Epilepsy

 causes epilepsy

Epilepsy is caused by abnormal electric impulses in groups of nerve cells (neurons) found in the brain. For diagnostic purposes, epilepsy is divided into three main groups

Idiopathic epilepsy

Electroencephalography (EEG) can show where in the brain the convulsions start.

Idiopathic comes from the Greek words idios – which means self, own and personal
In cases of this type, the cause is unknown. However, it is believed that attacks are caused by the lack of a particular group of chemical substances (the neurotransmitters) used to regulate the electric impulses in the brain.

• There may be an hereditary (genetic) background, since epilepsy of the same type is often seen among relatives. Moreover, EEG irregularities similar to those of the patient are often seen among family members, even if they do not suffer from epilepsy – a kind of genetic mark. New research has shown that certain cases of idiopathic epilepsy are clearly hereditary, caused by chromosomal abnormality.
• The patient has no other signs of neurological illness or mental defects. CT and MRI scans are normal.

Symptomatic epilepsy

Epilepsy of this type is caused by a known illness in the brain.

Cryptogenic epilepsy

This is usually related to patients who have no obvious cause, as above, for their epilepsy and is associated with learning difficulties or developmental problems, such as the autistic spectrum disorder. There are often EEG abnormalities

Epilepsy triggers

Numerous illnesses or types of brain damage can cause epilepsy. The following are the most common.

Developmental anomalies

Damage occurring to the brain as it develops during the first three months of pregnancy.
This can be revealed by modern MRI scans and causes many of the difficult-to-control cases in children.
On the other hand, damage inflicted during delivery (cerebral palsy) is fairly uncommon.

Trauma to the skull

Unlike ordinary concussion, trauma or accidental injury can be so serious that the patient is admitted to a neuro-surgical ward.
The possibility of epilepsy following trauma varies from 5 to 50 per cent, with the highest risk following a depressed skull fracture where the brain tissue has been partly damaged or a gunshot wound to the head.

Blood clots (infarcts) and haemorrhages in the brain

About 10 per cent of all brain infarcts cause epilepsy.

Problems at birth

Epilepsy can result die to the baby suffering from lack of oxygen to the brain during delivery, such as the umbilical cord getting pressed on or being twisted.

Brain tumours

Especially slow-growing superficial tumours. Since these can be surgically removed, it is important to check for these if a patient develops epilepsy, especially if the attacks start in a limited part of the brain (focal attacks – consult the article on the types of attacks).
The most important techniques are CT scans and MRI scans.

Encephalitis

Prolonged seizures and fever convulsions could induce brain damage.

Alcohol abuse

May cause epilepsy as a result of the cramps associated with delirium tremens.

Partial epilepsies

These are epilepsies with a clearly defined focal area within the brain. As a result, they have highly characteristic symptoms, such as visual hallucinations, or motor difficulties on one side of the body.

• Benign occipital epilepsy (Benign focal epilepsy with occipital paroxysms)
• Benign rolandic epilepsy (Benign focal epilepsy with centrotemporal spikes)
• Frontal lobe epilepsy
• Occipital lobe epilepsy
• Mesial temporal lobe epilepsy
• Parietal lobe epilepsy

Generalised idiopathic epilepsies

Generalised epilepsies are those which have no defined focal area within the brain; as a result they have generalised symptoms as the whole brain becomes affected. Idiopathic is a medical term meaning that there is no clear environmental cause for the epilepsy and it is presumed that genetic factors predominate. There are usually no other handicaps and the EEG is often normal between fits. The response to drug treatment is usually good.

• Benign myoclonic epilepsy in infants
• Juvenile myoclonic epilepsy
• Childhood absence epilepsy
• Juvenile absence epilepsy
• Epilepsy with generalised tonic clonic seizures in childhood

Generalised symptomatic epilepsies

Generalised epilepsies are those which have no defined focal area within the brain; as a result they have generalised symptoms as the whole brain becomes affected. Symptomatic is a medical term meaning that there is some structural abnormality in the brain, either present at birth or occurring later in life. Other disabilities may be caused by this same abnormality (physical, intellectual or psychiatric). EEG investigations may reveal the abnormality and the response to drug treatment is variable in different individuals. (Some individuals have cryptogenic epilepsy, which is epilepsy in which no cause can be found, even though a cause is suspected.)

• Infantile spasms (West syndrome)
• Lennox-Gastaut syndrome
• Progressive myoclonus epilepsies

Unclassified epilepsies

This, of course, is the grouping for epilepsies which do not fit the classification schema.

• Febrile fits
• Epilepsy with continuous spike and waves in slow wave sleep (ESES)
• Landau Kleffner syndrome
• Rasmussen's syndrome
• Epilepsy and inborn errors in metabolism

symptoms of epilepsy

Epilepsy is characterized by recurrent, disorganized, abnormal electrical firing in brain cells, which can disrupt normal functioning of the brain. This disruption can cause recurrent seizures, which is the main symptom of epilepsy. While these seizures are usually caused by abnormal electrical activity in the brain, they can manifest very differently from person to person. For instance, one type of seizure may cause a brief loss of consciousness, whereas another seizure type may cause uncontrollable jerking of the entire body.

Knowing the characteristic of your seizures is important because this will help your healthcare provider select the most appropriate treatment to manage your seizures. Most people suffering from epilepsy do not remember their seizures, or what was happening to them before their seizure occurred. In this case, it is important to involve family and friends to give an account of how your seizures presented and any other information related to it.
These are the most common symptoms experienced either before, or during, a seizure. Your symptoms will depend upon the type of seizures you are having, so you might not experience all of these symptoms:

Weakness

Weakness can occur in any seizure type and in any area of the body. For instance, weakness can either occur in an arm, a leg or both.

Anxiety

Anxiety is usually experienced in most seizure types and can signal a seizure is about to occur. In some types of seizures, anxiety, or an impending sense of doom, can be an aura, or a consistent symptom in a person right before they have a seizure.

Staring

Staring out into space is a symptom experienced by individuals who have absence seizures. Usually, these individuals appear to be briefly daydreaming when, in fact, they are actually experiencing a seizure. This usually only lasts for a few seconds and may be accompanied by blinking or repetitive movements, such as movement of the mouth or fingers.

Purposeless or Repetitive Movements

This can include actions such as picking lint off of a shirt, repetitive shifting, repetitive tapping of the fingers, repetitive chewing or repeating words. These movements can occur before a seizure occurs or during some seizures.

Loss of Consciousness

Some seizures may cause a loss of consciousness, which may last for a few seconds to hours.

Contraction, or Jerking, of Body Muscles

Usually when you think of seizures, the characteristic thought is that of every muscle contracting in the body. This is referred to as a grand mal seizure. However, involuntary muscle contractions can also occur in isolated areas of the body. For instance, muscle contractions in an arm may cause an object to crash to the ground. Muscle contractions in the legs may cause someone to drop to the ground, causing further injuries.

Epilepsy - Treatment Overview

Treatment can reduce or prevent seizures in most people who have epilepsy. This can improve quality of life. Controlling your epilepsy also lowers the risk of falling and other complications that can happen when you have a seizure.

First your doctor will figure out what type of epilepsy and what kinds of seizures you have. Treatment that controls one kind of seizure may have no effect on other kinds. Your doctor will also think about your age, health, and lifestyle when he or she plans your treatment.

It may take time for you and your doctor to find the right combination, schedule, and dosage of medicines to manage your epilepsy. The goal is to prevent seizures while causing as few side effects as possible. With the help of your doctor, you can weigh the benefits of a particular treatment against its drawbacks, including side effects, health risks, and cost.
After you and your doctor figure out the treatment that works best for you, make sure to follow your treatment exactly as prescribed.

Initial treatment

Initial treatment for epilepsy depends on the severity, frequency, and type of seizures and whether a cause for your condition has been identified. Medicine is the first and most common approach. Antiepileptic medicines do not cure epilepsy. But they help prevent seizures in well over half of the people who take them. For information about medicines for epilepsy, see Medications.
See information on:

Epilepsy: Taking Your Medicines Properly.

It is not always clear whether to begin treatment after a first seizure. It is hard to predict whether you will have more seizures. Antiepileptic medicines are not usually prescribed unless you have risk factors for having another seizure, such as brain injury, abnormal test results, or a family history of epilepsy.

