Neurological Disorders Topic Homepage

Neurological Disorders Overview

Neurological Disorders

Neurology is the branch of medicine dealing with all diseases of the nervous system, including those of the brain, spinal cord and nerves.1

The nervous system is a highly specialised and complex structure.2 It is an information-processing system that regulates all physiological functions of the body.2 When a disease affects this system, it can result in difficulty moving, speaking, breathing or ...

... problems with memory or behaviour.2

There are more than 600 neurological disorders; the most common are Alzheimer's disease (dementia), Parkinson's disease, migraine and epilepsy.3

Alzheimer's disease is a neurodegenerative disease that causes progressive and irreversible loss of mental functions, such as memory, language, orientation and judgment.3 Usually diagnosed from the age of 65, it is the leading cause of dementia and dependency in elderly, and affected about 24 million people worldwide in 2005 according to the World Health Organisation.3

Parkinson's disease is a neurodegenerative disease characterised by tremors when muscles are at rest, slowness of voluntary movements and increased muscle tone (rigidity).4 It is often diagnosed after 65 and affects 1% of people of this age bracket.4

Migraine is one of the most prevalent neurological disorders, affecting up to 18% of the population.5 Migraine is characterised by attacks of severe unilateral head pain, associated with nausea, vomiting, phonophobia, and photophobia.5

Epilepsy is a chronic neurological disorder affecting both sexes, regardless of age or country of origin.3 Epilepsy consists a set of neurological conditions characterised by the occurrence of at least one epileptic seizure.6 Epileptic seizure is a sudden symptom, characterized by abnormal brain hyperactivity. It may manifest as seizures or unconsciousness, or even visual or auditory hallucinations.6

Neurological diseases, especially neurodegenerative diseases like Alzheimer's or Parkinson's disease, remain incurable with a poorly understood etiology. With the population aging, neurological diseases are a major health problem, particularly for developing countries where life expectancy increases dramatically.3 Studies are ongoing to identify risk factors that would allow better prevention of neurological diseases, pending the development of effective treatments.3

1. Reinhard Rohkamm R. Color atlas of neurology. Thieme editionedition. 2004 : 440 pages.
2. Michael-Titus A. et al. The nervous system. Elsevier Editionedition. 2007 : 371 pages.
3. World Health Organization. Neurological disorders: Ppublic health challenges. WHO editionedition. 2006 : 218 pages. Available online.
4. Beers M.H. et al. The Merck manual of medical information. Merck research laboratories. Second home edition. 2003, : 431-96.
5. Zaza Katsarava Z. The many facets of migraine. The Lancet Neurology. July 2011 ; 10 (7) : 607.
6. Fisher R.S. et al. Eepileptic seizures and epilepsy: Ddefinitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005 ; 46 (4) : 470–472.

Neuropathic Pain

The Neuropathic Pain Knowledge Centre is a unique resource containing a wealth of current information in this field of medicine.

The nervous system (central and peripheral) constantly receives and interprets information about the body's surroundings and the body's own functioning, responding by sending out messages to tissues and organs.

The Knowledge Centre addresses the two types of pain: nociceptive and clinical. Nocicpetive pain aims to protect individuals from harm. Clinical pain results from damage or inflammation of a part of the body and consists of both spontaneous pain that may arise with no apparent peripheral stimulus, and from hypersensitivity to peripheral stimuli1 due to peripheral and central sensitisations.

Neuropathic pain is often described as a shooting, stabbing or burning sensation. Estimates suggest that neuropathic pain may affect as much as 3% of the population.

Different types of neuropathic pain exist depending on their origin, details of which can be found in the Knowledge Centre: Painful Diabetic Neuropathy, Herpes Zoster and Post-Herpetic Neuralgia (PHN), HIV Associated-Neuropathy (HIV-AN), Cancer-related Neuropathic Pain, Post-surgical/Post-traumatic Neuropathic Pain.

In the clinic, the diagnosis of neuropathic pain relies on an accurate history and examination and some pain evaluation tools are used.

As Neuropathic pain doesn’t respond to conventional therapy with analgesics, the different treatment regimens are antidepressants, anticonvulsants, opioids, topical agents and combination treatment.

To help physicians in the pharmacological management of this condition, recent guidelines are available.

Enter the Neuropathic Pain Knowledge Centre


References:

1. Ji R-R, et al. Central sensitization and LTP: Do pain and memory share similar mechanisms? Trends in Neuroscience 2003;26(12):696–705


Date of preparation: August 2012 PAIN/12/0003/EUd

Alzheimer's Disease

Neuropathic Pain

Alzheimer's disease (AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time, and it’s prevalence increases with age.

In the early stages in particular, dementia is often difficult to diagnose, since many symptoms are not recognized as such or are trivialized by the patient. 20% of actual dementia cases are reported to be incorrectly diagnosed as a different disease.

In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.

In general two main groups of dementia can be distinguished, requiring different types of treatment:

Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible. 

