Multiple sclerosis (MS) is the most common nervous system disorder affecting young adults. In this condition, nerves in the brain and spinal cord are progressively damaged, causing a wide range of symptoms that affect sensation, movement, body functions, and balance. Specific symptoms may relate to the particular areas that are damaged and vary in severity between individuals. For example, damage to the optic nerve may cause blurred vision. If nerve fibres in the spinal cord are affected, it may cause weakness and heaviness in the legs or arms. Damage to nerves in the brain stem, the area of the brain that connects to the spinal cord, may affect balance.

In many people with MS, symptoms occur intermittently and there may be long periods of remission. However, some people have chronic (long-term) symptoms that gradually get worse.

In the UK, about 85,000 people are affected by MS. People who have a close relative with MS are more likely to develop the disorder. The condition is much more common in the northern hemisphere, which suggests that environmental factors also play a part. MS is more common in females and the disorder is more likely develop between early adulthood and middle age.

What are the causes?

MS is an autoimmune disorder, in which the body’s immune system attacks its own tissue, in this case those of the nervous system. Many nerves in the brain and spinal cord are covered by a protective insulating sheath of material called myelin. In MS, small areas of myelin are damaged, leaving holes in the sheath, a process known as demyelination. Once the myelin sheath has been damaged, impulses cannot be conducted normally along nerves to and from the brain and spinal cord. At first, the damage may be limited to only one nerve, but myelin covering other nerves may become damaged over time. Eventually, damaged parches of myelin insulation are replaced by scar tissue.

It is thought that MS may be triggered by external factors such as a viral infection during childhood in genetically susceptible individuals.

What are the types?

There are two types of MS. In the most common, known as relapsing remitting MS, symptoms last for days or weeks and then clear up for months or even years. However, some symptoms may eventually persist between the attacks. About 3 in 10 people with MS have a type known as chronic-progressive MS, in which there is a gradual worsening of symptoms with no remission.

A person with relapsing-remitting MS may go on to develop chronic-progressive MS.

What are the symptoms?

Symptoms may occur singly in the initial stages and in combination as the disorder progresses. They may include:

- Blurred vision.
- Numbness or tingling in any part of the body.
- Tiredness, which may be persistent.
- Weakness and a feeling of heaviness in the legs or arms.
- Problems with coordination and balance, such as an unsteady gait.

Stress and heat sometimes make symptoms worse. About half of the people who have MS find it hard to concentrate and experience memory lapses. Depression is common. Later in the course of the disease, some people with muscle weakness develop painful muscle spasms. Spinal cord damage can lead to urinary incontinence, and men may have increasing difficulty in achieving an erection. Eventually, damage to myelin covering nerves in the spinal cord may cause partial paralysis, and an affected person may need a wheelchair.

How is it diagnosed?

There is no single test to diagnose MS, and, because symptoms are so wide-ranging, a diagnosis is only made once other possible causes of the symptoms have been excluded. Your doctor will take your medical history and carry out a physical examination. If you are having visual problems, such as blurred vision, you may be referred to an ophthalmologist, who will assess the optic nerve, which is commonly affected in the early stages of the disorder. Your doctor may arrange for tests to find out how quickly your brain receives messages when particular nerves are stimulated. The most common test measures damage to the visual pathways. You will probably also have an imaging test of the brain, such as MRI, to see if there are areas of demyelination.

Your doctor may arrange for a lumbar puncture, a procedure in which a small amount of the fluid that surrounds the spinal cord is removed for microscopic analysis. Abnormalities in this fluid may confirm the diagnosis.

What is the treatment?

There is no cure for MS, but if you have relapsing-remitting MS, interferon beta may help to lengthen remission periods and shorten the length of attacks. Your doctor may also prescribe corticosteroids to shorten the duration of a relapse. However, at present, there is no specific treatment to halt the progression of chronic-progressive MS.

Many of the more common symptoms that occur in all types of MS can be relieved by drugs. For example, your doctor may treat muscle spasms with a drug that relaxes muscles. Similarly, incontinence can often be improved by drugs. Problems in getting an erection may be helped by a drugs treatment such as sildenafil. If you have mobility problems, your doctor may arrange for you to have physiotherapy. Occupational therapy may make day-to-day activities easier.

What can I do?

If you are diagnosed with MS, you and your family will need time and possibly counseling to come to terms with the disorder. You should minimize stress in your life and avoid exposure to high temperatures if hear tends to make your symptoms worse. Regular, gentle exercise, such as swimming, will help to keep your muscle strong without the risk of overstraining them.

The progression of MS is extremely variable, but people who are older when the disease first develops tend to fare less well. About 7 in 10 people with MS have active lives with long periods of remission between relapses. However, some people, particularly those with chronic-progressive MS, become increasingly disabled. Half of all people with MS are still leading active lives 10 years after diagnosis, and the average lifespan from diagnosis is 25-30 years.


VISUAL EVOKED RESPONSES

A visual evoked response test measure the function of the optic nerve, the nerve that transmits messages from the eye to the brain. The test is most often used to in the diagnosis of multiple sclerosis and can detect abnormalities even if visual symptoms are not apparent. The test records brain activity in response to a visual stimulus to find out the speed at which messages from the eye reach the brain. The test takes 20-30 minutes.

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Motor neuron disease is rare, affecting 1-2 people in every 100,000 worldwide each year. In this disease, also known as amyotrophic lateral sclerosis, degeneration of the nerves involved in muscular activity results in progressive wasting of the muscles and weakness. There are several types of motor neuron disease. Some affect mainly the spinal nerves, while other types also affect the brain. The condition is not painful, does not affect bowel or bladder function, and does not usually affect the intellect or the senses, such as sight.

Steven Hawkins is the one of few people to ever live passed 5 years with MND. 

He has lived for around 40 years

The cause of motor neuron disease is unknown. Genetic factors are involved because, in about 1 in 10 cases, the disease runs in the family. The disease is slightly more common in men and usually develops after the age of 40.

What are the symptoms?

Initially, weakness and wasting develop over a few months and usually affect the muscles of the hands, arms, or legs. Other early symptoms may include:

- Twitching movements in the muscles.
- Stiffness and muscle cramps.
- Difficulty in carrying out twisting movements, such as unscrewing bottle tops and turning keys.

As the disease progresses, other symptoms may include:

- Dragging one foot or a tendency to stumble when walking.
- Difficulty in climbing stairs or getting up from low chairs.

Less commonly, the muscles of the mouth and throat are involved, and may cause slurred speech, hoarseness, and difficulty in swallowing.

An affected person may have mood swings and may become anxious and depressed. If the muscles involved in breathing and swallowing are affected, small particles of food may enter the lungs and cause recurrent chest infections and possibly pneumonia. The head may fall forwards because the muscles in the neck are too weak to support it. Eventually, weakness of the muscles that control respiration may cause difficulty in breathing.

How is diagnosed?

There is no specific test to diagnose motor neuron disease. However, electromyography may be carried out to detect a decrease in electrical activity in the muscles. Additional tests may be used to exclude other possible causes of the symptoms. For example, MRI or CT scanning of the brain and neck may be used to exclude a local problem such as a tumour or cervical spondylosis.

What is the treatment?

At present, no treatment can significantly slow down the progression of motor neuron disease, although a new drug called riluzole may have a small effect. Treatment for symptoms may include antidepressants to relieve depression and antibiotics to treat chest infections. If the person is having difficulty in swallowing, a gastrostomy maybe created surgically. This is an opening through which a permanent feeding tube is inserted directly into the stomach or the small intestine.

Usually, a team of specialists provide support and care for an affected person and members of the family. Counseling may be offered to both. The person affected by the disease may have physiotherapy to keep joints and muscles supple and may be given aids to help with activities such as eating and walking. A speech therapist can supply communication aids to help with speech difficulties and advise on swallowing problems. Joining a self-help group is often helpful to person with motor neuron disease and his or her family.

The outlook for motor neuron disease is variable, with approximately 2 in 10 affected people alive 5 years after diagnosis. About 1 in 10 affected people survives more than 10 years.

