Transcript Slide 1

A PASSPORT TO YOUR
NERVOUS SYSTEM:
Rachel Maassen MD
Medical Director Women’s Health
University of Iowa Hospitals and
Clinics
“Honey, have you seen my keys?”
Your Tour Guide: The Neurologist
• Trained in the diagnosis
and treatment of
diseases that affect the:
– Central nervous system
• Brain
• Spinal cord
– Peripheral nervous system
• Autonomic nervous system
• Somatic nervous system
• Muscles
– Blood vessels that relate
to the above
Who Suffers from Neurological
Disorders?
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Over 1 billion people worldwide
Alzheimer’s: 5,000,000+ Americans
Parkinson’s: 1,000,000+ Americans
Epilepsy: 2.2 million Americans
Huntington’s: 250,000+ Americans
Muscular Dystrophy: 1 in every 5,000 to 7,000 males
YOUR MAP OF THE BRAIN
Cerebrum
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Biggest part of the brain
– Makes up 85% of the brain’s weight
The “thinking” part of the brain
– Memories
– Reason
Made up of two halves:
– Left side: analytics
– Right side: abstraction
Left and right side control each other
Cerebellum
• Located below the cerebrum
• The balancing part of the brain
• Processes input from the brain, spinal cord
and sensory receptors
• Aids in coordination and fluid movement of
the body’s skeletal muscles
Brian Stem
• Composed of three structures:
– Midbrain
– Pons
– Medulla Oblongata
• Connects the brain with the spinal cord
• Enables breathing
DEGENERATIVE DISORDERS
Degenerative Disorders
• Affect balance, movement, speech, breathing and
heart function
• Common causes
– Alcoholism
– Tumor
– Stroke
• Most common forms: Alzheimer’s, Parkinson’s,
Huntington’s
Alzheimer’s, Defined
• Occurs when memory loss and other abilities
are affected enough to interrupt everyday life
• Most common form of dementia
• Affects over five million Americans
• Sixth-leading cause of death in the U.S.
• More common in women than men
Symptoms of Alzheimer’s
• Symptoms may differ in each person and develop over time
• Mild symptoms
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Getting lost easily
Trouble handling money and/or paying bills
Poor judgment
Misplacing or losing things
Moodiness or personality change
• First symptoms typically appear after age 60
Diagnosis of Alzheimer’s
– Memory screening
– Physical exam can test
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Reflexes
Muscle tone/strength
Walking ability
Sense of sight and hearing
Coordination
Balance
– Early diagnosis is key
Treatment of Alzheimer’s
• No known cure
• Approved medications
– Donepezil (Aricept)
– Rivastigmine (Exelon)
– Galantamine (Razadyne)
– Memantine (Namenda)
Menopause and memory
• Difficulty concentrating and remembering
– Common complaints in menopause transistional
– Maybe related to sleep disturbances, hot flashes,
midlife stress
– May be more intense if rapid transition (surgical)
– No firm evidence of actual decline!
Managing Cognitive Symptoms
“memory trouble”
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Maintain social network
Remain physically and mentally active
Quit smoking
Limit alcohol
Decrease cardiovascular risk (cholesterol, high
blood pressure)
Will hormone replacement help?
• Women’s Health Initiative ( WHIMS)
– In women who began HRT after age 65: Risk of
dementia doubled for women using EPT and
increased by half for women using estrogen only
therapy
• WHI study on aging: Hormones had no effect
on cognition
Parkinson’s, Defined
– Movement disorder
– Deficiency of the chemical dopamine
– Affects one in 100 people over the age of 60
Am I at Risk for Parkinson’s?
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Age
Gender
Family history
Exposure to
toxins
Symptoms of Parkinson’s
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Shaking of hands, arms, legs, jaw and face
Stiffness of arms, legs and trunk
Slowness in movement
Poor balance and posture
Changes in speech
Diagnosing Parkinson’s
• No specific test can diagnose Parkinson’s
Treatment of Parkinson’s
• Medication
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Carbidopa-levodopa (Parcopa)
Dopamine agonists
MAO B inhibitors
Catechol O-methyltransferase (COMT) inhibitors
Anticholinergics
Amandatine
• Deep brain stimulation
Huntington’s, Defined:
• Degenerative nerve disease
• Affects approximately 30,000 Americans
• An additional 250,000 Americans are at risk
because of genetics
• Everyone is born with the gene, but parents
with HD increase risk in their children by 50%
Symptoms of Huntington’s Disease
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Uncontrolled movement
Clumsiness
Loss of balance
Difficulty swallowing
Difficulty with speech
Loss of interest in social
activities
• Typically begins in their 40s
or 50s
• Onset before age 20 known
as juvenile Huntington’s
disease
Diagnosis of Huntington’s
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Predictive testing
Neurological exam
Psychiatric evaluation
Brain imaging and EEG
Stages of Huntington’s
– Early
– Mid
– Late
Treatment of Huntington’s
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Tetrabenazine (Xenazine)
Antipsychotic drugs (Haldol, Clozaril)
Antiseizure drugs (Klonopin)
Antianxiety drugs (Valium)
Antidepressants
Therapies (Psycho-, Speech, Physical, Occupational)
SEIZURE DISORDERS
Epilepsy, Defined
• Brain disorder that causes recurring seizures
• Fourth-most common neurological disorder in the U.S.
• Affects 2.3 million adults in the US
– 460,000+ children under the age of 18
• Approx. 150,000 Americans develop epilepsy each year
• One in 100 people in the US will have an unprovoked
seizure
Symptoms and Treatment of
Epilepsy
• Symptoms include temporary confusion,
uncontrolled movement or the arms and legs,
loss of consciousness or awareness.
• Treatment can range from a single type of
antiepileptic medication to a more prolonged
regimen or surgical option.
Epilepsy and the reproductive
female
• Oral contraceptives are acceptable
– There is a higher failure rate with certain medications, check with your
provider
– More of your anti-seizure medication may be needed with ocps and
with pregnancy
• Pregnancy is acceptable but planning required
– 4 mg of folic acid should be taken 3 months prior to pregnancy
– See an OBGYN prior to conception to check medication safety
University of Iowa Hospitals and
Clinics
• Women’s Health: 2 locations
– 356-2294 to schedule at the University
– 467-2000 to schedule at Iowa River Landing
• Neurology: 356-2456