Central Nervous System Disease

Overview

CNS disease is a broad spectrum of disorders in which the brain does not operate normally, restricting health and capacity to function. The issue might be a hereditary metabolic illness, the outcome of an infection, a degenerative condition, a stroke, a brain tumor, or another problem, or it could be the result of unknown or many reasons. Parkinson's disease, dystonia, and essential tremor are all central nervous system illnesses.

They all share the loss of adequate, intact nervous system circuits that coordinate processes as diverse as memory formation (in Alzheimer's) or voluntary movement (in movement disorders). While most of the problems in this category cannot be entirely healed, symptoms of central nervous system diseases may typically be treated using a variety of therapies ranging from medicinal to surgical therapy.

What is the nervous system?

The nervous system is made up of the brain, spinal cord, and nerves. They govern all of the body's functions when they act together. When a portion of your neurological system malfunctions, you may have difficulty moving, speaking, eating, breathing, or learning. You may also experience issues with your memory, perceptions, or emotions.

The nervous system is a sophisticated and complicated mechanism that governs and organizes physiological processes. It is divided into two major sections, which are as follows:

• Central nervous system. This consists of the brain and spinal cord.
• Peripheral nervous system. This consists of all other neural elements, including the peripheral nerves and the autonomic nerves.

The nervous system is vulnerable to various disorders. It can be damaged by:

• Injury
• Infections
• Degeneration
• Structural defects
• Tumors
• Blood flow disruption
• Autoimmune disorders

Symptoms of nervous system disorders

These are the most common general signs and symptoms of a nervous system disorder. But each person may have slightly different symptoms. Symptoms may include:

• Persistent or sudden onset of a headache
• A headache that changes or is different
• Loss of feeling or tingling
• Weakness or loss of muscle strength
• Loss of sight or double vision
• Memory loss
• Impaired mental ability
• Lack of coordination
• Muscle rigidity
• Tremors and seizures
• Back pain that radiates to the feet, toes, or other parts of the body
• Muscle wasting and slurred speech
• New language impairment (expression or comprehension)

What is Alzheimer’s disease?

The most frequent kind of irreversible dementia is Alzheimer's disease (gradual loss of memory, intellect, rational thought and social skills). Alzheimer's disease affects around 7 out of every 10 persons with dementia. While Alzheimer's disease affects up to one in every ten Australians over the age of 65, and up to three in every ten Australians over the age of 85, it is not a natural part of aging.

Millions of brain cells (neurons) organize how the brain retains memories, develops habits, and creates our personalities. Signals are carried along the synapses between brain cells by substances known as neurotransmitters. Alzheimer's disease disrupts memory, impairs thinking, and causes behavioral changes over time through affecting these cells and substances. Alzheimer's patients eventually require long-term care and support.

There are 2 main types of Alzheimer’s disease:

• The most prevalent type of Alzheimer's is sporadic Alzheimer's, which generally develops after the age of 65. Its cause is not completely known.
• Familial Alzheimer's (also known as 'hereditary' Alzheimer's) is caused by a relatively rare genetic disorder that culminates in dementia, most commonly in persons in their 40s and 50s. This is referred to as younger-onset dementia.

What are the symptoms of Alzheimer’s disease?

Alzheimer's disease might be difficult to detect in its early stages. Memory loss and difficulties finding the correct phrases for routine tasks are common early warning symptoms. However, many people have memory issues but do not have Alzheimer's, therefore it is critical to see a doctor to determine the actual source of memory problems.

Other common symptoms of Alzheimer’s disease include:

• vagueness in daily conversation
• lack of enthusiasm for activities you once enjoyed
• taking longer to do regular tasks
• forgetting well-known people or places
• difficulty processing questions and instructions
• a decline in social skills
• unpredictable emotions

Alzheimer’s disease is sometimes classified into 3 stages, based on the severity of symptoms:

1. Mild Alzheimer’s disease: early signs of dementia, no additional support is usually needed.
2. Moderate Alzheimer’s disease: symptoms are difficult to cope with and support is likely to be required.
3. Advanced Alzheimer’s disease: continuous care in all daily activities may be needed.

