Patient Information – some common facts
Headache
Headache is universal and few individuals can claim they have never experienced a headache. Fortunately, the majority of headaches are benign primary headaches. Tension – type headache accounts for most and next is migraine. While tension – type headaches are usually minor, migraines are debilitating and can be associated with a range of accompanying neurological symptoms. Many patients suffer unnecessarily with migraines and do not seek help – obtaining a correct diagnosis should lead to appropriate and effective management that can improve wellbeing and lifestyle.
Sinister causes of headache are usually accompanied by a variety of other symptoms such as weakness, cognitive impairment, fits, morning headaches and vomiting. There may be systemic symptoms eg fever and weight loss.
Thunderclap headache (sudden severe headache) may be a sign of a brain bleed. It is important to seek medical advice if you experience a first ever and sudden severe headache.
Useful information: https://www.nhs.uk/conditions/headaches/
Multiple Sclerosis (MS)
This is one of the commonest causes of disability in young adults in the developed world. Approximately 5,000 people per year are newly diagnosed with this condition. It is an autoimmune disorder – your body’s immune system attacks the central nervous system (brain and spinal cord). It can sometimes be difficult to diagnose the condition in the absence of a history of episodes of neurological symptoms. An individual may experience just one episode (Clinically Isolated Syndrome) and otherwise be well. Investigations may not be conclusive. Thus, monitoring over time may be what is required to come to a conclusion. Fortunately advances in imaging and diagnostic criteria have made it easier to diagnose the condition at an earlier stage than previously.
The majority (85%) of patients with MS will experience episodes of neurological symptoms in the early years; over time these relapses settle, but progressive loss of function (usually decline in walking ability) may follow – this is called secondary progression. A few individuals may have the rarer form of progressive MS that does not have obvious clinical relapses (Primary Progressive MS).
The diagnosis of MS leads to significant lifestyle changes for most individuals. Fatigue is a major cause of debility and is managed by careful ‘pacing’, good diet and as healthy a lifestyle as possible.
There are many medications that can be prescribed to help manage symptoms of MS. Acute attacks may need high dose steroids that help speed recovery. Other medications may be used to help control nerve type pain or muscular spasm (spasticity). There are also now a range of treatments that can be used to suppress the immune system and hopefully reduce the frequency of attacks and possibly accumulation of disability. Patients have to qualify for treatment according to criteria issued by The Department of Health and the individual Policies of the Devolved Governments.
There is evidence that vitamin D is important for the immune system – a body of evidence suggests that patients with MS benefit from taking supplementation. It is sensible to check levels and seek advice on the correct dose. Treatment over the winter months is particularly important.
For most individuals access to physiotherapy is vital for maintaining function and the help of a MS Nurse Specialist is invaluable.
Useful information: https://www.nhs.uk/conditions/multiple-sclerosis/
Parkinson’s Disease
This is a very common condition affecting older patients. As the population ages, more people will be affected by this and other neurodegenerative disorders.
Many will initially notice tremor affecting an arm, usually when resting. More specifically the condition is characterised by slowness for example walking (shuffling may be present), and there may be loss of dexterity in the initially affected hand. Most early symptoms are related to the motor system.
The diagnosis is typically made clinically by following the evolution of symptoms and signs. Occasionally a DaTSCAN (Dopamine Transporter Scan) may be undertaken if there are atypical features. Similarly a brain scan (CT or MRI) may be requested – however such scans do not positively diagnose the condition. The information from a scan must be evaluated in the light of the clinical features.
You may be given a diagnosis of Parkinsonism if your consultant is not certain that you have Idiopathic Parkinson’s disease (IPD). This is because people with symptoms commonly associated with IPD may occasionally have another degenerative condition, for example Multi System Atrophy. There are a number of such disorders; it is important that patients are carefully assessed to achieve diagnostic accuracy as this determines appropriate treatment and advice. Often it is only apparent after a period of clinical follow up that the individual has a particular form of Parkinsoism.
It should be remembered that as time goes on, most individuals with Parkinson’s disease will develop non – motor symptoms and these are usually screened for at periodic clinic appointments.