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Creutzfeldt-Jakob disease (CJD) is an extremely rare condition in which brain tissue is progressively destroyed by an unusual infectious agent. The disorder leads to a general decline in all areas of mental, and physical ability and ultimately to death. CJD affects about one person in a million each year worldwide.

What is the cause?

CJD is caused by an infectious agent known as a prion, which replicates in the brain and causes brain damage. One type of CJD, accounting for 15 in 100 cases, has been found to run in families.

Most people who develop CJD are over the age of 50. Usually, the source of the infection is unknown, but in about 1 in 20 people it can be traced to earlier treatment with products derived from human tissue. Before the use of artificial growth hormones to treat growth disorders, human growth hormone injections were one source of infection.

In the mid 1990s, a new, rare variant of CJD that affects people in their teens or 20s was discovered in the UK. By the year 2000, about 50 cases had been reported. This variant is believed to be linked with eating contaminated meat from cattle with a disease called bovine spongiform encephalopathy (BSE).

What are the symptoms?

It is thought that is present for 2-15 years before symptoms begin to develop gradually. They may include:

- Depression.
- Poor memory.
- Unsteadiness and poor coordination.

Other symptoms develop as the condition progresses and include:

- Sudden muscle contractions.
- Seizures.
- Weakness or paralysis on one side of the body.
- Progressive dementia.
- Impaired vision.

In the later stages CJD, a person may be unable to move and talk. Those who are confined to bed are prone to serious lung infections.

What might be done?

CJD is usually diagnosed from a person’s symptoms because no specific test is yet available. Anyone suspected of having CJD will have extensive tests, such as MRI, to exclude other treatable causes, and EEG to look for characteristic changes in electrical activity in the brain. A brain biopsy, in which a small piece of tissue is surgically removed for examination, may be performed. There is no cure for CJD, but drugs can relieve some symptoms. For example, symptoms of depression may be treated with antidepressant drugs, and muscle contractions may be controlled by muscle relaxant drugs. However, the disorder is usually fatal within 3 years.

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Parkinson’s disease results from degeneration of cells in a part of the brain called the basal ganglia, which controls the smoothness of muscle movements. Normally, these cells produce a neurotransmitter (a chemical that transmits nerve impulses) called dopamine, which acts with acetylcholine, an other neuro-transmitter, to fine-tune muscle control. In Parkinson’s disease, the level of dopamine relative to acetylcholine is reduced, adversely affecting muscle control.

About 1 in 200 people in the UJ has Parkinson’s disease. The disorder tends to occur after the age of 60 and is more common in men.

Parkinsonism is the term used for symptoms of Parkinson’s disease when they are due to an underlying disorder or certain drugs. Repeated head injuries may cause Parkinsonism, as may some antipsychotic drugs used to treat severe psychiatric illness.

What are the symptoms?

The main symptoms of Parkinson’s disease develop gradually over months or even years. Parkinsonism may have a gradual or sudden onset depending on the cause. Symptoms include:

- Tremor of on hand, arm or leg, usually when resting, that later occurs on both sides.
- Muscle stiffness, making it difficult to start moving.
- Slowness of movement.
- Shuffling walk with loss of arm swing.
- Expressionless or mask-like face.
- Stooped posture.

As the disease progresses, stiffness, immobility, and constant trembling of the hands may make some daily tasks difficult to perform. Speech may become slow and hesitant, and swallowing may be difficult. Many people with the disorder develop depression. About 3 in 10 people with the disease eventually develop dementia.

How is it diagnosed?

Since Parkinson’s disease begins gradually, it is often not possible to diagnose the condition immediately. Your doctor will examine you and may arrange tests such as CT scanning or MRI to exclude other possible causes. If a specific underlying disorder is found to be causing your symptoms, you will be diagnosed as having Parkinsonism rather than Parkinson’s disease.

How might the doctor treat it?

There is no specific cure for Parkinson’s disease, but drugs physical treatments, and more rarely, surgery can relieve symptoms. If you have Parkinsonism due to medications, your doctor may change your drugs. Symptoms the usually disappear within 8 weeks. If the symptoms persist, you may need to be treated with anti-parkinsonism drugs.

Drug treatment: in the early stages of Parkinson’s disease when symptoms are mild, treatment may not be necessary because drugs can not change the progression of the disease. Later on, drugs are used to relieve symptoms and reduce disability by correcting chemical imbalances in the brain, either by boosting dopamine levels or by blocking some the effects of acetylcholine or a combination of both. The choice and dosage of drugs is tailored to individual’s particular problems and adjusted to reduce side effects.

Often, an anti-cholinergic drug such as trihexyphenidyl (benzhexol) is given initially to reduce shaking and stiffness. Anti-cholinergic drugs can be effective for several years, but they may cause dry mouth, burred vision and difficulty in passing urine.

The main treatment for Parkinson’s disease is with levodopa, which boosts the level of dopamine within the brain. Levodopa controls major symptoms such as mobility problems but may initially cause side effects, such as nausea and vomiting. For this reason, the drug is increased gradually and is usually prescribed with other drugs, such as carbidopa or benserazide, which reduce the amount of levodopa that is needed. However, some people develop involuntary jerky or writhing movements as a side effect of this treatment. Levodopa is usually effective for 2-5 years, but long-term use may be associated with abrupt changes in symptoms known as the “one-off” effect of levodopa. The affected person has periods of normal mobility punctuated by unpredictable episodes of weakness and difficulty in moving.

When levodopa is no longer effective, seligiline, a drugs that slightly increases dopamine activity in the brain, may be tried, and later, other drugs, including dopamine agonists such s bromocriptine, may be used. Such drugs may cause confusion, hallucinations, and occasionally, aggressive behaviour. Although there is no wholly successful therapy for symptoms of this disease, new drugs are always being developed.

Physical treatment: the doctor may arrange for physiotherapy to help with mobility problems or speech therapy for speech and swallowing problems. If you are finding it difficult to cope at home, an occupational therapist may suggest changes, such as installing hand-rails to make it easier for you to move around.

Surgical treatment: younger people who are otherwise in good health may have surgery if the tremor cannot be controlled by drugs. Surgery involves destroying a part of the brain tissue responsible for the tremor. Therapies still being assessed include replacement of damaged brain cells with transplanted tissue and deep brain stimulation with electrical impulses to reduce tremor. Deep brain stimulation, in particular, holds promise as a future treatment.

What can I do?

It is important to pay attention to your general health. Taking a walk each day and doing simple stretching exercises will help you to maintain strength and mobility. You should also rest during they day to avoid getting tired. Emotional and practical help from family, friends, and support groups is important.

What is the prognosis?

The course of the Parkinson’s disease is variable, but drugs can be effective in treating the symptoms and improving the quality of life. People can lead active lives for many years after being diagnosed. However, most people with the disorder need daily help eventually, and their symptoms may be increasingly hard to control with drugs.

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Huntington’s disease is an inherited disorder that causes degeneration of a particular part of the brain. Also known as Huntington’s chorea, the condition causes jerky, involuntary movements, clumsiness, and progressive dementia. Huntington’s disease is rare, affecting only about 6,000 people in the UK. The symptoms commonly develop between the ages of 30 and 50.

Huntington’s disease is caused by an abnormal dominant gene. To develop the disease, an affected person has to inherit the abnormal gene from only one parent. People who have the gene have a 1 in 2 chance of passing it on to each of their children. Since the symptoms do not develop until later in life, an abnormal gene may be passed on to children before the affected parent becomes aware that he or she has Huntington’s disease. However, a genetic test can be carried out at any age to find out if an individual has inherited the abnormal gene from a parent.

What are the symptoms?

Symptoms develop gradually over a period of months or years. Initially, they may include the following:

- Jerks and spasms of the face, arms, and trunk.
- Clumsiness.
- Mood swings, including outbursts of aggressive, antisocial behaviour.
- Poor memory, especially for events that have occurred recently.

As the disease progresses, further symptoms of dementia, such as losing the ability to think rationally, may develop. There may be difficulty in speaking and swallowing, and problems with urinary incontinence. Anxiety and depression may also occur.

