swallowing.
 Recreational therapy. Some children benefit from
regular or adaptive recreational or competitive sports
activities, such as therapeutic horseback riding or
skiing. This type of therapy can help improve your
child's motor skills, speech and emotional well-being.
Surgical procedures - Surgery may be needed to lessen muscle
tightness or correct bone abnormalities caused by spasticity.
These treatments include:
 Orthopedic surgery. Children with severe contractures
or deformities might need surgery on bones or joints to
place their arms, hips or legs in their correct positions.
Surgical procedures can also lengthen muscles and
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tendons that are shortened by contractures. These

corrections can lessen pain and improve mobility. The
procedures can also make it easier to use a walker,
braces or crutches.
 Cutting nerve fibers (selective dorsal rhizotomy). In
some severe cases, when other treatments haven't
helped, surgeons might cut the nerves serving the
spastic muscles in a procedure called selective dorsal
rhizotomy. This relaxes the muscle and reduces pain,
but can cause numbness.
Complication  spasticity and contractures
 feeding difficulties
 drooling
 communication difficulties
 osteopenia
 osteoporosis
 fractures
 pain
 functional gastrointestinal abnormalities contributing
to bowel obstruction, vomiting, and constipation

Topic Description
Disease Bell palsy or Bell’s palsy
Definition Bell palsy (or Bell’s palsy) is paralysis on one side of the face. It
can be occurs when the seventh cranial nerve becomes swollen
or compressed, resulting in facial weakness or paralysis.
Cause  viral infection
 Bacterial infection
The viruses/bacteria that have been linked to the development
of Bell’s palsy include:
 herpes simplex, which causes cold sores and genital
herpes
 HIV, which damages the immune system
 sarcoidosis, which causes organ inflammation
 herpes zoster virus, which causes chickenpox and
shingles
 Epstein-Barr virus, which causes mononucleosis
 Lyme disease, which is a bacterial infection caused by
infected ticks
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Risk Factors  pregnant

 diabetes
 lung infection
 family history of the condition
Signs and symptoms  The symptoms of Bell’s palsy can develop one to two
weeks after a cold, ear infection, or eye infection. They
usually appear abruptly, and may notice them when wake
up in the morning or when try to eat or drink.
 Bell’s palsy is marked by a droopy appearance on one side
of the face and the inability to open or close your eye on
the affected side. In rare cases, Bell’s palsy may affect
both sides of your face.
Other signs and symptoms of Bell’s palsy include:
 drooling
 difficulty eating and drinking
 an inability to make facial expressions, such as smiling or
frowning
 facial weakness
 muscle twitches in the face
 dry eye and mouth
 headache
 sensitivity to sound
 irritation of the eye on the involved side
Diagnosis/ Investigation  Physical examination
 Blood tests to check for the presence of a bacterial or
viral infection.
 MRI
 CT Scan
Treatment  Antibiotics
 Antiviral drugs
 Corticosteroids
Complication  Irreversible damage to your facial nerve

Topic Description
Disease PARKINSON'S DISEASE
Definition A slowly progressive neurologic disease that is characterized
by a fixed inexpressive face, tremor at rest, slowing of
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voluntary movements, gait with short accelerating steps,

peculiar posture and muscle weakness (caused by degeneration
of an area of the brain called the basal ganglia), and low
production of the neurotransmitter dopamine.
Cause  Unknown
While there’s no known cause, research has identified groups
of people who are more likely to develop the condition. These
include:
 Sex: Men are one and a half times more likely to get
Parkinson’s than women.
 Race: Whites are more likely to get Parkinson’s than
African Americans or Asians.
 Age: Parkinson’s usually appears between the ages of 50
and 60. It only occurs before the age of 40 in 5-10
percent of cases.
 Family history: People who have close family members
with Parkinson’s disease are more likely to develop
Parkinson’s disease, too.
 Toxins: Exposure to certain toxins may increase the risk
of Parkinson’s disease.
 Head injury: People who experience head injuries may be
more likely to develop Parkinson’s disease.
Stages Stage 1
 Stage 1 Parkinson’s is the mildest form. It’s so mild, in
fact, The Patient may not experience symptoms that are
noticeable. They may not yet interfere with daily life
and tasks.
 If you do have symptoms, they may be isolated to one
side of your body.
Stage 2
 The progression from stage 1 to stage 2 can take
months, or even years. Each person’s experience will be
different. At this moderate stage, you may experience
symptoms such as:
o muscle stiffness
o tremors
o changes in facial expressions
o trembling
 Muscle stiffness can complicate daily tasks, prolonging
how long it takes to complete them. However, at this
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stage, patients are unlikely to experience balance