Depending on which parts of the brain are impacted, symptoms will proceed differently in different people. A person's symptoms might also alter from day to day and worsen as a result of stress, sickness, or exhaustion.

What causes Alzheimer’s disease?

In most cases, scientists are still unknown what causes plaques, tangles, and other molecular changes linked with sporadic Alzheimer's disease. Environmental influences, chemical abnormalities, and the body's own immune system are among suspected causes.

Alzheimer's disease tends to attack the brain's outermost layer first, which is related with learning and short-term memory. Other functions are impaired when the illness spreads further into the brain, and symptoms worsen.

Mutations in three genes have been revealed to promote the creation of amyloid plaques that harm the brain in persons with familial Alzheimer's disease. Other 'risk-factor genes' may enhance a person's chances of developing Alzheimer's disease earlier in life.

How is Alzheimer’s disease diagnosed?

Unfortunately, there is no single test that can confirm Alzheimer’s disease. A diagnosis comes after careful assessment. This may involve:

• a detailed medical history
• a complete physical and neurological examination
• tests to check intellectual function
• a psychiatric assessment
• neuropsychological tests
• urine and blood tests
• medical imaging, such as an MRI scan to assess shrinking of the brain

After other probable explanations of symptoms (such as vascular dementia, nutritional inadequacies, or depression) have been ruled out, a clinical diagnosis of Alzheimer's disease can be made.

An early diagnosis enables your doctor to determine whether there is another source of your symptoms that is curable. If Alzheimer's disease is suspected, you can begin to consider medical therapy and other aid to help down the degenerative process.

How is Alzheimer's disease treated?

Although there is no cure, many therapies may alleviate symptoms for a short period of time. Many persons with Alzheimer's disease learn how to manage their symptoms and enhance their quality of life.

• Medications

Cholinergic treatments, a class of medications, may temporarily relieve cognitive symptoms of mild-to-moderate Alzheimer's disease. These function by boosting the amount of acetylcholine in the brain, which aids in the restoration of communication between brain cells.

Other drugs aid in the treatment of behavioral problems such as insomnia, agitation, anxiety, and depression. These therapies do not directly treat Alzheimer's disease, but they can assist improve quality of life.

• Lifestyle changes

A person with Alzheimer's disease should attempt to retain normal social contact with friends and family as much as possible, as well as exercise frequently and engage in brain-stimulating activities. If you are concerned about your safety (for example, your driving abilities), get advice from your doctor.

• Other interventions

Alzheimer's disease-related emotional and behavioral changes might be difficult to manage. Irritability, anxiety, sadness, restlessness, sleep issues, and other challenges may become more prevalent. Treatment of the underlying causes of these alterations may be beneficial. Some may be drug side effects, discomfort from other medical illnesses, or hearing or vision issues.

What is Epilepsy?

Epilepsy is a long-term neurological disorder characterized by recurrent seizures. It is estimated that around three out of every hundred Australians are affected. Having only one seizure is not regarded to be epilepsy; almost half of those who have one seizure never experience another. Seizures can also be caused by other disorders such as fever, diabetes, heart disease, and alcohol withdrawal.

Epilepsy is not a single disorder; rather, it refers to a group of conditions that might produce seizures. If you see someone having a seizure, go visit Epilepsy Action Australia's seizure first aid tools. Seizures often last one to three minutes.

What are the symptoms of epilepsy?

Seizures are a sign of epilepsy. These are bouts of disturbed electrical activity in the brain, and their severity varies widely depending on the portion of the brain affected. Seizures can result in symptoms such as loss of consciousness, peculiar jerking movements (convulsions), and other strange feelings, sensations, and behaviors.