What might be done?

Unless the condition has already been diagnosed within the family, it may not be recognized during its early stages. Usually, a member of the affected person’s family first realizes that there is a problem. The affected person may be suspicious of others and refuse help. Diagnosis is usually made from the symptoms and by CT scanning or MRI of the brain, which may show distinct patterns of abnormality.

There is no cure for Huntington’s disease, bur drugs may relive certain symptoms. For example, antipsychotic drugs help to control jerks and spasms. Speech therapy and occupational therapy are used to help an affected person to lead as normal a life as possible. However, care in a nursing home may be necessary if the person is unable to live at home or when carers need a period of respite. Members of the family may decide to have a blood test to determine whether they have the abnormal gene themselves. These tests are performed after genetic counseling because the results are likely to have a bearing on whether or not they decide to have children.

Huntington’s disease has a slow progression. A person may live for 15-20 years after the onset of symptoms.

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Wernicke-Korsakoff syndrome is a rare disorder of the brain, causing dementia, abnormal eye movements, and an abnormal gait. The condition develops rapidly and is due to a severe deficiency of vitamin B1. It is a medical emergency. If untreated, coma and death may occur. About 2 in 10 individuals with the disorder die within 5 days. Vitamin B1 deficiency is usually caused by many years of severe alcohol abuse, but in may be due to extreme mal-nutrion or starvation. This order is most common in people over the age of 45 and affects more men than women.

What are the symptoms?

Symptoms may start gradually or suddenly, sometimes affect heavy drinking, and are easily mistaken for drunkenness. They include the following:

- Abnormal movements of the eyes, which often result in double vision.
- Unsteadiness when walking.
- Confusion and restlessness.

Unless the individual is given urgent treatment, he or she will develop severe memory loss, become drowsy, go into a coma, and eventually die.

What might be done?

A person with Wernicke-Korsakoff syndrome needs immediate admission to hospital for intravenous treatment with high-dose vitamin B1. After treatment, many of the symptoms may be reserved within days, but memory loss may persist. If untreated, the disorder is fatal.

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Multi-infarct dementia, also known as vascular dementia, occurs when blood flow in the small blood vessels supplying the brain is obstructed by blood clots. Each of these clots prevents oxygen from reaching a small part of the brain, and this causes tissue death (infarcts) in the affected parts. Infarcts occur in a number of distinct episodes. People who have multiple small infarcts are at increased risk of a major stroke, which can be life-threatening.

The risk of multi-infarct dementia is increased by atherosclerosis in which fatty deposits build up in the artery walls, causing them to become narrowed and increasing the risk of clots forming. The risk of atherosclerosis is increased if a person has high blood pressure. Lifestyle factors, such as eating a high-far diet and smoking, can also contribute to the development of atherosclerosis. Multi-infarct dementia is more common in men and is more likely to occur in people over the age of 60.

What are the symptoms?

Symptoms of multi-infarct dementia vary from one individual to another because they depend on the part of the brain affected. Unlike other types of dementia, multi-infarct dementia gets incrementally worse following each separate episode. Symptoms are similar to those that occur with other forms of dementia and include:

- Poor memory, particularly when trying to recall recent events.
- Difficulty in making decisions.
- Problems with simple, routine tasks, such as getting dressed.
- Tendency to wander and get lost in familiar surroundings.

It is common for a person with multi-infarct dementia to develop depression and have episodes of agitation. There may be other symptoms, depending on which part of the brain is affected. These may include partial loss of sight and slow, sometimes slurred, speech. Some people begin to walk with very small steps, or develop a weakness or partial paralysis in one leg that can make walking difficult.

What might be done?

Diagnosis of multi-infarct dementia is usually possible from the symptoms, although various tests, such as blood tests, may also be carried out to rule out other types of dementia. The doctor may arrange for CT scanning or MRI of the brain to look for evidence of multiple small infarcts. Although the dementia itself cannot be cured, treatment can help to prevent further infarcts that would make the condition worse. A person with multi-infarct dementia should eat a low-fat diet and take regular exercise. Smokers should stop smoking immediately. Anti-hypertensive drugs, which help to control raised blood pressure, and a daily dose of aspirin, which reduces the risk of blood clots, may be prescribed.

Weakness and loss of movement can be treated with physiotherapy, and speech therapy can help to alleviate speech problems. Antidepressants and counseling maybe used to treat depression.

What is the prognosis?

Many people with multi-infarct dementia find that their symptoms improve for short periods of time but later become worse again. Early recognition of the condition and treatment of risk factors, such as high blood pressure, may prevent further progression of the disorder and increasing disability and reduce the risk of a future, potentially fatal stroke.

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It is normal to become mildly forgetful with increasing age, but severe impairement of short-term memory may be a sign of Alzheimer’s disease. In this disorder, brain cells gradually degenerate and deposits of an abnormal protein build up in the brain. As a result, the brain tissue shrinks, and there is a progressive loss of mental abilities, known as dementia.

Alzheimer’s disease is the most common cause of dementia. In developed countries, the condition affects about 7 in 100 people by the age of 65 and 3 in 100 people by the age of 85. Sometimes, younger people are affected. The underlying cause of the tissue destruction is unknown, although genetic factors may be involved (liên quan). Studies have found that 15 in 100 people with Alzheimer’s disease have a parent affected by the disorder.

What are the symptoms?

The first symptom of Alzheimer’s disease is usually forgetfulness. The normal deterioration of memory that occurs in old age becomes much more severe and begins to affect intellectual ability. Memory loss is eventually accompanied by other symptoms, which may include:

- Poor concentrarion.
- Difficulty in understanding written and spoken language.
- Wandering and getting lost, even in familiar surroundings.

In the early stages of the disease, people are usually aware that they have become more forgerful. This may lead to derpression and anxiety. Over a longer period, the existing symptoms may get worse and additional symptoms may develop. These may include:

- Slow movements and unsteadiness when walking.
- Rapid mood swings from (thay đổi) happiness to tearfulness.
- Personality changes, aggression, and feelings of persecution.

Sometimes people find it difficult to sleep and become restless at night. After several years, most people with the disease cannot look after themselves and need full-time care.

How is it diagnosed?

There is no single test that can be used to diagnose Alzheimer’s disease. The doctor will discuss the symptoms with the affected person and his or her family. Tests may be arranged to exclude other possible causes of dementia. For example, blood tests may be carried out to check for vitamin B deficiencies. CT scanning, PET scanning, or MRI may be carried out to exclude other brain disorders, such as multi-infarct dementia, subdural haemorrhage, or a brain tumour. An assessment of mental ability, which may include memory and writing tests, may be used to determine the severity of the dementia.

What is the treatment?

There is no cure for Alzheimer’s disease, but drugs such as donepezil may slow the loss of mental function in mild to moderate cases. Some of the symptoms that are sometimes associated with Alzheimer’s desease, such as depression and sleeping problems, can be relieved by antidepressant drugs. A person who is agitated may be given a sedative drugs to calm him or her down.

Eventually, full-time care may be necessary, either at home or in a nursing home. Caring for person who has Alzheimer’s disease is often stressful, and cares need practifal and emotional support, especially if the affected person starts to become hostile and aggressive. Support groups can help a person to cope with caring for an elderly relative with the disease. Most people with Alzheimer’s disease survive for up to 10 years from the time of diagnosis.

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Dementia is a combination of memory loss, confusion, and general intellectual decline. The affected person may not realize that there is anything wrong, but his or her condition is usually distressing for close friends and family. Poor memory alone is not a sign of dementia because some memory impairment is a natural part of aging. Dementia is relatively common in elderly people, with about 1 in 10 people in the UK over the age of 65 affected to some degree. Although dementia is usually progressive and cannot be treated, in about 1 in 10 cases the underlying cause is treatable. An elderly person with severe depression may seem to have dementia because the conditions have similar features, such as forgetfulness.

What are the causes?

