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Essential Tremor

Alternative Names:  Tremor – essential; Familial tremor; Tremor – familial

Definition:
Essential tremor is a disorder of the nervous system that causes a rhythmic shaking. Essential tremor (ET) goes by many names (benign essential tremor and familial tremor being two others), but regardless of the name it is characterized by a shaking in primarily the hands and arms, but it can be found in the jaw and throat and even more rarely the legs. ET is a widely varying disease that can affect many body parts and can vary in its intensity. Some people have a minor tremor in their hands, while others will have a highly noticeable tremor that affects the afflicted’s quality of life and can be mistaken for Parkinson’s Disease by the lay person. Many diseases have a tremor associated with them, but what sets ET apart from other diseases is its lack of any symptom outside of the tremor. Most people will never be diagnosed as having ET, and even when diagnosed there are few treatments available. Essential tremor is inherited by more people on a year by year basis than any other movement disease, this being because it is a simple dominant autosomal trait……...click & see

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Although usually not a dangerous condition, essential tremor worsens over time and can be severe in some people.Essential tremor can occur at any age but is most common in older adults……....you may click  to read more

Symptoms:
The tremor is usually most obvious in the hands, but may affect the arms, head, eyelids, or other muscles. The tremor rarely affects the legs or feet. People with essential tremor may have trouble holding or using small objects such as silverware or a pen.

The shaking usually involves small, rapid movements — more than 5 times a second.

Specific symptoms may include:

*Begin gradually

*Worsen with movement

*Usually occur in the hands first, affecting one hand or both hands

*Are aggravated by emotional stress, fatigue, caffeine or extremes of temperature

*Head nodding (Can include a “yes-yes” or “no-no” motion of the head)

*Shaking or quivering sound to the voice if the tremor affects the voice box

*Difficulty writing, drawing, drinking from a cup, or using tools if the tremor affects the hands

The tremors may:

*Occur when you move (action-related tremor), and may be less noticeable with rest

*Come and go, but generally get worse as you age

*Get worse with stress, caffeine, and certain medications

*Not affect both sides of the body the same way

Essential tremor vs. Parkinson’s disease

Many people associate tremors with Parkinson’s disease, but the two conditions differ in key ways:

*When tremors occur. Essential tremor of the hands typically occurs when you use your hands. Tremors from Parkinson’s are most prominent when your hands are at your sides or resting in your lap.

*Associated conditions. Essential tremor doesn’t cause other health problems, whereas Parkinson’s is associated with a stooped posture, slow movement and a shuffling gait. However, people with essential tremor may sometimes develop other neurological signs and symptoms — such as an unsteady gait (ataxia).

*Parts of body affected. Essential tremor can involve your hands, head, voice and legs. Tremors from Parkinson’s typically affect your hands but not your head or voice.

Causes:
Essential tremor is the most common type of tremor. In general, tremors occur when there is a problem with the nerves supplying certain muscles. However, everyone has some essential tremor but the movements are usually so small that they can’t be seen.

About half of essential tremor cases appear to occur because of a genetic mutation. This is referred to as familial tremor. What causes essential tremor in people without a known genetic mutation isn’t clear.

Some research suggests that the cerebellum, the part of the brain that controls muscles movements, does not work correctly in patients with essential tremor.

Noticeable essential tremors can be seen at any age but are most common in people older than 65.

Essential tremor can also occur with other neurological conditions, including dystonia, parkinsonism, and certain inherited nerve conditions such as Charcot-Marie-Tooth disease.

If an essential tremor occurs in more than one member of a family, it is called a familial tremor. This type of essential tremor is passed down through families (inherited), which suggests that genes play a role in its cause.

Familial tremor is usually a dominant trait, which means that you only need to get the gene from one parent to develop the disorder. It usually starts in early middle age, but may be seen in people who are older or younger.

Risk Factors:
There are two known risk factors for essential tremor:

*Genetic mutation. The inherited variety of essential tremor is an autosomal dominant disorder, which means that a defective gene from just one parent is needed to pass on the condition. If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself.

*Age. Essential tremor is more common in middle age and older.

