1 / 111

Neurological System

Neurological System. Symptom Overview. Headache Dizziness and vertigo Confusion Memory/mental status changes Paresthesia Tremors. Common Symptoms. Headache Inflammation/Constriction Dizziness and vertigo Irritation Confusion/memory/mental status changes Executive Function

mireille-clarke
Download Presentation

Neurological System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neurological System

  2. Symptom Overview • Headache • Dizziness and vertigo • Confusion • Memory/mental status changes • Paresthesia • Tremors

  3. Common Symptoms • Headache • Inflammation/Constriction • Dizziness and vertigo • Irritation • Confusion/memory/mental status changes • Executive Function • Paresthesia • Nerve Inhibition • Tremors • Nerve Excitation

  4. Basis of Neurological Problems • Autoimmune/Degenerative • Pathologic excitation/inhibition nerve fibers • Degeneration/Destructions nerve fibers • Circulatory • Ischemia/hypoxemia • Decreased blood flow/decreased oxygen levels • Genetic • Mutations causing abnormal biochemistry • Infection/Trauma • Abnormal pathology through injury

  5. Degenerative Conditions • Parkinson’s disease • Multiple sclerosis • Brain tumors

  6. Circulatory • TIA/CVA • Aneursym • AV Malformation • Headaches • Migraine • Tension • Cluster • Peripheral neuropathy

  7. Infection/Trauma • Meningitis and encephalitis • Viral meningitis • Seizure disorders/ epilepsy • Bell’s palsy • Trigeminal neuralgia

  8. Nerve Fibers

  9. Pressure/Ischemia = Neuropathy • Peripheral (extremity) • Radiculopathy (“root”) • Myelopathy (muscle/nerve)

  10. Small myelinated axons are responsible for light touch, pain temperature. • Small unmyelinated axons are also sensory and subserve pain and temperature. • Neuropathies involving these are called small fiber neuropathies

  11. Nerves have a limited number of ways to respond to injury • Damage can occur at the level of the axon—this generally results in degeneration of both the axon and the myelin sheath • Damage at the motor neuron or dorsal root ganglion is often incomplete • Damage at the level of the myelin sheath are often inflammatory or hereditary—these can yield a rapid recovery or a progressive diffuse course of illness

  12. Severed = Paralysis

  13. Results of Neuropathy • Pain • Burning • Parathesia • Numbness • Hyperasthesia • Sensitivity • Paralysis • Loss of movement

  14. Various Neuropathy Conditions • Back pain • Radiculopathy • Sciatica • Myelopathy • Neuralgia/Parathesia • Trigeminal • Palsy (Bell’s, Ulnar) • Migraine (?) • Degenerative • Multiple Sclerosis • Amyotrophic Lateral Sclerosis

  15. Radiculopathy/Myelopathy

  16. Radiculopathy/Myelopathy • Burning pain along nerve • Loss of muscle strength • Atrophy • Injury

  17. Trigeminal Neuralgia • Cranial Nerve V • Tic douloureux • 5TH Decade (V!) • Young age ? MS • Multiple Cause • Paroxysmal • Unilateral • Trigger

  18. Bell’s Palsy/Nerve Palsy • Nerve paralysis • Facial Nerve (VII) • Motor not Sensory • Sir Charles Bell • Idiopathic • Altered Taste • Hyper Lacrimation

  19. Nerve Palsies • Neuropathy • “Saturday Night Palsy” • Nerve pressure causing paralysis • Sleeping standing up • Hours to Months

  20. EPS

  21. Testing Neuropathies • Electromyography (EMG) • Needles into the muscle • Measures muscle action potentials • A surface EMG (SEMG) is not accurate • Nerve Conduction Velocity (NCV) • Usually done at the same time as EMG • Evoked potential • Basis for EMG, can be auditory, visual

  22. EMG

  23. Treatment for Neuropathies • First treat the underlying cause then symptom management • TCAs • Muscle relaxants • SSRIs • Antiseizure meds • Vitamin B12 • Lidocaine patch • Analgesics • TENS unit, acupuncture, Biofeedback

  24. Headache

  25. Headaches • Migraines • Cluster Headaches • “Cluster cycle” • Tension Headaches • “Stress”, muscle tension, neck pain

  26. Migraines

  27. Types Simple or Classic Complex Hemiplegic Possible Aggravating factors (“triggers”) Stress / Emotion Glare Alcohol Exercise Stimulants: Excess Caffeine, cocaine, amphetamines Foods Analgesic rebound Estrogen Migraine Headaches

  28. Migraines • Trigeminal Nerve Symptoms • Several Criteria • Photophobia • Nausea/Vomiting • Aura • Recurrent MRI of a Migraine

  29. Diagnostic Requirements of Migraine • At least two of the following features: • Unilateral location • Throbbing character • Worsening pain with routine activity • Moderate to severe intensity • At least one of the following features: • Nausea and/or vomiting • Photophobia and phonophobia International Headache Society Classification of Headache