The underlying abnormality in dementia is a decline in the number of brain cells, resulting in shrinkage of brain cells. Alzheimer’s disease, which occurs mainly in people over 65 and may run in families, is the most common cause of dementia. In multi-infract dementia, blood flow in the small vessels of the brain is blocked by blood clots. Less common causes of dementia include other brain disorders, such as Huntington’s disease. Parkinson’s disease, and Creutzfeldt-Jacob disease.

Dementia may also occur in young people. For example, people with AIDS related dementia. Long-term abusers of alcohol are at risk of dementia because of derect damage to the brain tissue and because their poor diet often leads to vitamin B1 deficiency. Severe vitamin B1 can cause the brain disorder called as WernickeKorsakoff syndrome. In pernicious anaemia, there is a deficiency of vitamin B12 due to impaired absorption in the digestive tract. A severe deficiency can result in dementia. The disorder may also follow a serious head injury. Certain drugs, such as anticovulsant drugs and mood-stabilizing drugs, may cause memory impairment similar to that of dementia.

What are the symptoms?

The symptoms may develop gradually over a few months or years, depending on the cause. They may include:

- Impairment of short-term memory.
- Gradual loss of intellect, affecting reasoning and understanding.
- Difficulty engaging in conversations.
- Reduced vocabulary.
- Emotional outbursts.
- Wandering and restlessness.
- Urinary incontinence.

In the early stages of the disorder, a person is prone to becoming anxious or depressed due to awareness of the memory loss. As the dementia gets worse, the person may become more dependent on others.

What might be done?

The doctor may arrange for the person to have tests to look for the underlying cause and to exclude other disorders. If memory loss is due to a deficiency of one or more of the B vitamins, injections of vitamin supplements may be given. Symptoms that are caused by certain drugs may be relieved by a change of medication. Most other causes of dementia cannot be treated, but drugs may relieve some symptoms. For example, depression may be treated with antidepressants.

A person who has dementia usually needs support at home and may eventually need full-time care in a nursing home. Carers may also need support.

CARING FOR SOMEONE WITH DEMENTIA

If you are taking care of someone with dementia, you need to balance his or her needs with your own. In the early stages, it is important to allow the person to remain as independent and active as possible. As the disorder progresses, there are several measures you can take which help to compensate for the person’s failing memory, loss of judgment, and unpredictable behaviour:

- Put up a bulletin board with a list of things that need to be done during each day.
- If wandering is a problem, persuade the person to wear a badge with your contact details and phone number on it.
- Place notes around the house that help the person to remember to turn off appliances.
- Consider installing bath aids to make washing easier.
- Try to be patient. It is common for people with dementia to have frequent mood changes.
- Give your self a break whenever you can by finding someone who can help for a few hours.
- Join a carers’ support group and investigate day centres and respite care opinions.

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In a subdural haemorrhage, a vein in the subdural space is torn due to a head injury. The subdural space lies between the two outer membranes of the three membranes that surround the brain. Subsequent bleeding into the subdural space causes a blood clot, known as a haematoma, to form. As the blood clot enlarges, it compresses the surrounding brain tissue, causing symptoms such as headache and confusion.

A subdural haemorrhage is a potentially life-threating condition that requires prompt medical treatment. It is the most common cause of death from contact sports such as boxing.

What are the types?

After a head injury, bleeding may occur within minutes (acute subdural haemorrhage) or blood may build up slowly over a period of days or even weeks (chronic subdural haemorrhage).

An acute subdural haemorrhage may follow a severe blow to the head, the type of injury sustained in a road accident or while playing contact sports. Bleeding occurs immediately, and the blood clot enlarges quickly.

A chronic subdural haemorrhage can result from an apparently trivial head injury, especially in the elderly. Bleeding is slow, and it may be several months before the blood clot begins to cause symptoms. Chronic subdurall haemorrhage often affects people who have frequent falls and therefore occurs more commonly in elderly people or in people who drink excessive amounts of alcohol. Disorders or treatments that impair blood clotting, such as treatment with drugs that prevent blood clotting, also increase the risk of chronic subdural haemorrhage.

What are the symptoms?

Symptoms may develop at any time between hours and a few months after the head injury, depending on whether the subdural haemorrhage is acute or chronic. In both types, symptoms are variable and often fluctuate in severity. The symptoms of acute subdural haemorrhage may include:

- Drowsiness.
- Confusion.
- Coma.

The symptoms of a chronic subdural haemorrhage may include:

- Headaches.
- Gradually developing confusion and drowsiness.
- Visual disturbances.

In acute and chronic subdural haemorrhage, the symptoms may also include seizures, vomiting, and progressive muscle weakness or paralysis on one side of the body. If these symptoms develop, seek medical attention immediately.

What might be done?

If your doctor suspects that you have a subdural heamorrhage, he or she will arrange for CT scanning or MRI of your brain to look for a clot. If the condition is confirmed, a surgical procedure in which blood is drained through small holes made in the skull will probably be necessary.

In all cases, the prognosis is determined by the size and location of the clot. Many people recover rapidly, but some residual symptoms, such as weakness, may persist. If the haemorrhage has affected a large area of brain, the condition may be fatal.

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A subarachnoid haemorrhage occur when an artery near the brain ruptures spontaneously and leaks blood into the subarachnoid space, the erea between the middle and innermost of the three membranes that cover the brain. When this happens, the immediate symptom is an intensely painful headache.

Subarachnoid haemorrhage is rare, affecting only about 1 in 10,000 people in the UK each year. When the condition does occur, it is life-threatening and needs emergency medical attention.

What are the causes?

About 7 in 10 subarachnoid haemorrhages are caused by the rupture of a berry aneurysm, an abnormal swelling in an artery often found at a Y-shaped junction in the arteries that supply the brain. Berry aneurysms are thought to be present from birth, and there may be one or several. The aneurysms usually rupture between the ages of 40 and 60.

A further 1 in 10 subarachnoid haemorrhages are the result of a rupture of a knot of arteries and veins on the surface of the brain. The defect, known as an arteriovenous malformation, is present from birth, but haemorrhages do not occur until between the ages of 20 and 40. The cause of 2 in 10 subarachnoid haemorrhages s unknown.

In people who are at risk, subarachnoid haemorrhage may be triggered by intense exertion. The disorder is more common in people who have high blood pressure.

What are the symptoms?

The onset of symptoms is usually sudden and without warning. However, in a minority of cases, a headache comes on gradually a few hours before the haemorrhage occurs. Typical symptoms may include the following:

- Sudden, severe headache.
- Nausea and vomiting.
- Stiff neck.
- Dislike of bright light.
- Irritability.

In a few minutes, these may lead to:

- Confusion and drowsiness.
- Seizures.
- Loss of consciousness.

The body may react to the haemorrhage by constricting the arteries in the brain. As a result, the supply of oxygen to the brain is further reduced, and this may cause a stroke, possibly resulting in muscle weakness or paralysis.

What may be done?

If a subarachnoid haemorrhage is suspected, the affected person should be admitted to hospital immediately. CT scanning is usually carried out to identify the location and extent of bleeding. A lumbar puncture may need to be performed to look for signs of bleeding into the fluid surrounding the brain and spinal cord. MRI or cerebral angiography may also be performed to look at the blood vessels of the brain.

If a subarachnoid haemorrhage is confirmed, drugs called calcium channel blockers are usually given to reduce the risk of a stroke.

If cerebral angiography shows that one or more berry aneurysms are present, surgery will probably be required. During the operation, clips are applied to the affected arteries to prevent them from bleeding again at a later time. If surgery is carried out early, there is a good chance of recovery. Sometimes, knotted or distended vessels are blocked and made safe without the need for surgery by inserting coils or glue during angiography. If damage to the brain has caused persistent symptoms, such as muscle weakness as a result of a stroke, physiotherapy may be arranged.

What is the prognosis?

Nearly half of all people with a subarachnoid haemorrhage die before they reach hospital. Of those people admitted to hospital, about half are treated successfully, but the remainder have another subarachnoid haemorrhage. If there is no further haemorrhage within the next 6 months or if surgery is successful, further bleeding is unlikely.

