OzMS - Recent entries in lexikon

Multiple Sclerosis

16.10.2006 18:47

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis) is a chronic, inflammatory disease that affects the central nervous system (CNS). MS can cause a variety of symptoms, including changes in sensation, visual problems, muscle weakness, depression, difficulties with coordination and speech, severe fatigue, and pain. Although many patients lead full and rewarding lives, MS can cause impaired mobility and disability in the more severe cases.

Multiple sclerosis affects neurons, the cells of the brain and spinal cord that carry information, create thought and perception and allow the brain to control the body. Surrounding and protecting some of these neurons is a fatty layer known as the myelin sheath, which helps neurons carry electrical signals. MS causes gradual destruction of myelin (demyelination) and transection of neuron axons in patches throughout the brain and spinal cord, causing various symptoms depending upon which signals are interrupted. The name multiple sclerosis refers to the multiple scars (or scleroses) on the myelin sheaths. It is thought that MS results from attacks by an individual's immune system on the nervous system and is therefore categorized as an autoimmune disease.

Multiple sclerosis may take several different forms, with new symptoms occurring in discrete attacks or slowly accruing over time. Between attacks, symptoms may resolve completely, but permanent neurologic problems often persist. Although much is known about how MS causes damage, its exact cause remains unknown. MS currently does not have a cure, though several treatments are available which may slow the appearance of new symptoms. MS primarily affects adults, with an age of onset typically between 20 and 40 years, and is more common in women than in men.

Sourced from :- http://en.wikipedia.org/wiki/Multiple_sclerosis

References

# ^ Dangond, F.Multiple sclerosis. eMedicine Neurology.Updated 2005 Apr 25. full text.
# ^ Calabresi PA.Diagnosis and management of multiple sclerosis. Am Fam Physician. PMID 15571060

Optic Neuritis

16.10.2006 18:53

Optic neuritis (or retrobulbar neuritis) is the inflammation of the optic nerve that may cause a complete or partial loss of vision.

Causes

The optic nerve comprises axons that emerge from the retina of the eye and carry visual information to the primary visual nuclei, most of which is relayed to the occipital cortex of the brain to be processed into vision.

Inflammation of the optic nerve causes loss of vision usually due to the swelling and destruction of the myelin sheath covering the optic nerve.

Direct axonal damage may also play a role in nerve destruction in many cases.

Some causes are viral-bacterial infections (e.g. herpes zoster), autoimmune disorders (e.g. lupus) and the inflammation of vessels (vasculitis) nourishing the optic nerve.

Optic neuritis can also emerge as an attendant, first, or sole manifestation of multiple sclerosis.

Symptoms

Major symptoms are sudden loss of vision (partial or complete) and pain on movement of the affected eye. Many patients with optic neuritis may lose some of their color vision in the affected eye, with colours appearing subtly washed out compared to the other eye.

On medical examination the head of the optic nerve can easily be visualised by an ophthalmoscope; however frequently there is no abnormal appearance of the nerve head in optic neuritis, though it may be swollen in some patients. In many cases, only one eye is affected and patients may not be aware of the loss of color vision until the doctor asks them to close or cover the healthy eye.
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Treatment and Prognosis

In most cases, visual functions return to near normal within 8 to 10 weeks, but they may also advance to a complete and permanent state of visual loss.

Therefore, systemic intravenous treatment with corticosteroids, which may quicken the healing of the optic nerve, prevent complete loss of vision, and delay the onset of other multiple sclerosis symptoms, is often recommended. It has been demonstrated that oral administration of corticosteroids in this situation may lead to more recurrent attacks than in non-treated patients (though oral steroids are generally prescribed after the intravenous course, to wean the patient off the medication). This effect of corticosteroids seems to be limited to optic neuritis and has not been observed in other diseases treated with corticosteroids.

Very occasionally, if there is concomittant increased intracranial pressure the sheath around the optic nerve may be cut to decrease the pressure.

When optic neuritis is associated with MRI lesions suggestive of multiple sclerosis (MS) then general immunosuppressive therapy for MS is most often prescribed.

Diagnosis

Optic neuritis is often diagnosed by the neurologist and managed by an ophthalmologist. However, ideally, a neuro-ophthalmologist should be consulted at a major university hospital center.