Complications:
Essential tremor is not life-threatening, but symptoms often worsen over time. If the tremors become severe, you may find it difficult to:

*Hold a cup or glass without spilling

*Eat normally

*Put on makeup or shave

*Talk, if your voice box or tongue is affected

*Write — handwriting may become increasingly large, shaky and illegible

Diagnosis:

Your doctor can make the diagnosis by performing a physical exam and asking questions about your medical and personal history.

A physical exam will show shaking with movement, usually small movements that are faster than 5 times per second. There are usually no problems with coordination or mental function.

Further tests may be needed to rule out other reasons for the tremors. Other causes of tremors may include:

•Alcohol withdrawal
•Cigarette smoking
•Hyperthyroidism
•Pheochromocytoma
•Too much caffeine
•Use of certain medications
•Wilson’s disease
Blood tests and imaging studies (such as a CT scan of the head, brain MRI, and x-rays) are usually normal.
The most common way to diagnose ET is by having a patient draw the Archimedes Spiral, which is shown immediately below.

If there is a shakiness detected while drawing the spiral, ET can be diagnosed assuming there are no neurological or biological reasons to be found. Below is a picture of what the Archimedes Spiral looks like when drawn by a person with a relatively severe tremor:

Treatment:
Treatment may not be necessary unless the tremors interfere with your daily activities or cause embarrassment.

When diagnosed with ET there are several courses of action depending on the severity of the tremor.
Medicines may help relieve symptoms. How well medicines work depend on the individual patient.

Two medications used to treat tremors include:

•Propranolol, a drug that blocks the action of stimulating substances called neurotransmitters, particularly those related to adrenaline
•Primidone, an antiseizure drug that also controls the function of some neurotransmitters
The drugs can have significant side effects.

Side effects of propranolol include:

•Fatigue
•Nose stuffiness
•Shortness of breath (people with asthma should not use this drug)
•Slow heart beat
Side effects of primidone include:

•Drowsiness
•Difficulty concentrating
•Nausea
•Problems with walking, balance, and coordination
Other medications that may reduce tremors include:

•Antiseizure drugs such as gabapentin and topiramate
•Mild tranquilizers such as alprazolam or clonazepam
•Blood pressure drugs called calcium-channel blockers such as flunarizine and nimodipine
Botox injections, given in the hand, have been used to reduce tremors by weakening local muscles.

In severe cases, surgery to implant a stimulating device in the brain may be an option.

Prognosis:

An essential tremor is not a dangerous condition, but some patients find the tremors annoying and embarrassing. In some cases, it may be dramatic enough to interfere with work, eating, or drinking.

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Prevention:
Stress and caffeine can make tremors worse. Avoid caffeinated drinks such as coffee, tea, and soda, and other stimulants. Exercise and counseling to reduce emotional stress may also help.

Alcoholic beverages in small quantities may decrease tremors but can lead to alcohol dependence and alcohol abuse, especially if you have a family history of such problems. How alcohol helps relieve tremors is unknown.


Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://wiki.ggc.usg.edu/mediawiki/index.php/Essential_Tremor
http://www.mayoclinic.com/health/essential-tremor/DS00367
http://www.nlm.nih.gov/medlineplus/ency/article/000762.htm

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Movement Disorders

Introduction:
Movement disorders are a group of nervous system (neurological) conditions that cause you to have abnormal voluntary or involuntary movements, or slow, reduced movements.
Click to see the pictures
Even a simple action such as picking up a pencil engages several different parts of the brain. The conscious thought areas of the brain trigger the motor area to send signals to the muscles of the arm.

As the movement begins, sensors in the arm are activated, sending signals back into different areas of the brain that interpret them and then send further messages to the motor area to fine tune power, speed, coordination and balance.

Given such complexity, problems with the control of movement are understandably widespread. Essential tremor – the most common movement disorder – affects one in 20 people under the age of 40 and one in five people over 65. Up to one in ten people has restless legs syndrome.

Other conditions such as Parkinson’s disease (which affects one in 500 people) are less common, but can severely impair quality of life because they reduce the independence of those affected.

Types:
There are various types of  Movement disorders and that include :

*Ataxia. Ataxia is a neurological condition that affects the part of your brain that controls coordinated movement (cerebellum). Ataxia may cause uncoordinated movements, imbalance and other symptoms.