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If the blood supply to part of the brain is interrupted, the affected region no longer functions normally. This condition is called a stroke, although today it is often described as a “brain attack” to highlight the need for urgent medical attention. A stroke may be due to either a blockage or bleeding from one of the arteries supplying the brain. There is usually little or no warning of a stroke. Immediate admission to hospital for assessment and treatment is essential if there is to be a chance of preventing permanent brain damage. The after effects of a stroke vary depending on the location and extent of the brain tissue affected. They range from mild, temporary symptoms, such as blurred vision, to lifelong disability or death.

If the symptoms disappear within 24 hours, the condition is known as a transient ischaemic attack, which is a warning sign of a possible future stroke.

How common is it?

Each year, about 120,000 people in the UK have a stroke. The condition is more common in men and in older people. A 70 year old living in the UK is about 100 times more likely to have a stroke than a 40 year old. Although the number of deaths from stroke has fallen over the last 50 years, stroke is still the third most common cause of death in the UK after heart attacks and cancer.

What are the causes?

About half of all strokes occur when a blood clot forms in an artery in the brain, a process called cerebral thrombosis. Other major causes are cerebral embolism and cerebral haemorrhage (bleeding). Cerebral embolism occurs when a fragment of a blood clot that has formed in an other part of the body, such as in the heart or the main arteries of the neck, travels in the blood and lodges in an artery supplying the brain. Just under one-third of all strokes are caused by cerebral embolism. Cerebral heamorrhage, which causes about one-fifth of all strokes, occurs when an artery supplying the brain ruptures and blood seeps out into the surrounding tissue. The blood clots that lead to cerebral thrombosis and cerebral embolism are more likely to form in an artery that has been damaged by atherosclerosis, an condition in which fatty deposits build up in artery walls. Factors that increase the risk of atherosclerosis developing are a high-fat diet, smoking, diabetes mellitus, and high levels of lipids in the blood.

Cerebral embolism may be a complication of heart rhythm disorders, heart valve disorders, and recent myocardial infarction, all of which can cause blood clots to form in the heart. The risk of cerebral embolism, thrombosis, or haemorrhage is increased by high blood pressure. Sickle-cell disease, an abnormality of the red cells, also increases the risk of cerebral thrombosis because abnormal blood cells tend to clump together and block blood vessels. Less commonly, thrombosis is caused by narrowing of the arteries supplying the brain due to inflammation. The inflammation may be due to an autoimmune disorder, such as polyarteritis nodosa, in which the immune system attacks the body’s own healthy tissue.

What are the symptoms?

In most people, the symptoms develop rapidly over a matter of seconds or minutes. The exact symptoms depend on the area of the brain affected. The symptoms may include:

- Weakness or inability to move on one side of the body.
- Numbness on one side of the body.
- Clumsiness, or loss of control of fine movements.
- Visual disturbances, such as blurred vision or loss of vision in one eye.
- Slurred speech.
- Difficulty in finding words and understanding what others are saying.
- Vomiting, and difficulty in maintaining balance.

If the stroke is severe, areas of the brain that control breathing and blood pressure may be affected or the person may lapse into coma. In these circumstances, the outcome can be fatal.

How is it diagnosed?

If you suspect that a person has had a stroke, he or she should be taken to hospital immediately so that a cause can be identified and treatment can begin.

Imaging of the brain, such as CT scanning or MRI, may be used to find out whether the stroke was caused by bleeding or a blockage in a vessel. Cerebral angiography or carotid Doppler scanning may be performed to help to identify narrowed areas of arteries that can be corrected by surgery. Further tests may be carried out to look for the source of an embolus. These tests may include echocardiography to assess the heart valves and heart monitoring to check the heart rhythm.

What is the treatment?

The initial treatment following a stroke is close monitoring and nursing care to protect the person’s airways during recovery. If CT scanning reveals a clot in a blood vessel, immediate treatment with thrombolytic drugs to dissolve the dot may be considered. This treatment may improve the outcome, but it is not given routinely because it increases the risk of bleeding within the brain.

Long-term treatment to reduce the risk of further strokes will depend on the cause of the stroke. If the cause was a cerebral embolism, you may be given drugs such as aspirin or warfarin, which act on clotting factors in the blood to reduce the risk of further clots. If a narrowed artery has been identified, it may be widened surgically. After a cerebral haemorrhage, treatment tends to be focused on the underlying cause, although in a few cases, surgery to remove a clot from the brain is carried out first. Long-term treatment may include antihypertensive drugs to lower blood pressure. If the stroke is the result of inflammation of the arteries, corticosteroids may be given.

In all cases of stroke, rehabilitative therapies, such as physiotherapy and speech therapy, provided in hospital or at home, are essential. Lifestyle changes, such as reducing far in your diet and giving up ‘s smoking, can reduce the risk of another stroke.

What is the prognosis?

The outlook after a stroke is often difficult to predict at first and depends to some extent on the cause. Following a stroke, about one-third of people make a full or almost full recovery. Another third have some disability, and some of these may need long-term care in a nursing home. Symptoms that persist for more than 6 months are likely to be permanent. About 1 in 5 people dies within a month of the stroke.

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Brain abscess are collections of pus. They are rare and if left untreated, can be life-threatening. Pus may collect to form a single abscess or may form several abscesses in different parts of the brain. Brain tissue around the abscess or abscesses becomes compressed, and the brain itself may swell, increasing pressure inside the skull.

People with have impaired immunity, including those with HIV infection and those having chemotherapy, are more likely to develop a brain abscess. The risk of a brain abscess is also higher in intravenous drug users than in other people because reused needles may be contaminated with infectious micro-organisms. Men are twice as likely as women to develop a brain abscess.

What are the causes?

Most brain abscess are caused by a bacterial infection that has spread to the brain from an infection in nearby tissues in the skull. For example, the infection may spread from a dental abscess or from an infection in the sinuses. If the skull is penetrated, bacteria may enter the brain and cause infection. Bacterial infection can also be carried in the bloodstream to the brain from an infection in another part of the body, such as the lungs or the heart. In 1 in 10 cases, the source of the infection cannot be found. Occasionally, a brain abscess may be the result of a fungal infection.

What are the symptoms?

The symptoms of a brain abscess may develop in a few days or gradually over a few weeks. They may include:

- Headache.
- Fever.
- Nausea and vomiting.
- Stiff neck.
- Seizures.

Other symptoms, including speech and vision problems or weakness of one or more limbs, may develop depending on which part of the brain is affected. Without treatment, consciousness may be impaired and may lead to coma.

What might be done?

If your doctor suspects a brain abscess, you will be admitted to hospital immediately. The diagnosis can be confirmed by MRI or CT scanning of the head. You may have blood tests to identify the infecting organism and X-ray to look for its source.

Brain abscess caused by bacterial infections are treated with high doses of antibiotics, given intravenously at first and then orally for about 6 weeks. If the abscess is large or causing considerable brain swelling, a small hole may be drilled through the skull under general anaesthesia to allow pus to drain. The pus is then analysed to identify the infecting organism. You may have corticosteroids to control swelling of the brain. Anticonvulsant drugs may be prescribed to reduce the risk of seizures. In severe cases, mechanical ventilation in an intensive care unit may be needed.

What is the prognosis?

Up to 8 in 10 people recover from a brain abscess if treatment is begun early. However, some have persistent problems, such as seizures, slurred speed, or weakness of a limb.

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In a transient ischaemic attack, part of the brain suddenly and briefly, fails to function proberly because it is temporarily deprived of oxygen by blockage of its blood supply. Transient ischaemic attacks can last for anything from a few seconds to 1 hour and have no after-effects. However, if the symptoms persist for longer than 25 hours, the attack is classified as a stroke.

In the UK, about 1 in 2 2,000 people has a transient ischaemic attack, more commonly after the age of 45. attacks are three times more common in men. It is important that a transient ischaemic attack is not ignored because there is a strong possibility that it may be followed by a stroke. Without treatment, about 1 in 3 people who has an attack goes on to have a stroke later on.

What are the causes?

Two conditions can lead to blockage of an artery supplying the brain. A blob clot, called a thrombus, may develop in an artery, or a fragment from a blood clot, called an embolus, may detach itself from elsewhere in the body and travel in the blood to block an artery.