Ongoing treatment

If epileptic seizures continue even though you are being treated, additional or other antiepileptic medicines may be tried.
In addition to medicines, other treatments may be added to help reduce the frequency and severity of epileptic seizures, including:

• Ketogenic diet, which is a high-fat diet that has been used with some success to treat people, especially children, who have severe, uncontrolled seizures. Some doctors may not support its use.
• Vagus nerve stimulation. The stimulator device is used with medicine or surgery.
• Brain surgery. Some people with epileptic seizures do not respond to medicine but have great success with surgery.

Surgery is not used just as a last resort to treat epilepsy. Although brain surgery may sound frightening, it can successfully reduce seizures that are harmful, severe, frequent, or do not respond to medicines. Surgery can greatly improve the lives of some carefully screened people who have epilepsy. If you would like to know if surgery is a good choice for you, talk with your doctor.

Hydrocephalus

Hydrocephalus can be defined broadly as a disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF) that leads to an increase in volume occupied by this fluid in the CNS.^[1] This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute hydrocephalus occurs over weeks, and chronic hydrocephalus occurs over months or years. Conditions such as cerebral atrophy and focal destructive lesions also lead to an abnormal increase of CSF in CNS. In these situations, loss of cerebral tissue leaves a vacant space that is filled passively with CSF. Such conditions are not the result of a hydrodynamic disorder and therefore are not classified as hydrocephalus. An older misnomer used to describe these conditions was hydrocephalus ex vacuo.
Normal pressure hydrocephalus (NPH) describes a condition that rarely occurs in patients younger than 60 years.^[2] Enlarged ventricles and normal CSF pressure at lumbar puncture (LP) in the absence of papilledema led to the term NPH. However, intermittent intracranial hypertension has been noted during monitoring of patients in whom NPH is suspected, usually at night. The classic Hakim triad of symptoms includes gait apraxia, incontinence, and dementia. Headache is not a typical symptom in NPH.
Benign external hydrocephalus is a self-limiting absorption deficiency of infancy and early childhood with raised intracranial pressure (ICP) and enlarged subarachnoid spaces. The ventricles usually are not enlarged significantly, and resolution within 1 year is the rule.
Communicating hydrocephalus occurs when full communication occurs between the ventricles and subarachnoid space. It is caused by overproduction of CSF (rarely), defective absorption of CSF (most often), or venous drainage insufficiency (occasionally).
Communicating hydrocephalus with surrounding "atrophy" and increased periventricular and deep white matter signal on fluid-attenuated inversion recovery (FLAIR) sequences. Note that apical cuts (lower row) do not show enlargement of the sulci, as is expected in generalized atrophy. Pathological evaluation of this brain demonstrated hydrocephalus with no microvascular pathology corresponding with the signal abnormality (which likely reflects transependymal exudate) and normal brain weight (indicating that the sulci enlargement was due to increased subarachnoid cerebrospinal fluid [CSF] conveying a pseudoatrophic brain pattern). Noncommunicating hydrocephalus occurs when CSF flow is obstructed within the ventricular system or in its outlets to the arachnoid space, resulting in impairment of the CSF from the ventricular to the subarachnoid space. The most common form of noncommunicating hydrocephalus is obstructive and is caused by intraventricular or extraventricular mass-occupying lesions that disrupt the ventricular anatomy.^[3]
Noncommunicating obstructive hydrocephalus caused by obstruction of the foramina of Luschka and Magendie. This MRI sagittal image demonstrates dilatation of lateral ventricles with stretching of corpus callosum and dilatation of the fourth ventricle. Noncommunicating obstructive hydrocephalus caused by obstruction of foramina of Luschka and Magendie. This MRI axial image demonstrates dilatation of the lateral ventricles. Noncommunicating obstructive hydrocephalus caused by obstruction of foramina of Luschka and Magendie. This MRI axial image demonstrates fourth ventricle dilatation. Congenital hydrocephalus applies to the ventriculomegaly that develops in the fetal and infancy periods, often associated with macrocephaly.^[4] The most common causes of congenital hydrocephalus are obstruction of the cerebral aqueduct flow, Arnold-Chiari malformation or Dandy–Walker malformation.^[5] these patients may stabilize in later years due to compensatory mechanisms but may decompensate, especially following minor head injuries. During these decompensations, determining the extent to which any new neurological deficits may be due to the new acute event, compared with hydrocephalus that may have gone unnoticed for many years, is difficult.

Hydrocephalus Signs and Symptoms

Symptoms of hydrocephalus are determined by the following factors:

• Age
• Degree of ventricular enlargement
• Rate of hydrocephalus development
• Type
• Underlying condition

Symptoms of Hydrocephalus in Infants

The characteristic symptom seen in infants is enlargement of the head. An infant's skull expands to accommodate excess CSF because the bones of the skull have not closed yet.
Very young children commonly experience irritability, poor feeding, and lethargy.

Symptoms of Hydrocephalus in Children and Adults

Children and adults may experience the following symptoms:

• Blurred or double vision
• Cognitive difficulties
• Downward gaze or "sun-setting eyes"
• Headache
• Imbalance and dizziness
• Incontinence
• Irregular gait
• Lethargy
• Nausea
• Poor coordination
• Visual disturbances
• Vomiting
• Weakness

Diagnosis of Hydrocephalus

If you think that you or someone you care about may have hydrocephalus, we recommend you learn about the symptoms and diagnostic tests for this condition. We also encourage you to trust your instincts. If you notice changes or have an intuitive feeling that something is not right with the person you are concerned about, act on that feeling and seek medical attention.
Only a medical doctor can make a diagnosis of hydrocephalus. The information here is intended to help you understand and navigate through the process of seeking medical advice. In children, it is often a pediatrician who first suspects hydrocephalus. A pediatric neurosurgeon will typically make the final diagnosis. In adults, hydrocephalus is often diagnosed by a neurologist working with a neurosurgeon.
If you have already received a diagnosis, the information below will help you make sense of the classifications and causes of hydrocephalus.

Symptoms and Diagnostic Tests

Symptoms of untreated hydrocephalus are variable. During pregnancy, routine ultrasound can detect enlarged ventricles (spaces) within the baby’s brain. In children the symptoms tend to be related to high pressure and may include nausea, vomiting, headache and vision problems. In young and middle aged adults symptoms run the gamut of those seen in children and in older adults and most often include dizziness and vision problems. In older adults with NPH the symptoms are more likely to be loss of function in three main areas: walking, thinking and bladder control.

Infants and Children	Young & Middle Aged Adults	Older Adults (NPH)
Abnormal Head Enlargement	Difficulty Walking	Difficulty Walking
Tense, Bulging Fontanel	Cognitive Challenges	Cognitive Challenges
Prominent Scalp Veins	Urinary Urgency or Incontinence	Urinary Urgency or Incontinence
Skull bones may feel seperated	Chronic Headaches
Vomiting, Sleepiness, Irritability
Headache, Nausea, Vomiting, Vision
Downward Deviation of Eyes

The most common initial diagnostic test to determine hydrocephalus at any age is an image of the brain (CT Scan or MRI) to identify the enlarged ventricles (spaces) within the brain that are typical of hydrocephalus. More tests are often performed in adults. The following links take you to detailed information about the signs, symptoms and diagnostic tests for hydrocephalus in various age groups.

Acute hydrocephalus treatment

For initial treatment of acute hydrocephalus one will initially use medicines which reduce CSF production, and lumbar punctures. Mesurements of inter-cranial pressure, and the various scanning techniques are used to asses the further treatment.

If the CSF pressure does not return to normal other methods may be used to release the pressure such as "ventricular taps" where the CSF is drained dirrectly from the ventricule.

After some time it will become clear wether the increase in pressure has stopped, or has become continuous and requires surgical treatment.

Treating the causes

Treatment of the causative factors is the best strategy. When the ventricles are enlarged one needs to determine the cause. In the case of obstructive hydrocephalus, an unequal enlargement of the ventricles will point to the location of the obstruction. Causative factors for the obstruction are then searched for. Tumours or blood clots can obstruct the CSF pathways, and their removal can often re-establish a normal CSF flow pathway. Obstruction at the aqueduct or the outlets of the fourth ventricle can often be treated by surgically creating a new outlet for the ventricles, through the floor of the third ventricle (third ventriculostomy). Blockage of the foramen of Monroe with a resultant trapped lateral ventricle can be treated by surgically creating a window through the curtain of tissue separating the two lateral ventricles (septal fenestration).

Endoscopy operations involve inserting a small endoscope into the ventricle through a single small hole in the skull. The endoscope is connected via a micro-camera to a television monitor on which the surgeon can see inside the ventricles. Using these endoscopes, neurosurgeons can now create a bypass, allowing CSF to flow around certain blockages and restoring normal flow. Only certain patients are eligible for endoscopic surgery, and the patients must be selected carefully. In particular, patients with blockages within the ventricles themselves (those with obstructive hydrocephalus) are potentially candidates for endoscopic surgery.