problems.
 Symptoms may appear on both sides of the body.
Changes in posture, gait, and facial expressions may be
more noticeable.
Stage 3
 At this middle stage, symptoms reach a turning point.
While you’re unlikely to experience new symptoms, they
may be more noticeable. They may also interfere with all
of your daily tasks.
 Movements are noticeably slower, which slows down
activities. Balance issues become more significant, too,
so falls are more common. But people with stage 3
Parkinson’s can usually maintain their independence and
complete activities without much assistance.
Stage 4
 The progression from stage 3 to stage 4 brings about
significant changes. At this point, you will experience
great difficulty standing without a walker or assistive
device.
 Reactions and muscle movements also slow significantly.
Living alone can be unsafe, possibly dangerous.
Stage 5
 In this most advanced stage, severe symptoms make
around-the-clock assistance a necessity. It will be
difficult to stand, if not impossible. A wheelchair will
likely be required.
 Also, at this stage, individuals with Parkinson’s may
experience confusion, delusions, and hallucinations.
These complications of the disease can begin in the
later stages.
 This is the most common Parkinson’s disease stage
system, but alternative staging systems for Parkinson’s
are sometimes used.
Signs and symptoms  Tremor. A tremor, or shaking, usually begins in a limb,
often your hand or fingers. ...
 Slowed movement (bradykinesia). ...
 Rigid muscles. ...
 Impaired posture and balance. ...
 Loss of automatic movements. ...
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 Speech changes. ...

 Writing changes.
Diagnosis/ Investigation  Physical Exam
 Blood Test
Treatment  Dopamine agonists.
 MAO B inhibitors.
 Catechol O-methyltransferase (COMT) inhibitors.
 Anticholinergics.
 Amantadine.
 Carbidopa-levodopa
 Education
 Exercise
 Nutrion
 Support
Complication  Cognitive Problems. ...
 Depression and Anxiety. ...
 Difficulty in Swallowing. ...
 MORE: The five stages of Parkinson's disease.
 Sleep Disorders. ...
 Bladder and Bowel Problems. ...
 Sudden Changes in Blood Pressure

Topic Description
Disease TOURETTE SYNDROME
Definition A tic disorder characterized by the presence of chronic vocal
and motor tics, probably based on differences in or damage to
the basal ganglia of the brain.
Cause  The exact cause of Tourette syndrome isn't known. It's
a complex disorder likely caused by a combination of
inherited (genetic) and environmental factors. Chemicals
in the brain that transmit nerve impulses
(neurotransmitters), including dopamine and serotonin,
might play a role.
Risk Factors  Family history. Having a family history of Tourette
syndrome or other tic disorders might increase the risk
of developing Tourette syndrome.
 Sex. Males are about three to four times more likely
than females to develop Tourette syndrome.
Signs and symptoms The main symptom is tics. Some are so mild they're not even
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noticeable. Others happen often and are obvious. Stress,

excitement, or being sick or tired can make them worse. The
more severe ones can be embarrassing and can affect social
life or work.
There are two types of tics:
 Motor tics involve movement. They include:
o Arm or head jerking
o Blinking
o Making a face
o Mouth twitching
o Shoulder shrugging
 Vocal tics include:
o Barking or yelping
o Clearing your throat
o Coughing
o Grunting
o Repeating what someone else says
o Shouting
o Sniffing
o Swearing
 Tics can be simple or complex. A simple tic affects one
or just a few parts of the body, like blinking the eyes or
making a face.
 A complex one involves many parts of the body or saying
words. Jumping and swearing are examples.
Diagnosis/ Investigation  Neurological exam
 CT
 MRI
Treatment  Psychological problems do not cause Tourette syndrome,
but physicians have had some success in treating it with
the antipsychotic drug haloperidol (Haldol),
antidepressants, and mood stabilizers
Complication  Attention-deficit/hyperactivity disorder (ADHD)
 Obsessive-compulsive disorder (OCD)
 Autism spectrum disorder.
 Learning disabilities.
 Sleep disorders.
 Depression.
 Anxiety disorders.
 Pain related to tics, especially headaches.
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INFECTIOUS DISEASE
Topic Description
Disease MENINGITIS

Definition Meningitis is an inflammation of the meninges. The meninges

are the three membranes that cover the brain and spinal cord.
Meningitis can occur when fluid surrounding the meninges
becomes infected.

