How to Help During a Seizure

A person who is having a seizure may lose consciousness, fall to the ground, and move about violently. Here are some things you can do to help ensure that a person is not injured during a seizure.

• Do not try to restrain the person.

• Do not place your fingers or any object in the person's mouth during the seizure.

• Move away any large or sharp objects.

• After the seizure, make sure nothing is blocking the person's mouth or airway (such as food, gum, or dental devices).

• Place the person on his or her side.

• After the person regains consciousness, call a physician or take him or her to the nearest hospital emergency department.

• Call 911 or your local emergency number if the seizure lasts longer than 5 minutes or if the person has not had a seizure before.

• Call 911 if a second seizure begins shortly after the first seizure ends.




Multiple Sclerosis

Multiple sclerosis (MS) is a progressive, disabling disease of the central nervous system (the brain and spinal cord). MS is an autoimmune disease, in which the body's immune system mistakenly attacks and destroys its own tissue (in this case, the myelin that surrounds and protects nerve cells). Early in the disease, inflammation occurs at random sites in the brain or spinal cord, damaging myelin and causing scarring (sclerosis) that interferes with the transmission of messages between the brain and the body.

The initial symptoms of MS may include blurred or double vision, red color distortion, or blindness in one eye. Muscle weakness, lack of coordination and balance, fatigue, partial or complete paralysis, and spasticity (stiffness) can occur in the early stages of the disease. Other symptoms include numbness, tingling, tremors, dizziness, and slurred speech. About half of all people with MS also experience problems with concentration, attention, memory, and judgment, although intellectual and language skills remain unchanged. Depression and paranoia can occur, as can inappropriate mood swings. Sexual dysfunction and loss of bowel and bladder control also can occur. The symptoms may worsen when the body heats up from high environmental temperature, exercise, taking a hot bath, or having a fever. Early in the disease, symptoms often come and go. Later they may gradually worsen.

The symptoms of MS usually appear between ages 20 and 40, although a diagnosis may not be made immediately. A diagnosis is based on eliminating other possible causes of the symptoms, such as stroke (see page 323) or a brain tumor (see page 326), and detecting characteristic features of MS. For example, certain changes in the brain can be observed with magnetic resonance imaging (MRI; see "Diagnostic Procedures," page 342) after sufficient damage has occurred, and sometimes increased inflammatory proteins (antibodies) can be found in cerebrospinal fluid (obtained during a lumbar puncture; see "Diagnostic Procedures," page 342). These antibodies, which are produced for no known reason, are strongly associated with MS. In some cases the doctor may perform an evoked response test, in which electrodes are placed on the person's head, and electrical activity in the brain is recorded as he or she is exposed to various sensory stimuli such as sound or light.

The cause of MS is unknown. Evidence suggests that the disease may result from a combination of a person's genetic susceptibility (the disease tends to run in families) and a viral infection early in life. Environment also appears to have a role in susceptibility to MS. People who spend the first 15 years of their lives in a temperate climate have a higher risk of developing the disease later in life than those who spend their first 15 years in a tropical climate. This is thought to be the period when the viral infection occurs in susceptible people.

Whites are twice as likely as blacks to develop MS, and women are twice as likely to be affected as men (although, when the disease starts later in life, men are as likely as women to be affected). Most people with MS live a normal life span.

There is no cure for MS, although new treatments, such as interferon beta and glatiramer acetate, can reduce the likelihood of episodes and can slow progression of symptoms. Treatment will depend on symptoms. Corticosteroids (such as dexamethasone, methylprednisolone, or prednisone) or adrenocorticotropic hormone are prescribed to control inflammation in the nervous system during acute episodes, especially when the symptoms affect movement rather than sensation. To relieve fatigue, your doctor may prescribe amantadine or modafinil. He or she also will advise you to help prevent fatigue by staying cool (such as with air conditioning).