A thrombus usually forms in blood vessels that are affected by atherosclerosis, a condition in which fatty deposits build up in the vessel wall. People at increased risk of atherosclerosis include smokers and those who have a high-fat diet. People who have an inherited tendency towards high levels of fat or people with diabetes mellitus are at risk. High blood pressure increases the risk of atherosclerosis.

The emboli that cause transient ischaemic attacks usually originate in the heart, the aorta (the main artery of the body), or the carotid arteries in the neck. Blood clots are more likely to form in the heart if it has been damaged by a heart attack, if the heartbeat is irregular, of if the heart valves are damaged or have been replaced. Sickle-cell disease can also increase the risk of transient ischaemic attacks because abnormally shaped red blood cells tend to clumps together and block blood vessels.

What are the symptoms?

The symptoms of a transient ischaemic attack usually develop suddenly and are often short-lived, lasting for only a few minutes. Symptoms vary depending on which part of the brain is affected and may include the following:

- Loss of vision in one eye or blurred vision in both.
- Slurred speech.
- Problems understanding what other people are saying.
- Numbness on one side of the body.
- Weakness or paralysis on one of the body, affecting one or both limbs.
- Feeling of unsteadiness and general loss of balance.
- Brief loss of consciousness.

Although the symptoms of transient ischaemic attacks disappear within an hour, attacks tend to recur. People may have a number of attacks in one day or over several days. Sometimes, several years may elapse between attacks.

How are they diagnosed?

Your doctor will carry out a physical examination, which will include checking your blood pressure, heart rhythm, and neurological function. He or she may arrange for CT scanning or MRI of your brain to look for other causes of your symptoms. You might also have ultrasound scanning of the arteries in your neck to look for narrowing. If these arteries are significantly narrowed, further imaging tests will be carried out to assess the severity of the narrowing. For example, you may have cerebral angiography, in which X-rays are taken of the arteries that supply the brain.

Test to look for the source of the blood clots include echocardiography, which is used to look at the structure of your heart and the movement of its valves.

Your heart rate may also be monitored for 24 hours to look for irregularities in your heart rhythm.

Your may have blood tests to look for other factors that increase the risk of having a transient ischaemic attack, such as diabetes mellitus and hyper-lipidaemias. Blood tests may also be used to check for blood disorders that increase the risk of a clot forming.

What is the treatment?

Once a transient ischaemic attack has been diagnosed, the aim treatment is to reduce your risk of having a stroke in the future. You will be advised to reduce the amount of fat in your diet and if you smoke, you should stop. If you have diabetes mellitus, you should make sure your blood glucose levels are well controlled. Your doctor will prescribe appropriate drugs to treat high blood pressure or an irregular heartbeat if you have either of these conditions.

Treatment after a transicent ischaemic attack can be as simple as taking half an aspirin daily to help to prevent blood vessels. Other drugs that help to prevent blood clotting, such as warfarin, may be prescribed if emboli originate from clots that have formed in the heart.

If your doctor finds that the arteries in your neck are severely narrowed, he or she may suggest that you have a surgical procedure called a carotid endarterectomy to clear fatty deposits from the narrowed arteries. Alternatively, you may be referred for a surgical procedure called balloon angioplasty, in which a small balloon is inserted into the affected artery or arteries. Once in place, the balloon is inflated to open up the narrowed section of artery. Both of these procedures increase the diameter of the blood vessel and improve the blood supply to the brain.

What is the prognosis?

Transient ischaemic attacks may occur intermittently over a long period or they may stop spontaneously. Of those people who have a transient ischaemic attack, about 1 in 5 will have a stroke within a year. The more frequently you have transient ischaemic attacks, the higher your risk of having stroke in the future. However, if you take appropriate steps to change aspects of your lifestyle, such as giving up smoking and adopting a low-fat diet, you will reduce the risk of having further transient ischaemic attacks or a stroke.

TEST CAROTID DOPPLER SCANNING

Carotid Doppler scanning uses ultrasound to look at the flow of blood through blood vessels in the neck. The procedure is generally used to investigate disorders such as transient ischaemic attacks or stroke.

Ultrasound waves from a transducer produce a picture of the blood flow, which can reveal narrowing of the carolid blood vessels in the neck. The procedure takes about 20 minutes and is painless and safe.

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Brain tumours may be cancerous or noncancerous. Unlike most tumours in other parts of the body, cancerous and noncancerous brain tumours can be equally serious. The seriousness of a tumour depends on its location, size, and rate of growth. Both types of tumour can compress nearby tissue, causing pressure to build up inside the skull.

Tumours that first develop in brain tissues are called primary tumours. They may arise from support cells in the brain (gliomas) or from meningiomas, cells in the meninges (the membranes covering the brain). Gliomas are often cancerous, but most meningiomas are noncancerous. Primary brain tumours are slightly more common in men and usually develop between the ages of 60 and 70. Some types only affect children.

Secondary brain tumours (metastases) are more common than primary tumours. They are always cancerous, having developed from cells that have been carried in the blood from cancerous tumours in areas such as the breast or the lungs. Several metastases may develop in the brain simultaneously.

What are the symptoms?

Symptoms usually occur when a primary tumour or metastasis compresses part of the brain or raises the pressure inside the skull. They may include:

- Headache that is usually more severe in the morning and is worsened by coughing or bending over.
- Nausea and vomiting.
- Blurred vision.

Other symptoms tend to be related to whichever area of the brain is affected by the tumour and may include:

- Slurred speech.
- Unsteadiness.
- Double vision.
- Difficulty in reading and writing.
- Change of personality.
- Numbness and weakness of the limbs, on one side of the body.

A tumour may also cause seizures. Sometimes, a tumour blocks the flow of the cerebrospinal fluid, which circulates in and around the brain and spinal cord. As a result, the pressure inside the ventricles (the fluid-filled spaces inside the brain) increases and causes further compression of brain tissue. Left untreated, drowsiness can develop, which may eventually progress to a state of coma and death.

How are they diagnosed?

If your doctor suspects a brain tumour, he or she will refer you to for immediate assessment by a neurologist. You will have CT scanning or MRI of the brain to look for a tumour and check its location and size. If these tests suggest that a tumour has spread from a cancer elsewhere in the body, you may need to have other tests, such as chest X-rays or mammography, to check for tumours in the lungs or breasts. Cerebral angiography may be performed to look at blood flow around the tumour. You may also need to have a brain biopsy, in which a sample of the tumour is removed surgically under general anaesthesia. The sample is then examined in a laboratory to find the type of cell from which the tumour has arisen.

What is the treatment?

Treatment for brain tumours depend on whether there is one tumour or several, the precise location of the tumour and the type of cell affected. Primary brain tumours may be treated surgically. The aim of surgery is to remove the entire tumour, or as much of it as possible, with minimal damage to the surrounding brain tissue. Surgery will probably not be an option for tumours located deep within the brain tissue. Radiotherapy may be used in addition to surgical treatment, or as an alternative to it, for both cancerous and noncancerous primary tumours.

A brain metastases are often multiple, surgery is not usually an option. However, in cases where there is a single metastasis, surgical removal may be successful. Multiple tumours are usually treated with radiotherapy or, less commonly, with chemotherapy.

Other treatments may be necessary to treat the effects of brain tumours. For example, the drug dexamethasone may be given to reduce the pressure inside the skull, and anticonvulsant drugs may also be prescribed to prevent or treat seizures. If a tumour blocks the flow of cerebrospinal fluid in the brain and fluid builds up in the ventricles, a small tube may be inserted through the skull to bypass the blockage.

You may also benefit from treatments for the physical effects of the tumour, such as physiotherapy to help with mobility problems or speech therapy for speech problems.

What is the prognosis?

The general outlook for brain tumours depends on their location, size, and rare of growth. The outcome is usually better for a noncancerous tumour that grows slowly, many people with this type are completely cured by surgery.

The outlook for other tumours depends on the type of cell they affect and whether they can be surgically removed. About 1 in 4 people is alive 2 years after diagnosis of a primary cancerous brain tumour, but few people live longer than 5 years. Most people with brain metastases do not live longer than 6 months, although in rare cases, a person with a single metastatic tumour may be curred.

