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All about: the cognitive impairment [1]

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Diseases and conditions

  • What is the alexithymia
  • What is Alzheimer's
  • Amnesia: Alteration of the memory
  • What is Biofeedback
  • Dementia: cognitive impairment chronic
  • What is encephalitis
  • What is Huntington's disease
  • What is Wilson's disease
  • Epilepsy: Chronic neurological disease
  • What is stroke

What is the alexithymia

In 1972 Professor of Psiquiatría Peter Sifneos introduces the term 'alexithymia' ('a' - no, 'lexis' - word-, 'thimos' - affection-) to refer to a disorder that prevents the person to detect their own emotions and therefore give a name to express them verbally. Therefore, that alexitimicas people are unable to recognise and put a name to their emotions.
It is an important interference in the daily life of the patient, hampering him enormously interpersonal relationships, since the people who surround you hardly are informed by how their actions influence the alexitimico (for example are unable to express enthusiasm at good news). Therefore, that often seem cold and too pragmatic people.
Joins all the important level of emotional distress which accompanies the alexithymia and the patient not known to define, what more difficult you enormously regulate emotion.
The alexithymia can be present in different types of pathologies, being especially prevalent in the pervasive developmental disorders such as autism spectrum disorders. In most cases, the alexitima responds to biological factors such as neurological deficits, although it can also be a result of the exposure of the individual to traumatic situations.
How does an alexitimico?
The diagnosis of alexithymia is usually done from observation (and self-observation) behavior of the subject in different situations in which the recognition of their own emotions guarantees a successful coping. In addition to the basic component of alexithymia, inability to recognize their own emotions, is often found in this type of people some of the following behaviors also considered characteristic of the profile of people alexitimicas are:
  • Low capacity for introspection and fantasies; they are people with a very low inner life. They have a minimal tendency to fantasy.
  • They do not detect or recognize emotions in others. Lack of empathy.
  • They seem serious and boring.
  • They speak very little.
  • They are too practical and rational. Their cognitive style (way of thinking) is oriented towards the external and the concrete.
  • They show an important difficulty in handling the affections; establish and maintain affective links costs. This fact makes them to develop inappropriate relationships characterized by emotional dependency or social isolation.
  • Sexual problems; absence of desire or impotence.
  • They are impulsive; react disproportionately to emotions that they themselves are unable to identify.
  • They are person conformists.
The scale of Toronto is the method most used to support the observation clinic diagnosis of alexithymia without in any case replace the mentioned process.

Causes of alexithymia

Many authors argue that alexithymia is a concept of range, since not all people have it in the same degree, and in small doses may be relatively frequent. According to the Spanish society of Neurology, it is estimated that 10% of the population suffers from it, arising, according to existing studies, more frequently in males.
"Their pathological dose" is a disorder that mainly affects people who suffer from some type of neurological deficit or disorder psychiatric addictions or affective disorders (depression, cyclothymia, etc). This disorder has a high incidence rate (80-90%) in autism spectrum disorders.
Alexithymia can be classified into two types based on their causes: primary or secondary.

Primary alexithymia

It responds to biological causes. They are often neurological deficits which interfere with communication between the limbic system (involved in emotions) and the neocortex (involved in our reason), either, that hinder communication between the cerebral hemispheres; left responsible for the production of language and the right to charge regular and put a name to emotions.
Primary alexithymia may be due to heredity, manifesting itself in this case since childhood; or appear as a result of a neurological disease, such as multiple sclerosis or Parkinson's, or as a cause of stroke, trauma or brain tumors.

Secondary alexithymia

Is it due to traumatic causes which have place in certain evolutionary times or when the person has been subjected to intense traumatic situations in adult life (e.g. child abuse). Many of these people suffer from a disorder by post-traumatic stress (TEP), which explains their symptoms. Besides with the TEP, the alexithymia can appear in other psychopathological disorders such as depression, disorders (anorexia and bulimia), addictions...
You can also, due to a disorder in the affected emotional learning.

Treatment of alexithymia

The patients alexitimicos usually attend treatment pressured by the people who surround them, as they are people who really suffer from its symptoms. Treatment of alexithymia You should consider the use of techniques that help to the plaintiff to identify their emotions, at the same time that it provides strategies that allow you to graduate their emotions depending on the magnitude of stressful events, reviewing their current coping style. In this way will increase the emotional vocabulary of the patient, allowing you to differentiate between different gradients of emotion depending on circumstances (for example may be nostalgic, sad, of downturn or depressed).
In general the treatment of alexithymia is based on the cognitive development of emotional awareness. I.e., the main objective of the treatment will be help the patient to recognize and name your emotions. To do so, the patient must learn to follow these steps when it comes to understand and regulate your emotions:
  • Detecting his emotion or other emotions: "I'm sad."
  • Assimilate emotion: ability to take into account our own emotions when it comes to carrying out a certain reasoning or decision making. For example, you should be able to say "you spoke so because he was angry".
  • Understand: understand the different emotional signals, such as the feeling of tension that announces that we are angrier.
  • Regulate emotions: through the knowledge of different strategies of emotional control through psycho-educational strategies (e.g. reading) and behavior modification specific techniques (for example imitating the behavior of a person acting as a model, social skills training, etc).

Alexithymia from childhood prevention

The expression and regulation of emotions is part of a learning process that takes place along the evolutionary development of the child. Help the children to learn to identify their emotions and others is a fundamental task that parents can do to prevent cases of secondary alexithymia. For this purpose it is important to allow the child the expression of their emotions so we then teach you to regulate them. To achieve this, the communication style between the small and the Popes must be direct, expressing respect for the emotional States of the kid, combined with a clear educational guidelines that help you manage it at all times.
To enhance the emotional education in children, parents can help materials as elaborated that in game format to teach them to express and to regulate different emotions. Example of these are 'The Bingo of emotion' or 'Rabid animals', the publishing house TEA. The stories and metaphors are also excellent tools that help children understand their feelings of hand of fantasy.
We must also take into account that the parents are the main models of affection for children. We can not claim that a child express emotions if we ourselves do not. Parents who hide their emotions teach their children to repress them. Therefore, it is appropriate that the family environment is an open and appropriate expression of affection.

What is Alzheimer's

Alzheimer's disease is a neurodegenerative brain, progressive and irreversible pathology. It affects of diffusely to the neurons of the cerebral cortex and other adjacent structures, and leads to a degeneration of cognitive and behavioral disorders.
It is characterized by a deterioration in the ability of the subject to control their emotions, develop in its surroundings according to normal behavior patterns, and properly coordinating their movements and memory, among other disorders.
It is the most common form of dementia (represents 60% of all cases of dementia), and affects nearly 36 million people around the world. Prevalence reaches at least 30% of the population that exceeds 85 years. Still women about 70 per cent of those affected between 65 and 90 years old.
In addition, due to the increase in life expectancy, estimated the number of people with Alzheimer's is expected to triple in the next 40 years, coming to get it some 113 million people, of them 1.5 in Spain, according to data from the Spanish Neurology Society (SEN).

Causes of Alzheimer's disease

Identified several biological factors which interact with different mechanisms of genetic or environmental type, and which result in lesions that cause progressive nerve cell degeneration and the onset of Alzheimer's disease.
We have identified two characteristic signs of the disease as a cause of Alzheimer's that are: the emergence of the so-called senile plaques, plaques amyloid, or neuritic plaques, and the presence of tangles of neurofibrils:
Senile plaques are extracellular deposits of the protein beta-amyloid in the brain's gray matter, and are associated with degeneration and neuronal death. This beta amyloid protein is derived from the degradation of a larger protein called amyloid precursor protein, which is found in the membrane of many cells and whose mission is not fully clarified. The accumulation of beta-amyloid is due to an increase in its production or to a reduction in their elimination.
On the other hand, the formation of tangles of neurofibrils is the result of abnormal protein polymerization tau (a protein that is in neurons), and starts in the region of the hippocampus, where memory management function. These two processes involved in Alzheimer's disease may be interrelated and, in any case, cause a degeneration and neuronal dysfunction.

Risk factors for developing Alzheimer's

The main factors related to the development of the disease are age and family history of Alzheimer's disease. Exposure to certain substances, such as tobacco, also seems to favor his appearance.
On the contrary, a moderate intake of alcohol, the Mediterranean diet, physical exercise in the middle ages and an active social life, been associated with a lower risk of developing the disease in different studies. Also they have related to the years of education a lower risk of the disease.

Types of Alzheimer's disease

It is a disorder that can come associated with different causes; Thus, we can differentiate three types of Alzheimer's:
  • Family Alzheimer: are known to persons in whose family cases of Alzheimer's disease have been more likely to suffer from the disease. There is also a type of Alzheimer's specifically called familial Alzheimer's disease, characterized by starting so early, i.e., before the age of 60. This type of Alzheimer's disease is given by mutations in genes such as the gene for the amyloid precursor protein, the gene of the presenilin I or II presenilin gene. Mutations in these genes lead to an abnormal accumulation of the protein beta amyloid, a main component of senile plaques. This type of familial Alzheimer's disease is rare.
  • Associated with Down syndrome Alzheimer: due to Trisomy in chromosome 21, people with this syndrome present excess of amyloid precursor protein, which favors that your metabolism will lead to an accumulation of senile plaque causing fragments. In individuals with Down syndrome, we found cases of Alzheimer's from the age of 12.
  • Age-associated Alzheimer: although this disease is not a consequence of ageing, affects 5-7% of people older than 65. There are more than 70 genes whose presence in the organism can favour the onset of Alzheimer's disease associated with age. These include ubiquitin gene, the gene for the protein tau, or the gene for apolipoprotein E.
In any case, the altered metabolism of amyloid precursor protein is involved in all types of Alzheimer's disease described.

Symptoms of Alzheimer's disease

The first symptoms of Alzheimer's include a wide range of cognitive and behavioural. Many of the signs that can be seen in the earlier stages of the disease can be easily confused with the typical signs of aging, so it is good to know them and know to differentiate them.
One of the lighter which usually associated to Alzheimer's but also with old age could be starting to forget things, activities that would make, or names of people. This can be normal at a certain age, for example forgetting the name of a co-worker, a neighbor or Baker, and yet remember that working with you or living in the fifth. While a person with symptoms of Alzheimer's disease also forget the context, i.e., probably you don't even remember its name, but that is not your neighbor or your grocer.
Early symptoms of Alzheimer's
Memory and concentration
  • Change of place or loss of important objects.
  • Confusion about how to carry out everyday tasks.
  • Difficulty to solve simple arithmetic problems.
  • Difficulty to make routine decisions.
  • Confusion about the month or the season of the year.
  • Difficulty to perform drawings (test clock), buildings in three dimensions, or to orient themselves in open spaces. The patient gradually loses the ability to recognize objects, persons, or places.
Mood and behavior
  • Unpredictable mood swings.
  • Progressive loss of interest by the environment, or in their tastes or hobbies.
  • Depression, anxiety, or confusion in response to changes.
  • Denial of the symptoms.
  • It may present irritability, aggressiveness, agitation and social disinhibition.
Late symptoms of Alzheimer's
Language and speech
  • Difficulty completing sentences or find the right words.
  • Inability to understand the meaning of the words.
  • Reduced or irrelevant conversation.
Movements and coordination
  • Markedly deteriorated, including slowed movements, ailing March and sense of balance decreased movement and coordination.
The duration of the disease ranges between 5 and 20 years, and once it is diagnosed, life expectancy is reduced by half.