Seizures come in a variety of forms. Generalized seizures impact the entire brain and, as a result, the entire body. Only a portion of the brain is involved in focal seizures.

• Generalised tonic-clonic seizures

These forms of seizures, once known as "grand mal seizures," are the most well-known. The seizure starts with an abrupt loss of consciousness, then the body stiffens, followed by muscular twitching. Common symptoms include becoming crimson or blue, tongue-biting, and loss of bladder control. When you recover consciousness, you may experience confusion, sleepiness, memory loss, headache, and agitation.

• Generalised absence seizures

These seizures, once known as 'petit mal seizures,' generally begin in childhood but can occur in adults. These seizures are short and characterized by staring, lack of expression, unresponsiveness, and cessation of activity. Eye blinking or upward eye movements are occasionally observed. The individual normally recovers quickly and resumes their former activity, with no recollection of the incident.

• Focal seizures

Previously referred to as "partial seizures," they begin in one area of the brain and affect the areas of the body controlled by that section of the brain. Seizures can cause abnormal movements, emotions, sensations, or behaviors. During focal seizures, people's levels of awareness might vary.

• Febrile convulsions

Febrile convulsions are frequent seizures that affect roughly one in every 100 healthy children under the age of six. Seizures are normally innocuous and are connected with a fever-producing sickness, such as a viral infection.

If necessary, treatment includes treating the seizure as well as the underlying cause of the fever. Children with febrile convulsions have the same probability of developing epilepsy as the general population in the absence of any risk factors for epilepsy.

What causes epilepsy?

In half of all instances, the etiology of epilepsy is unknown. We already know that genetics (family history) have a significant impact. Seizures or epilepsy can also be induced by anything that causes brain damage, such as:

• Head injury or trauma
• Stroke or brain haemorrhage
• Brain infection or inflammation, such as in meningitis, encephalitis or a brain abscess
• Brain malformations or tumours
• Brain diseases, such as Alzheimer’s disease
• Chronic alcohol or drug use
• Genetic factors
• High or low blood sugar and other biochemical imbalances

However, seizures may not develop for years after the damage to the brain occurs.

When should I see my doctor?

Always see a doctor if:

• this is your first seizure
• you have repeated seizures
• you have seizures more often than normal
• you’re not sure if you’ve had a seizure

If you have been wounded, are pregnant, or have diabetes, you should seek medical assistance after having a seizure.

How is epilepsy diagnosed?

Your seizure history is used to make an epilepsy diagnosis. Your doctor will ask you what you recall and if you had any symptoms before to the seizure, such as feeling funny or having any warning signals. It may be beneficial to speak with anyone who observed your seizure and ask them precisely what they saw, especially if you cannot recall the seizure.

Your doctor may also perform tests such as blood tests, an electroencephalogram (EEG), and brain scans such as a CT scan or an MRI.

A person may have epilepsy even if their EEG and brain scans are normal; nevertheless, aberrant results can assist categorize the kind of epilepsy implicated. If your kid or someone you know experiences a seizure, recording it on your phone can be beneficial. This can assist your doctor in making a more precise diagnosis.

How is epilepsy treated?

Most persons with epilepsy can manage their seizures by taking antiepileptic medications and avoiding triggers. The sort of antiepileptic medicine you require is determined by factors such as your age and the type of seizures you are experiencing. Many antiepileptic drugs need blood tests to ensure that the levels in your blood are not too low or too high and are not creating other medical issues.

Several new treatments are being explored. These include:

• Surgery on the area of the brain causing the seizures
• Vagus nerve stimulation — nerves in the neck are stimulated by a device placed under the skin
• A strict medically supervised diet used in some children with epilepsy, called a ketogenic diet
• Medical cannabis, which has been shown in some studies to help people control seizures. You can read more about medical cannabis and epilepsy on the Epilepsy Action Australia website

Depending on the underlying cause of your epilepsy, you may require a different therapy. Keeping a seizure journal might help you track how effectively your epilepsy is being treated and discover your triggers. Your doctor may also assist you in developing an epilepsy management plan that you may share with schools, employers, and health experts.