Click to see the pictures

*Dystonia. Dystonia is a neurological condition in which your muscles contract involuntarily and may cause twisting and repetitive movements. Dystonia may involve the entire body (generalized dystonia) or one part of the body (focal dystonia).

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*Essential tremor. Essential tremor is a neurological condition that causes involuntary shaking (tremors). Your hands often are affected, but other parts of your body also may be affected.

Click to see the picture

*Huntington’s disease. Huntington’s disease is an inherited progressive, neurodegenerative disorder that causes certain nerve cells in your brain to deteriorate. This condition may cause uncontrolled movements, decreased thinking abilities (cognitive abilities), and emotional and mental health disturbances (psychiatric conditions).

You may click to see

*Multiple system atrophy. Multiple system atrophy is an uncommon, progressive neurological disorder that affects many areas of your brain and nervous system. Multiple system atrophy may cause ataxia or parkinsonism. This condition frequently impairs body systems that modulate your blood pressure, heart rate and bladder function (autonomic function).

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*Myoclonus.:  Myoclonus is a condition in which you have sudden, jerky movements, twitching, or intermittent spasms of a muscle or group of muscles.

click to see the picture
*Parkinson’s disease. Parkinson’s disease is a progressive neurological disorder that affects your movement and may cause shaking (tremor), muscle stiffness (rigidity), slowing of movement, impaired balance or other symptoms. Parkinsonism describes a group of conditions that has symptoms similar to those of Parkinson’s disease.

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*Progressive supranuclear palsy. Progressive supranuclear palsy is a rare neurological disorder that causes you to have problems with walking, balance and eye movements. It resembles Parkinson’s disease but is a distinct condition.

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*Restless legs syndrome. Restless legs syndrome causes unpleasant, abnormal feelings in your legs while you’re relaxing or lying down. Your symptoms often are relieved by movement.
Tardive dyskinesia. Tardive dyskinesia is a neurological condition caused by long-term use of certain drugs used to treat psychiatric conditions (neuroleptic drugs). Tardive dyskinesia causes repetitive and involuntary movements such as grimacing, eye blinking and other movements.

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*Tourette syndrome. Tourette syndrome is a neurological condition which starts between childhood and teenage years and is associated with repetitive movements (motor tics) and vocal sounds (vocal tics).

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*Wilson’s disease. Wilson’s disease is an inherited (genetic) disorder that causes excessive amounts of copper to build up in your body, causing neurological problems.

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Treatment :Treatment depends upon the underlying disorder

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Movement_disorder
http://www.bbc.co.uk/health/physical_health/conditions/movementdisorders1.shtml
http://www.ganeurosurg.org/specialties/movementdisorders.htm
http://www.mayoclinic.org/movement-disorders/

Dystonia


http://wiki.ggc.usg.edu/mediawiki/index.php/Essential_Tremor
http://www.bothbrainsandbeauty.com/academic-discussions/huntingtons-disease-991
http://www.chelationtherapyonline.com/anatomy/p3.htm

http://fisioterapiananeurologia.blogspot.com/2011/05/ataxia-de-friedreich.html

http://www.movementdisorders.org/james_parkinson/early_atypical.html

Homeopathy for Restless Legs Syndrome

http://worldsstrongestlibrarian.com/9257/tourettes-syndrome-pictures/

http://www.eurowilson.org/en/living/guide/what/index.phtml

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Dystonia

Definition:
Dystonia is a syndrome of spasms and sustained contractions of the muscles. These muscle movements are not under voluntary control and they result in repetitive abnormal movements of parts of the body or persistently abnormal postures.

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Dystonia is a movement disorder which causes involuntary contractions of your muscles. These contractions result in twisting and repetitive movements. Sometimes they are painful.

Dystonia can affect just one muscle, a group of muscles or all of your muscles. Symptoms can include tremors, voice problems or a dragging foot. Symptoms often start in childhood. They can also start in the late teens or early adulthood. Some cases worsen over time. Others are mild.

Some people inherit dystonia. Others have it because of another disease. Either way, researchers think that a problem in the part of the brain that handles messages about muscle contractions might cause dystonia. There is no cure. Instead, doctors use medicines, surgery, physical therapy and other treatments to reduce or eliminate muscle spasms and pain.