Diagnosis of Alzheimer's disease

Currently there is no diagnostic test specific or reliable to diagnose Alzheimer's, so it is necessary to resort to an array of tests of different types that allow, firstly, rule out other types of dementia and, secondly, assess the degree of the same.
  • The first step that will give the physician that is evaluating the patient will be the study of family history, personal history and symptoms that the patient presents. It will also perform a general physical examination and neurologic examination.
  • Neuropsychological testwill be held. Some of the most commonly used are called mini-mental test and the test of the clock. The mini-mental test consists of questions that explore the orientation, the ability to repeat a few words, concentration, calculation, memory and the language of the patient. It can be in 5-10 minutes. The patient gets a score that should be low, suggests a diagnosis of dementia. Watch test consists of making the patient draw a clock with the hands pointing out eleven and ten. This way we will be able to assess activity in the temporal lobes of the brain where they reside, among others, the functions related to memory and the development of complex Visual activities. It will be evaluated if the patient manages to write all the numbers, doing so in the right place, and if it is capable of situating the hands marking time which instructed. Each of these steps is assigned a score; from 7, it is considered that the patient is not suffering from the disease.
  • Neuroimaging studies are techniques used to confirm a suspected diagnosis in patients who present other signs of the disease.
    • By CT (computed Axial Tomography) and MRI be ruled out structural injury as a cause of dementia. In addition, in the case of Alzheimer's disease, is usually appreciate atrophy of certain brain structures.
    • The computed tomography by emission of Simple photon (SPECT) and Positron Emission Tomography (PET) allow to perform a functional analysis, i.e., provide information about metabolic changes related to Alzheimer's disease. A decrease in metabolism in some brain regions is characteristic.
    • Recent studies of the University of Pennsylvania are running a new method which consists in analyzing images obtained by magnetic resonance imaging (MRI) employing an algorithm allows to detect Alzheimer's disease and its progression with a 75% effective.
  • It is possible to use the detection of biomarkers as an additional method to the above. Pay special attention if you notice a decrease in the cerebrospinal fluid of the protein beta-amyloid and tau protein increased.

Treatment of Alzheimer's disease

Alzheimer's is a disease for which currently cure is not known. It is not possible to halt its advance or restore the damaged functions. The drugs that are on the market today are intended to slow the progression of the disease, reduce symptoms (depression, psychotic symptoms, sleep disorders...), improve cognitive function and slow down certain metabolic processes, which is believed to accelerate the degenerative process.
  • Drugs that protect the cholinergic system: system, that modulates information processing in different parts of the brain, is affected so early in the disease. These drugs Act on the enzyme that degrades acetylcholine (a neurotransmitter), increasing their levels in the brain. Some of the most commonly prescribed are Donepezil, rivastigmine and galantamine. They produce a slight improvement in the cognitive abilities of the sick. They all have side effects on the digestive tract, such as nausea and vomiting. They can also cause dizziness and decreased heart rate. All these side effects decrease if the administration of the drug at low doses and climb the dose gradually.
  • The NMDA receptor antagonists (N-methil-D-aspartate): the main component of this group is a drug called memantine, which inhibits the toxic action on an amino acid called glutamate neurons. Used in moderate to severe Alzheimer's disease. It can be used in combination with drugs in the former group. Its most common side effects are dizziness, headache and confusion.
  • Nonsteroidal anti-inflammatory drugs: are indicated both in prevention and in the treatment of Alzheimer's disease. Among them are the type drugs aspirin and ibuprofen, which act by blocking prostaglandins, the inflammatory response factors that seem to play an important role in Alzheimer's. Not recommended for long-term use.
  • Antioxidants: several studies have shown that antioxidants may slightly delay the progression of the disease or its symptoms. High doses of vitamin E, or the consumption of Ginkgo biloba - a medicinal plant that has antioxidant properties - contribute to a slight improvement in comparable to that experienced memory after the consumption of certain drugs, but without its side effects. It is necessary to take care and manage Ginkgo always under medical supervision, as there exist contraindications in use with certain medications.

Recommendations for living with Alzheimer's

Once you have been diagnosed Alzheimer's disease will begin a very difficult process, both for the sick and for the people that surround him (more if fit for the latter). The entire environment of the patient, the House and the family, should be reorganized to avoid any type of injury, to facilitate the management of complicated situations, and to ensure a quality of life appropriate to the patient and their carers.
A: should be taken measures
  • Preventing falls: be sure to remove all that with whatever it is easy to slide, remove obstacles that hamper the displacement, prevent cables to drag along the ground, ensure a good birth of stays, etc. Where necessary, there are adapted walkers which are available at orthopedic centers.
  • Accidents: is important to withdraw from circulation all sharp, flammable and toxic materials. It is advisable to equip the tub with bars that facilitate the entry and exit of the same, and non-slip bands. Install insurance in windows and doors, and not only never let the patient in places such as terraces, stairs, and other places that might be dangerous for him. It is highly recommended to always have the phone number for the emergency department or nearest health center.
  • Organize the environment: in general you should try to simplify the layout of the House and objects, not to let anything fall easily or with what is tripping. In addition, it should not change site things to not mislead the sick. It is good to indicate the path from the bedroom to the bathroom and the kitchen, and posters with the name (and preferably a simple drawing) can be placed from these stays at the door.
  • Activities of daily living: since the early stages of the disease are must create a routine and follow it more faithfully possible; What will help the patient to orient themselves in space and in time. This can also be achieved facilitating patient access to a calendar where this can go by day, drawing up a list of activities, or placing a watch that the patient understand view (usually find it easier to interpret the digital watches).

Tips for families of patients with Alzheimer's disease

The family will live and suffer all the progress of his illness with the Alzheimer's patient. Changes that are going to happen from now on will be in many cases the appearance of certain negative feelings (depression, fear, anxiety, guilt...), and a level of stress and wear, both physical and psychological, that will result in what has been called "the caregiver syndrome".
To avoid that the person that takes the main role of caregiver suffer this disorder must, first, be informed and receive some type of training to orient it in the development of its function. Second, you should know that you have help whenever you need it, psychological, social and family support.
Last, but not least, the caregiver must have time to rest and carry out activities outside the environment of the patient. In short, don't forget that the maintenance of the quality of life of the people that surround you is as important as the well-being of the patient.

Support Alzheimer's associations

The effects of this neurodegenerative disease go far beyond the symptoms related to the progressive deterioration of cognitive development and loss of memory. Relatives of the patient with Alzheimer's disease and its nearest surroundings also become protagonists of the disease to be emotionally affected by the change of behavior of the patient. This is why the major associations related to Alzheimer's disease to focus efforts not only on the person who suffers it, but also and in particular in the family and its closest surroundings.

Amnesia: Alteration of the memory

Memory is an indispensable part of what we are, in which will be recording what we have felt through sight, hearing, taste, touch or smell. Thanks to her we remember from our loved ones who we just know, from the dates of birthdays or anniversaries to the next appointment. But what happens when the memory is affected?
All have been able to suffer at any given time a failure of memory, that we have forgotten a commitment either to not remember the name of any person; but when this ceases to be somewhat anecdotal and punctual, we must consider the possibility of making us a Neuropsychological examination to rule out pathologies associated with alterations of memory as amnesia. Then review what is amnesia, are its symptoms and how it is produced, as well as diagnosis and treatment.

What is amnesia?

It is an alteration of the more or less permanent memory that it is unable to access part or all of our memories. Taking into account that in the memory are mainly involved three processes:
  • The first creation of the memory, where you learn new names and situations. Everything we perceive is information that is available for brief moments in our brain, in what is called short-term memory, and is responsible for selecting the relevant that we remember; If distracted requirements at that time, for example speak of a subject of our interest after submitting us a person, can we not be able to remember his name. Using the computer model it would be the equivalent of the RAM, which loses all information containing once the appliance shutdown.
  • The second, storage, once chosen the important our neurons recorded participating in that process different regions of the brain, where you create the "memory footprint" that will accompany us for years, in what is known as long-term memory. Continuing with the model of the computer, it would be tantamount to the hard disk, where is contained the information despite the time that passes.
  • The third, recovery, where you can access the memory. This, despite being a process that may seem minor, is important to not mix memories, and to remember precisely the moment or the name you need. This is where will be mainly the therapeutic intervention for the recovery of patients with amnesia, teaching new information management strategies.
Any alteration of any of these processes will lead to an inability to remember, either because it was not recorded and therefore there is nothing to recover; because damaged support where it was registered (the corresponding brain region); or because recovery recorded is not functioning properly.
This change can affect both the recovery of past events (retrograde amnesia), which is the best known subtype; as to the inability to learn and thus form new "traces of memory" (anterograde amnesia). Both subtypes are not exclusive, so it may occur at the same time.

What cause amnesia?

There are many causes that can alter memory and cause amnesia, from inadequate intake of certain substances as psychotropic drugs (drug-induced amnesia) or alcohol (Korsakoff syndrome), traumatic brain injury (post-traumatic amnesia), some types of infections such as encephalitis, physical malformations of the brain involving memory-related areas (organic amnesia), and even traumatic events that can cause shock (lacunar amnesia) or emotional disorder (dissociative amnesia).
It is easy to know the time of onset of disorder especially if it occurs after an accident or poisoning, but sometimes the cause may take longer to find, despite the evident effects on memory, especially if you are based in a traumatic event or organic origin.
As mentioned previously, any of these causes may affect any of the three processes, acquisition, saved or "memory footprint" recovery, with what would make it impossible to his memory.
Like any muscle, our brains must be oiled properly, overworked, a continued disuse or exciting substance intake may cause an atrophy, partial or total in their internal organization, and thereby cease to function properly.

Symptoms of amnesia

Symptoms of amnesia are basically focused on the loss of access to the memory, either from data specific and timely, dates or names, to more general events and even own bibliography of the person. Depending on the severity of the disorder, involvement will be of greater or lesser magnitude, even causing them to remember nothing of the past.
This loss of memory, when it is more serious and extensive, can lead to further deterioration in occupational and interpersonal relations of the person, antisocial behavior to try to relieve social pressure he feels when he is unable to function in society.
It is worth mentioning that although is can cause a deficit in the declarative memory, i.e., can that person isn't capable of narrating the events of the past, remains intact the processual memory, thanks to which we can cope in daily life, which we know to perform tasks such as walking, the lace...
Common is that there is a loss of memory of the moments leading up to events like car accidents involving a blow on the head or by alcohol poisoning, because the brain not had enough time to record "the footprint of memory", and this is impossible to be able to recover it.