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Viral encephalitis is a rare condition in which the brain becomes inflamed as a result of a viral infection. Often, the meninges, the membranes surrounding the brain and spinal cord, are also affected. Viral encephalitis varies in severity. An attack can be so mild that it causes almost no symptoms and is barely noticeable. However, occasionally it is serious and potentially life-threatening.

What are the causes?

Virus herpes

Many different viruses can cause viral encephalitis. Mild cases are sometimes the result of infectious mononucleosis. In addition, viral encephalitis still occurs as a complication of some childhood infections, such as measles and mumps, although routine immunization has made these disorders much less common.

The most common cause of life-threatening viral encephalitis is the herpes simplex virus, particularly in people with HIV infection. In tropical countries, viral encephalitis can be caused by mosquito and tick borne infections, such as yellow fever.

In the past, the disorder was frequently caused by infection with the polio virus. However, this disease is now rare in developed countries as a result of routine immunization.

What are the symptoms?

Mild cases of viral encephalitis usually develop gradually over several days and may cause only a slight fever and mild headache. However, in severe cases, the symptoms usually develop quickly over 24-72 hours and may include:

- High fever.
- Intense headache.
- Nausea and vomiting.
- Problems with speech, such as slurring of words.
- Weakness or paralysis in one or more parts of the body.
- Memory impairment.
- Hearing loss.

In the membranes that surround the brain become inflamed, other symptoms such as stiff neck and intolerance of bright light may develop. The person affected may have seizures. In some cases, there is confusion, which may then progress to drowsiness, a gradual loss of consciousness, and coma.

How is it diagnosed ?

If viral encephalitis is suspected, you will be admitted to hospital. Your doctor may arrange for a blood test to look for signs of viral infection. You may also have CT scanning or MRI to look for areas of brain swelling caused by inflammation and to exclude other possible reasons for the symptoms, such as brain abscess. A sample of the fluid surrounding the brain and spinal cord may be taken to look for evidence of infection. You may have an EEG to look for abnormal electrical activity in the brain, which is frequently a sign of viral encephalitis. Rarely, a brain biopsy is performed, in which a sample of tissue is taken from the brain under general anaesthesia and the examined to confirm the diagnosis.

What is the treatment?

Viral encephalitis that is caused y the herpes simplex virus can be treated with intravenous doses of aciclovir and possibly also with corticosteroids to reduce inflammation of the brain. In severe cases, intravenous aciclovir may be given, even if the cause has not been identified. Anticonvulsant drugs may be prescribed if seizures develop. Severely affected people may need to be treated in an intensive care unit.

What is the diagnosis?

It is often difficult to predict the out-come of viral encephalitis. People who have mild encephalitis usually make a full recovery over several weeks, but occasional headache may occur for a few months. However, in severe cases, the condition may be fatal. Incephalitis caused by the herpes simplex virus often produces long-term effects, such as memory problems or muscle weakness. In children, herpes simplex viral encephalitis may cause learning difficulties. The effects of this type of viral encephalitis can usually be minimized if treatment is begun early.

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In meningitis, the meninges, the membranes that cover the brain and spinal cord, are inflamed. The disease is most often caused by a viral or bacterial infection. The viral form of meningitis is the more common and is usually not as severe as bacterial meningitis. The bacterial form is rarer but can be life-threatening. Although both forms of meningitis can occur at any age, bacterial meningitis occurs predominantly in children, and viral meningitis is most common in young adults. In rare cases, meningitis may be caused by a fungal infection. This type predominates in people with AIDS and in those with other disorders that impair the immune system, such as leukaemia.

What are the causes?

Many different viruses can result in meningitis. Among the most common are enteroviruses, such as the coxsackie virus, which can cause sore throats or diarrhoea, and more rarely, the virus that causes mumps. Viral meningitis tends to occur in small outbreaks, most commonly in summer.

Bacterial meningitis most commonly occurs as a result of infection of the meninges with the bacterium Neisseria meningitidis in an otherwise healthy child or teenager. This bacterium is the cause of meningococcal meningitis and has three main types: A, B and C. Type B is the most common in the UK. Although many people carry Neisseria meningitidis bacteria in the back of their throats, only a fraction develop meningitis. Other bacteria that can cause the disease include Haemophilus influenzae (Hib) and Streptococcus pneumoniae, both of which can also cause infections in the lungs and the throat.

Less often, bacterial meningitis is a complication of an infection that has already developed elsewhere in the body. For example, the bacterium that causes tuberculosis can spread from the lungs to the meninges.

Bacterial meningitis usually occurs as single cases only. However, there may be small outbreaks, especially in institutions such as schools and colleges. This form of meningitis is most common during the winter.

People who have a weakened immune system as a result of an existing illness or a particular treatment, such as people with HIV infection or those having chemotherapy, are at increased risk of all types of meningitis.

What are the symptoms?

Initially, meningitis may produce vague flu-like symptoms, such as mild fever and aches and pains. More pronounced symptoms may then develop. Symptoms are the most severe in bacterial meningitis and develop rapidly, often within a few hours.

The symptoms of viral meningitis may take a few days to develop, while in fungal and tuberculosis meningitis, symptoms develop slowly and may take several weeks to become pronounced.

In adults, the main symptoms of meningitis may include the following:

- Severe headache.
- Fever.
- Stiff neck.
- Dislike of bright light.
- Nausea and vomiting.

In meningococcal meningitis, a rash of flat, reddish-purple lesions, varying in size from pinheads to large patches, that do not fade when pressed.

Unless prompt treatment is given, bacterial meningitis may lead to seizures, drowsiness, and coma. In some cases, pus collects, which results in compression of nearby tissue.

What might be done?

If meningitis is suspected, immediate medical attention and admission to hospital is necessary. Intravenous antibiotics are started immediately. A sample of fluid from around the spinal cord is the taken and tested for evidence of infection. CT scanning or MRI may also be carried out to look for a brain abscess.

If bacterial meningitis is confirmed by the lumbar puncture test, antibiotics are continued for at least a weeks. If meningitis is found to be caused by tuberculosis bacteria, anti-tuberculous drugs will be given. In cases of bacterial meningitis, continuous monitoring in an intensive care unit is often needed. Intravenous fluids, anti-convulsant drugs, and drugs to reduce inflammation in the brain, such as corticosteroids, may be given.

There is no specific treatment for viral meningitis. As long as bacterial meningitis has been excluded by tests, people with viral meningitis are usually allowed to go home if they are well enough. They may be given drugs to relieve symptoms, such as painkillers for headaches. Fungal meningitis is treatment with intravenous antifungal drugs in hospital.

What is the prognosis?

Recovery from viral meningitis is usually complete within 1-2 weeks. It may take weeks or months to make a complete recovery from bacterial meningitis. Occasionally, there may be long-term problems, such as impaired hearing or memory impairment due to damage to a part of the brain. About 1 in 10 people with bacterial meningitis dies despite treatment. Deaths most commonly occur in infants and elderly people.

Can it be prevented?

People in close contact with someone with meningococcal meningitis are usually given antibiotics for 2 days. This treatment kills any meningococcal bacteria that may be present in the back of the throat and prevents their spread to other people. Children are immunized against Haemophilus influenza type B (HiB) and Neisseria meningitis type C. Teenagers are also immunized against Neisseria meningitis type C unless they have been immunized previously. No vaccine is yet available against type B meningoccal meningitis. People traveling to high-risk areas, such as Africa, may be immunized against types A and C.

TEST LUMBAR PUNCTURE

A lumbar puncture is usually performed to look for evidence of meningitis or other nervous system disorders, such as multiple sclerosis. The procedure is carried out under local anaesthesia and takes about 15 minutes. During the procedure, the pressure of the cerebrospinal fluid is checked, and a sample is taken for analysis. You should remain lying down and rest for an hour afterwards to prevent a severe headache.

