Does Lesion Location Predict Post
There has been a lively debate on the subject of lesion location in relation to post-stroke depression. Data from the early 1980s first suggested that there was a relation between proximity of the lesion to the frontal pole and depression. This appeared to have been contradicted by a meta-analysis published in the Lancet in 2000. This analysis was further criticised by others on the grounds that the hypothesis was not specific enough and that some relevant studies had been omitted. When a similar methodology was used but the data looked at separately for each hemisphere, there was a clear relation between proximity of the lesion to the left frontal pole and depression, especially in the first few months after stroke. The results of this second meta-analysis were given further weight by a Finnish study published earlier this year. This study also found that a brain infarct affecting the pallidum was a strong predictive factor for post-stroke depression . This finding also fits with case reports of dysphoria in relation to insertion of deep brain stimulating electrodes in the same area.
Link Between Parkinsons Disease And Als
Parkinsons disease and ALS are a lot more similar than you may think. The two neurological diseases share neurons that are highly sensitive to stress, misfolded proteins and reduced protein recycling, toxic proteins that spread from neuron to neuron, and neuroinflammation which is triggered by the immune system and aggravates the condition.
These commonalities between ALS and Parkinsons disease allow researchers to better hone in on more effective treatments for both diseases.
Myasthenia Gravis And Multiple Sclerosis: Differences And Similarities
Multiple sclerosis presents patients with a number of symptoms that can disrupt everyday life. During an episode for those with relapsing-remitting MS, or those with one of the progressive MS forms with constant symptoms, obtaining a diagnosis that allows the patient to work with doctors and therapists to create a treatment and management regimen is crucial to living a full and healthy life.
Of course, MS is not the only chronic disease that causes such issues or requires direct attention. Another condition, called Myasthenia gravis, can also cause significant impairment when trying to complete daily activities. In fact, Myasthenia gravis actually seems quite similar to some aspects of multiple sclerosis and distinguishing one from the other is essential to prescribing the right treatment plan.
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The First Sign Of Parkinson’s And Multiple Sclerosis: A Dodgy Tummy
- Study suggests that brain disease can be caused by an unhealthy gut
- ‘Butterflies in the stomach’ could be linked to Parkinson’s and MS
17:07 EDT, 21 June 2014 | Updated:
Gut feeling: Brain disease can be caused by an unhealthy stomach
Anxiety or anticipation can often lead to a feeling of butterflies in the stomach which usually dissipates along with the source of the consternation.
But scientists have discovered that the nerve pathways between the gut and the brain that cause this phenomenon may also be linked to degenerative illnesses such as Parkinsons disease and multiple sclerosis , as well as some mental health problems.
Dr Anton Emmanuel, consultant neuro-gastroenterologist at University College London and the National Hospital for Neurology, explained: The gut and brain share the same nerve chemistry and have a dialogue.
‘Thats why when you feel stress and other strong emotions, such as fear, it leads to gastrointestinal symptoms, like rushing to the loo.
A new study suggests that brain disease can be caused by an unhealthy gut because these signals also travel in the opposite direction.
The study, which was published in the journal Movement Disorders, found that sufferers of Parkinsons disease had a higher prevalence of a condition called small intestinal bacterial overgrowth, or SIBO.
In SIBO, normally harmless bacteria proliferate in large numbers in the small intestine.
How Therapy Helps Ms And Parkinsons
While there are differences in Parkinsons and MS, physical, occupational and speech therapy can help both MS and PD patients improve their independence and safety, as well as achieve and maintain optimal function and cognition. Therapy can help prevent complications such as de-conditioning, muscle weakness from lack of mobility and muscle contractures related to spasticity. Training in energy conservation techniques and the use of adaptive tools and devices can help simplify everyday tasks. Therapists can even recommend strategic modifications to your home to ensure accessibility and safety even as the disease progresses.
Clinicians certified in LSVT ® and PWR! therapeutic programs can provide Parkinsons-specific exercises to target weight shifting, posture, trunk rotation and stepping strategies to overcome rigidity and slowness of movement. Education on specific exercises and strategies helps increase safety and slow the progression of the disease.
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A New Blood Test That Might Help With Diagnosis
Researchers recently discovered a blood test that can detect a specific protein found in the blood of Parkinsons patients but not MSA patients. The protein, known as alpha-synuclein, is produced in nerve cells in the brain and can be detected in the blood. It is one of the proteins that accumulate and damages the brains of people with both MSA and Parkinsons. However, the protein collects in different cells in the brain, depending on which disease it is.7
Pool Therapy: A Boon For The Healthcare Industry
The topic of healthcare for people of all ages, not merely seniors, is an important one. Its consistently making headlines, especially with the Baby Boomer population reaching retirement age.
Knowing that hundreds of thousands of seniors are going to be diagnosed with Alzheimers, Parkinsons and Multiple Sclerosis each year, senior living facilities with the means to invest in a warm-water pool with integrated treadmill technology would be wise to do so. By keeping their population of patients as active as possible through water-based therapies and exercise options, a facility could make great advances in the field.
