CONTENTS

INTRODUCTION OF CNS
EPILEPSY
PARKINSON DISEASE
ALZHEIMER DISEASE
The central nervous system consists of the brain and spinal cord.
It is referred to as "central" because it combines information from
the entire body and coordinates activity across the whole organism.
DISORDERS OF NERVOUS SYSTEM
Vascular disorders, such as stroke, transient ischemic attack
(TIA), subarachnoid hemorrhage, subdural hemorrhage and
hematoma.
Infections, such as meningitis, encephalitis, polio, and
epidural abscess
Structural disorders, such as brain or spinal cord injury,
Bell's palsy, brain or spinal cord tumors, peripheral
neuropathy.
Functional disorders, such as headache, epilepsy, dizziness,
and neuralgia
Degeneration, such as Parkinson disease, multiple sclerosis
and Alzheimer disease
It is a central nervous system (neurological) disorder in
which brain activity becomes abnormal
Epilepsy is a heterogeneous symptom complex, a chronic
disorder characterized by recurrent seizures.
1 Partial seizures
2 Generalized seizures
3 Status Epilepticus
 PARTIAL SEIZURES

Simple partial complex partial

seizures lasts for seizure
30 sec to 1 minute lasts for 1-2
, no loss of minutes
consciousness ,impaired
occur consciousness
 GENERALIZED SEIZURES
Generalized tonic- Myoclonic
clonic seizures seizures Absence seizure
characterized by Contraction Common in children,pt
unconsciousness, tonic of muscle of freeze and stares in one
spasm of all body, a limb or direction, no convulsion,
clonic jerking whole body lasts for <30sec
Lasts 1-2 min
Atonic seizures
Unconsciousness, all
muscle relaxed, patient
may fall.
STATUS EPILEPTICUS:
The term denotes seizures that
are repeated frequently enough that recovery between
attacks does not occur
PRIMARY CAUSE: Idiopathic , 60-75%

SECONDARY CAUSE:

▪ due to other diseases

▪ Head injury

▪ Brain tumor

▪ Hypoglycemia

▪ Infection meningitis
Seizure with no temperature


a short period, the person is unresponsive to instructions or

questions
the person becomes stiff, suddenly, for no apparent reason


the person suddenly falls for no clear reason


An EEG, or electroencephalography is a test that records the electrical

signals of the brain. Doctors use it to help diagnose epilepsy and sleep
disorders.
Other tests includes an evaluation of sodium, potassium, and blood

sugar levels. Kidney and liver function tests are also often included.
positron emission tomography (PET) scan may be used to locate the

part of the brain that is causing epilepsy.

Herbal treatment such as scullcap, burning bush
Vitamins such as vitamin B6 , vitamin E, vitamin D
and magnesium
Self control from fatigue, depression, anxiety
acupuncture
BARBITURATES: Phenobarbitone,Mephobarbitone
Hydantoins: Phenytoin

Iminostilbene: Carbamazepine

Succinimide: Ethosuximide
BZDs: clonazepam, clobazepam, diazepam

Newer drugs: Lamotrigine, Gabapentin, Vigabatrin

Parkinson's disease is a progressive disorder of the nervous system that

affects your movement.

It is degenerative disease of basal ganglia

Many of the symptoms are due to loss of neurons that produce a chemical

messenger in your brain called dopamine from basal ganglia.

certain nerve cells (neurons) in the brain gradually break down or die.

When dopamine levels decrease, it causes abnormal brain activity, leading

to signs of Parkinson's disease.

Parkinson is an idiopathic disease but other causes includes

Genetics: Specific genetic mutations that can cause Parkinson's disease, but these
are rare.

Head trauma

Cerebral anoxia

The presence of Lewy bodies. Clumps of specific substances within brain cells are
microscopic markers of Parkinson's disease.

Drug induced parkinsonism e.g haloparidol, metaclopramide

Environmental triggers. Exposure to certain toxins or environmental factors may

increase the risk
Risk factors for Parkinson's disease include:

Age. Young adults rarely experience Parkinson's disease. It ordinarily

begins in middle or late life, and the risk increases with age. People
usually develop the disease around age 60 or older.
Heredity. Having a close relative with Parkinson's disease increases the
chances that you'll develop the disease. However, your risks are still small
unless you have many relatives in your family with Parkinson's disease.
Gender. Men are more likely to develop Parkinson's disease than are
women.
Exposure to toxins. Ongoing exposure to herbicides and Pesticides
may put you at a slightly increased risk of Parkinson's disease.
Tremor. Your tremor, or shaking, usually begins in a limb, often your hand or fingers.
tremor at rest usually starting in the hands, you may notice a back-and-forth rubbing of
your thumb and forefinger known as a pill-rolling tremors.
Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles
can limit your range of motion and cause you pain.It is an extrapyramidal motor disorder
characterized by muscle rigidity ,
Slowed movement (bradykinesia or hypokinesia) often with dementia.