When the CT or MRI scans show a case of hydrocephalus which cannot be dealt with using one of the above techniques, a permanent device needs to be surgically implanted to draw the fluid out of the ventricles and to carry it to some other cavity within the body where it will be reabsorbed into the blood stream. Such devices are called shunts and they became practical in the 1950's when common problems with hydrocephalus treatments were being solved. These consisted of rejection of the tubing by the body's defences, as well as infections and blockages of the tube. 

Encephalitis

Encephalitis, an inflammation of the brain parenchyma, presents as diffuse and/or focal neuropsychological dysfunction. Although it primarily involves the brain, the meninges are frequently involved (meningoencephalitis).
From an epidemiologic and pathophysiologic perspective, encephalitis is distinct from meningitis, though on clinical evaluation both can be present, with signs and symptoms of meningeal inflammation, such as photophobia, headache, or stiff neck. It is also distinct from cerebritis. Cerebritis describes the stage preceding abscess formation and implies a highly destructive bacterial infection of brain tissue, whereas acute encephalitis is most commonly a viral infection with parenchymal damage varying from mild to profound.
Although bacterial, fungal, and autoimmune disorders can produce encephalitis, most cases are viral in origin. The incidence of encephalitis is 1 case per 200,000 population in the United States, with herpes simplex virus (HSV) being the most common cause. Considering the subacute and chronic encephalopathies, the emergency department (ED) physician is most likely to encounter toxoplasmosis in an immune-compromised host.
The relatively common acute arboviral encephalitides vary widely in epidemiology, mortality, morbidity, and clinical presentation, and no satisfactory treatment exists for these infections. However, attempts to distinguish these acute arboviral encephalitides from the treatable acute viral encephalitides due to herpes simplex or varicella are important.
Herpes simplex encephalitis (HSE), which occurs sporadically in healthy and immune-compromised adults is also encountered in neonates infected at birth during vaginal delivery and is potentially lethal if not treated. Varicella-zoster virus encephalitis (VZVE) is life threatening in immune-compromised patients. Swift identification and immediate treatment of HSE or VZVE can be lifesaving. From a risk-benefit standpoint, most authorities recommend initiating ED treatment with acyclovir in any patient whose central nervous system (CNS) presentation is suggestive of viral encephalitis, especially in the presence of fever, encephalopathy, or focal findings, and in all neonates who appear ill for whom a CNS infection is being considered.

Encephalitis Causes

• Herpes simplex (HSV): This type of virus causes cold sores and lesions of the genitals. HSV is transmitted directly through human contact. Newborns can also get the virus by passing through an infected birth canal. Once inside the body, the virus travels through nerve fibers and can cause an infection of the brain. The virus may also undergo a period of latency in which it is inactive. At a later time, emotional or physical stress can reactivate the virus to cause an infection of the brain. It causes the most subacute (between acute and chronic) and chronic (lasting three or more months) encephalitis infections in humans.
• Arbovirus: Hosts are animals such as birds, pigs, chipmunks, and squirrels that carry the virus. Mosquitoes (known as vectors or ways of transmitting the virus) feed on these animals and become infected. The virus grows and cycles between the hosts and the vectors. Humans become infected through mosquito bites. Once inside the body, the virus replicates and travels in the bloodstream. If there is a large enough amount of the virus, the brain can become infected. The majority of cases occur between June and September when the mosquitoes are most active. In warmer climates, the disease can occur year-round.

Figure 2: Picture of arbovirus transmission cycle and worldwide distribution; SOURCE: CDC.

• West Nile virus (WNV): This virus was first isolated from an adult woman with a fever in the West Nile District of Uganda in 1937. The nature of the virus was studied in Egypt in the 1950s. In 1957, as a result of an outbreak in Israel in the elderly, the WNV became recognized as a cause for severe inflammation of the spinal cord and brain in humans. In the early 1960s, it was first noted that horses were becoming ill in Egypt and France. This virus then emerged in North America in 1999, with encephalitis reported in humans and horses.
• The virus cycles between the Culex mosquito and hosts such as birds, horses, cats, bats, chipmunks, skunks, squirrels, and domestic rabbits. The mosquito feeds on the infected hosts, carries the virus in its salivary glands, and then passes it on to humans or other animals during a blood meal. It usually takes three to 15 days from the time of infection to the onset of disease symptoms. In the U.S., crows became a major host, but the disease would kill the crows; as a result, the number of infections dropped dramatically as the crow population died off.
• West Nile encephalitis is not transmitted from person to person (such as through touching or kissing or from a health care worker caring for a sick person) nor can it be passed from animal to human. Blood transfusions are the exception; the virus may be passed among people with blood transfusions.
• The chance that people will become severely ill from a mosquito bite is extremely small. According to the Centers for Disease Control and Prevention (CDC), even in areas where mosquitoes are reported to carry the virus, much fewer than 1% are infected. Furthermore, less than 1% of the people who get bitten and become infected will become severely ill. Therefore, the majority of cases are mild, and people can fully recover. The CDC reported 690 people infected in 2011,with a total of 43 deaths.
• Prognosis is usually guarded in the extremes of age (infants, young children, and the elderly). Death rates as a result of West Nile encephalitis range from 3%-15% and are highest among the elderly. At the present time, there is no documented evidence to suggest that a pregnancy is at risk due to WNV infection. It is assumed that if a person contracts WNV, he or she will develop a natural immunity that is lifelong. However, it may wane in later years. Currently, as of 2012, there is no commercially available vaccine for humans.
• La Crosse encephalitis: The first case occurred in La Crosse, Wisconsin, in 1963. Since then, the largest number of cases has been identified in woodland areas of the Midwestern and Mid-Atlantic United States. This virus is the most common cause of mosquito-borne encephalitis in children younger than 16 years of age. Each year, about 75 cases are reported to the Centers for Disease Control and Prevention (CDC). The virus cycles between the daytime-biting treehole mosquito (Aedes triseriatus) and hosts such as chipmunks and squirrels. Some investigators consider the cause of California encephalitis to be the La Crosse virus. The La Crosse encephalitis virus can cause adverse effects on IQ and school performance. About 80-100 people are diagnosed each year in the U.S., and 1% of people with this infection may die.
• St. Louis encephalitis: Since 1964, an average of about 102 people are reported infected per year. Outbreaks can occur throughout most of the United States, although large urban epidemics have occurred in the Midwestern and Southeastern regions. The last major epidemic of St. Louis encephalitis occurred in the Midwest from 1974-1977. There were 2,500 cases in 35 states reported to the CDC. Most recently, there were 20 reported cases in New Orleans in 1999. The virus cycles between birds and the Culex mosquitoes breeding in stagnant water. It grows in both the mosquito and the bird but does not make either one sick. Only the infected mosquito can transmit the disease to humans during the blood meal. The virus cannot be transmitted from person to person through kissing or touching nor can it be transmitted from the infected bird. The disease tends to affect mostly adults and is generally milder in children.
• Eastern equine encephalitis (EEE): According to the CDC, there have been confirmed cases in the United States since 1964 with a rate of about 0-21 diagnosed infections per year (average about six per year). This virus is found along the East and Gulf Coasts. The virus causes severe disease in horses, puppies, and birds such as pheasants, quails, and ostriches. In humans, flulike symptoms develop four to 10 days after the bite of an infected mosquito. Usually, human illnesses are preceded by those in horses. EEE can cause death in 50%-75% of all human infections; 90% of infected people have mild to severe impairments. Those who recover may suffer severe permanent brain damage such as mental retardation, seizures, paralysis, and behavior abnormalities.
• Western equine encephalitis (WEE): This virus was isolated from the brain of a horse with encephalitis in California in 1930. The worst epidemic was in Canada and the western U.S. when over 300,000 horses and mules were diagnosed along with over 3,300 humans in 1941. Since 1964, there have been at least 639 confirmed cases, but currently only a few per year are reported. However, it remains a cause of encephalitis in the western part of the United States and Canada. In 1994, there were two confirmed and several suspected cases of WEE reported in Wyoming. In 1997, 35 strains of WEE virus were isolated from mosquitoes collected in Scotts Bluff County, Nebraska. The WEE virus cycles between certain types of birds (small, mostly songbirds) and the Culex tarsalis mosquitoes, a species associated with irrigated agriculture and stream drainage. The virus has also been found in several other mammals. Horses and humans become sick through mosquito bites by infected mosquitoes. Infants are particularly affected and can have permanent problems such as seizure disorders and developmental delay as a result of the infection. A vaccine is not available for humans.
• Venezuelan equine encephalitis (VEE): This virus is found in Central and South America and is a rare cause of encephalitis in the southwestern part of the United States. It is an important cause of encephalitis in horses and humans in South America. From 1969-1971, an outbreak from South America to Texas killed over 200,000 horses. In 1995, there were an estimated 90,000 human infections with VEE in Columbia and Venezuela. The virus cycles between forest-dwelling rodents and mosquito vectors, especially the species Culex. VEE infection in humans is much less severe than that of WEE and EEE. While adults tend to develop a flulike illness, children tend to develop overt encephalitis. Deaths are rare in humans but are common in horses. There is an effective vaccine for horses but none for humans.
• Japanese encephalitis: This virus is responsible for 50,000 cases and 15,000 deaths per year. Most of China, Southeast Asia, and the Indian subcontinent are affected. The geographic distribution is expanding. Rarely, cases may appear in United States civilians and military personnel traveling to and living in Asia. Children and young adults are mostly affected. Older adults are affected when there are epidemics in new locations. The virus cycles between domestic pigs, wild birds, and the Culex tritaeniorhynchus mosquitoes, which breed in rice fields. The disease is not transmitted through human contact, pigs, or birds. Only the mosquitoes can transmit the disease during feedings.
• The following is a short summary of the viruses that cause the majority of encephalitis infections, although they may also cause other diseases.