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People with narcolepsy fall asleep at any time of the day, often when carrying out a monotonous task. Sleep may also occur at inappropriate times, such as while eating. Affected people can be awakened easily but may fall asleep again soon afterwards. Narcolepsy can seriously interfere with daily life.

Some people with narcolepsy have vivid hallucinations just before falling asleep. Others find that they are unable to move while they are falling asleep or waking up (sleep paralysis). About 3 in 4 people with narcolepsy also have cataplexy, in which there is a temporary loss of strength in the limbs that causes the person to fall to the ground. Cataplexy is sometimes triggered by an emotional response, such as fear or laughter.

The cause of narcolepsy is unknown, but it can run in families. It affects about 1 in 1,000 people in the UK, usually developing before the age of 20.

What might be done?

Your doctor will probably diagnose narcolepsy from your symptoms. EEG may also be used to record the electrical activity of your brain. These tests may be carried out while you are asleep in a hospital clinic.

You should take regular, short naps during the day and keep busy while you are awake. Your doctor may prescribe amphetamines, to help you to keep awake. Certain tri-cyclic antidepressant drugs are used to in treating people with cataplexy.

Although narcolepsy is usually a life-long condition, in some cases, there is a spontaneous improvement over time.

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In a person who has epilepsy, recurrent seizures or brief episodes of altered consciousness are caused by abnormal electrical activity in the brain. Epilepsy is a common disorder, affecting about 1 in 130 people in the UK.

The condition usually develops in childhood but may gradually disappear. However, elderly people are also at risk of developing epilepsy because they are more likely to have conditions that can cause it such as stroke.

Many people with epilepsy lead normal lives. However, people who have recurrent seizures may have to limit particular aspects of their lifestyle.

What are the causes?

In 6 out of 10 people with epilepsy, the underlying cause is not clear, although a genetic factor may be involved. In other cases, recurrent seizures may be the result of disease or damage to the brain caused by an infection such as meningitis, a stroke, a brain tumour, or scarring following a severe head injury.

In people with epilepsy, seizures may be triggered by lack of sleep or by missing a meal. Other trigger factors include drinking excessive alcohol and visual effects such as flashing lights and flickering television and computer screens.

A single seizure is not labeled as epilepsy. For example, high fever in a child can result in a single febrile convulsion. People who abuse alcohol over a long period may have a seizure, either while drinking heavily or during withdraw from alcohol. Very low blood glucose levels, which can occur as a result of treatment for diabetes mellitus, can also trigger a seizure.

What are the types?

Epileptic seizures may be generalized or partial, depending on how much of the brain is affected by abnormal electrical activity. During a generalized seizure, all areas of the brain are affected at the same time, whereas during a partial seizure only one part of the brain is affected. Generalized seizures fall into two categories: tonic-clonic seizures and petit mal seizures. There are also two types of partial seizure: simple partial seizures and complex partial seizures. Both simple partial and complex partial seizures can become generalized.

Tonic-clonic seizures: this types of seizure may be preceded by a warning of an attack, known as an aura. This aura lasts for few seconds and gives people an opportunity to sit or lie down before they lose consciousness and fall. Auras may consist of a sensation of fear or unease. During the first 30 seconds of a seizure, the body stiffens and breathing may become irregular or stop briefly. This stage is followed by several minutes of uncontrolled movement of the limbs and trunk. After the seizure, consciousness is regained, breathing returns to normal, and the muscles relax. Relaxation of the muscles in the bladder can cause incontinence. The person may be confused and disoriented for a few hours afterwards and may develop a headache. After a tonic-clonic seizure, the person affected usually has no memory of what has happened.

Status epilepticus is a serious condition in which a person has repeated tonic-clonic seizures without regaining consciousness in between. The condition can be life-threatening, and medical attention should be sought urgently.

Petit mal seizures: these seizures are sometimes known as absence seizures. They start in childhood and may continue into adolescence. Petit mail seizures are rare in adults. During as attack, the child loses touch with his or her surroundings and seems to be daydreaming because his or her eyes remain open and staring. Each attack lasts for between 5 and 30 seconds, and the child is usually unaware afterwards that anything was wrong. Since the seizures are almost never associated with abnormal movements or the child falling down, they may no be noticed. However, frequent attacks can affect schoolwork.

Simple partial seizures: during a simple partial seizure, the affected person remains conscious. The head and the eyes may turn to one side, the hand, arm, and one side of the face may twitch, or the person may feel a tingling sensation in some of these areas. Temporary weakness or paralysis, of one side of the body may follow an attack. The person may also have strange sensations, such as odd smells, sounds, and tastes.

Complex partial seizures: before this type of seizure, an affected person may experience odd taste or smells or have a feeling of having already experienced what is happening. A brief dream-like state follows during which the person may be uncommunicative. During the attack, there may be smacking of the lips, grimacing and fidgeting. Afterwards, the person may not remember what has happened. Sometimes, a generalized seizure occurs as a progression of the complex partial seizure.

How is it diagnosed?

You should consult a doctor if you lose consciousness for an unknown reason or if someone witnesses you having a seizure. If your child has a seizure, you should also seek medical advice immediately. It is helpful if you can obtain full details of your seizure from a witness so that you are able to give the doctor a reliable account of what happened. The doctor may arrange tests to look for an underlying cause of the seizure, such as a brain tumour or an infection such as meningitis. If no cause is found or if you have recurrent seizures, you may have an EEG also helps to diagnose the particular type of epilepsy because some forms produce a distinctive pattern of electrical activity. Your doctor may also arrange for CT scanning or MRI of the brain to look for structural abnormalities that may be causing epilepsy.

How might the doctor treat it?

If only one seizure has occurred, treatment may not be needed. However, an underlying problem, such as poor control of diabetes, may need to be treated. If you have had recurrent seizures, you will probably be treated with anticonvulsant drugs. Usually, the dose of the drugs is gradually increased until the seizures are controlled. Occasionally, a second anticonvulsant is needed.

You will probably have regular blood tests to monitor drug levels. If you have no seizures for 2-3 years, it may possible to reduce the drug treatment or even stop it, depending on a number of factors including the results of the EEG tests and the brain scan. However, any changes in dosage must be carried out under medical supervision. Up to 1 in 2 people who stop taking anticonvulsant drugs have seizures again within 2 years. If drugs do not control the seizures and a small area of brain tissue is found to be their cause, it may be removed surgically.

People with status epilepticus need to be admitted to hospital immediately, where they will be given intravenous drugs to control the seizures.

What can I do?

If you have epilepsy, you should avoid anything that triggers an attack, such as stress or lack of sleep. You should carry identification that will alert others to your condition in case you have a seizure.
If you witness someone having an epileptic seizure, you can help by turning the person onto his or her side and protecting him or her from self-injury. If the seizure lasts for more than 5 minutes, you should call an ambulance.

What is the prognosis?

About 1 in 3 people who have a single seizure will have another one within 2 years. The risk of recurrent seizures is highest in the first few weeks after an attack. However, the outlook for most people with epilepsy is good, and more than 7 in 10 people go into long-term remission within 10 years.

EEG

Electroencephalography (EEG) is used to diagnose conditions, such as epilepsy, that are associated with abnormal electrical activity in the brain. Electrodes are attached to a person’s scalp, and recordings are made of brain activity with the eyes open and closed. A stroke light may be switched on for short periods to see if brain activity changes. The procedure takes approximately 20-30 minutes and is painless.

LIVING WITH EPILEPSY

If you have recently been diagnosed as having epilepsy, the following points may be helpful:

- Avoid anything that has previously triggered or may trigger a seizure, such as flashing lights.
- Learn relaxation exercises to help you cope with stress, which may trigger seizures.
- Eat and sleep at regular times.
- Avoid drinking too much alcohol.
- Check with your doctor before taking medications that may interact with anticonvulsant drugs.
- Make sure that you have someone with you if you are swimming or playing water sports.
- Wear protective headgear when participating in contact sports.
- Before applying for a driving licence, talk to your doctor and contact the Driver and Vehicle Licensing Agency for regulations.
- Consult an adviser before choosing a career because some types of employment may not be suitable.
- Seek advice from your doctor if you plan to become pregnant.

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