Devic's disease

16.10.2006 19:07

From Wikipedia, the free encyclopedia

Devic's disease, also known as neuromyelitis optica or NMO, is the simultaneous inflammation of the optic nerve (optic neuritis) and the spinal cord (myelitis).

Devic's disease is an inflammatory disease of the central nervous system in which there are episodes of inflammation and damage to the myelin (fatty, protective covering of nerves) that almost exclusively affect the optic (eye) nerves and spinal cord. It usually causes temporary blindness, occasionally permanent, in one or both eyes. It can also lead to varying degrees of weakness or paralysis in the legs or arms, loss of sensation, and/or bladder and bowel dysfunction from spinal cord damage. A rare disorder which resembles multiple sclerosis (MS) in several ways, but requires a different course of treatment for optimal results.

Dysdiadochokinesis

19.10.2006 10:49

Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements. Dysdiadochokinesia is usually caused by multiple sclerosis in adults and cerebellar tumors in children. Note that patients with other movement disorders (e.g. Parkinson's disease) may have abnormal rapid alternating movement testing secondary to akinesia or rigidity, thus creating a false impression of dysdiadochokinesia.

Dysmetria

19.10.2006 11:05

Dysmetria is the clinical term for the inability to perform point-to-point movements due to over or under projecting ones fingers.

Myokymia

19.10.2006 12:08

Continuous involuntary quivering or rippling of muscles at rest, caused by spontaneous, repetitive firing of groups of motor unit potentials.

Successive and rapid contractions of motor units associated with chronic nerve injury. The discharges arise from the peripheral aspects of regenerating nerves, and clinically impart a nearly continuous undulation of the body surface overlying the muscle.

Examples: Twitching of the eye

Myelin

19.10.2006 15:58

(a) A soft white substance constituting the medullary sheaths
of nerve fibers, and composed mainly of cholesterin,
lecithin, cerebrin, protein, and some fat.
(b) One of a group of phosphorized principles occurring in
nerve tissue, both in the brain and nerve fibers.

Interferons

19.10.2006 16:55

There are three major classes of interferons: alpha (α), beta (β), and gamma (γ). They generally have several effects: antiviral and antioncogenic properties, macrophage and natural killer lymphocyte activation, and enhancement of major histocompatibility complex glycoprotein classes I and II.

Interferon-α is secreted by leukocytes (B-cells and T-cells). Interferon-β is secreted by fibroblasts, and interferon-γ is secreted by T-cells and natural killer lymphocytes.

All classes of interferon production are very important in the course of RNA virus infections. However, their presence also accounts for some of their symptoms, such as sore muscles and fever. They are emitted when abnormally large amounts of dsRNA are found in a cell. dsRNA is normally present in very low quantities. The dsRNA acts like a trigger for the production of interferon. The gene that codes for this cytokine is switched on in an infected cell, and is secreted to surrounding cells.

As the original cell dies from the cytolytic RNA virus, these thousands of viruses will infect nearby cells. However, these cells have received the interferon, which essentially warns these other cells that there's a wolf in the pack of sheep. They then start producing large amounts of a protein known as protein kinase R (P.K.R. or PKR). If a virus chooses to infect a cell that has been �pre-warned� by interferon, it is like charging into a hail of bullets for the virus.

The P.K.R. is activated by the dsRNA, and begins transferring phosphate groups (phosphorylating) a protein known as eIF2, a eukaryotic translation initiation factor. Upon phosphorylation, eIF2 has a reduced ability to initiate translation, the production of proteins coded by cellular mRNA. This prevents viral replication, but also inhibits normal cell ribosome function, killing both. All RNA within the cell is also degraded, preventing the mRNA from being translated by eIF2 if some of the eIF2 failed to be phosphorylated.

Interferon was scarce and expensive until 1980 when the interferon gene was inserted into bacteria using recombinant DNA technology, allowing mass cultivation and purification from bacterial cultures.

Avonex

19.10.2006 17:00

Avonex (Interferon beta-1a)

is a once a week intramuscular injection using a 27 gauge needle (thicker than Rebif). It is produced by the Biogen Idec biotechnology company. Originally it was under competition protection in the US under the Orphan Drug Act.