Dystonia is incurable  thought to affect at least 40,000 people in the UK.

The different types of dystonia include:

•Cervical dystonia (spasmodic torticollis) – affects the neck muscles, causing the head to twist, pull in one direction or shake
•Blepharospasm – dystonia of the muscles around the eyes
•Oromandibular dystonia – affecting the muscles of the jaw, tongue and mouth
•Laryngeal dystonia – affecting the speech muscles
•Writer’s cramp – affecting the ability to write and sometimes other hand-based tasks
There are several types of dystonia that affect more than one area of the body including generalised dystonia, which affects most of the body, frequently involving the legs and back (trunk).

If dystonia develops in childhood, particularly if it starts in the legs, it may spread to other parts of the body and can become generalised. However, when it develops in adults, it usually confines itself to one part of the body (focal dystonia).

Although dystonia is a neurological disorder, it does not lead to problems with other functions of the brain, such as intellect.

It occurs in all parts of the world and affects people of all ages.

Dystonia can affect virtually any single part of the body or several different areas at once.

Classification:

Types of dystonia
*Generalized
*Focal
*Segmental
*Sexual
*Intermediate
*Acute Dystonic Reaction

Generalized dystonias:
*Normal birth history and milestones
*Autosomal dominant
*Childhood onset
*Starts in lower limbs and spreads upwards
*Also known as “idiopathic torsion dystonia” (old terminology “dystonia musculrum deformans”)

Focal dystonias:
These are the most common dystonias and tend to be classified as follows:
*Anismus…. muscles of the rectum……… Causes painful defecation, constipation; may be complicated by encopresis.

*Cervical dystonia (spasmodic torticollis)…. muscles of the neck…. Causes the head to rotate to one side, to pull down towards the chest, or back, or a combination of these postures.

*Blepharospasm…. muscles around the eyes The sufferer experiences rapid blinking of the eyes or even their forced closure causing effective blindness.

*Oculogyric crisis.. muscles of eye and head….An extreme and sustained (usually) upward deviation of the eyes often with convergence causing diplopia. It is frequently associated with backwards and lateral flexion of the neck and either widely opened mouth or jaw clenching. Frequently a result of antiemetics such as the neuroleptics (e.g., prochlorperazine) or metoclopramide. Also can be caused by Chlorpromazine.

*Oromandibular dystonia….muscles of the jaw and muscles of tongue……Causes distortions of the mouth and tongue.

*Spasmodic dysphonia/Laryngeal dystonia…muscles of larynx…..Causes the voice to sound broken or reducing it to a whisper.

*Focal hand dystonia (also known as musician’s or writer’s cramp)…..single muscle or small group of muscles in the hand…..It interferes with activities such as writing or playing a musical instrument by causing involuntary muscular contractions. The condition is sometimes “task-specific,” meaning that it is generally only apparent during certain activities. Focal hand dystonia is neurological in origin, and is not due to normal fatigue. The loss of precise muscle control and continuous unintentional movement results in painful cramping and abnormal positioning that makes continued use of the affected body parts impossible.
Symptoms:
The progress of dystonia is unpredictable.

The severity of symptoms can vary from day to day, and while there often is an element of overall progression, it is difficult to estimate how long this will last.

Typically, a focal dystonia will progress gradually over a five-year period, and then progress no further.

Symptoms in all dystonic conditions can vary.

For some people, their dystonia may sometimes improve or disappear altogether for no apparent reason.

As with the onset of any long-term medical condition, some people who develop dystonia may go through an initial period of depression, embarrassment and outrage – or relief that there is an explanation for their symptoms.

Causes:
Dystonia is a movement disorder. Although the causes of dystonia are not fully known it is currently thought that the condition results from a malfunction in a part of the brain called the basal ganglia.

The basal ganglia are structures situated deep in the brain. They help to regulate voluntary and involuntary movement by controlling muscle contractions in the body.

The problem may mainly lie in an area of the basal ganglia called the globus pallidus. If this area of the brain is not functioning correctly then the control of another structure in the brain called the thalamus is affected.