Other symptoms are

Impaired posture and balance. drooling, gait disorder
Loss of automatic movements.
facial masking
and slurred speech.
 COMPLICATIONS
Parkinson's disease is often accompanied by these additional problems, which may be
treatable:

Thinking difficulties.

Depression and emotional changes.

Swallowing problems.

Sleep problems and Sleep disorders.

Bladder problems.

Constipation.
Accurate diagnosis of PD relies on clinical examination and a thorough review of a
patient’s history, a review of your signs and symptoms, and a neurological and physical
examination.
No definitive laboratory or imaging tests are available to confirm the diagnosis

Improved symptoms in response to carbidopa-levodopa is one of the characteristics of

PD; therefore administration of single doses has been suggested as a diagnostic test.
However, the test is not recommended as a diagnostic tool.

Single photon emission computed tomography (SPECT) measures the uptake of

radiolabelled tracers that bind to the dopamine transporter protein (DAT) in
nigrostriatal nerve endings. A DAT scan will be abnormal for patients with PD.
Non pharmacological treatment strategies in Parkinson'
disease include
physiotherapy,

occupational therapy,
speech therapy,

cognitive training and deep brain stimulation

Dopamine Precursor: Levodopa, the most effective Parkinson's disease medication, is
a natural chemical that passes into your brain and is converted to dopamine.
Levodopa is combined with carbidopa, which protects levodopa from premature
conversion to dopamine outside your brain, which prevents or lessens side effects such as
nausea.

Dopaminergic agonist: bromocriptine, lisuride

Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic
dopamine effects in your brain.

Peripheral decarboxylase inhibitor: carbidopa

Other drugs include Amantadine,selegiline, anticholinergics (benzhexol, biperiden)

Antihistaminics such as promethazine

Surgical procedures

Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant

electrodes into a specific part of your brain. The electrodes are connected to a
generator implanted in your chest near your collarbone that sends electrical pulses
to your brain and may reduce your Parkinson's disease symptoms.

DBS isn't helpful for problems that don't respond to levodopa therapy apart from
tremor.
Alzheimer's disease is a progressive disease that destroys memory and other
important mental functions.
It's the most common cause of Dementia — a group of brain disorders that
results in the loss of intellectual and social skills. These changes are severe
enough to interfere with day-to-day life.
In Alzheimer's disease, the brain cells themselves degenerate and die, causing
a steady decline in memory and mental function.
In AD plaques develop in the hippocampus, a structure deep in the brain that
helps to encode memories and in other areas of cerebral cortex that are used in
thinking and making decisions.
Advancing age: Alzheimer's is not a part of normal aging, but your risk increases
greatly after you reach age 65. Nearly half of those older than age 85 have Alzheimer's.
Family history:Your risk of developing Alzheimer's appears to be somewhat higher
if a first-degree relative — your parent or sibling — has the disease.
Obesity
Insulin resistance
Vascular factors
Hypertension
Past head Trauma: People who've had a severe head Trauma or repeated head
Trauma appear to have a greater risk of Alzheimer's disease.
AD is most common cause of dementia especially among people over age 65.
Memory loss
Patient with younger age of onset are more likely to have problems with
judgment , language or visuospatial function as the presenting complaint.

language impairment
Apraxia is a disorder of skilled movement , despite intact strength and
coordination.
Emotional experience
Appetitive issues
A person with Alzheimer's disease may not be able to:

Communicate that he or she is experiencing pain — for example, from a dental problem

Report symptoms of another illness

Follow a prescribed treatment plan

Notice or describe medication side effects

As Alzheimer's disease progresses to its last stages, brain changes begin to affect physical
functions, such as swallowing, balance, and bowel and bladder control. These effects can
increase vulnerability to additional health problems such as:

Pneumonia and other infections.

Inability to control emptying of the bladder

Injuries from falls.

ECGPhysical and neurological exam
Your doctor will perform a physical exam, and is likely to check your overall neurological health by testing your:
Reflexes
Muscle tone and strength
Ability to get up from a chair and walk across the room
Sense of sight and hearing
Coordination
Balance
Lab tests
CBC
LFT
CSF study
PET
CT
MRI
QUALITY MANAGEMENT: American academy of neurology has proposed series of
quality measures under the physician quality reporting system process to guide
appropriate care of the patient with dementia.
Staging
Cognitive assessment
Neuropsychiatric assessment
Neuropsychiatric symptom treatment
Depression screening
Driving risk
Caregiver education and support
Cholinesterase inhibitors. These drugs work by boosting levels of a cell-

to-cell communication chemical depleted in the brain by Alzheimer's

disease. Most people can expect to keep their current symptoms at bay for a
time.
Donepezil, Rivastigmine are approved for use in treatment of AD
 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.