Disease	Geographic Location	Vector/ Hosts	Comment
Herpes encephalitis	United States/the world	Human-to-human contact	Prompt treatment with acyclovir increases survival to 90%
West Nile encephalitis	Africa, West Asia, Middle East, United States	Mosquito/mostly birds	Majority are mild cases. Less than 1% of those infected will become severely ill. Full recovery is expected. A vaccine for humans is not commercially available.
Eastern equine encephalitis	East Coast (from Massachusetts to Florida), Gulf Coast	Mosquito/birds	Often occurs in horses. High mortality rate (50%-75%); frequent outcomes (seizures, slight paralysis), especially in children
Western equine encephalitis	Western United States and Canada	Mosquito/birds	Often occurs in horses. Particularly affects infants
Venezuelan equine encephalitis	Western Hemisphere	Mosquito/rodents	Rare in United States; low mortality rate, rare after-effects
La Crosse encephalitis	Throughout the United States, especially in midwestern & southeastern regions	Mosquito/ chipmunks, squirrels	Most common cause of encephalitis in children younger than 16 years of age
St. Louis encephalitis	Midwestern & mid-Atlantic United States	Mosquito/birds	Mostly affects adults
Japanese encephalitis	Temperate Asia, southern and southeastern Asia	Mosquito/birds and pigs	Vaccine available for ages 17 and older. See Prevention section. High morbidity/mortality rates

Other causes of encephalitis are as follows but will not be further discussed in this article; the reader is referred to the links provided:

• Bacteria, such as N. meningitidis, and those that cause Lyme disease, syphilis, tuberculosis, and occasionally other bacteria
• Fungi such as Candida, Mucor, Cryptococcus, and others
• Parasites such as Toxoplasma (often seen in HIV-infected patients) or the parasite Naegleria
• Allergies to vaccinations
• Autoimmune disease such as Rasmussen's encephalitis
• Cancers involving the brain tissue

Signs & Symptoms

Initially, the signs and symptoms of encephalitis are similar to that of flu or any other viral infection symptoms. Encephalitis can affect any brain function and the common symptoms are:

• Severe headache
• Fever
• Nausea
• Vomiting
• Drowsiness or confusion
• Sensitivity to bright lights
• Loss of memory
• Unable to speak
• Unable to control movement
• Weakness of one or more parts of the body
• Behavior that is not characteristic
• Change to any of the senses, e.g. touch
• Taste
• Smell
• Sight
• Hearing
• Stiff neck and back
• Muscle weakness
• Seizures (fits)
• Sleepiness that may lead to coma. (8)

Neurological complications may be permanent or improve as the infection runs its course with following signs and symptoms:

• Altered mental state (e.g., disorientation, personality changes)
• Convulsions
• Drooping eyelids (ptosis), double vision (diplopia), crossed eyes (strabismus)
• Hyperactive deep tendon reflexes
• Increased intracranial pressure
• Loss of consciousness
• Motor dysfunction
• Partial paralysis (paresis) of the extremities
• Projectile vomiting
• Pupil irregularities
• Restlessness
• Seizures
• Tremors (1)
• 
  

• Medical Tests & Diagnosis Methods/Tools

  Diagnosis of encephalitis is done with the help of the following:
  Medical History: Recent exposure to insects, travel, personality changes and contact with unusual animals or illnesses (9).
  Neurological Examination: Neurological examination consists of several components with each focusing on different parts of the nervous system such as:
  
  • Mental status
  • Cranial nerves
  • Motor system
  • Sensory system
  • The deep tendon reflexes
  • Coordination and the cerebellum
  • Gait
  Therefore, a neurological exam helps evaluate mental status, detect neurological problems such as motor dysfunction and seizures and help determine the area of brain that is affected (9) & (10). Other tests include:
  

  Blood and Urine Tests: These tests help isolate and identify the viruses. Enzyme-linked immunosorbent assays (ELISA), including IgM-capture ELISA (MAC-ELISA) and IgG ELISA can help identify the virus causing encephalitis. Polymerase chain reaction (PCR) helps in identification of small amounts of viral DNA. Imaging Tests: Imaging tests consist of Computed Tomography (CT scan) and Magnetic Resonance Imaging (MRI scan) producing computer images of the brain which help in detecting abnormalities like swelling (edema) and bleeding (hemorrhage). In Electroencephalogram (EEG), electrodes placed on the scalp are used to record and analyze the electrical activity in the brain. Wave patterns thus recorded suggest seizure disorder or specific viral infection.

  Spinal tap: In this procedure, cerebrospinal fluid is collected by inserting a needle between two vertebrae in the lower spine. The fluid is analyzed for an elevated count of White Blood Cells (WBC), blood and presence of virus (9). 
•  

Treatment for mild cases mainly consists of:

• Bed rest
• Plenty of fluids
• Anti-inflammatory drugs — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — to relieve headaches and fever.

Antiviral drugsMore-serious cases of encephalitis usually require aggressive antiviral treatments. Antiviral drugs commonly used to treat encephalitis include:

• Acyclovir (Zovirax)
• Ganciclovir (Cytovene)

Some viruses, such as insect-borne viruses, don't respond to these treatments. However, because the specific virus causing the infection may not be identified immediately or at all, treatment with acyclovir is often begun immediately. This drug can be effective against the herpes simplex virus, which can result in significant complications or death when not treated promptly.
Side effects of the antiviral drugs may include nausea, vomiting, diarrhea, loss of appetite, and muscle or joint soreness or pain. Rare serious problems may include abnormalities in kidney or liver function or suppression of bone marrow activity. Appropriate tests are used to monitor for serious adverse effects.
Supportive careAdditional supportive care also is needed in the hospital for people with severe encephalitis. The care may include:

• Breathing assistance, as well as careful monitoring of breathing and heart function
• Intravenous fluids to ensure proper hydration and appropriate levels of essential minerals
• Anti-inflammatory drugs, such as corticosteroids, to help reduce swelling and pressure within the skull
• Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures.

Follow-up therapyAfter the initial illness, it may be necessary to receive additional therapy depending on the type and severity of complications. This therapy may include:

• Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
• Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities
• Speech therapy to relearn muscle control and coordination to produce speech
• Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes — with medication management if necessary

Down Syndrome

Down syndrome (DS), also called Trisomy 21, is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically. It affects about 1 in every 800 babies born in the United States.
The physical features and medical problems associated with Down syndrome can vary widely from child to child. While some kids with DS need a lot of medical attention, others lead healthy lives.
Though Down syndrome can't be prevented, it can be detected before a child is born. The health problems that may go along with DS can be treated, and many resources are available to help kids and their families who are living with the condition

causes Down syndrome

Down syndrome occurs because of an abnormality characterized by an extra copy of genetic material on all or part of the 21st chromosome. Every cell in the body contains genes that are grouped along chromosomes in the cell's nucleus or center. There are normally 46 chromosomes in each cell, 23 inherited from your mother and 23 from your father. When some or all of a person's cells have an extra full or partial copy of chromosome 21, the result is Down syndrome.