The thalamus controls the planning and execution of movement and sends nerves to muscles via the spinal cord. The end result is that muscle co-ordination is not regulated properly. The wrong muscles will contract on movement or all muscles will contract unnecessarily causing abnormal movement and posture.

Muscles positioned around joints usually work in pairs opposite each other, eg the biceps and triceps muscles of the upper arm bend or straighten the elbow respectively. Usually if one muscle of a pair is contracted the other is relaxed. However, in dystonia both muscles in the pair contract at the same time leading to the abnormal movement or posture.

It is thought that in some cases there may be a chemical imbalance or ‘wiring fault’ in the basal ganglia. Chemical transmitters, such as dopamine, convey messages from one nerve cell to another within the basal ganglia. If this balance is upset then incorrect signals will be sent out resulting in loss of regulation of co-ordinated movements.

Supporting this theory is the fact that people with dystonia do not show structural abnormalities of the brain. The ‘wiring fault’ theory is therefore more likely because it works at a much smaller scale.

The fault in the basal ganglia may be caused by an inherited factor or be secondary to another problem such as drugs or toxins, or a separate neurological disease. Recently scanning studies using positron emission tomography (PET) in patients with cervical (neck muscle) dystonia have revealed reduced basal ganglia density of an important dopamine receptor (the D2 receptor).

Genetic risk factors:
Dystonia that develops in childhood is often inherited through one or more affected genes.

Most primary segmental or generalised dystonia is inherited in a dominant manner, which means if a parent has this type of dystonia, there’s a 50% chance of passing the dystonia gene to each child.

However, not everyone who inherits the gene develops dystonia, a phenomenon known as reduced penetrance.

Dystonia which develops in adults may also be inherited.

Diagnosis:
There is no definitive test for dystonia. Diagnosis depends on the presence of characteristic clinical symptoms and signs. The neurologist will perform a full neurological examination and may also perform blood tests or a brain scan to rule out an illness or injury that may be causing the dystonia. If no cause can be found the dystonia is termed ‘idiopathic’.

Treatment:
There is no cure for most forms of dystonia. However, many dystonic conditions can be successfully managed.

Most people manage to develop effective strategies for coping with the challenges their condition brings.

Successful treatments to lessen their symptoms, effective pain control and the acquisition of sensory ‘tricks’ all help to ameliorate social situations.

Various treatments are available for dystonia. These will be determined depending upon the type and severity of the particular condition.

The main options are:
•Botulinum toxin – injections are generally the most effective treatment for dystonia where it affects the muscles of the neck or around the eyes. However, resistance to botulinum toxin can develop in a minority of patients over time.
•Drugs – some work by interfering with neurotransmitters, the chemical substances that carry messages within the brain, while others are designed to relax the muscles, reducing shaking and control muscle spasms. To be effective, they have to be taken continuously.
•Surgery – may be an option where patients have never been or are no longer receptive to other treatments. Treatments include selective denervation and deep brain stimulation (DBS). In the case of the latter, electrodes are planted in the basal ganglia to help rebalance movement and control posture. Recent research has led to a refinement in the placing of electrodes for optimum effect.

Other treatment:
Physical therapies such as physiotherapy with ice, heat or ultrasound, speech therapy for spasmodic dysphonia, acupuncture, osteopathy or chiropractic techniques help some patients. However, treatments involving manipulation of the neck are not recommended for spasmodic torticollis. Relaxation therapies such as hypnosis, behaviour therapy, biofeedback and meditation may also help.

Good advice:
A positive attitude is vital. Dystonia is not life-threatening but can be disabling. Dystonia can have a profound effect both emotionally and functionally. Sufferers should try to continue to lead as normal a life as possible. Counselling and family and social support is helpful.

Many patients with focal dystonias such as torticollis can control the abnormal posture for a short time by using sensory tricks or ‘gestes antagonistiques’. The most common geste is to place a finger or hand against the lower face on the same or opposite side to the direction of movement. Other gestes include sucking a pen or necklace or pulling on the end of the nose or an earlobe. Ambient sound has also been found to relieve dystonia.

