Common Neurological Problems

Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease) – a disease that affects the brain and spinal cord causing gradual loss of control and weakness of muscles. ALS affects muscles in the form of weakness, muscle cramps and twitching, stiffness, slurred speech, trouble swallowing, fatigue, and weight loss. Intellectual and mental abilities are preserved throughout the course of illness. There is no specific test for ALS but a neurologist has the capability of diagnosing ALS based on symptoms and electromyogram findings. There is no cure for this disease and treatment involves relieving symptoms and providing supportive care.

Alzheimer’s disease – a disorder of the brain resulting in a decline in mental function that affects memory, thinking, language, and behavior. The disease can rarely occur in people in their 40’s and 50’s, but it is most common in those 65 and older. Alzheimer’s results from changes in the chemical and physical structures of the brain. Early symptoms include mild forgetfulness. As the disease progresses it may become noticeable to friends and family. He or she affected may have difficulty losing important objects, concentrating, handling money, making decisions, and driving. In the later stages of Alzheimer’s the person can become disoriented and confused. There is no one test to diagnose Alzheimer’s but memory testing, brain scans, and blood tests can be useful. It is especially important to also rule out underlying depression as a potential cause of memory problems. There is no cure but medication has the potential to help preserve mental and physical function.

Bells Palsy – a form of temporary facial paralysis from damage or trauma to the facial or 7th cranial nerve. This nerve controls the muscles of one side of the face, including those of blinking and eye closing, and facial expressions such as smiling or frowning. The facial nerve also regulates nerve impulses controlling the tear ducts and saliva glands. Bell’s palsy occurs spontaneously when the nerve is inflamed or compressed resulting in facial weakness and paralysis. It is thought that Bell’s palsy may be caused from the herpes simplex virus; however, there is still some uncertainty. It affects all ages and races. Some cases are mild and subside within several weeks spontaneously. Others never completely recover. Some cases are treated with antiviral agents and prednisone. Treatment is not always necessary and the most important factor in Bell’s palsy treatment is eye protection as the eyelid’s natural ability to blink is affected. Lubricating eye drops and eye patching at night are usually sufficient.


Carpal Tunnel Syndrome (CTS) – a combination of changes and unusual sensations in the wrist and hand. Many patients describe CTS as a pain, numbness, and/or tingling in the hand or fingers sometimes resulting in weakness of the hand muscles. CTS is associated with many conditions including arthritis, diabetes, thyroid disease, wrist injury, pregnancy, and menopause. Use of power tools and repetitive hand movements such as pinching, gripping, or lifting may aggravate the symptoms of CTS. It is important for your doctor to determine what is causing CTS and if there is any nerve damage that may cause you to lose the use of your hand. Laboratory tests, nerve conduction studies, and x-rays may be necessary to confirm the diagnosis. Treatments include wrist splinting, weight loss, anti-inflammatory medicines, and vitamin B supplements. If simple treatments fail, surgical intervention may be necessary on an outpatient basis.


Dizziness – a term used to describe a variety of symptoms including feelings of the room spinning, unsteadiness, wooziness, or lightheadedness. Dizziness is not a disease. It is a symptom or a signal that the balance mechanism in your inner ear is not working properly or that there is a disturbance in your brain. Often dizziness is minor and temporary and no specific cause is found. Sometimes it is caused by a specific infection of the inner ear but can also be caused by stress, tiredness, fever, anemia, heart arrhythmias, low blood sugar, or stroke. Dizziness may be psychological in origin caused by depression or fears. It is rarely from tumors, brain infections, or multiple sclerosis. The treatment will depend on the cause of the dizziness. You may be prescribed medication for motion sickness or physical therapy to help regulate functions of the inner ear. For mild dizziness the best treatment is no treatment and simple measures such as lying down and relaxing and avoiding activities that precipitate the dizziness.


Fibromyalgia – is a disorder classified by the presence of chronic widespread pain. Fibromyalgia patients are also typically affected by a number of symptoms other than pain, including debilitating fatigue, sleep difficulties, bowel disturbances, headaches, anxiety, and depression. Fibromyalgia is seen in about 2% of the general population.It is most commonly diagnosed in individuals between the ages of 20 and 50. Fibromyalgia can be difficult to diagnosis. The diagnosis is usually made after ruling out other medical problems with similar symptoms. The disorder is not progressive nor-degenerative. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission. The most successful treatments for fibromyalgia include a healthy diet, balanced exercise and rest. If these measures don’t work your doctor may prescribe medications to treat muscle pain, insomnia, and depression. These types of medications have been found very beneficial in the treatment of fibromyalgia, especially when used in combination with non-pharmacological interventions.