Though none of the aforementioned conditions that have been covered has a cure, they can all be managed through a combination of prescription drugs, diet and exercise. HydroWorx aquatic therapy equipment might just wind up being the deciding factor for someone looking for a long-term place to stay during their later decades.
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Epidemiology Of Depression In Ms
Many of the earlier studies into prevalence of depression in MS were subject to considerable ascertainment bias. Two recent, community based studies have addressed this problem to some extent. In the first study, subjects from a large community sample were evaluated using the Center for Epidemiological Studiesdepression scale , which is used to screen for depression in primary care. Forty one per cent of respondents had depression with a subgroup of 30% having moderate or severe depression . Depression was related to shorter duration of illness. Patten et al obtained data from the Canadian community health survey, which looked at health in 115 071 people. The prevalence of depression in MS in this study was 25%. Rates of depression are higher in nursing home settings and one study noted that younger people with MS were more likely to be depressed than their older counterparts with similar levels of physical disability.
Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
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Depression In Parkinsons Disease
Diagnosis and management of depression in Parkinsons disease is important for two main reasons: firstly, depression is common in PD , and secondly depression causes significant morbidity in terms of quality of life, disability , and carer stress. This effect is independent from the effect of motor disability.
Scales Used To Measure Depression In Parkinsons Disease
As mentioned above, symptoms of idiopathic PD have considerable overlap with those of depression. This means that standard rating scales for depression may not be valid in this situation. Rating scales for depression may be loaded with somatic or vegetative symptoms, which reduce their validity.
Three rating scales have been tested using a clinical interview with operationalised diagnosis as a gold standard. Using receiver operating curves, the sensitivity and specificity at a given cut off point can be calculated. From this methodology, it is clear that the Beck depression inventory is not a useful rating scale in PD. The Montgomery and Asberg depression rating scale and the Hamilton depression scale have performed better. In summary, diagnosis of depression should be made clinically, using appropriate diagnostic criteria, with severity or response to treatment being measured using MADRS or HAM-D.
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Signs It Might Be Multiple System Atrophy Instead Of Parkinsons Disease
Here are some clues as to whether it is multiple system atrophy or Parkinsons disease. One of the easier distinctions is between PD and MSA-C .If the patient presents with unsteadiness while walking, uncoordinated arms and legs, bladder disturbance and/or dizziness when standing the diagnosis is more likely to be MSA-C. On the other hand, if a person looks Parkinsonian the distinction can be harder, but there are clues:
- In the earlier stages of MSA-P , which is often when people have just been told they have Parkinsons disease, some patients will fall often.Frequent falls also occur in Parkinsons disease, but it typically occurs 10-15 years after diagnosis.
- In patients with MSA the classic Parkinsons drug L-Dopa may work initially but will stop working very quickly.It can continue working in PD patients for many years.
- Dementia is not associated with MSA however, it does occur in patients with lewy body Parkinsons disease.
- Early autonomic nervous system symptoms such as low blood pressure when standing and issues with the bladder are often signs of possible MSA in patients diagnosed with Parkinsons.
- Vocal cord issues are less common but very typical in MSA and much less common in PD.Some examples include difficulty getting words out, odd sighs and even falling asleep during a conversation.
What Is Myasthenia Gravis
Myasthenia gravis is an autoimmune condition distinguished by the fast-weakening and fatigue of voluntary muscles and muscle groups. In most cases, this happens when the immune system produces a specific antibody that interferes with the communication between nerves and muscles. Muscles are equipped with receptors into which neurotransmitters fit and send signals for functionality. These antibodies block the transmitters and sometimes destroy the receptors, leaving fewer lines of communication between the brain and muscle, which leads to weakness. These antibodies also seem to block the function of the protein which builds these junctions.
Its believed that these antibodies are formed in the thymus gland, which may have a tumor or could be oversized . The biggest confusion is that, in some patients, the disease is not caused by antibodies, and there is no known reason for the problem.
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Diagnosis Of Depression In Parkinsons Disease
Diagnosing depression in PD can be particularly difficult because of the clinical overlap between the two syndromes.
Symptoms that are common to both depression and idiopathic Parkinsons disease include motor slowing, bradyphrenia, sleep and appetite disturbance, weight loss, loss of interest and concentration, and reduced libido. The body language of depression looks similar to that of PD at first glance. The patient often appears hunched with a lack of an obvious affective response and spontaneity .
Symptoms that may help in the diagnosis of depression in people with PD include
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pervasive low mood with diurnal variation
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early morning wakening
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pessimistic thoughts about the world, themselves, and the future
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suicidal ideation.
Table 1 lists the Diagnostic and statistical manual, 4th revision criteria for major depressive episode.
Table 1
DSM-IV criteria for major depressive episode
Depression should be considered in any patient whose function deteriorates notably over a few days or weeks.
Table 2
Differential diagnosis of depression in Parkinsons disease
A variety of mood disorders have been described in the setting of neurosurgery for PD. These include transient dysphoria during surgery . More chronic changes in mood have also been described following pallidotomy and deep brain stimulation although definitive studies have not been performed in this area.