Enter the Alzheimer's Disease Knowledge Centre

Niemann-Pick type C

Neuropathic Pain

Niemann-Pick type C disease is a rare genetic lysosomal storage disorder that causes severe, progressive neurological symptoms. It is a very serious, life-threatening condition that can affect infants, children and adults. NP-C is characterized by cellular accumulation of lipids, in particular unesterified cholesterol and glycosphingolipids, in many parts of the body including brain, liver and spleen.

The variability of NPC presentations provides a wide range of life expectancy. In general, early-onset patients tend to die during childhood or early adolescence, while patients with later-onset disease who appear to be less drastically affected can live into late adulthood.

Accurate diagnosis of NPC requires awareness of many clinical phenotypes, narrowing of differential diagnosis by ancillary testing and final confirmation by biochemical testing – the current mainstay of primary diagnosis in NPC.

The prevalence of NPC has undoubtedly been underestimated in the past due to a mixture of factors including confusing terminology, prior lack of specific biochemical or genetic tests, varied pathology, and the many variant clinical manifestations of the disease.

Current, non-specific treatments for NPC focus mainly on supportive care, aimed toward managing the symptoms of the disease. As such, these treatments have no effect on disease progression or long-term outcomes.

Specific therapies for the intended treatment of NPC are based on targeting known pathophysiological and/or biochemical defects involved in the pathogenesis of the disease. While earlier attempts proved largely ineffective, more recent efforts indicate possible hope for the future. 

Enter the Niemann-Pick Type C Knowledge Centre

Soft Tissue Sarcoma

Neuropathic Pain

Soft Tissue Sarcomas (STS) are malignant (cancerous) tumors that develop in tissues which connect, support, or surround other structures and organs of the body. Muscles, tendons (bands of fiber that connect muscles to bones), fibrous tissues, fat, blood vessels, nerves, and synovial tissues are types of soft tissue.

Soft tissue sarcomas are grouped together because they share certain microscopic characteristics, have similar symptoms, and are generally treated in similar ways.1 They are usually named for the type of tissue in which they begin.

Every year approximately 13,000 new cases of soft tissue sarcomas are diagnosed in adults and children in Europe. The 5-year survival rate for patients with soft tissue sarcoma is around 90% if the cancer is detected in early phases and before it has spread. However, the 5-year survival rate is 10% to 15% for sarcomas with metastasis.

Management of STS depends on the stage of disease and histological subtype.2 Surgery is the mainstay of treatment for patients with localised disease and is often curative. However, as recurrence is likely to occur when tumour cells remain after surgery, adjuvant radiotherapy is often also considered, especially for patients with intermediate or high-grade tumours. Radiotherapy is also often administered for patients in whom surgery is inappropriate or who decline surgery.2

There are a number of Associations and Organisations across Europe who strive to inform others of this disease as well as offer help and support to those affected or to those who know and want to help those suffering.

Enter the Soft Tissue Sarcoma Knowledge Centre


References

1. Cormier JN, Pollock RE. Soft tissue sarcomas. CA: A Cancer Journal for Clinicians 2004; 54(2):94–109.
2. Clark MA, Fisher C et al. (2005) “Soft-tissue sarcomas in adults.” N Engl JMed 353(7): 701–11.

Drug News

Phase III COMFORT-II study shows Jakafi/Jakavi (Novartis) improves overall survival in Myelofibrosis patients

17-06-2013

Results from a Phase III three-year follow-up study that showed Jakafi/Jakavi (ruxolitinib), from Novartis, demonstrated improved overall survival and sustained reductions in spleen size compared...

RELY-ABLE trial shows long-term safety profile of Pradaxa (Boehringer) in patients with Atrial Fibrillation

16-06-2013

Results from the RELY-ABLE trial, a long-term extension of the pivotal RE-LY study of Pradaxa (dabigatran etexilate), from Boehringer, in patients with non-valvular Atrial Fibrillation (NVAF),...

TRANSFORMS study of Gilenya (Novartis) shows sustained improvements in patients with Multiple Sclerosis

16-06-2013

Two new analyses from the pivotal Phase III TRANSFORMS study of Gilenya (fingolimod), from Novartis, show early and sustained improvements in disease activity in patients with relapsing remitting...

Neurological Disorders Drug Data - A-Z

Possible searches include drugs or medicines (by brand, generic ingredient or drug class), diseases, conditions and more.

Drug Lang:

Medical Images

Single large left posterior fossa lesion
Single large left posterior fossa lesion
CT head with contrast, shows oedema, enhancement of tuberculoma increased
 CT head with contrast, shows oedema, enhancement of tuberculoma increased
Contrast enhanced MRI head
Contrast enhanced MRI head
Cerebral atrophy
Cerebral atrophy
Diffuse hyperintensity signal
Diffuse hyperintensity signal
Cerebral tuberculoma with a paradoxical reaction in HIV
Cerebral tuberculoma with a paradoxical reaction in HIV
CNS IRIS after ARV initiation
CNS IRIS after ARV initiation
T1-weighted transverse cranial MRI
T1-weighted transverse cranial MRI
Immunocytochemical staining
Immunocytochemical staining
Miliary TB
Miliary TB

Clinical Guidelines

Headaches: Diagnosis and management of headaches in young people and adults

Sep 2012

Headaches are one of the most common neurological problems presented to GPs and neurologists. They..