  30. Ergotamine - Unknown “Abortive” or “rescue” tx Dosage forms – oral, sublingual, rectal, parenteral Contraindications Cardiac disease Peripheral vascular disease Cerebrovascular disease Sepsis Advanced Liver and Kidney disease Pregnancy, Breast Feeding Caffeine Increases intestinal absorption of ergotamine Potentiates vasoconstriction and pain relief when combined with ergotamine and analgesics Adverse effects GI disturbances Nausea Vomiting Anorexia Acute Migraine Treatment

  31. Sumatriptan Dosage Forms Subcutaneous injection Oral tablet Nasal Spray Adverse effects Oral - nausea and vomiting, malaise, dizziness Intranasal – bitter, unpleasant taste Subcutaneous Injection - mild pain, redness, rebound HA Drug Interactions Ergot alkaloids Lithium Serotonin-specific reuptake inhibitors Other triptans Monoamine Oxidase Inhibitors - use with these products may precipitate serotonin syndrome Acute Migraine Treatment- Triptans

  32. Second Generation triptans Eli-, zolma-, nara-, frova- Acute treatment of migraines Comparison to sumatriptan Similar pharmacologic features Improved oral bioavailability Able to cross blood brain barrier Possible reasons for treatment failures Medication administration too late Swallowing Sublingual products Vomiting tablet prior to absorption Rebound headache due to overuse Dehydration/ ketosis/acidosis Analgesic rebound Diagnosis? Acute Migraine Treatment

  33. Intractable migraines • Sumatriptan subcutaneous injection • Parenteral form of ergot derivatives • IV antiemetic • Corticosteroid - oral or parenteral • Hydration! • Parenteral Narcotic analgesics

  34. Migraine Adjunctive therapy • Antiemetics • Systemic relief of nausea and vomiting • Increased absorption of other medications, prokinetic • NSAIDS • Not approved by FDA for migraine headache indication • Selected NSAIDS effective as abortive therapy

  35. Migraine Prophylactic therapy • Goals • Reduces frequency • Reduces severity • Criteria • Headaches that occur twice monthly or more often • Disabling headache that occurs less frequently but are unresponsive to usual abortive therapy • Abortive agents contraindicated • Headaches that occur in unpredictable patterns

  36. Migraine Prophylactic therapy- cont’d. • Topomax Use in low dose of 25 to 50 mg at hs to prevent migrane • Valproic Acid • 1000mg po q HS prophylaxis

  37. Cluster Headaches • Gender - males>females • Onset - second and fourth decade of life • Intensity of Headache Pain • Same side of head, tearing, flush • Severe throbbing/stabbing • Not preceded by aura • Last 45-60 minutes

  38. Cluster Headache Abortive Therapy • Oxygen inhalation • Ergotamine

  39. Tension Type Headaches • Gender - women 88%, males 69% • Intensity of headache pain • No aura • No nausea, vomiting • No photophobia

  40. Abortive- NSAID’s Muscle relaxants Anxiolytics Analgesics Prophylactic Antidepressants Non-drug techniques Massage Hot bath Acupuncture Biofeedback Tension Headache Therapy

  41. Seizures • VFib of the brain • Various Reasons • Electrical • Ischemic • Chemical

  42. Seizure Disorders- Pharmacologic Treatment • Optimization of drug therapy • Choice of appropriate AED • Individualization of dosing • Compliance

  43. Therapeutic endpoints: Patient response • Seizure frequency and severity • Presence and severity of symptoms of dose related toxicity

  44. Indications for use Uncontrolled seizures despite greater than average doses Seizure recurrence in a previously controlled patient Documentation of intoxication Assessment of compliance Dose change Assessment of therapyin patients with infrequent seizures When dosage changes are made Interpretation of serum concentrations Laboratory variability Interindividual variability Active metabolites of AED’s may not be measured Binding of serum proteins Therapeutic blood levels useful for: Phenytoin Valproate Carbamazepine Phenobarbital Serum drug concentrations

  45. Idiopathic Grand Mal Epilepsy • Drugs • Phenytoin (hydantoins) (Dilantin) • Valproic Acid=Depakote • Carbamazepine (Tegretol) • Phenobarbital (barbiturates) • Topiramate (Topomax) • Duration of therapy • Seizure free for 2-5 years or may be lifetime • Withdrawal of AED’s • Two to three months withdrawal schedule • Multiple therapy - each drug tapered separately

  46. Complex Partial Seizures with secondary generalization • Carbamazepine (Tegretol) • Lamotrigine (Lamictal) • Gabapentin (Neurontin) • Tiagabine=Gabitril • Levatiracetam=Keppra • Oxcarbazepine=Trileptal • Pregabalin=Lyrica

  47. Absence Seizures • Valproate when secondary tonic/clonic also • Clonazepam

  48. Febrile Seizures • Fever control • Anticipatory management in the future

  49. Testing Seizures • EEG EEG

More Related