Prognosis:
Focal dystonias such as torticollis and blepharospasm may worsen over several years before stabilising. They may improve or disappear for no apparent reason. The likelihood of this has been estimated from anything from 1 in 10 to 1 in 20, but there is no way to predict whether it will happen. In some cases the dystonia will return after a period of remission, but other patients can remain symptom free for the rest of their lives.

Focal dystonias are unlikely to spread to become generalised dystonia. However, some focal dystonias may be associated with each other.

If the dystonia develops in childhood then it usually spreads to other parts of the body and becomes generalised. This type of dystonia is much more disabling than the adult focal type.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/dystonia.shtml
http://en.wikipedia.org/wiki/Dystonia
http://www.nlm.nih.gov/medlineplus/dystonia.html#cat5
http://www.netdoctor.co.uk/diseases/facts/dystonia.htm

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Blepharospasm

Definition:
Benign essential blepharospasm (BEB) is a progressive neurological disorder characterized by involuntary muscle contractions and spasms of the eyelid muscles. It is a form of dystonia, a movement disorder in which muscle contractions cause sustained eyelid closure, twitching or repetitive movements. BEB begins gradually with increased frequency of eye blinking often associated with eye irritation.

CLICK & SEE
click to see the picture
Benign means the condition is not life threatening. Essential indicates that the cause is unknown, but fatigue, stress, or an irritant are possible contributing factors. Symptoms sometimes last for a few days then disappear without treatment, but in most cases the twitching is chronic and persistent, causing lifelong challenges. The symptoms are often severe enough to result in functional blindness. The person’s eyelids feel like they are clamping shut and will not open without great effort. Patients have normal eyes, but for periods of time are effectively blind due to their inability to open their eyelids.

Although strides have recently been made in early diagnosis, blepharospasm is often initially mis-diagnosed as allergies or “dry eye syndrome“. It is a fairly rare disease, affecting only one in every 20,000 people in the United States.


Symptoms:
*Excessive blinking and spasming of the eyes, usually characterized by uncontrollable eyelid closure of durations longer than the typical blink reflex, sometimes lasting minutes or even hours.
click for the picture
*Uncontrollable contractions or twitches of the eye muscles and surrounding facial area. Some sufferers have twitching symptoms that radiate into the nose, face and sometimes, the neck area.

*Dryness of the eyes

*Sensitivity to the sun and bright light

click to see the picture
Causes:
Some causes of blepharospasm have been identified; however, the causes of many cases of blepharospasm remain unknown, although some educated guesses are being made. Some blepharospasm patients have a history of dry eyes and/or light sensitivity, but others report no previous eye problems before onset of initial symptoms.

Some drugs can induce blepharospasm, such as those used to treat Parkinson’s disease, as well as sensitivity to hormone treatments, including estrogen-replacement therapy for women going through menopause. Blepharospasm can also be a symptom of acute withdrawal from benzodiazepine dependence. In addition to blepharospasm being a benzodiazepine withdrawal symptom, prolonged use of benzodiazepines can induce blepharospasm and is a known risk factor for the development of blepharospasm.

Blepharospasm may also come from abnormal functioning of the brain basal ganglia. Simultaneous dry eye and dystonias such as Meige’s syndrome have been observed. Blepharospasms can be caused by concussions in some rare cases, when a blow to the back of the head damages the basal ganglia.

Blepharospasm often occurs out of the blue for no specific reason. Rarely, it can run in families.

Diagnosis:
The diagnosis of blepharospasm depends on recognition of its characteristic features by an expert, such as a neurologist or ophthalmologist. There are no medical tests for proving the diagnosis, but some tests may be conducted to rule out other possible problems. These may include tests for allergies or dry eyes or scans of the brain.


Treatment:
*Drug therapy: Drug therapy for blepharospasm has proved generally unpredictable and short-termed. Finding an effective regimen for any patient usually requires trial and error over time. In some cases a dietary supplement of magnesium chloride has been found effective.

*Botulinum toxin injections (Botox is a widely known example) have been used to induce localized, partial paralysis. Among most sufferers, botolinum toxin injection is the preferred treatment method.[3] Injections are generally administered every three months, with variations based on patient response and usually give almost immediate relief (though for some it may take more than a week) of symptoms from the muscle spasms. Most patients can resume a relatively normal life with regular Botulinum toxin treatments. A minority of sufferers develop minimal or no result from Botox injections and have to find other treatments. For some, Botulinum toxin diminishes in its effectiveness after many years of use. An observed side effect in a minority of patients is ptosis or eyelid droop. Attempts to inject in locations that minimize ptosis can result in diminished ability to control spasms.