... are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society. Headache disorders are classified as primary or secondary. The aetiology of primary headaches is not well understood and they are classified according to their clinical pattern. The most common primary headache disorders are tension-type headache, migraine and cluster headache. Secondary headaches are attributed to underlying disorders and include, for example, headaches associated with medication overuse, giant cell arteritis, raised intracranial pressure and infection. Medication overuse headache most commonly occurs in those taking medication for a primary headache disorder. The major health and social burden of headaches is caused by primary headache disorders and medication overuse headache. This guideline makes recommendations on the diagnosis and management of the most common primary headache disorders in young people (aged 12 years and older) and adults.

Alteplase for treating acute ischaemic stroke

Sep 2012

Alteplase (Actilyse, Boehringer Ingelheim) is a tissue plasminogen activator manufactured by..

... recombinant DNA technology. It activates the production of plasmin from its precursor plasminogen. Plasmin is an enzyme that degrades fibrin clots. The aim of treatment is to reduce the impact of ischaemia by restoring blood flow through the occluded (blocked) artery.

Online CME

Risk prediction of very early recurrence, death and progression after acute ischaemic stroke

Apr 2013
... years, ischaemic stroke remains a leading cause of mortality and morbidity worldwide. This activity is centred around risk prediction in very early recurrence, death and progression after ischaemic stroke.

Cognitive impairment in HIV infection is associated with MRI and CSF pattern of neurodegeneration

Apr 2013
... HIV is common. The nomenclature of HIV-associated neurocognitive disorders (HAND) has been recently revised and updated. This exercise looks at cognitive impairment in HIV infection is associated with MRI and CSF pattern of neurodegeneration.

Clinical Trials

Risk of Falls in Fibromyalgia (FM)

29-03-2013

Fibromyalgia is a chronic illness characterized by persistent widespread muscle pain with generalised hyperalgesia and allodynia. It can be accompanied by other concomitant symptoms: fatigue, sleep disturbances, musculoskeletal disorders, distress and psychological disorders. The prevalence has been reported to be..

... between 2 and 5%. The hypothesis of this study is that women with fibromyalgia present high risk of falls and balance disorders compared with healthy women. The objective of this study was to investigate wether gait pattern changes in single and dual task conditions were associated with the risk of falling in women with fibromyalgia.

Neurodynamic Intervention in Fibromyalgia (FM)

29-03-2013

Fibromyalgia is a chronic illness characterised by persistent,widespread muscle pain with generalised hyperalgesia and allodynia. It can be accompanied by other concomitant symptoms like fatigue, sleep disturbances, musculoskeletal disorders, distress and psychological disorders. This condition is very prevalent. It..

... has been reported to be about 2-5% of the general global population. Fibromyalgia have been reported to have neurodynamic disorders. The purpose of this prospective study was to examine the combined effects of soft tissue mobilization and nerve slider neurodynamic technique on pain and pressure sensitivity in women with fibromyalgia.

Medical Videos

An Overview of Brain Surgery and the Current Understanding of Brain Function
An Overview of Brain Surgery and the Current Understanding of Brain Function
Does chronic venous insufficiency play a role in MS pathogenesis? Commentary (CONy 2010)
Does chronic venous insufficiency play a role in MS pathogenesis? Commentary (CONy 2010)

Medical Journal Abstracts

Value of quantitative sensory testing in neurological and pain disorders: NEUPSIG consensus

PAIN
Jun 2013

Quantitative sensory testing (QST) is a psychophysical method used to quantify somatosensory function in response to controlled stimuli in healthy subjects and patients. Although QST shares similarities with the quantitative assessment of hearing or vision, which is extensively used in clinical practice and research,..

Induction of Monocyte Chemoattractant Protein-1 (MCP-1) and Its Receptor CCR2 in Primary Sensory Neurons Contributes to Paclitaxel-Induced Peripheral Neuropathy

The Journal of Pain
Jun 2013

The use of paclitaxel (Taxol), a microtubule stabilizer, for cancer treatment is often limited by its associated peripheral neuropathy (chemotherapy-induced peripheral neuropathy [CIPN]), which predominantly results in sensory dysfunction, including chronic pain. Here we show that paclitaxel CIPN was associated with..

Social Media

Frailty. Is it an important clinical syndrome?

on doc2doc

... s decision, and possibly the family´s, more. This is of course difficult, many people have unrealistic expectations, so additional guidelines ...

What's the most ridiculous rule your hospital has enforced?

on doc2doc

What's the most ridiculous rule your hospital has enforced? In Response to Re: What's the most ridiculous rule your hospital has enforced?:This ...

Frailty. Is it an important clinical syndrome?

on doc2doc

Frailty. Is it an important clinical syndrome? There's a lot of talk about frailty and our local hospital has even developed a 'frailty unit' attached ...

Back to top