It is critical to collaborate with your doctor in order to get the greatest seizure management. Consult your doctor to determine if it is safe for you to drive or engage in other high-risk activities such as operating heavy machinery. Most people will be able to resume driving after 6 months of seizure-free driving, depending on the type of epilepsy they have.

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a degenerative illness of the central nervous system. It affects around 25,000 Australians and is three times more frequent in women than in males.

MS indicates that the protective layer (known as myelin) that protects the nerve fibers in the brain and spinal cord has been damaged. Scars, or lesions, form in the nervous system as a result of this injury, preventing the nerves from adequately transmitting impulses throughout the body. A person's chances of having MS are raised if they have a close relative who has the disease.

The etiology of MS is unknown, although ideas include that it is an autoimmune illness, that it is caused by genetic or environmental factors (it is more prevalent the farther away you live from the equator), and that it is caused by a virus. There is no known cure for MS at the moment, although there are therapy alternatives. MS affects various people in different ways, and therapy frequently consists of symptom management.

What are the different types of multiple sclerosis?

• Relapsing-remitting MS (RRMS):

This is the most prevalent kind of MS, and about three out of every four patients with MS begin with a relapsing-remitting stage.

With RRMS, new symptoms arise or current symptoms worsen over days, weeks, or even months, followed by a partial or complete recovery, followed by another relapse. Some people's relapses worsen, and their handicap remains. Their health deteriorates progressively. This is referred to as secondary progressive MS.

• Primary progressive MS (PPMS) 

PPMS affects one or two out of every ten patients with MS. These patients frequently notice that their symptoms worsen gradually over time, with no distinct episodes.

• Secondary progressive MS (SPMS) 

The majority of patients who have RRMS will eventually develop SPMS. Disability normally worsens steadily in this form, regardless of relapses.

What are the symptoms of multiple sclerosis?

MS often begins with minor symptoms that may or may not worsen over time. Symptoms vary depending on which region of the central nervous system is damaged and the extent of damage.

The most common symptoms are:

• Problems with controlling the body — like muscle spasms, weakness, loss of coordination and balance
• Tiredness and sensitivity to heat 
• Other nervous symptom problems — including vertigo, pins and needles, dizziness, neuralgia and problems with eyesight
• Continence problems — including bladder incontinence and constipation
• Changes in memory, in concentration, in reasoning, in emotions, or in mood (such as depression)

The symptoms of MS vary widely from person to person. They can also come and go in any one person. MS is unpredictable.

How is multiple sclerosis diagnosed?

An MRI to identify lesions in the central nervous system, a physical examination to examine reflexes and reactions, blood tests, lumbar punctures, and other forms of nerve activity testing can all be used to diagnose MS.

Because there is no one test for MS, it might take years to get a diagnosis. A person will be diagnosed with MS if there is evidence of lesions in various sections of the central nervous system at different periods that cannot be explained by anything other than MS.

How is multiple sclerosis treated?

Medicines can slow the course of MS and lower the likelihood of relapses. These are referred to as "disease modifying treatments." Other medications are used to alleviate symptoms. The optimal medication for you is determined by the type of MS you have. Consult your doctor or other health experts who care for you about the best treatment plan for your specific condition.

Disease-modifying medicines function by directing the immune system's attention to the disease. They reduce the frequency and intensity of assaults, resulting in reduced damage to the myelin sheaths. Immunotherapies are another name for these medications. These therapies, however, do not cure present symptoms and sometimes have serious negative effects. These medications are typically prescribed to persons who have relapsing-remitting MS.

By lowering inflammation and inhibiting the immune system, steroids can lessen the intensity of an MS episode. Immune suppressants (medications that inhibit the immune system) are sometimes utilized, particularly in persons with progressive MS.