Diagnosis of amnesia

Diagnosis of amnesia will basically depend on the fact that caused it. Thus, in case of accident early detection of memory disturbance is usually performed through exploration of own health personnel who treats you, thanks to the emergency protocols, and where evaluates their level of awareness, so that intervention can be started as soon as the person to stabilize and thereby to expect a better prognosis, provided that it is reversible.
In other cases, it is essential to the detection by family and friends that something is wrong, since omitted talk of a certain stage of their life without apparent reason, have difficulties with the proper use of words clogging when talking about or is unable to remember dates or names, or even learn new tasks.
The person suffering, especially in the beginning, doesn't it give the importance due to their "failure of memory", attributing them to temporary causes such as stress, fatigue or lack of attention, without realizing account that may be concealing a disorder that must be diagnosed and treated in time.
For diagnosing amnesia, it is necessary to conduct an assessment of Neuropsychological battery of tests, which will be evaluated performance in different memory tasks to explore the extent and severity of trauma, where there is.
At this point we must distinguish the amnesia of others lost memories, as the associated to age because of natural aging, or those caused by disorders such as dementia, which includes the best-known case, Alzheimer's. In both circumstances it is a progressive loss of memory and memories, more or less accused, unlike amnesia, which is episodic and sudden.

Treatment of amnesia

Some of the forms of existing amnesias are incurable, especially those that are associated with disorders of the brain, whether due to malformation congenital or acquired by head injury; at other times, the effects usually disappear spontaneously in a short time, as in the case of transient global amnesia lasting less than 24 hours.
Depending on the type of amnesia is sustained will apply a treatment or another, sometimes more medical supervision is required to maintain controlled cholesterol or blood pressure; in others it must intervene in the cause directly treating the disease, as in the case of the thyroid, liver or kidney.
In other patients, it is important to apply occupational therapy, which teaches the person to develop strategies that help to compensate for their loss of memory, so that you can lead a normal life, which will employ strategies of information organization, and even technological tools such as PDAs or notebooks that help you to remember important events and appointments.
Psychotherapy is more indicated for those cases where there is a significant psychological component involved, as it occurs in amnesia lacunar, where a stressful or traumatic event causes inability to partial or total of retrieving information. The most extreme case would be dissociative amnesia, in which the person is unable to recall important personal information.
In addition, it is important to count with the collaboration of family members who live with the person who suffers from amnesia, so serve them support in moments of bewilderment, as well as to alleviate the limitations that could cause. It is also good to participate in aid groups where release concerns and emotional tension that causes the disorder.

Tips to prevent the effects of amnesia

Just like in any other muscle, the brain health depends on the quantity and quality of what do you work. Among the tips to have a suitable memory, preventing in this way the emergence of some cases of amnesia, would be the following:
  • Try to keep you busy in multiple activities that involve going out and interact with others, because this way you'll be exercising much of your memory.
  • It's sleep about eight hours a day, since they are which requires your brain to archive the memories of that day.
  • It avoids stress situations, as they disrupt the normal functioning of the brain and therefore the memory.
  • It's healthy living, without excesses, usually eating vegetables and exercise moderately, as the walk in, that will extend not only the health of your brain but your life itself.

What is Biofeedback

The best teacher is within us; Therefore, watching and paying attention to signals that the body sends us, we can reduce, and even eliminate, certain health problems. This theory is defends biofeedback (biofeedback in Spanish), a relatively new therapy that we can learn to improve our health and performance that we get from our own body.
Precisely to maximize the performance of the body is what athletes seek tirelessly, but not only them can be benefited by biofeedback. This treatment provides a greater self-control of certain physiological variables that can influence our health status; What other words can be defined as "making the unconscious conscious".
The body itself provides certain information that, if we know how to handle it, we can help our body to function better and, therefore, to reduce or eliminate health problems. In a first phase, the biofeedback measures different factors related to the nervous system and its activity, such as muscle tension, breathing, skin temperature, brain waves, or blood flow. Based on this information, we can get a plan designed by professionals to manage these variables and thus control certain problems.
For example, our breathing is accelerated when we are stressed, as we can see on the monitor; We will learn to control the breathing, and will see the results of our efforts in a screen for, then know how to detect a problem and autogestionarlo out of the inquiry. And it is that biofeedback is that I learn to take more advantage of our capabilities and better control of our body's physiological processes.

Origins of the biofeedback

It was in the middle of the 20th century, when one of the professors of the University of Chicago, José Kamiya, realized that they could control their brain waves , and therefore their Psychophysiological processes. Little by little it was improving and developing this technique, and only 15 years later another American professional, Barry Sterman, began to use it for therapeutic purposes. He was born the biofeedback .
Biofeedback include a mode that every day is more widespread: neurofeedback. Also known as EGG-Biofeedback, is a very specific part of the biofeedback which focuses on the electrical activity of the brain and that, therefore, teaches to control brain waves to adjust the State of mind.

Benefits of biofeedback

Biofeedback for help, according to its supporters, the recovery or improvement of different pathologies, by what its health benefits are presented as fairly broad.
One of the main advantages of biofeedback is that it provides an increased ability of relaxation, because the training of this therapy teaches to control breathing and to reinforce the concentration in an autonomous way. This will provide us with an internal state of tranquility and will also cause a substantial increase in our self esteem and confidence which, in turn, will help us in the decision-making process.
Other aspects that will improve with the biofeedback are response speed and memory, both short-term and long-term. This, coupled with the fact that we have less mental wear, will cause a great development of the emotional intelligence and, therefore, a great psychological well-being.
If the biofeedback is proving effective for our ailments, maybe we can avoid or reduce other types of more aggressive physical or pharmacological treatments. However, we must tell our doctor of the progress achieved thanks to the biofeedback, and it will be he who decides if you need to change the traditional treatment. Same counterproductive self-medicate, also it is remove or change medication willingly, without consultation with the specialists.
In addition to a preventive and curative method, biofeedback is presented as an adequate therapy for the improvement of the practice of athletes. And it is that semi-professional or professional athletes can learn through biofeedback, reducing and managing anxiety that occurs before the competition, as well as to increase the concentration which will lead to more consistency and regularity in its performance. In addition, biofeedback can help in the recovery of injuries.

Biofeedback is indicated for people who

Biofeedback is a success as a method to combat various psychosomatic problems, among which stands out the stress. This therapy teaches how to handle it, by what is ideal for people who suffer it, as well as for those who suffer from other problems of similar like anxiety, even depression.
Although stress is one of the most common diseases that are consulted experts on biofeedback, female urinary incontinence is the disease where there is a greater degree of success, according to the Association for Applied Psychophysiology and Biofeedback (AAPB), the International Society for Neurofeedback and Research (ISNR) and the World Association of Biofeedback. And it is this therapy helps women to achieve an effective bladder emptying, identify the muscular proprioception, and coordinate the muscles of the urinary system in order to eliminate the inappropriate patterns.
Equally, these international associations indicate that biofeedback is effective against the deficit disorder attention and hyperactivity (ADHD), chronic pain, constipation, epilepsy, migraines, hypertension, psychomotor problems, Raynaud's disease and temporomandibular dysfunctions.
However, the list of diseases and problems for which is indicated the biofeedback is very long and spans from disorders caused by the consumption of toxic substances, breathing problems or coronary.

Tips for biofeedback

As in any other treatment that we're going to submit, is important to ensure that therapists who taught biofeedback are professionals, they have specific training, and are suitable to detect our problem and educate ourselves to fix it or improve it.
Equally, we need to be clear about what we want to achieve with biofeedback, since, according to our goals, we will have to choose a clinic equipped with more devices of mediation. Perhaps it is better to pay a little more for each session, but make sure that it is as complete as we need.
On the other hand, our mentality has to be receptive to understand that this type of processes require learning that only will be in the first sessions, and therefore the results lack of immediacy. In this way, we should not think that we will get the quick success or worry if it fails as soon as we'd like; and it is that precisely this attitude only cause us stress and anxiety, which will delay our evolution.
In this regard, our way of acting must be active and our positive attitude. And is that, finally and after, we ourselves who have to finish regulating our system physiological through what has been learned in biofeedbacksessions, since the therapist only is our guide.

How is a typical session of biofeedback

Each session of biofeedback will be different since it's a therapy that is customized according to what the patient wants to treat and the learning phase that is found.
However, what is common at the start of any treatment of biofeedback is conducting an initial interview, where the patient will explain their medical history and what you want to try. With these data the specialist will inform us about how the sessions are to avoid that uncertainty causes a change in the results of the measurements. Also in this initial interview should explain us the entire process: approximate time of treatment with each session, frequency of the sessions, the difficulties with which we may find ourselves, and if there is need to practice what they learned in our House.
With all the theoretical part clarified, it is time that the patient is connected to different measuring devices, that will depend on the roadmap that the specialist has been marked. The information obtained thanks to these devices will be the starting point of the intervention, and will be used to define the type of training that must be done.
In General, we can say that there are three main types of measurements according to the kind of answers that we hope to achieve. In this sense, if what you want is information of the somatic nervous system, the patient will undergo an electromyogram, while for responses of the system autonomous nervous, is used the control of blood pressure, heart rate or body temperature. Finally, the responses of the central nervous system can be measured with the electroencephalogram.
Upon registration of measurements, the next phase of a biofeedback session consists of targets, which is another thing that determine what is intended to get at the end of the treatment of several sessions. With this we will understand where we go, and we'll see if the process is still adequate or must redirect it.
The next step is, the most important part of the biofeedback training . We will return to measuring devices, and the information provided our body will reach us by means of Visual or auditory stimuli. In this way we can see on a scale how our physiological response increases or decreases after go to perform the exercises marked by the expert. In this sense, it will be the therapist which teach the patient how to perform exercises to control those levels; instruct you as well, so you can focus on breathing, relaxation, concentration, the remembrance of pleasant memories, the use of images that evoke you various types of sensations, etc.
In the following sessions the therapist will begin assessing the progress we are having and where we have had to do some kind of activity at home, we will discuss how we have been making and the possible problems encountered will be analysed. Subsequently professional we will connect to machines and we will again carry out exercises that tell us.
In some cases it teaches the patient to use the equipment so that it can perform training solo itself is trained to do so alone. This does not mean that the therapist you leave completely, since that will continue reviewing measurements to be sure that everything is going well.
The prices for sessions of biofeedback vary greatly depending on the Center, but you can find them from the 60 euros. However, this amount will increase according to the different types of metrics that we need and the complexity of the machines that we are going to use in our biofeedback sessions.
Logically, each pathology and each person will need different treatment and different number of sessions. However, it is estimated that a minimum of ten is more suitable for the vast majority of cases, some dating to be extended over two months and a half.

Dementia: cognitive impairment chronic

What is dementia?