Diagnosis Of Depression Post
A number of factors can make the diagnosis of depression difficult post-CVA. Communication difficulties, impairments of facial and emotional expression, and disturbance in vegetative functions can make assessment of mental state extremely difficult. A deterioration in function over a few days or weeks following a period of improvement is one clinical clue for the development of depression.
Extreme abulia can sometimes be mistaken for depression and can be related to either frontal and diencephalic lesions. The patient may appear to be extremely retarded but may function at a high level within a structured environment. Dopamine agonists, such as bromocriptine, have been used to treat abulia.
Pathological emotionalism is relatively common after stroke, affecting up to 20% of patients in the first six months post-stroke but tending to improve over the following year. Severe examples of pathological emotionalism have been treated with antidepressant medication and levodopa.
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Which Is Worse Als Or Ms
Multiple sclerosis is an autoimmune disease, while ALS is hereditary in 1 out of 10 people due to a mutated protein. MS has more mental impairment and ALS has more physical impairment. Late stage MS rarely is debilitating or fatal, while ALS is completely debilitating leading to paralysis and death.
Symptoms Of Depression In Ms
Like Parkinsons disease, vegetative or somatic symptoms do not tend to be good diagnostic discriminators for depression in MS. Some vegetative symptoms may be specifically related to fatigue rather than depression, but this area is fraught with methodological and conceptual difficulties. One study has indicated that disinterest in sex was uniquely related to depression in MS . Important clues to depression in MS are illustrated in table 4.
Important clues to depression in multiple sclerosis
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Benefits Of Inpatient Rehabilitation
Inpatient rehabilitation hospitals are required to provide an interdisciplinary approach to patient caremeaning specialists from many disciplines are involved in creating and implementing a patients care plan. Interdisciplinary team members include physical, speech and occupational therapists, rehabilitation physicians, nurses, case managers, dietitians and pharmacists. Patients participate in three hours of therapy each day for a total of 15 hours per week, and an individualized plan of care is created for each patient to meet their needs while providing necessary intervention to make functional gains. Inpatient rehabilitation can be beneficial for both MS and Parkinsons disease.
Educational sessions with the patient and family members can also improve understanding for all involved in the patients care about the progression of each disease and ways to combat symptoms.
Bethany Moss is a physical therapist at Encompass Health Rehabilitation Hospital of Jonesboro. She is a PWR! certified therapist and a LVST BIG certified clinician.
How Do You Diagnose These Diseases
Both diseases can be difficult to diagnose, and they require a neurology workup and medical history. You might have some brain imaging or blood tests to rule out other causes for your symptoms.
For MSA, doctors will test your autonomic functions, like how well you produce sweat and how well your body maintains a stable blood pressure when you stand up after sitting or lying down.5 Parkinsons doesnt have a specific test for diagnosis. Sometimes doctors will prescribe anti-Parkinsons medication and diagnose Parkinsons if it helps improve your symptoms.1
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Multiple Sclerosis Vs Parkinsons Disease: Risk Factors And Complications
Risk factors for multiple sclerosis include being female, having a family history of multiple sclerosis, having certain infections, being white of European descent, living furthest from the equator, living in temperate climate regions, already having an autoimmune disease, and smoking.
Complications resulting from multiple sclerosis include muscle stiffness and spasms, paralysis, problems with bladder, bowel, and sexual function, as well as forgetfulness, mood changes, depression, and epilepsy.
Risk factors for Parkinsons disease include being over the age of 50, being male, having a family history of Parkinsons disease, carrying gene variations, experiencing a head injury, being exposed to environmental toxins, and taking certain medications such as anti-anxiety medications or sleeping pills.
Complications associated with Parkinsons disease include difficulty thinking, depression, emotional changes, swallowing problems, sleep problems and disorders, bladder issues, constipation, changes in blood pressure, smell dysfunction, fatigue, pain, and sexual dysfunction.
Parkinsons And Multiple Sclerosis Case Study: Virginia
One recent case illustrating the power of water to combat problems related to major conditions involves a 67-year-old patient diagnosed with both Multiple Sclerosis and Parkinsons who sought treatment at a senior living campus. The woman, Virginia, has been wheelchair bound due to her illnesses, but was particularly concerned because her body had begun to lean to the left to the point where she could not easily read the newspaper, play the piano or easily put on her slacks.
Virginia was determined not to allow her conditions to stop her from having a good quality of life. Therefore, she turned to water therapy twice a week. When she began her rehabilitation, it was very difficult for her to bear any weight until she was significantly submerged and the buoyancy could prevent her from falling. After three months, she improved her core strength to the point where she could sit and stand upright, and could exercise in water depths that were lower than before.
As Virginias physical therapist now notes, she has improved to the point where she can stand against currents created by resistance jets. Additionally, her posture is much better. Most exciting of all from Virginias perspective was when she had a check-up with her neurologist who was amazed at the results. Now, Virginia plays the piano for up to 45 minutes at a time without leaning to the left, and can feel the positive effects of being stronger and more stable.
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