A local Parkinson’s Disease Nurse Specialist is a great asset to patients and their clinicians.
https://www.nhs.uk/conditions/parkinsons-disease/
Blackouts & Seizures
Epilepsy is one of the commonest neurological disorders. Most individuals develop epilepsy in childhood and teenage years. In the majority of people with epilepsy, there is usually no sinister brain disease identified. Epilepsy starting in middle age and later should be thoroughly investigated as there is a higher incidence of sinister causes. In old age, the most common cause of epilepsy in blood vessel disease affecting the brain including stroke.
The diagnosis of epilepsy rests mainly on the observations of witnesses and on symptoms recalled by the individual. Tests are not necessarily diagnostic and normal tests do not rule out a diagnosis of epilepsy. It is vital to obtain comprehensive accounts from any witnesses of a seizure.
Blackouts (syncope) may be a manifestation of epilepsy but may also arise due to heart disease and other conditions that may affect blood pressure. It is important to note any symptoms that may be relevant eg palpitations, chest pains or shortness of breath with exertion, which may provide clues to the cause of syncope. Sudden loss of consciousness is more likely to be due to heart disease than epilepsy.
Fainting is common. There is usually an identifiable trigger and a series of typical symptoms that precede the loss of consciousness. Individuals who faint may experience a few jerks of the limbs or lose control of their bladder. It is this that may cause confusion with a seizure. A careful history will usually help to differentiate between epilepsy, heart disease or simple faints.
https://www.nhs.uk/conditions/epilepsy/
Peripheral Neuropathy
Patients with symptoms arising from the nerves in their limbs may have developed a peripheral neuropathy. Typically these include numbness, tingling, stinging, pins and needles sensations, burning, coldness and shooting pains. Weakness may also be present.
Common entrapment neuropathies include Carpal Tunnel Syndrome. Leaning on elbows can produce pressure on the Ulnar nerve and result in nerve type symptoms in the hand. Similarly crossing the legs can produce pressure on the Common Peroneal nerve at the knee producing nerve symptoms in the lower leg and foot.
Length dependent neuropathies present with symmetrical nerve symptoms in the legs are very common and in the developed world diabetes is the most frequently identified factor.
In up to a quarter of patients no cause is identified despite blood tests and other appropriate investigations.
Optimal management of diabetes and treating vitamin deficiencies may help control symptoms and prevent progression. Pain may be a problem associated with neuropathy – this is usually managed by careful use of neuromodulators (oral and topical medications) when necessary. Fortunately, many people affected by typical length dependent neuropathies are aware of their symptoms but can function perfectly normally. Many neuropathies do not progress significantly or cause real limitations to daily lifestyle.
https://www.nhs.uk/conditions/peripheral-neuropathy/
Functional Neurological Symptoms
Many patents attending general neurology clinics fortunately do not have a neurological disease. However. such patients have very real symptoms that cause varying levels of concern and loss of function. The nervous system is intact but does not seem to be working normally – messages seem to be ‘muddled’ leading to a range of symptoms eg blackouts, tingling, numbness, weakness, walking problems, abnormal movements. A thorough assessment should rule out structural, inflammatory, infective and metabolic causes.
In some cases, it may be possible to identify an event that could be linked with the onset of symptoms. Once a diagnosis of a functional disorder has been made, a treatment plan should be agreed with the individual. This may often involve physiotherapists, patient education, psychologists or psychiatrists and possibly medication.
Further information can be found at neurosymptoms.org.
Medications
There are many drugs prescribed for specific neurological conditions eg anticonvulsants for epilepsy and triptans for migraine attacks. Recommendations are usually tried by the patient and dose adjustments made according to response.
Some medications are prescribed purely empirically. The ‘neuromodulators’ are drugs such as Amitriptyline, Gabapentin, Duloxetine that may be recommended when symptoms are accompanied by pain. These medications can be used in a wide variety of conditions including for functional neurological symptoms, migraine prevention, peripheral and central neuropathic pain. A particular medication may be trialled and if helpful a patient is usually encouraged to remain on treatment for a specified period (generally 3 – 6 months). Assuming a good response the aim is to wean medication once symptoms have improved or settled.