Dementia is a chronic deterioration of at least three higher functions (at the start, finally usually alter the intellectual functions), purchased (main difference with mental retardation, since this usually arise from childhood), and with a level of awareness and attention normal (unlike the delirium, in which there is a decreased level of consciousness). The diagnosis usually occurs when the patient takes three months presenting a set of signs and symptoms that respond to these changes.
Dementias undertake intellectual faculties of those affected such as language, memory, and visuospatial skills, as well as their emotional ability and personality.
Dementia affects 2% of persons aged 65-70, and 20% of those older than 80 years. It is the leading cause of long-term disability in the elderly, which is an important public health problem, taking into account the increase in the life expectancy in the developed societies.

Types of dementia

There are varied types of dementia. These are the most common:
  • Alzheimer's disease
  • Fronto-temporal dementia (or Pick's disease)
  • Vascular dementia
  • Multi-infarct dementia
  • Binswanger disease
  • Lewy body dementia

Alzheimer's disease

It is the most common cause of dementia in the West. The onset of symptoms usually occurs beginning at age 65, but in some patients it may occur before age 40 (in which case is usually associated with hereditary forms of the disease, which can occur in 25% of cases).
At the beginning the clinic is limited to occasional lapses of memory, but then sets an alteration of recent memory (capacity to store new information and retrieve it after a period of time) and learning ability, and with the passage of time remote memory will also be lost (to recall distant events).
To learn more, see the section dedicated to Alzheimer's disease.
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Fronto-temporal dementia (Pick's disease)

It is a degenerative alteration, characterized by the presence of abnormal substances, which are referred to as bodies and Pick cells, in the interior of some neurons located in the frontal and temporal lobes.
It typically affects patients in the ages of life; so, it is more frequent in patients dementia aged between 45 and 65 years old.
It is usually a dementia progressing slowly, and the main clinical alteration is in the sphere of personality; the most striking symptoms are:
  • Difficulties in social relations, which leads to isolation.
  • Compulsive and inappropriate behavior in different environments.
  • Alterations in the control of emotions.
  • Loss of executive capabilities.
  • Involvement of the language from the early stages of the disease, which may be the first noticeable symptom.
  • Deterioration of the ability to read and write, as well as decrease in vocabulary.
  • Abrupt changes in mood.
  • Muscle stiffness.
  • Advancing disease, apathy is the symptom that dominates in the clinic.
  • Alterations in recent memory and learning ability are usual.
The diagnosis is based on the symptoms presented by the patient, since the compulsive behavior and emotional alterations are evident from the beginning of the disease. Tests that may be performed include: magnetic resonance imaging of the brain, electroencephalography (EEG), examination of the cerebrospinal fluid, computed tomography of the head, etc.
Cure for this disease, which comes to completely incapacitate the patient is no known. Treatment they used antidepressants and antipsychotic drugs to control the emotional ups and downs of the sick, as well as those drugs that help relieve other associated disorders like nutrition and thyroid problems, depression, infections, anemia, etc.
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Vascular dementia

Vascular dementia are due to a stroke that causes the blood circulation to stop water a part of the brain, which causes the death of the affected neurons.
This is one of the few dementia that can be prevented, avoiding or controlling the risk factors such as high blood pressure, hypercholesterolemia, which can cause atherosclerosis or diabetes, to reduce the chances of suffering from it in the future.
Indeed, there are studies showing that proper treatment of hypertension reduces the presence of impairment congnitivo and the risk of dementia.
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Multi-infarct dementia

As its name suggests, this dementia is multi-infarct or cerebral embolism, which can be asymptomatic, and that leave residual infartadas areas.
His home is usually abrupt, especially if it occurs after one of these strokes, and are usually neurological symptomatology companion as a sequela of ischemic accident.
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Binswanger disease

Subtype of vascular dementia, which is due to high blood pressure and atherosclerosis, so it is also known as atherosclerosis subcortical encephalopathy.
This insanity is due to degeneration of the white matter of the brain cause of occlusion of cerebral blood vessels, which limits the amount of blood reaching the brain in general, and white matter in particular. Brain cells deprived of oxygen, they deteriorate and die, which causes dementia.
Risk factors that increase the chances of occurrence of this disorder are:
  • High blood pressure.
  • Atherosclerosis (hardening of the blood vessels).
  • Cardiovascular diseases.
  • Diabetes.
The symptoms usually occur gradually, worsening progressively although, occasionally, they stabilize and even improve. The main manifestations of this disease are:
  • Alteration of the March (more slow and unstable).
  • Loss of memory.
  • Progressive deterioration of cognitive, motor and intellectual faculties.
  • Difficulties to express themselves.
  • Depression.
  • Incontinence.
  • Loss of coordination, tremors...
  • Apathy.
  • Disorientation.
  • Paralysis on one side of the body.
The diagnosis is determined through tests such as magnetic resonance imaging and computed tomography of the brain. You can also be a photo simple emission computed tomography (SPECT according to its acronym in English), which aims to identify the function of the cerebral white matter degeneration.
No known cure for this disease, and drugs that are administered to the patient aim to control the pathologies associated with hypertension, hypercholesterolemia and depression, as well as decrease the risk of stroke.
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Lewy body dementia

It is the third leading cause of dementia in the elderly, after ad and vascular dementia and, as its name suggests, the typical characteristic is the presence of so-called Lewy bodies, which are abnormal protein deposits scattered throughout the brain, affecting on the functions of certain neurotransmitters, altering perception, thinking and behavior of those affected.
Symptoms:
  • Slowly progressive cognitive impairment. Cognitive fluctuations are typical data of this disease, and are mainly based on the State's attention and alert.
  • Visual hallucinations are also features, as well as alterations of sleep (in the phase of muscle relaxation these patients tend to have lots of activity).
  • The patient may also have auditory, olfactory, tactile and gustatory hallucinations.
  • Changes in mood and behavior (sadness, depression, anger, lack of initiative...).
  • Trembling, and other symptoms like weakness and muscle stiffness may be and unsteady gait, make difficult times the differential diagnosis of Parkinson's disease.
The diagnosis includes physical and neurological examinations assessing capacity functional and expressive of the patient, his memory, and other skills, as well as perform tests such as CT or MRI. However, the only definitive diagnosis is obtained after the death of the patient, to perform an autopsy.
No known cure for this insanity and the treatment should be customized because the disease causes sensitivity to certain drugs.

Causes of dementia

Dementias can be degenerative, when there is a progressive and irreversible death of the neurons (such as in the case of Alzheimer's disease), and no degenerative when loss of neurons can be stopped, such as in the case of dementia caused by alcohol abuse, where the loss of neurons ends when the patient stops consuming alcohol (although not recover the neurons that have already been destroyed). Also be considered primary when dementia is, in itself, the main disorder presenting patient; and secondary, when the deterioration of intellectual function occurs as a result of other factors such as head trauma, intoxication by alcohol, drugs or drugs, a deficit of vitamins, or dementia is associated with other pathology (as AIDS, Creutzfeld-Jakob disease, parkinson...).
The most frequent reasons for dementia are:
  • Alzheimer's disease (50-90%).
  • Multiple cerebral infarctions (5-10%).
  • Alcoholism (5-10%).
  • Endocrino-metabolicos disorders, such as hypothyroidism and deficiency of vitamin B12.
  • Brain disorders, such as neoplasms, bruises...
  • Other degenerative diseases, such as the Pick, parkinson, Huntington.
  • Infections of the CNS.
Most dementias are irreversible and have no cure, though the accompanying symptoms can be treated. It is very important to find out if the cause of dementia is treatable, since about 10% of dementias are reversible if treated in time, in another 10% you can stop the progression of the disease, and another 10% is due to psychiatric causes (pseudodemencias).

Treatable causes

  • Vascular dementias, due to an insufficient cerebral blood flow.
  • Post-traumatic dementia.
  • Dementia as a result of alcohol abuse.
  • Metabolico-carenciales diseases: thyroid disorders, deficiency of vitamin B12, folate, and vitamin B1, alterations in the regulation of calcium...
  • Inflammatory and infectious, diseases such as meningitis, syphilis, vasculitis...
  • Intracranial process.
  • Depression.

Not treatable and irreversible causes

  • Degenerative diseases.
  • Infectious diseases, such as AIDS.

Symptoms of dementia

The first symptoms of dementia are mild and rare times are associated with a possible disease. The patient has a slight deterioration of memory, mistaken for fatigue on many occasions, but he may not be aware of these oversights. They tend to be coworkers or family, those who see a loss of efficiency, a greater number of errors, and a greater reliance on agendas and annotations to remember tasks (mild dementia).
Later the patient with dementia have difficulty maintaining their social relations, forget names, quotes or conversations, it repeats several times the same question because it does not hold the answers... The patient is ever more disoriented, fails simple commitments, and miss out on making regular tours (moderate dementia).
Every day he forgets more events and shows more indifferent toward the environment and society in general, begins to need help to carry out the basic activities of daily living, and has serious problems with language; It also presents sudden changes in mood and emotional disorders. Finally, they lose all the mental faculties do not recognize family members and are totally dependent (severe dementia).
The main symptoms that manifest the majority of people with severe dementia are:
  • They lose the notion of their own identity and time.
  • They have hallucinations and delusions, and sometimes your behavior is violent.
  • They cannot be themselves simple and routine tasks.
  • Your sleep patterns are altered, and wake up frequently during the night.
  • They often suffer incontinence.
  • They may have trouble swallowing.
  • It is difficult to communicate with them because they don't understand the language, and talk in a confusing manner, or do not use the words correctly.
Patients often die from pneumonia or another infection because, after 5-10 years of evolution of the disease, its defenses are diminished.

Diagnosis of dementia

Diagnosis is mainly clinical: physician develop a complete medical history, and inquire about possible family history.
Most dementias are due to degenerative processes, but the loss of brain mass (cerebral atrophy) is not synonymous with dementia.
Many test have been developed to assess cognitive impairment, and most used is currently the minimental test that quickly allows you to assess memory, temporo-spatial orientation, language, writing, reading, calculation, and visuospatial and ideomotoras actions. It is scored from 0 to 30 points, whereas normal 27 to 30 points, and dementia under 24 points.
Memory loss is the most common sign early, but is usually attributed to the age or they underestimated its importance, so that from the onset of symptoms until the patient is diagnosed sometimes arrive to spend up to two years. Family members tend to be the first to detect that a problem exists, it is therefore advisable to consult with a specialist if you look at any suspicious behavior on your loved ones.

Treatment of dementia

Some dementias can be cured (see types). In that case, the treatment will be focused to cure disease or eliminate the problem that has caused the dementia, as it is the case with alcohol abuse, a brain tumor, a metabolic disorder... However, in those cases in which is a degenerative and irreversible process, the goal of treatment is to relieve the symptoms of the disease, and should be customized depending on the type of dementia and symptoms that the patient manifests.
The treatment of other conditions, associated or not to dementia, such as anemia, depression, nutritional deficiencies, thyroid disorders or infections, can also improve or reduce the symptoms of the disease.
In general, tend to use medications to control behavior problems arising from the loss of cognitive abilities of the subject, which aim to reduce the confusion, impulsiveness, anxiety, and even the aggressiveness of patients, such as:
  • Antipsychotics (haloperidol).
  • Antidepressants (fluoxetine, citalopram, paroxetine).
  • Sedative or Neuroleptics (risperidone, olanzapine).
  • Drugs that Act on serotonin (trazodone).
  • Anxiolytic (alprazolam, diazepam).
  • Benzodiazepines, to alleviate disorders of sleep (lorazepam, triazolam).
  • Inhibitors of acetylcholinesterase (donepezil, galantamine).
Psychotherapy is not effective for these patients, since it can generate anxiety and greater confusion.
It is important to note that patients with mild cognitive impairment do not have why to develop dementia. However, the prognosis for patients with dementia is not good, since they tend to get worse and suffer a physical impairment that significantly reduces its quality and life expectancy. In paragraph recommendations offer a number of tips which facilitate the task of the caretaker and contribute to improving the safety of patients.