Types  Viral meningitis

 Bacterial meningitis

Cause  Viral and bacterial infections
 Cancer
 Chemical irritation
 Fungi
 Drug allergies

Risk Factors  People with weakened immune systems

 Child care providers
 Pregnant women
 College students and other people who live in close
proximity to one another
Signs and symptoms  Viral meningitis

 Decreased appetite
 Irritability
 Sleepiness
 Fever
 Headaches & Nausea
 Stiff neck
 Seizures
 Sensitivity to bright light

 Bacterial meningitis

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 Altered mental status

 Nausea & Vomiting
 Sensitivity to light
 Irritability
 Headache
 Fever
 Stiff neck
Diagnosis/ Investigation  History and physical exam
 Spinal tap
 Blood cultures
 Chest X-rays
 CT scan
Treatment  Bacterial meningitis: Antibiotic
 Fungal meningitis: Antifungal
 Viral meningitis: t usually resolves on its own
Complication  Hearing loss.
 Cortical blindness.
 Other cranial nerve dysfunction.
 Paralysis.
 Muscular hypertonia.
 Ataxia.
 Multiple seizures.
 Mental motor retardation.

Topic Description
Disease SHINGLES (Herpes zoster)
Definition Viral infection affecting peripheral nerves.
Cause  Shingles is caused by reactivation of the varicella
zoster virus, the same virus that causes chickenpox.
 emotional stress
 aging
 undergoing cancer treatments or major surgery
Signs and symptoms  The first symptoms of shingles are usually pain and
burning. The pain is usually on one side of the body and
occurs in small patches. A red rash typically follows.
 Rash characteristics include:
o red patches
o fluid-filled blisters that break easily
o wraps around from the spine to the torso
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o on the face and ears

o itching
 fever
 chills
 headache
 fatigue
Diagnosis/ Investigation  physical examination
 tissue scraping or culture of the blisters
Treatment  antiviral medications, including acyclovir, valacyclovir,
and famciclovir
 anti-inflammation drugs, including ibuprofen
 narcotic medications or analgesics
 anticonvulsants or tricyclic antidepressants
 antihistamines, such as diphenhydramine (Benadryl)
numbing creams, gels, or patches, such as lidocaine
 capsaicin (Zostrix)
Complication  Postherpetic neuralgia. For some people, shingles pain
continues long after the blisters have cleared.
 Vision loss. Shingles in or around an eye (ophthalmic
shingles) can cause painful eye infections that may
result in vision loss.
 Neurological problems.
 Skin infections.

NEOPLASTIC DISORDERS

Topic Description
Disease Brain tumor
Definition A benign or malignant growth in the brain. Primary brain
tumors initially form in brain tissue. Secondary brain
tumors are cancers that have spread (metastasized) to the
brain tissue from tissue elsewhere in the body.
Cause  The exact cause of brain cancer is unknown.
Risk factors  Family history
 Age
 Race
 Chemical exposure
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 Exposure to radiation
Types  Primary brain tumors - Primary brain tumors originate
in your brain. They can develop from
o brain cells
o meninges
o nerve cells
o glands
Primary tumors can be benign or cancerous. In adults, the most
common types of brain tumors are gliomas and meningiomas.
 Gliomas - Gliomas are tumors that develop from glial
cells. Gliomas can develop from different types of glial
cells. The types of tumors that begin in glial cells are:
o astrocytic tumors such as astrocytomas, which
originate in the cerebrum
o oligodendroglial tumors, which are often found in
the frontal temporal lobes
o glioblastomas, which originate in the supportive
brain tissue and are the most aggressive type