The most common form of Down syndrome is known as Trisomy 21, a condition where individuals have 47 chromosomes in each cell instead of 46. This is caused by an error in cell division called nondisjunction, which leaves a sperm or egg cell with an extra copy of chromosome 21 before or at conception. Trisomy 21 accounts for 95% of Down syndrome cases, with 88% originating from nondisjunction of the mother's egg cell.

The remaining 5% of Down syndrome cases are due to conditions called mosaicism and translocation. Mosaic Down syndrome results when some cells in the body are normal while others have Trisomy 21. Robertsonian translocation occurs when part of chromosome 21 breaks off during cell division and attaches to another chromosome (usually chromosome 14). The presence of this extra part of chromosome 21 causes Down some syndrome characteristics. Although a person with a translocation may appear physically normal, he or she has a greater risk of producing a child with an extra 21st chromosome.


down syndrome symptoms

There are more than 50 features of Down syndrome. But not every person with Down syndrome has all the same features or health problems. Some features and problems are common.

Body shape and size

• Short stature (height). A child often grows slowly and is shorter than average as an adult.
• Weak muscles (hypotonia) throughout the body. Weak belly muscles also make the stomach stick out.
• A short, wide neck. The neck may have excess fat and skin.
• Short, stocky arms and legs. Some children also have a wide space between the big toe and second toe.

Face shape and features

• Slanted eyes. Tissue may also build up on the colored part of the eye (iris). But the child's vision is not affected by this buildup.
• A nasal bridge that looks pushed in. The nasal bridge is the flat area between the nose and eyes.
• Small ears. And they may be set low on the head.
• Irregularly shaped mouth and tongue. The child's tongue may partly stick out. The roof of the mouth (palate) may be narrow and high with a downward curve.
• Irregular and crooked teeth. Teeth often come in late and not in the same order that other children's teeth come in.

Health problems

Health problems related to Down syndrome, such as:

• Intellectual disability. Most children with Down syndrome have mild to moderate cognitive disability.¹
• Heart defects. About half of the children who have Down syndrome are born with a heart defect.
• Hypothyroidism, celiac disease, and eye conditions.
• Respiratory infections, hearing problems, or dental problems.
• Depression or behavior problems associated with ADHD or autism.

Exams and Tests
A doctor can often make an initial diagnosis of Down syndrome at birth based on how the baby looks. The doctor may hear a heart murmur when listening to the baby's chest with a stethoscope.
A blood test can be done to check for the extra chromosome and confirm the diagnosis. See: Chromosome studies
Other tests that may be done include:

• Echocardiogram to check for heart defects (usually done soon after birth)
• ECG
• X-rays of the chest and gastrointestinal tract

Persons with Down syndrome need to be closely screened for certain medical conditions. They should have:

• Eye exam every year during infancy
• Hearing tests every 6 - 12 months, depending on age
• Dental exams every 6 months
• X-rays of the upper or cervical spine between ages 3 - 5 years
• Pap smears and pelvic exams beginning during puberty or by age 21
• Thyroid testing every 12 months

Because it is a problem with the chromosomes, there are no cures for Down syndrome. Therefore, treatment for the condition focuses on controlling symptoms and any medical conditions that result because of Down syndrome.

A new prenatal test for Down's syndrome hit the market in Germany and several other European countries Monday, the manufacturer said, amid a controversy over whether it could lead to more abortions.
The product, marketed as PrenaTest and manufactured by German life sciences company LifeCodexx, "is targeted exclusively toward women in their 12th week of pregnancy and beyond who are at an increased risk" of delivering a child with Down's syndrome, the company said in a statement.
The test which involves screening pregnant women's blood samples for the presence of foetal Down's syndrome -- also known as trisomy 21 -- had recently come under fire from rights groups concerned about abortions.
In June, the international federation of Down's syndrome organisations objected to such testing at the European Court of Human Rights.
The federation, grouping 30 associations in 16 countries, said the Strasbourg court should "recognise the human condition and protect the right to life of people with Down's syndrome and those handicapped".
But last month, Switzerland gave the test the green light with a decision by Swissmedic, the national agency for therapeutic products.
Germany's ombudsman for the disabled, Hubert Huppe, for his part called the test "illegal", fearing a "selection of man by Down's Syndrome", but it did not stop the test from going to market.
Down's syndrome is caused by having an extra copy of chromosome 21 and the risk increases as a woman gets older.
LifeCodexx described their procedure as a "risk-free alternative to common invasive examination methods such as amniocentesis".
Invasive procedures currently used for prenatal diagnosis -- in the 16th week of pregnancy -- pose a one percent risk of foetal loss. The diagnosis is therefore only made available to high risk women, which fails to catch all cases.
Besides Germany and Switzerland, the test is also now available in Austria and Liechtenstein.


Read more: http://www.nydailynews.com/life-style/health/syndrome-testing-sparks-abortion-controversy-article-1.1141012#ixzz24CI5r1iR

Treatment for Down syndrome can include:

• Regular checkups and screening
• Medications
• Surgery
• Counseling and support.

Regular Checkups and Screening as Part of Down Syndrome Treatment

People with Down syndrome are at increased risk for certain medical problems, such as:

• Congenital heart disease
• Leukemia and other cancers
• Immune system problems
• Thyroid problems
• Bone, muscle, nerve, or joint problems
• Hearing problems
• Eye problems
• Seizure disorders
• Developmental delay
• Mental retardation
• Premature aging
• Alzheimer's disease.

Because of these medical conditions and their associated complications, a person with Down syndrome is at increased risk of premature death. Regular checkups are important. These visits help ensure that any changes in health are noted and treated if necessary.

The doctor may also schedule certain screening tests to look for problems before symptoms occur. This is important, given the increased risk of vision and hearing problems, infections, and cancer in people with Down syndrome.

Medications Used to Treat Down Syndrome

Medications can be used to treat certain conditions that occur in someone with Down syndrome. At this point, however, there is no medicine that will cure the disorder.

Surgical Treatments for Down Syndrome

Some medical conditions seen in people with Down syndrome require surgery. For example, approximately half of the children with Down syndrome have congenital heart disease and associated early onset of pulmonary hypertension (high blood pressure in the lungs).

Common congenital heart problems include:

• Tetralogy of Fallot
• Persistent ductus arteriosus
• Atrial septal defect
• Ventricular septal defect.

If the heart defects have been identified before the onset of pulmonary hypertension, surgery has provided favorable results.

Furthermore, cataracts occur in approximately 3 percent of children with Down syndrome. Cataracts can generally be removed surgically (see Cataract Surgery).

Treatment for Down Syndrome: Counseling and Support

Counseling for parents and people with Down syndrome at different stages of development has been shown to be beneficial. Learning as much as possible about Down syndrome and possible problems is also important. Doctors, nurses, and other members of the healthcare team can answer questions about Down syndrome treatment options.

Patients and their families often find they need help coping with the emotional and practical aspects of Down syndrome. Meeting with a social worker, counselor, or member of the clergy can be helpful for those who want to talk about their feelings or discuss their concerns.

Down syndrome support groups can also help. In support groups, patients and their family members get together to share what they have learned about coping with the disease. People with Down syndrome may want to talk with a member of their healthcare team about finding a support group. These groups can offer support in person, over the telephone, or on the Internet.

Cerebral Palsy

Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.
CP is usually caused by brain damage that occurs before or during a child's birth, or during the first 3 to 5 years of a child's life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition

Types of cerebral palsy are as follows:

• Spastic (pyramidal): Increased muscle tone is the defining characteristic of this type. The muscles are stiff (spastic), and movements are jerky or awkward. This type is classified by which part of the body is affected: diplegia (both legs), hemiplegia (one side of the body), or quadriplegia (the entire body). This is the most common type of CP, accounting for about 70% to 80% of cases.
• Dyskinetic (extrapyramidal): This includes types that affect coordination of movements. There are two subtypes.
  • Athetoid: The person has uncontrolled movements that are slow and writhing. The movements can affect any part of the body, including the face, mouth, and tongue. About 10% to 20% of cerebral palsy cases are of this type.
  • Ataxic: This type affects balance and coordination. Depth perception is usually affected. If the person can walk, the gait is probably unsteady. He or she has difficulty with movements that are quick or require a great deal of control, such as writing. About 5% to 10% of cases of cerebral palsy are of this type.
• Mixed: This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid. 