Recommendations for the caregiver

If you care to care for a family member or person who suffer dementia, here are some tips that will be of help in your work:
  • It is important to adapt housing and the environment of the patient, in accordance with the evolution of the disease.
  • Establish habits and schedules for the sick not trash it.
  • Have the House tidy and avoid carpet or furniture which can trip.
  • Place to view calendars and clocks.
  • The clothes and shoes should be comfortable and also easy to apply and remove.
  • Preserve to maximize their independence and privacy, but overseeing their activities to prevent accidents.
  • Stored in inaccessible places for the sick objects or substances which can be dangerous for him.
  • Placed in the bathtub or shower grab bars and non-slip mat.
  • Not lead to noisy and crowded places because it could alter.
  • Do not yell or push him. Talk slowly and clearly and concisely as possible.
  • It is important for the caregiver to come in contact with other people in your same situation, associations or groups of support, which can provide psychological support, and inform you of your right to receive certain benefits as the home help.
  • Refer to the possibility of the patient to attend a day centre, which will deal with it for a few hours, and the patient can follow therapies that help delay the progression of the disease.

What is encephalitis

Encephalitis is a diffuse inflammation of the brain, i.e., of the brain. Its main cause is viral infections. It's a disease whose frequency is difficult to determine; This is because most of the time the encephalitis cause symptoms mild and very diffuse, similar to the flu or a cold. Why is suspected that some flu-like pictures are actually mild encephalitis that heal alone. However, in a small percentage of cases, encephalitis can cause severe symptoms, which are the manifestation of a brain injury. Although the mortality of encephalitis is not very high, it is frequent neurological sequelae after illness from appearing.

Incidence of encephalitis

The frequency of encephalitis in the general population is not very high. Only appear three or five cases for every million inhabitants. The population groups that suffer most from the disease are children, in those who are five or 10 cases per 100,000 inhabitants, and especially the children of less than one year of age. The aftermath of encephalitis are much more dramatic in this age group, since they have a whole life ahead which may be conditioned by a disability.
Encephalitis can be cured, only treatment of symptoms is required and to let time do its work. Fortunately, every time there are more specific drugs to kill the viruses responsible for. But if there is something that has changed the impact of this disease in the society they are vaccines. Many viral infections that cause encephalitis (measles, enterovirus, poliomyelitis, etc.) are preventable today with vaccines safe, and mandatory in most countries of the world.

Causes of encephalitis

The cause of encephalitis are infections by virus neurotropos, i.e. viruses that have a special affinity for the central nervous system. These viruses can be transmitted in different ways; some of them by airway (such as measles virus), some faecal (such as polio virus) and even STDs (such as herpes simplex type 2 virus). The main virus that can cause encephalitis are:
  • Herpes simplex virus type 1 or 2 (VHS): are the viruses that cause innocent cold sores or genital herpes. The virus remains in nervous ganglia life, and occasionally migrates to the skin causing itching and blistering. In a few cases the virus can go wrong and migrate towards the central nervous system causing an encephalitis.
  • Other herpes-type viruses: within the Group of herpes viruses, there are others that can cause encephalitis, as well as other diseases. Some of them are the Epstein-Barr virus (responsible for infectious mononucleosis), the Cytomegalovirus (CMV), or the varicella virus (which also causes herpes zoster).
  • Mosquito-borne viruses: are called Arboviruses. They appear especially in specific regions of the world, such as West Nile Virus and Japanese encephalitis virus (which is also found in Southeast Asia). Other viruses that cause encephalitis are transmitted through animal bites, such as rabies virus.
  • Pediatric virus: measles, mumps, and rubella can cause acute encephalitis. The vaccination of all children has made that cases decrease in the population.
  • HIV: HIV can produce an encephalitis from the first contact (rare) or in any of the Reactivations of the virus by abandonment of antiretroviral therapy.
To contact any of these viruses does not mean that you are going to develop a secure encephalitis. In fact, many of these viruses are known by other more specific diseases. That appears an encephalitis depends on in addition to other factors such as age (children and the elderly are most at risk) and the State of the immune system.

Symptoms of encephalitis

The symptoms of encephalitis most seem minor flu symptoms. Headache may persist for a few days, appear fever, pains in joints and muscles, and very tired. The picture can last three to ten days, just like the flu, and when it happens so rarely diagnosed encephalitis.
Sometimes the symptoms are most striking and give the alarm that there is concrete damage in the brain. The most frequent are:
  • Alteration of consciousness: be drowsy or have very slow thinking are signs indicating brain damage. There have been cases of cerebral coma and death, although it is not as often.
  • Ataxia: named to the alteration of the March; people suffering from ataxia cannot walk without much separate toes and cling to any point of support.
  • Very severe headache: much more than what can be expected in a flu.
  • Seizures: appear suddenly and in people who have not previously had epileptic patterns.
  • Loss of muscle strength or sensation: they simulate a stroke, but his appearance at the time added symptoms and body distribution, help differentiate it.
  • Visual or olfactory hallucinations: smell odors, see double or fuzzy shapes with colors, are fairly common symptoms.
  • Personality changes: although it seems rather anecdotal, is a very common and characteristic symptom. It can happen suddenly and is the fact that most alert to family members.
  • Nausea and vomiting: especially in young children.
  • Irritability and continuous crying: can be the only symptom in children under one year.
Neurological sequelae are unpredictable. Most of the time be damaged nerve pathways responsible for muscle strength (resulting in partial paralysis), or there are specific brain lesions, which can cause epilepsy in the future. The most serious cases can cause mental retardation, total paralysis, or neurological disease complex (Parkinson's disease, for example).

Diagnosis of encephalitis

The early encephalitis diagnosis is essential to provide a specific treatment, if any, and control the symptoms to prevent a severe brain damage. The most important aspect to the diagnosis of this pathology are clinical symptoms, which can help the physician to suspect the disease. To do this, the doctor will perform a clinical interview the patient, and in most cases also family members.
Within complementary to diagnose tests to be done to diagnose encephalitis is the most important is the lumbar puncture. Thanks to it you get cerebrospinal fluid (which is the fluid that lubricates the brain), and can be analyzed in the laboratory in search of abnormalities characteristic of viral infection. The analysis of laboratory that is essential is PCR (polymerase chain reaction), that detects the presence or absence of viruses that cause encephalitis frequently in cerebrospinal fluid.
Other important tests to detect an encephalitis are the Imaging of the central nervous system such as computed tomography (CT) and magnetic resonance imaging (MRI). The TC must always be before making a lumbar puncture to check that there are no major internal changes and that the puncture can be well. MRI is not a test that is carried out urgently, but it is useful to make it the days or hours of the onset of symptoms, because sometimes the encephalitis cause brightness of the brain in these images. Also useful evidence is the electroencephalogram (EEG) because it allows to know if there is damage to the brain electrical activity and estimates the odds that it is an epilepsy as a sequel.

Treatment of encephalitis

The ideal encephalitis treatment must meet three key points: controlling symptoms, remove the virus from the nervous system, and prevent the onset of permanent neurological sequelae.
  1. Control of symptoms: General measures as to remain lying down with the head of the bed elevated, and drink lots of fluids, help a lot to improve the malaise, and headaches and joint disorders. They used most often analgesics and NSAIDs (such as paracetamol or ibuprofen) to lower the fever and pain. Corticosteroids are also used in all cases, since they help to decrease cerebral inflammation in a direct way and that decreases the probability of appearance of sequelae.
  2. The virus removal: not all viruses have a specific treatment that remove them from the nervous system. Only the family of herpes viruses can be attacked using antiviral drugs. The first to be discovered was the acyclovir, which is also used in chicken pox in adults, or to prevent genital herpes. Another known drug ganciclovir, which has special utility in (Cytomegalovirus infections is CMV). In recent years have been studied most powerful new drugs, such as foscarnet, and thanks to large investments in HIV research will soon be available new antiviral medications.
  3. Prevention of permanent sequelae: the emergence of sequels is prevented with early treatment from all fronts. After completing the symptoms of encephalitis testing may be making sure really what residual damage is in the brain, and once identified, various therapies can advertise:
    1. Speech therapy: resumes speech, understanding, or the writing of a particular language.
    2. Physical therapy: consists of physical exercises to improve muscle strength, mobility, gait and coordination.
    3. Occupational therapy: is to improve different neurological capacities through the implementation of activities of daily living (make the bed, cooking, crafts, etc).

Prevention of encephalitis

Prevention of viral encephalitis consists of the basic measures that prevent any other viral illness, from a cold to gastroenteritis. In cases of more specific virus (rabies, Japanese encephalitis, HIV...) extra efforts. In general, these tips for preventing this infection:
  • Comply with the measures of hygiene: wash your hands before eating or going to the bathroom, sneezing in handkerchiefs and not sharing cutlery, are some of them.
  • Washing fruits and vegetables before eating them, with two drops of bleach and water.
  • Sexual intercourse with a condom.
  • Get vaccinated and vaccinate children of viruses that most commonly cause this disease.
  • Protect yourself from mosquito bites in places of risk, using repellent, long sleeves of insects, mosquito nets, etc.

What is Huntington's disease

Huntington's disease is a genetic disorder that causes the destruction of certain brain neurons. The patient cannot control its movements, resembling a dance, and ends up developing dementia.

Huntington's disease

Known as Huntington's disease (HD) a type of movement disorder that stems from a problem in an area of the brain called the basal ganglia; in particular, in the area known as the caudate. Neurons that govern this part of the brain begin to destroy your own programmed genetically; i.e., our own inheritance dictates that these neurons must be destroyed. This causes a decrease in the levels of the neurotransmitter acetylcholine, which contributes to worsening symptoms and favors the onset of dementia in advanced stages of Huntington's disease.
Along with the cerebellum, basal ganglia are the most important structures of our nervous system in movement control. When this area neurons degenerate, the motion control functions are unregulated, resulting in one of the main symptoms of Huntington's disease: the Chorea, or uncontrolled movements and which resemble a dance (dancers), because the involuntary movements are no longer inhibited.
The condition usually starts in the middle ages of life. In later stages, this degeneration begins to become more extensive, affecting other areas; and finally appear dementia.