The doctor may prescribe muscle relaxants to relieve muscle spasms and also may recommend that you swim or participate in a water therapy program. Physical therapy can help maintain muscle strength and improve your balance and coordination. Occupational therapy can help you learn easier ways to perform daily tasks. For urinary incontinence, your doctor may prescribe an antispasmodic medication (such as dicyclomine or hyoscyamine) to relax the bladder and control muscle contractions.

Brain and Nervous System

Parkinson's Disease

Parkinson's disease is a progressive degenerative disease like amyotrophic lateral sclerosis (see page 333), though it has a much slower course. Researchers believe that a combination of factors—including environmental toxins, genetic predisposition, accelerated aging, or damage to cells from free radicals—may bring about the disease. The average age of onset is 60, but many younger adults have early symptoms. Men and women are affected equally by Parkinson's disease.

In Parkinson's disease, the neurons in the basal ganglia (clusters of paired nerve cells deep inside the brain) that control muscular activity become damaged or die. These nerve cells produce an important neurotransmitter (chemical messenger) called dopamine, which has an essential role in controlling muscle actions. Without sufficient dopamine, the nerve impulses are disrupted, causing the primary symptoms of the disease: tremor (trembling) in the hands, feet, arms, legs, and head; stiffness and weakness; slow movement; and impaired balance and coordination.

The early symptoms of Parkinson's disease are subtle and appear gradually. The hands and feet may tremble slightly. Eventually the person's speech may become slow and halting, and his or her handwriting will become very small. Some people may have a flat facial expression and become stiff and unsteady. As the disease progresses, they may experience problems with memory and thought processes. The skin may become oily (especially on the forehead, nose, and



Concerns scalp) or very dry, or excessive sweating may occur. People with Parkinson's disease often have difficulty sleeping. Depression also is common.

A diagnosis of Parkinson's disease is based on the symptoms. There is no cure for the disease, but medication can relieve the symptoms for most people in less severe stages of the disease. The most common medication is levodopa (also called L-dopa), which the body converts to dopamine. Not all symptoms respond well to levodopa, and those that do will return if the medication is stopped. Anticholinergic drugs such as benztropine may be prescribed to relieve tremor. Brain surgery to reduce tremor and rigidity may be performed on some people for whom medication has not been effective. Although the progression of Parkinson's disease cannot be slowed, treatment to relieve symptoms can help people continue to lead active lives.

Tourette's Syndrome

Tourette's syndrome is a rare inherited disorder characterized by involuntary movements and nasal and vocal sounds. Researchers believe that the abnormality in the gene or genes responsible for the disease affects the way the brain controls neurotransmitters (chemical messengers such as serotonin and dopamine). Symptoms usually begin before age 18, and men are up to four times more likely to have the disease than women. In some cases the symptoms are not noticeable or do not continue into adulthood.

Early symptoms of the disease include facial tics such as eye blinking, nose twitching, or grimaces. (Note that most such tics are not due to Tourette's syndrome.) Over time the tics may become more noticeable and may include head jerking, neck stretching, foot stamping, and body twisting or bending. The person also may make strange noises, such as coughing, sniffing, grunting, yelping, barking, or shouting. More disturbing symptoms, such as involuntary shouting of obscenities, constantly echoing words of others, touching others excessively, or repeating actions obsessively, also may occur. In severe cases people with Tourette's syndrome may harm themselves by biting their lips and cheeks and banging their heads against hard objects.

Tics periodically change in number, frequency, type, and location. They also may disappear for a time and then reappear. If a person tries to suppress a tic, tension will build until the tic occurs, often in a more dramatic manner. Tics tend to worsen in stressful situations and improve during periods of relaxation or when the person concentrates on another activity.

Tourette's syndrome is diagnosed through monitoring of symptoms (the tics must be present for at least 1 year) and confirmation of a family history of the disease. In some cases neurological tests may reveal another cause of the symptoms.

There is no cure for Tourette's syndrome, although symptoms tend to decrease with age. The disorder does not affect the intellect. The person may not require any treatment, but the doctor may prescribe medications to reduce specific symptoms that interfere with daily routine. Relaxation techniques (see page 119) and biofeedback (see page 118) can help prevent tics.

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