Other primary brain tumors include:

 pituitary tumors, which are usually benign
 pineal gland tumors, which can be benign or malignant
 ependymomas, which are usually benign
 craniopharyngiomas, which occur mostly in children and
are benign but can have clinical symptoms like changes in
vision and premature puberty
 primary central nervous system (CNS) lymphomas, which
are malignant
 primary germ cell tumors of the brain, which can be
benign or malignant
 meningiomas, which originate in the meninges
 schwannomas, which originate in cells that produce the
protective cover of your nerves (myelin sheath) called
Schwann cells
 Secondary brain tumors
 Secondary brain tumors make up the majority of brain
cancers. They start in one part of the body and spread,
or metastasize, to the brain. The following can
metastasize to the brain:
o lung cancer
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o breast cancer
o kidney cancer
o skin cancer
 Secondary brain tumors are always malignant. Benign
tumors don’t spread from one part of your body to
another
Signs and symptoms The signs and symptoms of a brain tumor vary greatly and
depend on the brain tumor's size, location and rate of growth.

General signs and symptoms caused by brain tumors may

include:
 New onset or change in pattern of headaches
 Headaches that gradually become more frequent and
more severe
 Unexplained nausea or vomiting
 Vision problems, such as blurred vision, double vision or
loss of peripheral vision
 Gradual loss of sensation or movement in an arm or a leg
 Difficulty with balance
 Speech difficulties
 Confusion in everyday matters
 Personality or behavior changes
 Seizures, especially in someone who doesn't have a
history of seizures
 Hearing problems
Diagnosis/ Investigation  Neurologiccal Exam
 CT Scan
 MRI Scan
 PET Scan
 Biopsy
Treatment  Surgery
 Radiation therapy
 Chemotherapy
Complication 

TRAUMATIC DISORDERS

Topic Description
Disease Cerebral concussion
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Definition Type of traumatic brain injury caused by a blow to the head

Cause  motor vehicle collisions, falls, sports injuries and bicycle
accidents
Riskfactors  drinking alcohol and a prior history of concussion
Signs and symptoms  memory problems
 confusion
 drowsiness or feeling sluggish
 dizziness
 double vision or blurred vision
 headache
 nausea or vomiting
 sensitivity to light or noise
 balance problems
 slowed reaction to stimuli
Diagnosis/ Investigation  History collection
 Physical examination
 MRI
 CT scan
 Electroencephalogram
Treatment  Treatment for a concussion depends on the severity of
your symptoms. You might need surgery or other medical
procedures if you have:
 bleeding in the brain
 swelling of the brain
 a serious injury to the brain
 However, most concussions don’t require surgery or any
major medical treatment.
 Analgesic - Relieves pain.
Complication  Post-traumatic headaches. Some people experience
headaches within a week to a few months after a brain
injury.
 Post-traumatic vertigo. ...
 Post-concussion syndrome. ...
 Cumulative effects of multiple brain injuries. ...
 Second impact syndrom

Topic Description
Disease Cerebral contusion
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Definition Bruising of brain tissue as a result of direct trauma to the

head. A cerebral contusion usually is associated with a fracture
of the skull, as well as with with edema and an increase in
intracranial pressure.
Cause A foreign object or pushed-in bone fragment from a skull
fracture.
Signs and symptoms  Headache
 Confusion
 Sleepiness
 Dizziness
 loss of consciousness
 Nausea and vomiting, seizures, difficulty with
coordination and movement, lightheadedness, tinnitus,
and spinning sensations.
Diagnosis/ Investigation  CT scan
 MRI
Treatment  Ice
 Rest
 Analgesics
 Craniotomy
Complication  Seizures
 High blood pressure
 low oxygen levels
 loss of memory.

VASCULAR DISORDERS

Topic Description
Disease Cerebrovascular accident (CVA)
Definition Disruption in the normal blood supply to the brain; stroke. This
condition, also known as a cerebral infarction, is the result of
impaired oxygen supply to the brain.
Cause  Ischemia (loss of blood supply) or hemorrhage (bleeding)
in the brain.
Risk factor
Major risk factors for stroke

 Hypertension
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 Diabetes
 Smoking
 Heart disease.
Other risk factors

 Obesity
 Substance abuse (cocaine)
 Elevated cholesterol levels.
Types 1. Thrombotic—blood clot (thrombus) in the arteries leading to
the brain, resulting in occlusion (blocking) of the vessel.
Atherosclerosis leads to this common type of stroke as blood
vessels become blocked over time. Before total occlusion
occurs, a patient may experience symptoms that point to the
gradual occlusion of blood vessels. These short episodes of
neurologic dysfunction are known as transient ischemic attacks
(TIAs).