Causes of the Huntington

The Huntington's disease (HD) is developed on the basis of an genetic alteration. One of our chromosomes, in particular chromosome number 4, suffers a mutation in its short arm. Not to be a chromosome of sexual content, both men and women can develop HD, on the basis of genetic inheritance they received from their parents.
To be a dominant gene, it is only necessary that one parent has in its genetic material one copy of the defective gene descendant that has inherited this gene develop Huntington's disease (if it is recessive, both the father and the mother should carry one copy of the gene to appear the disease, but unfortunately this is not the case). Anyone who has inherited a defective gene, will end up developing disease if they live long enough.
So the only hope is that, two copies of each gene with which each parent may provide to the descendants, copy that inherits is the sound and not the faulty.
Sometimes it may happen that a person who does not have a family history of Huntington's disease develop disease. It's spontaneous cases, in which the gene suffers a sporadic mutation, which leads to the onset of symptoms.

Symptoms of Huntington's

During the early stages of the disease, involuntary movements may appear mixed with the intentional; Therefore, it is easy to pass unnoticed in these moments. As a general rule, the effects progress faster the younger is the patient. Thus, a person who begins to have symptoms at 30 years of age will suffer a disease progression more quickly than if the patient begins to develop symptoms at age 50.
Gradually, movements are becoming ever more apparent, until you carry out everyday actions like swallowing, dressing, bathing... become almost impossible.
The main symptoms are movements that involve, but are not the only ones. One of the most frequent, especially in the early stages, are changes in character. The person is more irritable, aggressive, apathetic, or even depressed.
The also affect cognitive abilities: memory, concentration, reasoning... can be decreased. As Huntington's disease progresses, they begin to observe symptoms of dementia, to decrease the neurotransmitter acetylcholine, which is in charge of the connections between neurons to function perfectly.

Diagnosis of the Huntington

The fact of the discovery of the gene containing the mutation that allows the development of Huntington's disease gave way to a diagnostic test in which, looking for the number of times it is repeated that gene in our genetic code (repeats) we can know if we are at risk of developing the disease. It is known as pre-symptomatic Test (TP), so called because it allows to know if the person is likely to develop Huntington's disease on the basis of the family genetic heritage.
Reached a consensus on the number of repetitions that you must have to know the risk that's suffering Huntington's disease. Like this:
  • Less than 28 repetitions: is very unlikely to develop.
  • 29-34: it is very unlikely to develop, but the offspring will be at risk of developing it.
  • Of 35 to 39: many patients develop the disease; and the next generation will be at risk.
  • 40: is very likely that the person develops symptoms of HD.
There are other tests that can be used. The computerized axial tomography (TAC) can get sharp images of the brain and show that the basal ganglia (in particular, caudate and putamen) are decreased in size. The ventricles may be increased in size. These data are not exclusive of Huntington's disease, since other cerebral pathologies also share these characteristics; But yes may indicate the path to follow for the diagnosis.
The family history is also highly important. The neurologist will perform a series of questions aimed to know the family history in relation to the possibility that a parent may have been carrying the gene for Huntington's disease, or have suffered the disease without being diagnosed as such.

Where to go to perform pre-symptomatic testing?

Anyone with a family history of Huntington's disease can take the decision to carry out the test, and thus know the risk which has developed symptoms. To do so, by contacting with the Korea Association of Huntington Spanish (www.e-huntington.org), or its regional offices, will indicate where to go to perform the test.
The test itself includes several stages: a neurological test, where the doctor trying to find out if the symptoms have already begun; a blood test that is sent to a Genetics laboratory to evaluate the appearance of the defective gene and count the repetitions of the same (what is known as genetic counselling); and an advice from a social worker before, during, and after the results.

Treatment of Huntington's

Huntington's disease has no cure, but many medications can be used to decrease the severity of symptoms and to try, to the extent possible, facilitate the life of the patient and caregivers.
Some of these medications used for the treatment of Huntington's are primarily dopamine, such as antipsychotics (haloperidol or chlorpromazine) antagonists, since the decrease of acetylcholine-producing neurons causes this neurotransmitter level is reduced and increase the effect (which not levels) of dopamine, and thus increase the involuntary movements. These drugs help to the control of the emotional, such as aggressiveness, hallucinations... but not control movements. Indeed, some may even worsen with time, due to a phenomenon of hypersensitivity. They are used to lower doses of which are usually used in psychoses, to try not to engage in sleepiness or catalepsy; but because of the progressive nature of the disease, you will notice a gradual loss of efficiency.
The antidepressants are useful to treat depression; and lithium can help to control variations in mood.
The neurologist is physician responsible for initiating treatment, choosing the drug best suited in each case, taking into account the particular characteristics of each patient, and considering the adverse effects.
Always order information to your doctor or pharmacist if you have any questions about your treatment or any possible adverse effects.

Care of the patient with Huntington

The care that requires a patient of Huntington's disease are complicated. The usual work as dressing, put on, eat, take a shower... can become real problems.
Speech may be affected, making very difficult that the patient can express what he thinks. It is advisable to talk to the patient, so don't feel isolated from the environment that surrounds it, and let him understand that he has understood what you mean.
Footwear must be easy to put and remove, and fasten the foot properly.
The diet should be balanced, with five meals a day; many patients may need one intake greater than normal food, due to wear and tear involved in continuous motion. And however, it is possible to observe that no catch weight.
There are many associations and organizations struggling to advance in the knowledge of this disease. Investigations are complicated and it makes the progress slow. In Spain, Huntington's disease is still fairly unknown, but several Spanish hospitals genetics services have opened various lines of research in the field of the Huntington in order to advance their knowledge and treatment.

What is Wilson's disease

This rare disease is characterized by an alteration in the transport and disposal of copper which comes from the diet, which has just been deposited in the liver, the brain and the cornea, causing disntintos problems.
Wilson's disease is by definition a hereditary disease that is characterized by an alteration in the transport and disposal of copper which comes from the diet, which brings as a consequence in the long term the deposit of this metal in three bodies mainly: the liver, the brain and the cornea of the eye, with consequential faults in them.
Wilson's disease is considered a rare disease, its frequency in almost all populations studied is one per 40,000 inhabitants. People carrying the mutation frequency - but in which no disease appears not to be a dominant mutation - it is close to 1%.

What happens with copper metabolism?

It is estimated there about 50-100 mg of copper that are necessary to carry out different functions of metabolism in the body. And through the food we eat every day about 2-5 mg of this trace element.
In patients with Wilson's disease, the intermediary metabolism of copper is altered due to a mutation in the ATP7Bgene. This gene encodes a protein, called in the same way, which is required for the removal of copper in the bile and that copper passing to ceruloplasmin, which is the protein that transports copper in the blood. In the absence of a correct disposal of copper through the bile, there is a tendency to excessive accumulation of this metal, which cause injury liver that can start even from the three years of life.
With the progression of the disease, the concentration in the serum of unbound to protein copper - also called free copper - produces this metal deposit in other locations of the human body, mainly in the Central nervous system, which brings with it level of neurological and psychiatric disorders symptoms.
On the other hand, ceruloplasmin, a protein synthesized in the liver responsible for transporting the 95% copper in the body, is decreased by a defective incorporation of copper to the protein. This fact can help to diagnosis, because measurable levels of ceruloplasmin in blood and, in case of disease, these levels are abnormally low.

How is it inherited?

Wilson's disease is inherited in a manner autosomal recessive, i.e., to make it appear disease should inherit the mutation in the gene, ATP7B both the father and the mother. People who inherit the mutation from one parent but not the other are carriers of the mutation, but do not develop the disease.
In the ATP7B gene mutation is not always the same, they have been described in the medical literature more than 350 possible mutations in this gene.

How and when Wilson disease manifested?

Wilson's disease mainly affects the liver, being one of its earliest manifestations of this organ inflammation, what is known in medical terms as hepatitis. When this happens there is a release into the blood stream and liver enzymes, known as transaminases, bilirubin, substance responsible for the yellowish colour that takes the skin and mucous membranes of these patients (jaundice). Hepatitis tends to heal on their own, but it can be repeated several times and the patient can eventually develop a chronic inflammatory process of the liver, causing normal tissue is destroyed and is replaced by fibrous tissue, causing what is known as cirrhosis of the liver. When this happens the liver is unable to function properly.
The other type of clinical manifestation of Wilson's disease occurs at the neuro-psychiatric level, and is characterized by alterations of movement, tremors and lack of coordination, difficulty in speech and trouble swallowing food. Also loss of memory, decline of intellectual performance, headaches, behavior disorders, neurotic or psychotic manifestations, symptoms of dementia and seizures can occur.
The eyeball involvement is also very common. The most affected by inappropriate copper deposit is the cornea, in its most outer diameter, resulting in a phenomenon known as Kayser-Fleischer rings. This ring is produced by copper deposit initially at the top and bottom poles after surrounding the iris and the cornea. This ring can be detected in an ophthalmologic examination, which can help the diagnosis of Wilson's disease. On the other hand can lead to hardening of the lens and increasing the opacity of the same, referred to as falls.

Diagnosis of Wilson's disease

Paramount to be able to diagnose Wilson's disease is clinical suspicion, based on the signs and symptoms of the patient and the changes in liver function tests. At a clinical suspicion, you can perform the following tests:
  • Quantification of copper in the urine in 24 hours. Values higher than 100 micrograms day are common in these patients (the values for a healthy person ranged from 20 to 50 micrograms/day).
  • Free in serum copper levels. In Wilson's disease are over the age of 25 microgram/dl.
  • Ceruloplasmin in serum levels. They are handicapped in this disease, usually below 20 mg/dl.
  • Presence of Kayser-Fleischer rings in the eye. This alteration is usually detected by an ophthalmologist using a special light called slit-lamp.
  • Genetic Test to detect the DNA of the gene mutation patient, for which used genetic sequencing techniques. Screening of first-degree relatives under 40 years of age is also important.
  • Imaging studies: if the patient is having symptoms neuro-psychiatric usually request an MRI (magnetic resonance imaging) of the brain, thus allowing to detect deposits of copper and cerebral atrophy.
  • If it is necessary to make a differential diagnosis with other liver diseases that are with the same symptoms, it is advisable to perform a liver biopsy to determine the concentration of hepatic copper. Biopsy diffuse inflammatory changes, fibrosis, deposits are found in fat and copper. In addition to diagnose the disease, the biopsy allows to determine the degree of involvement of the liver by copper deposit.

Treatment of Wilson's disease

Wilson's disease does not cure permanently, treatments can only be applied for by life aimed to control the deposit of copper in the body.
To do this, firstly should be recommended to the patient make changes in their eating habits and avoid those that are especially rich in copper, such as products derived from cocoa, products of animal origin as viscera, some vegetables and vegetables such as broccoli, seafood in general or nuts such as walnuts, hazelnuts, almonds, peanuts.
Secondly, from the point of view of therapeutic medicines available currently are aimed to reduce deposits of copper, through a chemical process called Chelation, i.e. drugs bind copper irreversibly and facilitate their elimination via kidney or bowel. The most common are penicillamine (increasingly obsolete by their adverse neurological level), Trientine, and zinc acetate.
The latest recommendations point to start the treatment with zinc acetate as soon as possible, even in patients with homozygous for the mutation that still have not shown symptoms. Zinc acetate, moreover, is the treatment of choice in pregnant women and in children.
Thirdly, if the patient requires it, i.e. If he has liver failure, liver transplantation may be performed.