Many individuals with cerebral palsy have normal or above average intelligence. Their ability to express their intelligence may be limited by difficulties in communicating. All children with cerebral palsy, regardless of intelligence level, are able to improve their abilities substantially with appropriate interventions. Most children with cerebral palsy require significant medical and physical care, including physical, occupational, and speech/swallowing therapy.
Despite advances in medical care, cerebral palsy remains a significant health problem. The number of people affected by cerebral palsy has increased over time. This may be because more and more premature infants are surviving. In the United States, about 2 to 3 children per 1,000 have cerebral palsy. As many as 1,000,000 people of all ages are affected. Cerebral palsy affects both sexes and all ethnic and socioeconomic groups.

cerebral palsy causes
Cerebral palsy results from damage to certain parts of the developing brain.

• This damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life.
• In many cases, the exact cause of the brain damage is never known.

At one time, problems during birth, usually inadequate oxygen, were blamed for cerebral palsy.

• We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal).
• In fact, current thinking is that at least 70% to 80% of cases of cerebral palsy begin before birth (prenatal).
• Some cases begin after birth (postnatal).
• In all likelihood, many cases of cerebral palsy are a result of a combination of prenatal, perinatal, and postnatal factors.

Risk factors linked with cerebral palsy include the following:

• Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother
• Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism
• Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus (Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.)
• Certain hereditary and genetic conditions
• Complications during labor and delivery
• Premature birth
• Low birth weight (especially if less than 2 pounds at birth)
• Severe jaundice after birth
• Multiple births (twins, triplets)
• Lack of oxygen (hypoxia) reaching the brain before, during, or after birth
• Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding

cerebral palsy symptoms
person with cerebral palsy will generally show symptoms during the first three years of life. A child/baby with cerebral palsy may have some of the signs and symptoms below:

• Achieves developmental milestones, such as crawling, walking, or speaking, later than his/her peers.
  
• Crawls in an unusual way.
  
• Has abnormal muscle tone - the child will slouch while sitting. Muscle tone refers to a person's automatic ability to tighten and relax muscle when required.
  
• Has difficulty feeding and sucking.
  
• Lies down in awkward positions.
  
• Can be easily startled.
  
• Favors one side of the body over the other.
  
• Has overdeveloped or underdeveloped muscles (has floppy or stiff movements).
  
• Has bad coordination and balance (ataxia).
  
• Has involuntary, slow writing movements (athetosis).
  
• Muscles are stiff and contract abnormally (spastic paralysis).
  
• Has hearing problems.
  
• Has problems with eyesight.
  
• Has bladder control problems.
  
• Has bowel movement control problems.
  
• Has seizures.
  
• Has problems swallowing.
  
• Range of movements are limited.

There are several types of cerebral palsy

Spastic cerebral palsy

• Spastic hemiplegeia
  
  A child with spastic hemiplegeia will typically have spasticity (muscle stiffness) on one side of the body - usually just a hand and arm, but may also involve a leg. The side that is affected may not develop properly. The child may have speech problems. In the majority of cases intelligence is not affected. Some children will have seizures.
  
• Spastic diplegia
  
  The lower limbs are affected, and there is no or little upper body spasticity. The child's leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when the child is upright is often referred to as scissoring.
  
• Spastic quadriplegia
  
  The child's legs, arms, and body are affected. This is the severest from of spastic cerebral palsy. Children with this kind of cerebral palsy are more likely to have mental retardation. Walking and talking will be difficult. Some children have seizures.

Ataxic cerebral palsy

Diagnosis of and Tests for Cerebral Palsy

Diagnosing cerebral palsy takes time. There is no test that confirms or rules out cerebral palsy.
In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years.
For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of age. For example, the average age of diagnosis for a child with spastic diplegia, a very common form of cerebral palsy, is 18 months.
This can be a difficult time for parents who suspect something might be different about their child. Often, parents are first to notice their child has missed one of the age-appropriate developmental milestones.
If a growth factor is delayed, parents may hope their child is just a slow starter who will “catch up.” While this may be the case, parents should inform the child’s doctor of concerns, nonetheless.
Confirming cerebral palsy can involve many steps. The first is monitoring for key indicators such as:

• When does the child reach development milestones and growth chart standards for height and weight?
• How do the child’s reflexes react?
• Does it seem as if the child is able to focus on and hear his or her caregivers?
• Does posture and movement seem abnormal?

Doctors will test reflexes, muscle tone, posture, coordination and other factors, all of which can develop over months or even years. Primary care physicians may want to consult medical specialists, or order tests such as MRIs, cranial ultrasounds, or CT scans to obtain an image of the brain. Even once a diagnosis of cerebral palsy is made, parents may wish to seek a second opinion to rule out misdiagnosis.

A diagnosis is important for many reasons:

• To understand the child’s health status
• To begin early intervention and treatment
• To remove doubt and fear of not knowing
• To find and secure benefits to offset the cost of raising a child with cerebral palsy

A variety of benefit programs are available to children with disability or impairment. To qualify for these programs, the child must have a formal diagnosis. Without a diagnosis, parents can fall into a limbo pattern

The process for diagnosing cerebral palsy usually begins with observations made by the child’s primary care physician, usually a pediatrician, and the child’s parents. There are some exceptions.
If a baby is born prematurely, or at a low birth weight, he or she is monitored closely in the neonatal intensive care unit of the hospital from time of birth. In extreme cases of child abuse, or shaken baby syndrome a pediatric neurologist called to the hospital’s emergency or NICU unit will diagnosis the child’s condition. In the majority of cases the child will attend regular well-baby visits where the pediatrician first uncovers signs of cerebral palsy during examination. In some cases, it is the parents who notice symptoms they relay to the child’s doctor during these visits.
Developmental delay, abnormal growth charts, impaired muscle tone, and abnormal reflexes are early indications of cerebral palsy. Because there is no test that definitely confirms or rules out cerebral palsy, other conditions must be excluded from the list of possible causes, and cerebral palsy must be fully considered. Other disorders and conditions can appear as cerebral palsy, and cerebral palsy is often accompanied by associated conditions that complicate the process of diagnosis.
The medical examination process can involve multiple doctors, tests, and appointments. During this time doctors will rule out other similar conditions such as:

• Degenerative nervous disorders
• Genetic diseases
• Muscle diseases
• Metabolism disorders
• Nervous system tumors
• Coagulation disorders
• Other injuries or disorders which delay early development, some of which can be “outgrown”

Common tests that involve neurologists or neuroradiologists, include neuroimaging, such as cranial ultrasound, computed tomography scan (CT Scan), and magnetic resonance imaging scans (MRIs). These tests allow neurologists to actually “see” the brain. Various disorders, injuries, and conditions yield different results. These can be used to rule out cerebral palsy.
Infants who test positive for a developmental disorder may be referred to medical specialists for further evaluations.
A child may be sent to an orthopedic surgeon to ascertain delay in motor development, record persistence of primitive reflexes, examined for dislocated hips, and assessed for abnormal posture.
Medical specialists are brought in to test hearing, vision, and perception, as well as cognitive, behavioral, and physical development.
A genetic specialist may be consulted for hereditary components.
The pediatrician will document all surveillance, screening, evaluation, and referral activities in the child’s health record.
The lengthy and detailed process can help rule out or confirm cerebral palsy. A formal diagnosis is usually made once the brain is fully developed between 2 to 5 years of age.

• Pediatrician
• Developmental Behavioral Pediatrician
• Geneticist
• Neurologist
• Neuroradiologist
• Ophtalmologists
• Orthopedic Surgeon
• Otologists
• Neonatologists
• Pediatric Geneticists

After the child has been diagnosed with cerebral palsy, the doctors will ascertain the extent, location and severity of the condition as well as any associative conditions or co-mitigating factors. Cerebral palsy cannot be cured, however it can be managed. The focus of treatment will be on the management of the child’s health status. This often requires a team of medical specialists. For more information on the management of cerebral palsy

Treating cerebral palsy: treatments of CP including various therapies and attending disciplines.

Treatment options that this website explores includes behavioral therapy, counseling, braces, drugs, mechanical aids, music therapy, dance therapy, physical therapy, occupational therapy, play therapy, speech & language therapy and surgery including specialists such as audiologists, developmental pediatricians, neurologists, nutritionists, occupational therapists, orthopedic surgeons, and speech pathologists.