2. Embolic—an embolus (a dislodged thrombus) travels to

cerebral arteries and occludes a small vessel. This type of
stroke occurs very suddenly.

3. Hemorrhagic—a blood vessel, such as the cerebral artery,

breaks and bleeding occurs. This type of stroke can be fatal
and results from advancing age, atherosclerosis, or high blood
pressure, all of which result in degeneration of cerebral blood
vessels. With small hemorrhages, the body reabsorbs the blood
and the patient makes good recovery with only slight disability.
In a younger patient, cerebral hemorrhage usually is caused by
mechanical injury associated with skull fracture or rupture of
an arterial aneurysm (weakened area in the vessel wall that
balloons and may eventually burst).
Signs and symptoms  difficulty walking
 dizziness
 loss of balance and coordination
 difficulty speaking or understanding others who are
speaking
 numbness or paralysis in the face, leg, or arm, most
likely on just one side of the body
 blurred or darkened vision
 a sudden headache, especially when accompanied by
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nausea, vomiting, or dizziness

Diagnosis/ Investigation  Blood test
 Angiogram
 Carotid ultrasound
 CT scan
 MRI
 Echocardiogram
 Electrocardiogram
Treatment  antiplatelet or anticoagulant (clotdissolving) therapy
 Tissue plasminogen activator (tPA)
 Surgical intervention with carotid endarterectomy
(removal of the atherosclerotic plaque along with the
inner lining of the affected carotid artery)
Complication  Brain edema — swelling of the brain after a stroke.
 Pneumonia — causes breathing problems,
a complication of many major illnesses.
 Common swallowing problems after stroke can
sometimes result in things 'going down the wrong pipe',
leading to aspiration pneumonia.

Topic Description
Disease Migraine
Definition A condition marked by recurring moderate to severe headache
with throbbing pain that usually lasts from four hours to three
days, typically begins on one side of the head but may spread to
both sides, is often accompanied by nausea, vomiting, and
sensitivity to light or sound, and is sometimes preceded by
an aura and is often followed by fatigue
Cause  Emotional triggers: Stress, depression, anxiety,
excitement, and shock can trigger a migraine.
 Physical causes: Tiredness and insufficient sleep,
shoulder or neck tension, poor posture, and physical
overexertion
Signs and symptoms  Migraine symptoms may begin one to two days before
the headache itself. This is known as the prodrome
stage. Symptoms during this stage can include:
o food cravings
o depression
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o fatigue or low energy

o frequent yawning
o hyperactivity
o irritability
o neck stiffness
 In migraine with aura, the aura occurs after the
prodrome stage. During an aura, you may have problems
with your vision, sensation, movement, and speech.
Examples of these problems include:
o difficulty speaking clearly
o feeling a prickling or tingling sensation in your
face, arms, or legs
o seeing shapes, light flashes, or bright spots
o temporarily losing your vision
 The next phase is known as the attack phase. This is
the most acute or severe of the phases when the actual
migraine pain occurs. In some people, this can overlap or
occur during an aura. Attack phase symptoms can last
anywhere from hours to days. Symptoms of a migraine
can vary from person to person. Some symptoms may
include:
o increased sensitivity to light and sound
o nausea
o dizziness or feeling faint
o pain on one side of your head, either on the left
side, right side, front, or back, or in your temples
o pulsing and throbbing head pain
o vomiting
 After the attack phase, a person will often experience
the postdrome phase. During this phase, there are
usually changes in mood and feelings. These can range
from feeling euphoric and extremely happy, to feeling
very fatigued and apathetic. A mild, dull headache may
persist.