Guillain-Barre syndrome (GBS) – is an uncommon inflammatory disorder in which your body’s immune system attacks your nerves, typically causing severe weakness and numbness that usually starts in your extremities and quickly worsens. The exact cause of GBS is unknown. GBS usually begins with weakness, tingling or loss of sensation starting in your feet and legs and spreading to your upper body and arms. In some people, these symptoms begin in the arms or even the face. As the disorder progresses, muscle weakness can evolve into paralysis. Guillain-Barre syndrome can be difficult to diagnose in its earliest stages. The first step in diagnosing GBS is for your doctor to take a careful medical history to fully understand the cluster of signs and symptoms you’re experiencing. A spinal tap (lumbar puncture) and nerve function tests are commonly used to help confirm a diagnosis of GBS. Treatments for GBS are not a cure but have been shown to speed the recovery and reduce the severity of the disorder. These treatments include plasmapheresis and intravenous immunoglobulin. Most people reach the stage of greatest weakness within the first 3 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack.


Migraines headaches – a special kind of headaches often preceded by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A typical migraine produces moderate to severe pain which may be confined to one side of the head or may affect both sides. Migraines are often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days. Not all migraines are the same. Most people experience migraines without auras, which were previously called common migraines. Some, however, have migraines with auras. Causes of migraines include hormonal changes, stress, certain foods, changes in sleep patterns, changes in environment, physical factors, and even medications. If you have typical migraines or a family history of migraines, your doctor will likely diagnose the condition on the basis of your medical history and a physical exam. But if your headaches are unusual, severe or sudden, your doctor may recommend a variety of tests to rule out other possible causes for your pain. These tests may include brain imaging and/or blood work. Treatment options include medication such as anti-inflammatory and pain relieving medications. Your doctor will manage your migraines depending on the frequency, severity, and disability produced by your headache. It is important that you try and identify causes of you headaches and make lifestyle changes that can help reduce the number and severity of migraines.


Multiple Sclerosis (MS) – is thought to be an autoimmune disease that affects the central nervous system (CNS). The central nervous system consists of the brain, spinal cord, and the optic nerves. Surrounding and protecting the nerve fibers of the CNS is a fatty tissue called myelin which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as plaques or lesions. Sometimes the nerve fiber itself is damaged or broken. Myelin not only protects nerve fibers, but makes their job possible. When myelin or the nerve fiber is destroyed or damaged, the ability of the nerves to conduct electrical impulses to and from the brain is disrupted, and this produces the various symptoms of MS. Symptoms of MS are variable from patient to patient and may includeclumsiness, weakness, difficulty walking or maintaining balance, dizziness, eye problems such as double vision, fatigue, muscle spasms, problems with bladder or bowel control, stiffness, tremors, tingling or numbness, depression, mild intellectual changes, and sexual dysfunction.

Scientists do not yet know what triggers the immune system to do this. Most agree that several factors are involved including genetics, gender, environmental triggers, and possible viruses. At this time, no single test is available to identify or rule out MS.Several tests and procedures are needed. These are likely to include a complete medical history, nervous system testing, brain MRI’s, and a lumbar puncture. Treatment options vary depending on the severity and duration of symptoms and results of diagnostic testing. The goal of treatment is to reduce the severity and duration of attacks, modulate the body’s immune system, relieve symptoms, and repair damage caused by MS. . Other medications may be prescribed to treat or control the symptoms of MS such as depression, fatigue, pain, spasticity and tremors. Treatment programs and services may include exercise and physical therapy, occupational therapy to help maintain your independence in daily living and stress-reduction.

Myasthenia Gravis (MG) – a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups. Certain muscle groups are more frequently affected including those that control eye movements, eyelids, chewing, swallowing, coughing, and facial expressions. Muscles that control breathing and movements of the arms and legs may also be affected. The muscle weakness of MG increases with continued activity and improves after periods of rest. To establish the diagnosis of MG your doctor will complete a thorough physical examination, blood tests, and electromyography. There is no cure for MG but there are many effective treatments that allow most people to lead full lives. Medications such as mestinon, prednisone, and immunosuppressants are the most frequently form of treatment. Other treatments include intravenous immunoglobulins, surgical removal the thymus gland, and plasmapheresis. Treatments decisions are made based on symptom severity.


Neuropathy – a disorder of the peripheral nerves that connect the spinal cord to muscles, skin and internal organs.  It usually affects the hands and feet, causing weakness, numbness, tingling, and pain. Pain my range from minor discomfort to severe sharp or electrical like pain. Some may have extreme sensitivity to the slightest touch. Neuropathy’s course is variable; it can come and go, slowly progressing over many years, or it can become severe and debilitating.  However, if diagnosed early, it can often be controlled. There are many causes of neuropathy.  Approximately 30% of neuropathies are of an unknown cause. In another 30% of cases in the USA, the cause is diabetes. Other causes include autoimmune disorders, tumors, heredity, nutritional imbalances, vitamin deficiencies, infections or toxins. Your doctor will try and determine a cause when you are initially evaluated. Diagnostic testing usually includes blood work and nerve conduction studies. Some types can be cured, however, most cannot.  However, many can be helped.  Therapy is directed at treating the underlying disease and at improving the symptoms with the right medications. A neurologist can help patients feel more comfortable, and their quality of life can be greatly improved if treated properly.