Brain Tumour and Brain Cancer

brain tumor is an abnormal mass of tissue in which some cells grow and multiply uncontrollably, apparently unregulated by the mechanisms that control normal cells. The growth of a tumor takes up space within the skull and interferes with normal brain activity. A tumor can cause damage by increasing pressure in the brain, by shifting the brain or pushing against the skull, and by invading and damaging nerves and healthy brain tissue. The location of a brain tumor influences the type of symptoms that occur. This is because different functions are controlled by different parts of the brain. Brain tumors rarely metastasize (spread) to other parts of the body outside of the central nervous system (CNS). The CNS includes the brain and spinal cord.
Some tumor types are more common in children than in adults. When childhood brain tumors occur in adults, they often occur in a different part of the brain than in children. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, whereas others, such as medulloblastomas, more commonly affect boys and young men.
The prognosis for brain tumor patients is as individual as the patients themselves. Your doctors will help you understand the possible repercussions of your specific tumor.

 Symptoms of brain tumours

Symptoms due to increased pressure in the skull

The brain is contained within the skull and has a fixed amount of space. If a tumour grows in the brain it will often cause an increase in pressure within the skull, which can cause symptoms to develop. An increase of pressure in the skull is called raised intracranial pressure (ICP). The most common symptoms of raised pressure within the brain are headaches, feeling sick (nausea) and being sick (vomiting).
Of course, many other things can cause headaches or feelings of sickness, but if you have either of these for over a week with no sign of getting better, it’s important that you see your GP to get them checked out.

Headaches

A pressure headache is usually dull and constant, and occasionally throbbing. Severe headaches are uncommon. A headache may get worse when you cough, sneeze, bend down or do any hard physical work. All of these tend to raise pressure in the brain. Headaches may be worse at night and may wake you.

Feeling sick (nausea) and vomiting

If the raised pressure makes you sick, it may be worse in the morning than during the day. It may also get worse if you suddenly change position, for example from sitting or lying to standing. 

Seizures

Seizures (fits) are another common symptom of brain tumours. Some people may experience muscle spasms, which could be twitching or jerking of an arm or leg, or sometimes the whole body. Occasionally they can cause moments of unconsciousness.
A seizure can be a frightening experience. If you have one you should seek medical help so that the cause can be diagnosed and treated. It’s important to remember that a seizure can be caused by medical conditions other than a brain tumour.

Drowsiness

Another possible symptom is drowsiness. This can happen as the pressure in the skull increases. You may find that you sleep more or that you drop off during the day when you wouldn’t normally.
As well as the symptoms described here, raised intracranial pressure can also cause changes to your sight, such as blurred vision, ‘floating objects’ and tunnel vision. It may also make you confused or affect your balance. 

Symptoms connected with the tumour’s position

Some symptoms may be caused by tumours in particular parts of the brain. Sometimes a headache can feel worse on the same side of the head as the tumour. In general, each area of the brain controls different functions. A tumour in a particular part of the brain may prevent that area of the brain from working normally.
Some of these symptoms are listed on the following pages, grouped under the different parts of the brain. They are included as a guide. An exact diagnosis can only be made by a doctor and confirmed by tests.
The diagram showing the lobes and functions of the brain| show some of the different functions of each area of the brain.
Frontal lobe − changes in personality and intellect; uncoordinated walking or weakness of one side of the body; loss of smell; occasional speech difficulties.
Parietal lobe − difficulty speaking or understanding words; problems with writing, reading or doing simple calculations; difficulty coordinating certain movements, and finding your way around; numbness or weakness on one side of the body.
Temporal lobe − seizures, which may cause strange sensations: a feeling of fear or intense familiarity (déjà vu), strange smells or blackouts; speech difficulties; memory problems.
Occipital lobe − loss of vision to one eye, which the person may not notice at first and may sometimes be discovered during routine eye tests.
Cerebellum − lack of coordination; slurred speech (dysarthia); unsteadiness; flickering involuntary movement of the eyes (nystagmus); vomiting and neck stiffness.
Brain stem − unsteadiness and an uncoordinated walk; facial weakness, a one-sided smile or drooping eyelid; double vision; difficulty speaking and swallowing; vomiting or headache just after waking (this is rare). Symptoms may appear gradually.
Meninges – headaches, sickness and problems with sight and movement.
Pituitary gland – the pituitary gland produces lots of different hormones so a tumour in the gland can cause a variety of symptoms including: irregular periods; infertility; weight gain; lethargy; high blood pressure; diabetes; mood swings; and enlarged hands and feet. A tumour in the pituitary gland can also cause pressure on the nerves to the eyes, causing tunnel vision.
All the above symptoms may be caused by conditions other than a brain tumour. If you have any of the symptoms described it’s important to see your GP.

Personality changes

Sometimes brain tumours may cause changes in personality or behaviour. This usually happens when the tumour is in the brain’s cerebral hemispheres. This situation can be very unsettling for the person and their family. Sometimes a referral to a psychologist for assessment and support can help.

Driving
As brain tumours can cause changes in the way the brain works, it may be dangerous to drive. In the UK, there are laws that restrict some people with brain tumours from driving for a while. The restrictions vary with the type of tumour you have, and the type of driving license you hold.
You’ll not usually be allowed to drive for at least a year after the condition has been diagnosed and, in some circumstances, you may not be allowed to drive again. With some types of benign tumours you may be able to drive again once you have recovered from your treatment.
It’s your legal responsibility, not your doctor’s, to tell the Drivers and Vehicle Licensing Authority (DVLA)| about your illness. The DVLA will advise you of any restrictions on your right to drive. You can speak to the DVLA on 0300 790 6806 (car and motorcycle licence holders) or 0300 790 6807 (bus, coach and lorry driver licence holders). You should also inform your vehicle insurance company.

Diagnosis of Brain Tumors

To find the cause of a person's symptoms, the doctor asks about the patient's personal and family medical history and performs a complete physical examination. In addition to checking general signs of health, the doctor does a neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain. Depending on the results of the physical and neurologic examinations, the doctor may request one or both of the following: A CT (or CAT) scan is a series of detailed pictures of the brain. The pictures are created by a computer linked to an x-ray machine. In some cases, a special dye is injected into a vein before the scan. The dye helps to show differences in the tissues of the brain. MRI (magnetic resonance imaging) gives pictures of the brain, using a powerful magnet linked to a computer. MRI is especially useful in diagnosing brain tumors because it can "see" through the bones of the skull to the tissue underneath. A special dye may be used to enhance the likelihood of detecting a brain tumor. The doctor may also request other tests such as: A skull x-ray can show changes in the bones of the skull caused by a tumor. It can also show calcium deposits, which are present in some types of brain tumors. A brain scan reveals areas of abnormal growth in the brain and records them on special film. A small amount of a radioactive material is injected into a vein. This dye is absorbed by the tumor, and the growth shows up on the film. (The radiation leaves the body within 6 hours and is not dangerous.) An angiogram, or arteriogram, is a series of x-rays taken after a special dye is injected into an artery (usually in the area where the abdomen joins the top of the leg). The dye, which flows through the blood vessels of the brain, can be seen on the x-rays. These x-rays can show the tumor and blood vessels that lead to it. A myelogram is an x-ray of the spine. A special dye is injected into the cerebrospinal fluid in the spine, and the patient is tilted to allow the dye to mix with the fluid. This test may be done when the doctor suspects a tumor in the spinal cord

Diagnosis of Brain Tumors

To find the cause of a person's symptoms, the doctor asks about the patient's personal and family medical history and performs a complete physical examination. In addition to checking general signs of health, the doctor does a neurologic exam. This includes checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain. Depending on the results of the physical and neurologic examinations, the doctor may request one or both of the following: A CT (or CAT) scan is a series of detailed pictures of the brain. The pictures are created by a computer linked to an x-ray machine. In some cases, a special dye is injected into a vein before the scan. The dye helps to show differences in the tissues of the brain. MRI (magnetic resonance imaging) gives pictures of the brain, using a powerful magnet linked to a computer. MRI is especially useful in diagnosing brain tumors because it can "see" through the bones of the skull to the tissue underneath. A special dye may be used to enhance the likelihood of detecting a brain tumor. The doctor may also request other tests such as: A skull x-ray can show changes in the bones of the skull caused by a tumor. It can also show calcium deposits, which are present in some types of brain tumors. A brain scan reveals areas of abnormal growth in the brain and records them on special film. A small amount of a radioactive material is injected into a vein. This dye is absorbed by the tumor, and the growth shows up on the film. (The radiation leaves the body within 6 hours and is not dangerous.) An angiogram, or arteriogram, is a series of x-rays taken after a special dye is injected into an artery (usually in the area where the abdomen joins the top of the leg). The dye, which flows through the blood vessels of the brain, can be seen on the x-rays. These x-rays can show the tumor and blood vessels that lead to it. A myelogram is an x-ray of the spine. A special dye is injected into the cerebrospinal fluid in the spine, and the patient is tilted to allow the dye to mix with the fluid. This test may be done when the doctor suspects a tumor in the spinal cord

brain tumor diagnoses
Identifying a brain tumor usually involves a neurological examination, brain scans, and/or an analysis of the brain tissue. Doctors use the diagnostic information to classify the tumor from the least aggressive (benign) to the most aggressive (malignant). In most cases, a brain tumor is named for the cell type of origin or its location in the brain. Identifying the type of tumor helps doctors determine the most appropriate course of treatment.
A neurological examination is a series of tests to measure the function of the patient s nervous system and physical and mental alertness. If responses to the exam are not normal, the doctor may order a brain scan or refer the patient to a neurologist or neurosurgeon, who will then order a brain scan.
A brain scan is a picture of the internal structures in the brain. A specialized machine takes a scan in much the same way a digital camera takes a photograph. Using computer technology, a scan compiles an image of the brain by photographing it from various angles.
Some types of scans use a contrast agent (or contrast dye), which helps the doctor see the difference between normal and abnormal brain tissue. The contrast agent is injected into a vein and flows into brain tissue. Abnormal or diseased brain tissue absorbs more dye than normal healthy tissue. The most common scans used for diagnosis are as follows:

