All diseases affecting nerves of the body, particularly the brain, are included in the areas of interest of neurology.
Major Areas of Interest of Neurology
Epilepsy is a disorder that manifests itself in the form of seizures by over- stimulation of cells that make up the brain as a result of temporary abnormal electrical spread. Patients display behavioral, emotional, movement or perception disorders such as loss of consciousness for a certain period of time, body convulsions, fainting, incontinence, shaking off arms and hands, etc.
Epilepsy is the most common neurological disease seen during childhood and puberty. Although it is seen in every age group.
This disease requires a long-term treatment and significantly affects the quality of life. In majority of patients, seizures can be controlled with correct treatment and the patient resumes a normal life. However, in 25% of patients, despite the use of appropriate drugs, seizures can not be controlled. If epilepsy couldn’t be controlled and drug treatment has failed, surgical methods are used.
There are two main types of epilepsy surgery method. The first and the one preferred is removal of the epileptic focus (resective surgery). The other is the surgical method for reducing spread, frequency and severity of seizures by cutting seizure propagation paths(functional surgery, palliative surgery). Resective surgery is mainly applied in resistant epilepsies in which medication therapy has been tried.
Parkinson’s disease resulting from reduction in or damage to dopamine -secreting cells in the brain as one gets older causes movement disorders and involuntary movements. The disease manifests itself by shaking hands and feet, movements slowing down, muscle stiffness and difficulty with walking.
The first treatment to be applied in Parkinson‘s is drug treatment. If the patient has given a positive response to medication, he may live a problem-free life for a long time. However, over the years, due to the progression of the disease and the development of tolerance to the drug, drugs taken in former dose and frequency become inadequate. If the disease cannot be controlled despite higher doses and more frequent administration, i.e. drug treatment gets blocked, then surgery is brought to the agenda.
There are two methods for surgical treatment of Parkinson’s. If symptoms of the disease are on one side, burning technique, similar to laser, is applied. But if the symptoms are in two sides, patients can no longer get up from a seated position or in general terms, both sides have to be treated, then treatment is applied to both sides and often a brain battery is implanted.
The cells responsible for the disease and location of the surrounding anatomical structures are found by a method called ‘ Microelectrode Recording and Stimulation Technique ‘, which is used in surgical interventions and by which electrical activity of the cells in the brain can be listened. Therefore, during this procedure, the patient is kept awake and the procedure is performed while talking to the patient. Hence it will be easier to reach the problem area by measuring the patient’s response. After reaching the corresponding region, burning method is applied or a brain battery is implanted.
Migraine is a type of headache. In migraine, pain is felt on one side of the head and every headache is not migraine.
Headache is one of the symptoms of migraine and the pain has certain features. Pain often comes in the form of attacks.
Incidence of migraine is 10-12% in the society. It is more frequently seen in women. While there are findings that genetic predisposition is important in the case of migraine, its exact cause hasn’t been determined.
Medications are used to treat migraine; medicines are used to reduce frequency and severity of an attack rather than treat migraine.
Dementia is one of the major health problems of the brain encountered in older adults, and its incidence increases with age.
Aging can be defined as a phenomenon where an organism gradually loses its biological efficiency. As one gets older, the majority of brain cells undergo cellular death. Along with advanced age, decline in sensory and cognitive functions such as movement, hearing, taste, memory, speech is noted.
Alzheimer’s disease often occurs at the age of 60 and above. After the age of 65, risk of developing Alzheimer’s disease gradually increases.
In the early stages of Alzheimer’s disease, symptoms are often confused with senescent forgetfulness so it is not noticed early, and as the disease progresses, it is noticed by the family by an increase in the forgetfulness and behavioral changes (irritability, introversion, suspiciousness, etc.). The disease is difficult to treat if it is not noticed at an early stage.
In middle stages of Alzheimer’s disease, more help is needed during activities of daily living (dressing , bathing, toilet cleaning, brushing teeth , etc.).
In advanced stages, because of hallucinations, excessive tension, suspiciousness, severe sleep disorders, moving the patient to a nursing home could be considered.
For early diagnosis of Alzheimer’s disease, which is among the most common type of dementia, neurological examination, imaging studies and neuropsychological assessments are required.
For the treatment of Alzheimer’s disease, drugs that delay or slow down progression of the disease are used in all stages. These drugs are selected according to the course of the disease and their usage.
Multiple Sclerosis (MS)
Multiple sclerosis is a disease developing in the central nervous system consisting of brain and spinal cord. There is an insulating material around nerve tissues in order to ensure correct and fast communication between nerve cells, and it is called myelin. For reasons unknown, this insulating material can be damaged, resulting in destruction of sensation and movement paths. Especially the brain loses control over areas such as seeing, walking, and talking.
Its symptoms may occur in one or more places. They can be mild or severe, occur suddenly as well as rarely disappear.
Causes of MS disease are still unknown.
The main objective for the treatment of multiple sclerosis disease is repair of damaged myelin sheaths and axons (fibers from nerve cells). Therefore, different treatments should be applied according to the types and frequency of symptoms. Some of the drugs used in cancer therapy and cortisone may prove to be successful in the repair of damage seen in central nervous system. Utilization of physical therapy can slow down the rate of clinical manifestations of disease. It will help limited mobility caused by a stroke, balance defects, and hardening of the muscles.
Diagnostic Methods Used in Neurology
CT (Computed Tomography)
Computed tomography is a special imaging technique that gives a cross-sectional image of the tissues and organs of the body using x-rays. In comparison to ordinary plain radiographs, CT provides more detailed information about head injuries, brain tumors and other brain disorders. Bone , soft tissues and blood vessels can also be displayed by CT.
MR is a painless procedure that can display internal organs and tissues in a clear and detailed manner. MR uses radio waves and a strong magnetic field, instead of X-rays.
It is the recording of electrical activity produced by nerve cells in the brain on paper in the form of brain waves.
The brain’s normal electrical activity is disrupted in many cases, including epilepsy in particular. Information is obtained about the location and form of this disorder by evaluation of brain waves comprising EEG. EEG test is applied in the investigation of the causes of headaches in many nerve disorders, other than epilepsy and in the evaluation of brain functions.
It can be performed either while sleeping or awake. Sleep helps emergence of abnormal electrical activity in the brain. Where EEG taken while awake doesn’t give adequate results, sleep EEG is taken.
It is a technique that examines muscles and nerves. It consists of 2 steps.
The first stage is transmission study in which how fast the nerves transmit is calculated. A very mild electrical impulse is given to the nerve by an electrode placed on the muscles.
In the second stage, very fine needles are inserted into the corresponding muscles to check activity of these muscles. In this stage, there is no electrical impulse. It is administered to patients with pre-diagnosis such as back and neck hernia, muscle diseases, motor neuron disease, neuropathies, and nerve compressions.