What's new in Wilson's disease?

Since the discovery of the human genome major advances have occurred in the knowledge of the disease. The application of the genetic test to detect healthy carriers in heterozygosity (carriers of the mutation but only one parent) could prevent the birth of children affected with this disease through genetic counselling to make informed decisions, preimplantation genetic diagnosis (selection of embryos healthy before being implanted into the womb) and prenatal diagnosis (diagnosis of fetus already within the womb).

Epilepsy: Chronic neurological disease

What is epilepsy

It epilepsy is one of the most important chronic neurological diseases and prevalent, caused by one or more disorders that predispose the brain to generate recurrent seizures, which has consequences not only neurobiological, but also cognitive and psychological. Literature about epilepsy has been, historically, plagued by errors that have fed his black legend and have motivated the epileptic patients suffering from unjustified social stigma.
To consider that a person suffers from epilepsy as a disease, the World Health Organization (who) and the International League against epilepsy (ILAE), require chronic recurrence of seizures, i.e. the epilepsy is diagnosed when the patient has had two or more spontaneous crisis throughout his life.
Epilepsy is the third most common neurological disorder after stroke (cerebral vascular accident) and dementia, and it is estimated to affect 5-1, 0, 5% of the population. In Spain alone there are more than 400,000 affected, according to the estimates of the Spanish Federation of epilepsy (FEDE).
The majority of cases occur in people older than 65 and children under 10 years old. They are more common in underdeveloped countries and among disadvantaged socio-economic classes.

Seizure

Epileptic seizures are caused by an abnormal and exaggerated discharge of certain neuronal groups in the brain. So abnormal neuronal discharges trigger epileptic seizures a number of processes should take place: timing, amplification and propagation of the discharges.
The epileptic discharge occurs as a result of an imbalance between excitatory and inhibitory mechanisms that neurons are exposed. Epileptogenesis is the process by which a normal nerve structure becomes hiperexcitable, to generate spontaneous seizures.
To determine if it's a seizure should take into account that:
  • Not all paroxysmal discharge of the brain, although it is detectable in the electroencephalogram (EEG), is a seizure if it produces no clinical.
  • Paroxysmal brain dysfunction that have not occurred as a result of a download neuronal hipersincrona, but otherwise, not be considered epileptic seizures, although they may cause similar clinical manifestations.
  • Downloads of other neuronal groups outside of the cerebral cortex, for example of the brain stem or cord, give rise to paroxysmal manifestations, such as muscle spasms, which non-epileptic seizures, but they respond to the same drugs.

Types of seizures

There are two major groups of seizures: focal (or partial) seizures and generalized seizures.

Before a crisis

  • Prodromal symptoms: are nonspecific sensations such as changes of mood, irritability, sleep disturbances, appetite or behavior, from hours to days before the seizure, especially.
  • Epileptic aura: is the feeling immediately prior to the crisis. Applies to the psychic as fear, distress, indefinable unease or nervousness or epigastric sensations.

Generalized seizures

They are those whose first noticeable symptom depends on the injury of both cerebral hemispheres. Loss of consciousness occurs from the first moment of the attack and motor manifestations affect the four extremities.

Generalized seizures

Tonic-clonic seizures or "grand mal"
The tonic phase begins with the contraction of the muscles in flexion or extension. Lasting from 10 to 30 seconds. Breathing is interrupted. The sick can emit a sharp scream by spasm of the larynx and the tight jaw. The clonic phase begins with very short light and little shocks that gradually become more spacious, violent and spaced, synchronised and symmetrical in all four extremities. Lasts around 1 minute. The patient sweats and drooling. Breathing is choppy. There may be a rise in blood pressure and tachycardia. It is frequent that the sick get hurt falling and will urinate. The language can be biting. To the awakening of the crisis, the patient is confusing and does not remember what happened, has headache and muscle pain. You may be tired and sleep several hours.
Tonic crisis
They produce a prolonged muscle spasm. Muscle contraction is increased and gradually extends over the trunk and extremities. It is common at the beginning of the crisis the patient has open the eyes and mouth and emit noise. Bend the arms and legs and trunk extends. These crises are very brief, less than 1 minute, and often cause the fall of the patient.
Crisis Myoclonic
They are brief muscle jerks, as electric shock. They appear spontaneously or caused by sensory or sensory stimuli (beams of light flashing), and facilitated by fatigue, stress, alcohol or sleep deprivation.
Atonic seizures
There is a loss of postural tone, i.e., muscles "lose their strength". They cause the fall of the patient. They can last from a few seconds to several minutes.

Generalized seizures

Typical absences or "Petit mal"
Manifested by a sudden loss of consciousness without loss of postural tone. The beginning and end of the crisis is abrupt. The most lasting less than ten seconds. The crisis manifests itself as a disconnection of the patient with their environment. The sick disrupts activity was carried out at that time and keeps staring, expressionless face, and ajar eyelids. When he regains consciousness resumes the interrupted activity and most of the times does not remember what happened. They can be frequent waking up or be provided by fatigue, sleep, and the intermittent photostimulation. They are sensitive to hyperventilation (breathing very fast).
Atypical absences
They are characterized by the sudden loss of consciousness. The beginning is more gradual and they are longer. The patient may suffer a partial unconsciousness and wandering during the crisis. They tend to be accompanied by low intellectual level or learning disorders.

Focal seizures

They are those in which the discharge originates in a relatively limited area of the cerebral cortex and during which the patient experiences a combination of motor, sensory, sensory, psychic and vegetative, signs and symptoms of which is partially or fully aware.
  • Vegetative signs and symptoms: include color changes (pallor or redness) skin, increase in blood pressure, tachycardia or bradycardia, piloerection, pupil dilation... They are sometimes serious, and even fatal, because they produce fainting, respiratory arrest, anoxia (lack of oxygen) and pulmonary edema (fluid in the lung).
  • Sensory symptoms: can be elementary, such as tingling, burning, pain and other unpleasant sensations; or more elaborate.
  • Simple Visual symptoms: consist of hallucinations in the form of lights or colors. They can also be more complex hallucinations or illusions.
  • Motor signs and symptoms: occur in a given body segment and not the entire body. They tend to be repetitive behaviors.
  • Speech impairments: speech or vocalization can be stopped in some cases. In other cases, the patient repeat meaningless phrases, or inadequately answered to the observer.
  • Psychic symptoms: the patient experiences a feeling of unreality and unfamiliarity with the environment that surrounds him, as if everything was unknown and you got yourself in a strange place (jamais vu); either to the contrary, notices a familiar feeling or attend a family event (déjà vu).
  • Hallucinations: in addition to Visual, there is olfactory and auditory. In each case can be simple (an unpleasant smell, a buzz, beep...) or complex (elaborate smells, hearing music, voices or messages). They may also have experiences of happiness next to mystical States with feeling of grandeur, levitation space, or celestial appearances.
  • Automation: the simplest are the chupeteo, swallowing, opening and closing of a hand or a change in facial expression (joy, surprise and fear). Other more complex are rubbing the hands together, clothes or genitals.
  • Gelasticas crisis: are those in which the subject experiences a feeling of joy unprompted and automatic uncontrollable laughter.

Continuous crisis, status epilepticus or status epilepticus

A status epilepticus is considered when the crisis lasts at least 30 minutes, or when its repetition is so prevalent that there is no recovery of the patient from one episode to the next. They can be divided into two groups: the convulsive evil and the evil States non-convulsive (they have the same clinic as described above but lasting at least 30 minutes or crises overlap without recovery among them). The most frequent cause is the abandonment of the medication in patients treated with antiepileptic drugs, but also occurs with alcohol abuse, fever, some drugs and because of metabolic alterations. It is more common in children than in adults.
It is called status epilepticus refractory to treatment when the crisis last more than 60 minutes, while the patient follow a treatment with antiepileptic drugs.

Causes of epilepsy

Epilepsy can have various causes:
Hereditary causes
They are genetically determined Epilepsies.
Congenital causes
  • Brain tumors.
  • Intrauterine lesions.
  • Vascular malformations.
  • Syndromes (neurofibromatosis, tuberous sclerosis, Sturge-Weber) Neurocutaneous.
  • Chromosomal abnormalities (Down's syndrome, Angelman Syndrome).
  • Congenital disorders of the metabolism (aminoacidurias, leukodystrophies).
  • Congenital myopathies.
  • Myoclonic Epilepsies.
Acquired causes
  • Trauma.
  • Post-surgical injury.
  • Postinfecciosas lesions (sequel to bacterial meningitis or viral encephalitis).
  • Infarction and cerebral hemorrhage.
  • Tumors (astrocytomas, oligodendrogliomas and meningiomas).
  • Sclerosis of the hippocampus (of the temporal lobe).
  • Toxic (alcohol and other drugs).
  • Degenerative illnesses (dementia and others).
  • Acquired metabolic diseases.

Classification

According to the cause of epilepsy it is classified into:
  • Sintomaticas: is the one that has a proven history, in which the cause that produces it is known.
  • Cryptogenic: is one to which the clinical context or image is assumed a cause or lesion origin, which can not be safely. I.e., you sensed the cause but it has not been demonstrated.
  • Idiopathic: it is the one that has no known cause and in which the genetic influence is greater.

Symptoms of epilepsy

Epileptic symptom par excellence, and one that defines the disease, is the seizure, since it is necessary two or more spontaneous crises arise that will diagnose this pathology, since you can have an isolated seizure and does not mean that you have epilepsy. Other symptoms of epilepsy, include dizziness, difficulty to speak, feeling of disconnection with the environment, seizures, muscle rigidity, etc.
On the other hand, epileptic syndrome is called to the set of signs and symptoms that define a process epileptic by the type of crisis, its natural history, which includes one or several known causes, hereditary predisposition, a certain type of crisis and abnormalities in the EEG, the response to treatment and prognosis.
The clinical manifestations of a seizure occur suddenly and its duration is short. They may be mental, vegetative, sensitive, motor with or without decrease in consciousness. The symptoms depend on the area of the brain in which originates is the download, and its extension or not the whole of the brain. A seizure is considered a symptom, and isolated character, does not demonstrate the existence of a syndrome or epileptic disease; in fact, from 2 to 3% of the population suffers a seizure at some point in their lives.

Triggers

Seizures may arise in response to different stimuli, and according to the nature of the collateral are classified as:
  • Provoked crisis: is the one that appears in immediate temporal relationship with an acute injury of the brain such as a stroke, trauma, anoxia (lack of oxygen), encephalitis or acute toxico-metabolica alteration.
  • Crisis precipitated: is what happens as a result of a factor of nonspecific as lack of sleep, stress or excessive consumption of alcohol in a person with or without previous spontaneous crises.
  • Reflects crisis: is what happens to a sensory or sensory stimulation.