MRI (Magnetic Resonance Imaging) is a scanning device that uses magnetic fields and computers to capture images of the brain on film. It does not use x-rays. It provides pictures from various planes, which permit doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors.
CT or CAT Scan (Computed Tomography) combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification. Usually, iodine is the contrast agent used during a CT scan.
PET Scan (Positron Emission Tomography) provides a picture of the brain s activity, rather than its structure, by measuring the rate at which a tumor absorbs glucose (a sugar). The patient is injected with deoxyglucose that has been labeled with radioactive markers. The PET scan measures the brain s activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment).

There some drawbacks to these diagnostic tests, however. Please refer to What else should I know about diagnostic tests? for more information.
A biopsy is a surgical procedure in which a sample of tissue is taken from the tumor site and examined under a microscope. The biopsy will provide information on types of abnormal cells present in the tumor. The purpose of a biopsy is to discover the type and grade of a tumor. A biopsy is the most accurate method of obtaining a diagnosis.
An open biopsy is done during a craniotomy. A craniotomy involves removing a piece of the skull in order to get access to the brain. After the tumor is resected (completely removed) or debulked (partially removed), the bone is usually put back into place. A closed biopsy (also called a stereotactic or needle biopsy) may be performed when the tumor is in an area of the brain that is difficult to reach. In a closed biopsy, the neurosurgeon drills a small hole into the skull and passes a narrow hollow needle into the tumor to remove a sample of tissue.
Once a sample is obtained, a pathologist examines the tissue under a microscope and writes a pathology report containing an analysis of the brain tissue. Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. In some cases, the tissue may be sent to another institution for additional analysis.



about diagnostic tests

Because an MRI uses magnetic fields, people who have metal implanted in their body in any form should let the doctor know about it before scheduling the procedure. An MRI may not be an option for these patients because the intense magnetic fields can damage some types of implanted medical devices. Patients should advise the doctor if they have a pacemaker, cardiac monitor, surgical clip, or facial tattoos.
In a standard MRI scan, the patient lies on a narrow table, which slides through a long, cylindrical tube with a narrow opening. Although there is enough room for the patient s body inside the cylinder, the patient will not be able to move around. The scan takes approximately 15-45 minutes. During the scan, the patient will hear loud banging sounds, caused by the electronics within the machine. Patients may request earplugs to reduce noise. Some people find the MRI claustrophobic and ask for a sedative beforehand to relax. Other people request an open MRI.
An open MRI machine does not have a cylinder, so the patient is not enclosed. The procedure lasts approximately 45 minutes. There is some discussion among doctors concerning the quality of the images of an open MRI compared to the standard or closed MRI.
Contrast agents may cause reactions in some patients. Gadolinium, the contrast agent used with an MRI, may cause temporary headaches. Patients with chronic renal disease may develop a condition called nephrogenic system fibronolysis (NSF). The FDA recommends using gadolinium only when clearly necessary in patients with stage 4 and 5 renal disease, which it defined as a glomerular filtration rate lower than 30 mL per minute per 1.73 m2. If patients with renal insufficiency receive gadolinium, then specific steps are taken to limit the possibility of NSF occurring, Patients undergoing MRI with gadolinium are screened for risk factors prior to receiving the scan.

Iodine is the contrast agent most commonly used for CT scanning. If you know you are allergic to iodine, tell your doctor. Allergic reactions can include rashes, a warm. sensation, or, in rare cases, difficulty breathing.
CT scans involve exposure to ionizing radiation, which is known to cause cancer. This is a concern for people who may need multiple CT scans and for children, because they are more sensitive to radiation than adults. It is wise for people who have had frequent x-ray exams and parents of children who have brain tumors to keep a record of their x-ray history. This information can help doctors make informed decisions and minimize radiation over-exposure

Brain Tumor
Treatment

Treatment for brain tumors depends on a number of factors including the type, location and size of the tumor as well as the patient's age and general health. Treatment methods and schedules differ for children and adults.
Brain tumors are treated with surgery, radiation therapy and chemotherapy. Our doctors also are studying a vaccine for treating a recurrent cancer of the central nervous system that occurs primarily in the brain, known as glioma.
Depending on your needs, several methods may be used. Our team includes neurosurgeons, medical oncologists, radiation oncologists, nurses, a dietitian and a social worker, who work together to provide the best possible care.
Before treatment begins, most patients are given steroids, drugs that relieve swelling or edema. Your may receive anticonvulsant medicine to prevent or control seizures.
If hydrocephalus is present, you may need a shunt to drain cerebrospinal fluid. A shunt is a long, thin tube placed in a ventricle of the brain and then threaded under the skin to another part of the body, usually the abdomen. It works like a drainpipe. Excess fluid is carried away from the brain and is absorbed in the abdomen. In some cases, the fluid is drained into the heart.

Surgery

Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy. Whenever possible, the surgeon attempts to remove the entire tumor. If the tumor cannot be completely removed without damaging vital brain tissue, your doctor may remove as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.
Some tumors cannot be removed. In such cases, your doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps your doctor decide which treatment to use.
Sometimes, a biopsy is done with a needle. Doctors use a special head frame (like a halo) and CT scans or MRI to pinpoint the exact location of the tumor. The surgeon makes a small hole in the skull and then guides a needle to the tumor. Using this technique to do a biopsy or for treatment is called stereotaxis.
Other advanced techniques during surgery include brain mapping to find functional pathways near tumors, endoscopy to perform biopsies and open spinal fluid pathways through a small scope and advanced frameless stereotaxic computer assisted tumor resections. Intraoperative MRI also is available to help maximize tumor removal.

Radiation Therapy

Radiation therapy, also called radiotherapy, is the use of high-powered rays to damage cancer cells and stop them from growing. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy also is used when surgery is not possible.
Radiation therapy may be given in two ways. External radiation comes from a large machine. Generally, external radiation treatments are given five days a week for several weeks. The treatment schedule depends on the type and size of the tumor and your age. Giving the total dose of radiation over an extended period helps to protect healthy tissue in the area of the tumor.
External radiation may be directed just to the tumor, the surrounding tissue or the entire brain. Sometimes the radiation is also directed to the spinal cord. When the whole brain is treated, the patient often receives an extra dose of radiation to the area of the tumor. This boost can come from external radiation or from an implant.
Radiation also can come from radioactive material placed directly in the tumor, or implant radiation therapy. Depending on the material used, the implant may be left in the brain for a short time or permanently. Implants lose a little radioactivity each day. The patient stays in the hospital for several days while the radiation is most active.
The Gamma Knife, or stereotactic radiosurgery, is another way to treat brain tumors. The Gamma Knife isn't actually a knife, but a radiation therapy technique that delivers a single, finely focused, high dose of radiation precisely to its target. Treatment is given in just one session. High-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without damaging other brain tissue.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use just one drug or a combination, usually giving the drugs orally or by injection into a blood vessel or muscle. Intrathecal chemotherapy involves injecting the drugs into the cerebrospinal fluid.
Chemotherapy is usually given in cycles. A treatment period is followed by a recovery period, then another treatment period and so on. Patients often don't need to stay in the hospital for treatment and most drugs can be given in the doctor's office or clinic. However, depending on the drugs used, the way they are given and the patient's general health, a short hospital stay may be necessary.
Advances in chemotherapy include direct placement into the tumor cavity using a new technique called convection enhanced delivery.
Reviewed by health care specialists at UCSF Medical Center