Diagnosis/ Investigation  medical and family history

 Physical examination
 CT Scan
 MRI
Treatment  Self-care
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o Avoid migraine triggers - Common triggers

include alcohol, caffeine or poor sleep.
o Stress management - Pursuing an enjoyable
activity or verbalising frustration to reduce
stress and improve mental health.
o Improved sleep habits - Good sleep practices
include having a regular bedtime schedule and
avoiding naps, caffeine and TV before bedtime.
o Diet modification- Adjusting diet to reduce
triggers causing disease or address dietary
deficiencies.
 Medications
o Antipsychotic - Reduces or improves the
symptoms of certain psychiatric conditions.
o Analgesic -Relieves pain.
o Nonsteroidal anti-inflammatory drug - Relieves
pain, decreases inflammation and reduces fever.
o Stimulant -Increases neurotransmitter levels,
heart rate and blood pressure. Decreases
appetite and sleep.
o Nerve pain medication - Blocks pain caused by
damaged nerves.
o Triptan - Relieves pain and symptoms associated
with migraines and cluster headaches.
o Neurotoxin - Reduces or eliminates muscle
activity and spasms by paralysing muscles.
o Dietary supplement - Works alone or in
conjunction with other treatments to promote
health.
 Therapies
o Progressive muscle relaxation - Tensing and then
relaxing muscle groups from head to toe or vice
versa.
o Acupuncture - Insertion of needles into specific
points on the body to relieve pain and treat other
conditions. A form of traditional Chinese
medicine.
Complication  Status Migrainosus - This rare and severe migraine with
aura lasts for longer than 72 hours. Some people have
been hospitalized due to the intense pain.
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 Migrainous Infarction - This is when a migraine is

associated with stroke. Typically, this is a migraine
headache with an aura that lasts more than an hour.
Sometimes, the aura is present even when the headache
disappears. An aura that lasts longer than an hour can
be a sign of bleeding in the brain. If you have a migraine
with an aura that lasts more than an hour.
 Persistent Aura Without Infarction - This complication
arises if an aura lasts for more than a week after a
migraine has ended. This complication has similar
symptoms to migrainous infarction, but there is no
bleeding in the brain.
 Migralepsy - This is a condition where an epileptic
seizure is triggered by a migraine. Typically the seizure
will occur within an hour after a migraine. This condition
is rare.
 Stroke - A stroke occurs when blood supply to your
brain is cut off or blocked by a blood clot or fatty
material in your arteries. According to
England’s National Health Service, people who have
migraines have about twice the risk of having a stroke,
and women with migraines who take oral contraceptives
also have a greater risk of stroke. The reasons for this
are not fully understood.
 Mental Health Issues - According to the Anxiety and
Depression Association of America, migraines have been
associated with a small increased risk of:
o major depression
o general anxiety disorder, GAD
o bipolar disorder
o panic disorder
o substance abuse disorders
o agoraphobia
o post-traumatic stress disorder, PTSD

DIAGNOSTIC INVESTIGATIONS/LABORATORY TESTS AND CLINICAL

PROCEDURES

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Cerebrospinal fluid analysis: Cell counts, bacterial smears and cultures of samples of CSF
are done when disease of the meninges or brain is suspected. Normal constituents of CSF
are water, glucose, sodium, chloride and protein and changes in their concentrations are
helpful in diagnosis of brain disease. CSF normally has more chloride and less glucose than
blood.

Cerebral angiography: Contrast medium is injected into an artery (usually the femoral)
and x-rays are taken of the blood vessel system of the brain. The purpose of the test is to
diagnose vascular disease (aneurysm, occlusion and hemorrhage) in the brain.

Computed tomography (CT): X-rays are used to compose a computerized cross-sectional

picture of the brain and spinal cord. Contrast medium may also be injected intravenously to
see the abnormalities. The contrast material leaks through the blood-brain barrier from
the blood vessels into the brain tissue and shows areas of tumor, hemorrhage, and blood
clots.

Myelography: Contrast medium is injected into the subarachnoid space (via lumbar
puncture) and x-rays are taken of the spinal cord. This procedure demonstrates neoplasms
of the spinal cord and slipped discs.

Electroencephalography: Ultrasonic waves are beamed through the head and echoes
coming from brain structures are recorded as a picture. This is useful in detecting head
injuries, brain tumors and hydrocephalus.

MRI of the brain: Use of magnetic waves to create an image of the brain (frontal, cross
sectional and sagittal planes can be viewed). MRI and CT are used to complement each
other in diagnosing brain and spinal cord lesions. MRI is excellent for viewing soft tissues.

Brain scan: Radioactive chemicals are given intravenously and travel to the brain. Special
scanner machines then record the passage and absorption of the chemicals into the brain
tissue. If there is a brain lesion, the radioactive molecules leak across the blood-brain
barrier and concentrate in abnormal sites.