What is Parkinson's disease?

Parkinson's disease is a nervous system condition. It is caused by injury to the nerve cells that create dopamine, a neurotransmitter required for smooth muscle control and movement. Parkinson's disease primarily affects persons over the age of 65, but it can strike at any age.

What are the symptoms of Parkinson's disease?

The main symptoms of Parkinson's disease are:

• Tremor or shaking, which occurs frequently when relaxing or exhausted. It generally starts with one arm or hand.
• Muscle stiffness or rigidity, which can impede mobility and be uncomfortable
• Slowing of movement, which may result in spells of freezing (inability to move) and short shuffling steps.
• Problems with slouched posture and balance

The symptoms of Parkinson's disease vary from person to person as well as over time. Some people also experience:

• Loss of unconscious movements, such as blinking and smiling
• Difficulties with handwriting
• Changes to speech, such as soft, quick or slurred speech
• Anxiety or depression
• Loss of smell
• Constipation
• Lack of urinary control
• Sleep disturbance
• Fatigue
• Impotence
• Drop in blood pressure leading to dizziness
• Difficulty swallowing
• Sweating

Many of the symptoms associated with Parkinson's disease may be caused by other illnesses. Stooped posture, for example, might be caused by osteoporosis. However, if you are concerned about your symptoms, you should consult your doctor.

What causes Parkinson's disease?

Doctors do not yet know what causes the condition, and only a tiny percentage of cases are considered to be hereditary. Toxin exposure in the environment is also considered to play a minor influence.

When should I see my doctor?

Consult your doctor if you have shaking, tight muscles, a loss of balance, or a slowdown of your movement. They will recommend you to a specialist, such as a neurologist or geriatrician, if they believe you have Parkinson's disease.

How is Parkinson's disease diagnosed?

Diagnosis is challenging at any stage of the illness, but it is more problematic in the early stages. There is no one test that can offer a diagnosis. Physical and neurological exams will most likely be performed throughout time to measure changes in reflexes, coordination, muscular strength, and mental function. Your doctor may also observe how you react to medication.

Brain imaging studies may be required to rule out other disorders that might be causing your symptoms. MRI and CT scans, as well as maybe other types of scans, could be included in such testing. Blood tests may also be performed to rule out other diseases.

How is Parkinson's disease managed?

Your therapy will be tailored to your specific needs by your doctors. You will be able to manage your disease best if you work with a team that includes a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialized nurse, and dietician.

While there is no cure for Parkinson's disease, the symptoms can be managed with a combination of the following treatments.

• Medicines

Parkinson's disease medications are meant to enhance the amount of dopamine in the brain. They can be administered as pills, injections, or tubes directly into the small intestine.

There are many different types of these medicines. The most commonly used are:

• Levodopa, which replaces dopamine
• Dopamine agonists, which copy the function of dopamine
• COMT inhibitors, which boost the response of levodopa
• MAO-B inhibitors, which help stop the breakdown of dopamine in the brain
• Anticholinergics to help with the tremor
• Amantadine, which is used for people who may have developed abnormal movements (known as dyskinesia)

People react to medications in a variety of ways. So, if you've been prescribed Parkinson's disease medication, it may take some time to locate the one that works best for you.

• Surgery

Some patients may benefit from deep brain stimulation surgery to lower the quantity of medication they require. It can help to minimize tremors and wiggling motions in the body.

It entails inserting electrodes into the region of the brain that regulates movement. The electrodes are linked to a small generator implanted in the chest, which may be activated to transmit electrical impulses to the brain. In most circumstances, you will be awake throughout the process.

Deep brain stimulation isn't for everyone. If you are considering surgery, please consult with your doctor to see whether it is appropriate for you.

Conclusion

Central nervous system illnesses, often known as central nervous system disorders, are a collection of neurological disorders that affect the structure or function of the brain or spinal cord, which make up the central nervous system as a whole.