*Surgery: Patients that do not respond well to medication or botulinum toxin injection are candidates for surgical therapy. The most effective surgical treatment has been protractor myectomy, the removal of muscles responsible for eyelid closure.

*Dark glasses are often worn because of sunlight sensitivity, as well as to hide the eyes from others.

*Stress management and support groups can help sufferers deal with the disease and prevent social isolation.

Prognosis:
With botulinum toxin treatment most individuals with BEB have substantial relief of symptoms. Although some may experience side effects such as drooping eyelids, blurred or double vision, and eye dryness, these side effects are usually only temporary.

Researches:
The NINDS supports a broad program of research on disorders of the nervous system, including BEB. Much of this research is aimed at increasing understanding of these disorders and finding ways to prevent, treat, and cure them.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Blepharospasm
http://www.ninds.nih.gov/disorders/blepharospasm/blepharospasm.htm
http://www.bbc.co.uk/health/physical_health/conditions/blepharospasm1.shtml
http://www.nature.com/eye/journal/v18/n3/fig_tab/6700624f1.html
http://microbewiki.kenyon.edu/index.php/File:Botwoman.jpg
http://rarediseasesnetwork.epi.usf.edu/dystonia/patients/learnmore/craniofacial/

http://www.graphicshunt.com/health/images/blepharospasm-608.htm

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Binswanger’s Disease

Alternative Name: Subcortical vascular dementia.

Definition:
Binswanger’s disease is a form of small vessel vascular dementia caused by damage to the white brain matter. White matter atrophy can be caused by many circumstances including chronic hypertension as well as old age. This disease is characterized by loss of memory and intellectual function and by changes in mood. These changes encompass what are known as executive functions of the brain. It usually presents itself in 54 and 66 years of age, and the first symptoms are usually mental deterioration or stroke.

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Click for picture………..(1.)………(2)…………….

A  form of multi-infarct dementia caused by damage to the white brain matter.

Binswanger’s disease is a particular type of atherosclerosis-related dementia, in which there are widespread, microscopic areas of damage to the white matter below the outer layer or cortex of the brain. This is called subcortical dementia and produces a particular pattern of symptoms which is somewhat different to other types of dementia.

The disease may develop gradually or seem to be triggered or rapidly aggravated by a stroke or other event that leads to brain damage.

It was described by Otto Binswanger in 1894, and Alois Alzheimer first used the phrase “Binswanger’s disease” in 1902.  However, Olszewski is credited with much of the modern-day investigation of this disease which began in 1962

Symptoms:
Binswanger’s disease affects the speed at which the brain can process information and this typically causes problems with higher brain functions such as:

•Organisation
•Planning
•Decision making
•Attention
•Concentration (all of which impinge on intellectual function)
•Mood (typically apathy, irritability, and depression)
•Behaviour
Memory loss can occur but is not usually as bad as in other forms of dementia such as Alzheimer’s, while a feature known as psychomotor slowness (where a person takes longer than normal to turn a thought into an action) is common in Binswanger’s disease.

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There may also be changes in speech, an unsteady gait, shaking similar to that seen in Parkinson’s disease, clumsiness or frequent falls and loss of bladder control. These symptoms are not always present in all patients and may sometimes appear only as a passing phase. Seizures may also occur.

Patients usually show other signs of atherosclerosis and cardiovascular disease such as:

•Raised blood pressure
•Stroke
•Blood abnormalities
•Disease of the large blood vessels in the neck
•Disease of the heart valves
Brain scans such as CT scans or magnetic resonance imaging (MRI) show a characteristic pattern in Binswanger’s disease.

Causes:
Atherosclerosis, a disease process that narrows the blood vessels and cuts off the blood supply to the neurons or nerve cells of the brain, causing death of those cells, is a common cause of dementia.