Positron emission tomography (PET scan): An isotope (radioactive chemical) that gives
off particles called positron is injected intravenously combined with a form of glucose. The
uptake of the radioactive material is then recorded on a television screen. The cross
sectional images show how the brain uses glucose and give information about brain
function. PET scans give valuable information in patients with Alzheimer's disease, stroke,
schizophrenia and epilepsy.
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Electroencephalography (EEG): Recording of the electrical activity of the brain, EEG is

used to demonstrate seizure activity in the brain, brain tumors and other diseases and
injury to the brain. Some specialized type of EEG testing are Strobe lighting, sleep
deprived EEG, and ambulatory EEG.

Lumbar (spinal) puncture: CSF is withdrawn from between two lumbar vertebrae. A device
to measure the pressure of the CSF can be attached to the end of the needle after it has
been inserted. Contrast medium for x-ray studies (myelography) or intrathecal medicines
may be administered through the lumbar puncture as well. Leakage of CSF around the
puncture site can sometimes lead to lower pressure in the subarachnoid space and cause
headache.

Stereotactic radiosurgery: Use of a stereotactic instrument that, when fixed onto the
skull, can locate a target by three-dimensional measurement. Stereotactic radiosurgery
with a gamma knife (high-energy radiation beams) has been used to treat deep and often
inaccessible intracranial brain tumors and abnormal blood vessel masses without surgical
incision.

ABBREVIATIONS

ADD: Attention deficit disorder

AFP: Alpha-fetoprotein

ALS: Amyotrophic lateral sclerosis

CNS: Central nervous system

CSF: Cerebrospinal fluid

CT: Computed tomography

CAT: Computed axial tomography

CVA: Cerebrovascular accident

EEG: Electroencephalogram

ICP: Intracranial pressure

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LP: Lumbar puncture

MRI: Magnetic resonance imaging

MS: Multiple sclerosis

PET: Positron emission tomography

RIND: Reversible ischemic neurological deficit

TENS: Transcutaneous electrical nerve stimulation

TIA: Transient ischemic attack

DRUGS FOR A FEW NEUROLOGICAL DISORDERS

Drugs used to treat epilepsy

Barbiturates used to treat epilepsy

 Mebaral (mephobarbital)
 Luminal (phenobarbital)

Hydantoins used to treat epilepsy

 Peganone (ethotoin)
 Dilantin (phenytoin)

Succinimide used to treat epilepsy

 Zarontin (ethosuximide)

Other drugs used to treat epilepsy

 Tegretol (carbamazepine)
 Felbatol (felbamate)
 Neurontin (gabapentin)
 Lamictal (lamotrigine)
 Topamax (topiramate)
 Depakote, Depacon (valproic acid)

Drugs used to treat tonic-clonic seizures

 Tegretol (carbamazepine)
 Klonopin (clonazepam)

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 Luminal (phenobarbital)
 Dilantin (phenytoin)
 Mysoline (primidone)

Drugs used to treat absence seizures

 Klonopin (clonazepam)
 Depakote, Depacon (valproic acid)
 Zarontin (ethosuximide)

Drugs used to treat complex partial seizures

 Tegretol (carbamazepine)
 Tranxene (clorazepate)
 Neurontin (gabapentin)
 Lamictal (lamotrigine)
 Mysoline (primidone)
 Topamax (topiramate)

Drugs used to treat Status epilepticus

 Valium (diazepam)
 Ativan (lorazepam)
 Luminal (phenobarbital)
 Dilantin (phenytoin)

Drugs used to treat Parkinson disease

 Cogentin (benztropine)
 Mirapex (pramipexole)
 Larodopa (levodopa)
 Parlodel (bromocriptine)
 Sinemet (carbidopa and levodopa)

Drugs used to treat Alzheimer disease

 Aricept (donepezil)
 Exelon (rivastigmine)
 Reminyl (galantamine)
 Cognex (tacrine)

Drugs used to treat myasthenia gravis

 Mestinon (mestranol and norethindrone)
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 Enlon (edrophonium)
 Tensilon (edrophonium)
 Prostigmin (neostigmine)

Drugs used to treat insomnia

 Allerdryl (diphenhydramine)
 Amytal (amobarbital)
 Atarax (hydroxyzine)
 Ativan (lorazepam)
 Dalmane (flurazepam)
 Restoril (temazepam)
 Sonata (zaleplon)

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