Activity and remission

Epilepsy is in activity when the patient has suffered a crisis in the last two years. Epilepsy is in remission if crisis not occurred in two years. This distinction is important to determine if the patient should continue or not in drug treatment.

Diagnosis of epilepsy

The diagnosis of epilepsy is clinical and is based on the interrogation. It is necessary to obtain information from a family member or close friend who has witnessed the attacks, because the patient is not able to describe them as a whole.
We must try to know everything that happened before, during and after the crisis. It is very important to have an impact on the personal history (perinatal trauma, alterations in psychomotor development, febrile convulsions, meningoencephalitis, brain trauma, or family history of epilepsy). Analysis of blood and urine, an electrocardiogram (ECG), chest radiograph and an electroencephalogram (EEG) should always be performed.
Neuroimaging by CT-MRI allows you to identify the majority of epilepsy (visible anatomical lesions) that cause brain lesions, but can not be all patients. Used in those Epilepsies of unknown cause, especially if it is of recent onset, if the neurologic examination is abnormal or if there are signs of focal cerebral suffering in the EEG.

Treatment of epilepsy

The treatment of epilepsy is primarily pharmacological. 50-60% of patients, drug treatment is simple, effective on the first attempt, and requires little supervision; 20% of the patients need settings or combinations of drugs, and another 20% of patients are uncontrollable with current drugs. A minority of patients are susceptible to surgical treatment.
Antiepileptic drugs (FAEs) are intended to complete control of seizures without adverse effects. In general, they inhibit the brain's neural circuits and are effective if they are properly prescribed.
The FAEs should be introduced slowly and progressively. In general the dose increase in 4-6 weeks. Strict adherence to treatment is important and very serious is the sudden abandonment of the same. If a change is necessary, this will take place gradually. If a drug is ineffective, it introduces other progressively, and the second or third week, withdraws the first.
Only the toxicity produced by the FAEs is reason enough to suspend an antiepileptic treatment. If the treatment is effective and no side effects do not modify for any reason. However, considered that the suspension of treatment (generally 2-5 years) may arise after a period of several years without crisis. This decision should be individualized and advised by a neurologist.
The surgical treatment of epilepsy is done to a patient carrier of a lesion benign and static, in order to free it from the crisis. They must meet the requirement of developing a drug-resistant epilepsy. It also takes into account the number and type of crisis and its impact on the quality of life of the patient. A prior to surgery should be done to locate the area that originates the crises, and can remove without cause neurological defects.

Prognosis of epilepsy

The prognosis of a person with epilepsy is very variable. There are benign syndromes that forwards completely; others who, without disappearing, can be adequately controlled with medications and allow the sick to lead a normal life; and others, finally, being rebels to the treatment. A prognosis regarding the specific epileptic syndrome that has a patient can only be.
In general, the prognosis of epilepsy depends on factors as the cause, the type of crisis, the age of onset and the rapid establishment of the treatment. They are generally more serious if they begin in childhood, when there are organic brain injury, if the intellectual level is low, if the patient suffers from different types of crises, and the greater the length of the illness.
If the patient responds to the first treatment and crisis-free during 1-2 years, you have a 95% chance of remission.

Tips for patients with epilepsy

Epileptic patients should take two fundamental precautions: refrain from using alcohol and other drugs, and keep a regular night's sleep.
Most patients do not require restrictions on his usual diet nor changes in his regime's life.
They can sports a moderate under supervision, with the exception of those considered to be sports of maximum risk and either performed solo, or would be very dangerous in the event that the patient suffers a crisis during the practice of them, mountaineering, fishing underwater, or those that require the use of motor vehicles.
The only use of television, computers or video games and assisting clubs are restricted in the case of epilepsy triggered by light stimuli.

What is stroke

The term stroke encompasses all cerebrovascular diseases due to interruption, temporary or permanent, of the blood supply to any part of the brain that appear suddenly.
The brain, like any other organ, receives blood for its operation through the arteries. They feed it with oxygen and glucose, which are the main food of the brain. When blood flow ceases to reach any area of the brain, they can alter the functions in that area, temporarily if the irrigation has recovered instantly; or permanently, if the flow is stopped during an important time and brain cells have been damaged.
The stroke has come to be considered one of the leading causes of death in developed countries. In fact, in women is the first cause; and men second, behind myocardial infarction. Are considered health priority; and they are the most common reason for admission to any service of Neurology.
Stroke is also the first permanent, physical and intellectual disability. and the second cause of dementia after Alzheimer's disease.

Types of stroke

Types of stroke they can be classified according to the vascular phenomenon that has caused them. Mainly, distinguished two main types of stroke: ischemic stroke and hemorrhagic stroke.

Ischemic stroke: stroke and TIA

This type of stroke is the most common. Occurs when the stuffiness of the artery, preventing blood to reach an area of the brain. When this occurs, or oxygen or nutrients arrive and cells suffer an injury. It is what is known as cerebral ischemia; and if the lack of blood supply is prolonged, cerebral infarction occurs. In this case, the tissue is already dead. Occlusion may be due to thrombus, the presence of a tumor that compress the artery, or a clot (usually sent from the heart).
When the flow is not blocked during an important time period, this type of attack are known as transient ischemic accident (TIA). It usually takes a few minutes; as a result, are usually valued by the doctor when they have gone. The symptoms are varied, depending on the area of the brain that has been exempt from watering (see stroke symptoms), and the risk factors are the same as in cerebral infarction. This type of attack, although they revert spontaneously, should be evaluated by a neurologist, it is important to know if the brain tissue has been damaged, and since people that have undergone AIT are more likely to end up suffering a longer ischaemic stroke in time, cerebral infarction and death in a part of the brain.

Hemorrhagic stroke

In this case, less often, the problem is the rupture of an artery, which can be intracerebral (from within the brain) or the surface of the brain (about layers that surround it, the meninges). In the first case, the cause is often associated with high blood pressure in the artery (which breaks and produces the intracerebral hemorrhage) and, less frequently, by malformations in vessels; in the second, it is more common that the cause is a head injury (a blow or fall), or an expansion of the artery (aneurysm), which makes the artery wall may not expand more and break, releasing the blood into the space between the brain and the meninges (subarachnoid hemorrhage). This blood, as well as not nourish brain cells, can create pressure on it, causing damage. These damages are usually more severe than those produced by the ischemic stroke. Some infections of the brain, certain tumors, and the consumption of certain drugs, can also cause bleeding.

Risk factors for a stroke

They are mainly associated to age, sex, race, and family history. Obviously, these stroke risk factors cannot be avoided; Although people who are in these groups, they can benefit from more rigorous controls of the modifiable risk factors described in the section on prevention.
  • Age: according to numerous studies, the age of 55, the occurrence of stroke is more common. Since that age, for every 10 years, the risk is multiplied by two. and after 75 years of age, is already the leading cause of deaths vascular age and decade Strip (source: clinical practice guidelines on primary and secondary prevention of stroke, Ministry of health, 2009).
  • Sex: in women, death from cerebrovascular disease is more frequent. This is explained because older, more likely to suffer an attack; and on the fringes of advanced ages dominated by women, by their longer life expectancy.
  • Race: seems to be that people of black and Hispanic race are more likely to suffer a stroke. Although it is believed that it might be the black people are more prone to high blood pressure and diabetes, it seems clear that these factors explain the high incidence of stroke in certain breeds.
  • Family history: if someone in your family of stroke and cerebrovascular disease patients, has increased risk of any type of stroke, in part by the genetic heritage of some of the risk factors.

Symptoms of a stroke

The symptoms of a stroke can vary considerably depending on the region of the brain that has been free of blood. This largely hampers the acknowledgment of the attack. However, in general, almost all strokes are studying with, at least, some of these symptoms, sudden appearance:
  • Abrupt disorder of sensation in the face, arm or leg on one side of the body.
  • Sudden muscle weakness on one side of the body.
  • Difficulty speaking or understanding what is being said.
  • Disorders of vision.
  • Loss of balance.
  • Headache of sudden appearance and a high, unlike the usual intensity; that can be accompanied by nausea and vomiting, loss of consciousness or coma, if it is a very serious attack. Most important thing in strokes by hemorrhage.
If there is one (or more) of these symptoms, should immediately call emergency medical phone, trying to keep calm, and indicating to staff the symptoms the person in the most accurate manner possible.
Diagnosis of a stroke
Largely, the symptoms the patient will indicate the possibility of stroke to the neurologist. Physical examination may be useful for the doctor suspected of what area of the brain is affected (although alarm symptoms very similar, there are very specific symptoms depending on the different areas of the brain that may be damaged).
Advances in diagnostic imaging will allow to confirm the suspicion of stroke and type; as well as know the severity of it and the area of the brain affected. If the neurologist suspected cardiac cause (clot), you may request a consultation to cardiology to treat the problem jointly.

Treatment of a stroke

In general, establishes that the stroke should be treated in less than three hours by the team of neurologists for a good prognosis. To do this, doctors can try to inject medications that dissolve the clot or thrombus and retrieve blood flow, in case of an ischemic stroke (by plugging).
In the case of hemorrhages, it may be more complicated; and it is possible that the patient required surgery or catheterization to repair the damaged artery, if there is no suspicion that can repair itself; or to remove the hematoma that presses the brain. Not all bleeding require surgical treatment. Some can benefit from drug treatment to prevent bleeding to continue.
Rehabilitate a stroke
It is common, after some major stroke, the patient should go to rehabilitation, especially if it has come to cause infarction (death) of any region of the brain, since there is to get as far as possible to another area of the brain pass to control the functions that formerly controlled the area.
Usually, the rehabilitation should begin as soon as the patient is stable. Doctors, nurses and physiotherapists are the multidisciplinary team that will try to help the patient recover altered functions.
Prognosis of stroke
It is very difficult to establish a prognosis for stroke. As you have seen, will depend greatly on type stroke in question and the time that has been brain tissue without receiving blood; in the affected area; of age, sex, and race of the patient; and their own ability to recovery.
Advances in diagnosis and treatment have been fundamental; and the control of risk factors is vital to prevent the emergence of a first stroke (primary prevention) or a relapse (secondary prevention).

Stroke prevention

Stroke prevention, in many cases, is trying to eliminate certain modifiable risk factors of daily life. The most important, traditionally, are:
  • Smoking.
  • Excessive consumption of alcohol.
  • Uncontrolled arterial hypertension.
  • Diabetes.
  • High cholesterol.
  • Obesity.
  • Sedentary lifestyle.
  • Diets rich in salt and fats.
  • Some pathologies of heart arrhythmias or myocardial infarctions, which can send clots of blood to the arteries of the brain, by dabbing them (ischemic stroke by stroke).
  • Atherosclerosis (fatty deposits in the vessels which, to let go, can act as a plug in the artery).
How many more listed risk factors a person, the greater the risk of suffering from a stroke; for this reason, many more risk factors can suppress or control (in the case of diseases), the lower the likelihood of attack.

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