Parkinson Disease (PD) – a disease that is characterized by four major features including a rest tremor of a limb (shaking of the arm or leg at rest), slowness of movements (bradykinesia), rigidity (stiffness, increased resistance to passive movement) of the limbs or trunk, and poor balance. When at least two of these symptoms are present, and especially if they are more evident on one side than the other, a diagnosis of PD is made, unless there are atypical features that suggest an alternative diagnosis. Symptoms typically begin on one side of the body and spread over time to the other side. Other features of PD include changes in facial expression, so that there is a certain facial fixity (blank expression showing little emotion) or a staring appearance (due to reduced frequency of eye blinking) and walking difficulty. PD is a chronic, progressive disease that results when nerve cells in a part of the midbrain, called the substantia nigra, dies or is damaged.  These nerve cells produce dopamine, an important chemical messenger that transmits signals from the substantia nigra to another part of the brain called the corpus striatum.  These signals allow for coordinated movement. When the dopamine-secreting cells in the substantia nigra die, the other movement control centers in the brain become unregulated.  These disturbances in the control centers of the brain cause the symptoms of PD. The goal of treatment is not to abolish symptoms, but rather to help the patient manage their symptoms, function independently, and make the appropriate adjustments to a chronic illness. The illness will not go away, but management of its symptoms can be successful in reducing disability or other handicap. There are several different medications used to treat PD, most working to replace the lack of dopamine in the brain.


Restless Leg Syndrome (RLS) – a neurological condition that is characterized by the irresistible urge to move the legs. Symptoms of RLS include a strong urge to move your legs which you may not be able to resist; the need to move is often accompanied by uncomfortable sensations. Some words used to describe these sensations include: creeping, itching, pulling, creepy-crawly, tugging, or gnawing. RLS symptoms start or become worse when you are resting. RLS symptoms get better when you move your legs. The relief can be complete or only partial but generally starts very soon after starting an activity. Symptoms are typically worse in the evening especially when you are lying down. RLS can also cause difficulty in falling or staying asleep which can be one of the chief complaints of the syndrome. Currently, there is no single diagnostic test for RLS. The disorder is diagnosed clinically by evaluating the patient’s history and symptoms. For those with mild to moderate symptoms, prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, foliate, calcium, and magnesium. Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Regular exercise, a hot bath at night, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms. If simple measures do not relieve your symptoms physicians may suggest a variety of medications to treat RLS. Generally, physicians choose from dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. Dopaminergic agents, largely used to treat Parkinson’s disease, has been shown to reduce RLS symptoms and are considered the treatment of choice.

Seizures – A seizure is a temporary abnormal electro-physiologic phenomenon of the brain resulting in abnormal synchronization of electrical discharges in the brain. Seizures can cause involuntary changes in body movement or function, sensation, awareness, or behavior. A seizure can last from a few seconds to status epilepticus a continuous seizure that will not stop without intervention. Seizure is often associated with a sudden and involuntary contraction of a group of muscles. However, a seizure can also be as subtle as marching numbness of a part of the body, a brief loss of memory, sparkling or flashes, sensing an unpleasant odor, a strange epigastric sensation or a sensation of fear. In some cases, the full onset of a seizure event is preceded by some of the sensations described above. These sensations can serve as a warning to the sufferer that a full tonic-clonic seizure is about to occur. These “warning sensations” are cumulatively called an aura. Seizure types are organized according to whether the source of the seizure within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures). It determine if a patient has had a seizure or epilepsy your physician will take a detailed history about the seizure like events and will usually get an EEG, brain scan, and blood tests to determine the cause of the seizure. Causes of seizures include head injury, brain injury at birth, brain infections, tumors, stroke, drug intoxication, drig withdrawl, and metabolic disturbances. You doctor will determine is treatment with medication is needed for seizures depending on the cause.


Stroke – stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke: ischemic – blockage of a blood vessel supplying the brain, and hemorrhagic – bleeding into or around the brain. Recovery from stroke is variable depending on the degree of brain damage incurred. If stroke is suspected, prompt, accurate diagnosis and treatment is necessary to minimize brain tissue damage. Diagnosis includes a medical history and a physical examination, brain imaging, blood work, and carotid ultrasonography. Treatment varies depending on the cause of the stroke.


Transient Ischemic Attack (TIA) – a brief episode of stroke-like symptoms usually lasting only a few minutes and no longer than 24 hours without a residual deficit. TIA’s are often referred to as mini strokes and are usually the result of a blood clot temporarily clogging an artery, which results in part of the brain not getting the blood that it needs. Risk factors for TIA include high blood pressure, heart disease, high cholesterol, smoking, lack of exercise, an unhealthy diet, and being overweight. The symptoms of a TIA include sudden weakness or numbness of the face, arm, or leg especially on one side of the body. Other symptoms are sudden confusion, slurred speech, walking difficulty, dizziness, and/or loss of balance or coordination. If you suspect you are having a TIA you should not ignore them and should quickly be evaluated by a health care provider.


Trigeminal Neuralgia – Trigeminal neuralgia (TN) is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode.  The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years.  In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind.  TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. A presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose.  But finding the cause of the pain is important as the treatments for different types of pain may differ.  Treatment options include medicines such as anticonvulsants and tricyclic antidepressants. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment.  These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.