Binswanger’s disease is a particular type of atherosclerosis-related dementia, in which there are widespread, microscopic areas of damage to the white matter below the outer layer or cortex of the brain. This is called subcortical dementia and produces a particular pattern of symptoms which is somewhat different to other types of dementia.

Diagnosis:
Binswanger’s disease can usually be diagnosed through a CT scan, MRI, and a proton MR spectrography. Indications include infarctions, lesions, or loss of intensity of central white matter and enlargement of ventricles, and leukoaraiosis or white matter atrophy. click & see

Click to see the picture

CT Brain Scan showing active NCC (left) and lacunar infarction on the head of the caudate nucleus (right) and lecoara.

Presentation:
Leukoaraiosis (LA) are white matter changes that are common in Binswanger’s Disease. However, LA can be found in many different diseases and even in the general population, especially in people older than 65 years of age.

There is controversy whether LA and mental deterioration actually have a cause and effect relationship. Recent research is showing that different types of LA can affect the brain differently, and that proton MR spectroscopy would be able to distinguish the different types more effectively and better diagnosis and treat the issue.[8] Because of this information, white matter changes indicated by a MRI or CT cannot alone diagnose Binswanger’s disease, but can aid to a bigger picture in the diagnosis process. There are many diseases similar to Binswanger’s disease including CADASIL syndrome and Alzheimer’s disease which makes this specific type of white matter damage hard to diagnose.Binswanger’s disease is best when diagnosed of a team by experts including a neurologist and psychiatrist to rule out other psychological or neurological problems. Because doctors must successfully detect enough white matter alterations to accompany dementia as well as an appropriate level of dementia, two separate technological systems are needed in the diagnosing process.

Technology:
Much of the major research today is done on finding better and more efficient ways to diagnose this disease. Many researchers have divided the MRIs of the brain into different sections or quadrants. A score is given to each section depending on how severe the white matter atrophy or leukoaraiosis is. Research has shown that the higher these scores, the more of a decrease in processing speed, executive functions, and motor learning tasks. Other researchers have begun using computers to calculate the percentage of white matter atrophy by counting the hyper-intense pixels of the MRI. These and similar reports show a correlation between the amount of white matter alterations and the decline of psychomotor functions, reduced performance on attention and executive control. One recent type of technology is called susceptibility weighted imaging (SWI) which is a magnetic resonance technique which has an unusually high degree of sensitivity and can better detect white matter alternations.

Recently a Mini Mental Test (MMT) has been created to accurately and quickly assess cognitive impairment due to vascular dementia across different cultures. Binswanger’s disease has been shown to be the most severe impairment of all of the vascular dementia.


Treatment:
There is no specific treatment for Binswanger’s disease. What treatment there is consists of keeping associated symptoms under control and supporting the patient with their activities of daily living such as dressing, washing and preparing meals.

Medications may be used to treat symptoms such as depression, or generally treat arterial disease and its effects throughout the body (so helping to preserve blood flow to the brain and delay the progression of Binswanger’s).

Specific drugs called “cognitive enhancers” used generally in dementia may be given but the results with them are variable and many people get little benefit.

It has been shown that current Alzheimer’s medication, Aricept, may help Binswanger’s Disease patients as well. Aricept increases the acetocholine in the brain through a choline esterase inhibitor which deactivates the enzyme that breaks down acetocholine. Alzheimer as well as Binswanger patients have low levels of acetocholine and this helps to restore the normal levels of neurotransmitters in the brain. This drug may improve memory, awareness, and the ability to function. If no medical interception of the disease is performed then the disease will continue to worsen as the patient ages due to the continuing atrophy of the white matter from whatever was its original cause.

You may click to see :Homoeopathy and  Binswanger’s disease

Prognosis:
Binswanger’s disease has no cure and patients with the disorder usually die within five years of its onset.
The best way to manage the vascular risk factors that contribute to poor perfusion in the brain is to treat the cause, such as chronic hypertension or diabetes.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Binswanger’s_disease
http://www.bbc.co.uk/health/physical_health/conditions/binswangers_disease.shtml

Binswanger’s disease or Binswager’s Dementia

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijn/vol2n1/bins.xml

http://www.walgreens.com/marketing/library/contents.html?docid=000002&doctype=10

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