Avonex was approved in USA in 1996, and in Europe in 1997, and is registered in more than 80 countries worldwide. It is the leading MS therapy in the US, with around 40% of the overall market, and in Europe, with around 30% of the overall market.

Biogen Idec markets Avonex in two formulations: the original powder form, which requires the patient to reconstitute it before administration; and a newer pre-reconstituted "liquid Avonex" syringe kit.

Betaferon Betaseron

19.10.2006 17:09

Betaferon (also called Betaseron) (Interferon-1b)
is a drug in the interferon family used to treat multiple sclerosis. It is administered by sub-cutaneous injection and has been shown to slow the advance of the affliction as well as reduce the frequency of attacks. Betaseron is manufactured by Berlex Corporation.

It is believed that Interferon-Beta based drugs achieve their beneficial effect on MS progress via their anti-inflammatory properties. Studies have also determined that Interferon-Beta improves the integrity of the blood-brain barrier(BBB)�which generally breaks down in MS patients, allowing increasing amounts of undesirable substances to reach the brain. This strengthening of the BBB may be a contributing factor to Interferon-Beta's beneficial effects. These studies were carried out in vitro (outside a living organism - a "petri dish" experiment), so it does not necessarily mean it works the same in people.

Closely related is Interferon beta-1a, also indicated for multiple sclerosis, and with a very similar drug profile.
Betaferon/Betaseron costs approximately US$1300 for 0.3 mg solution, or equivalent to 15 vials.

Copaxone

19.10.2006 17:10

Copaxone (Glatiramer Acetate)or glatiramer (GA; trademark Copaxone� by Teva Pharmaceutical Industries, Ltd.) is licensed in much of the world for relapsing-remitting multiple sclerosis (MS). In early trials of the drug, it was known as Copolymer-1 and Cop-1.

Glatiramer reduces the average relapse rate in people with the relapsing-remitting (RRMS) form MS. The formation of new MS-related lesions in the central nervous system and rate of brain atrophy are also reduced.
Glatiramer is a random chain polymer of amino acids - glutamic acid, lysine, alanine and tyrosine (hence GLATiramer). It is synthesized in solution from a molarratio of alanine to lysine to glutamic acid to tyrosine of approximately 5 : 3 : 1.5 : 1 : 1. The amino acids in the reaction mixture and presented in the carboxyamino acid anhydride form.

Originally glatiramer was designed to mimic myelin basic protein, a component of myelin, with the intention of inducing EAE (an animal disease used as a scientific model for MS). Unexpectedly, it was found to suppress the disease and as a result came to be trialed in human MS. For this reason, it was originally believed to act as a decoy by drawing the immune system's attack away from myelin.

Currently, the precise mechanism of action of glatiramer is considered unknown. There is some evidence that it converts the body's immune response from a Th1 type to a Th2 one, promotes suppressor T cells or acts as an altered peptide ligand.

The drug is self-administered by daily sub-cutaneous injections of 20 mg.

It is generally well tolerated. The most common problem that users experience are injection site reactions which include itching and inflammation. These reactions can be mitigated against by revolving the injection site, preparing it with ice and ensuring that the drug is at room temperature before injecting. Some users experience flushing, chest and joint pains, weakness, nausea, anxiety and muscle stiffness. These tend to resolve after about a quarter of an hour without special treatment.

Rebif

19.10.2006 17:12

Rebif (interferon beta-1a)
is a subcutaneous injection 3 times a week. It comes in pre-filled syringes with a 29 gauge needle, thinner than the needle supplied with Avonex. It can be used with the Rebiject II autoinjector.

Rebif is a disease-modifying drug used to treat relapsing forms of multiple sclerosis and is similar to the interferon beta protein produced by the human body. Interferon helps modulate the body�s immune system, fight disease and reduce inflammation. It is comarketed by Serono and Pfizer in the US under an exception to the Orphan Drug Act.

Rebif, which was approved in Europe in 1998 and in the U.S. in 2002, is registered in more than 80 countries worldwide. Rebif is available in a 22 mcg and 44 mcg ready-to-use pre-filled syringe and can be stored at room temperature for up to 30 days if a refrigerator is not available.

Paraesthesia

18.12.2006 16:20

What is Paraesthesia?
Paresthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.

Most people have experienced temporary paresthesia -- a feeling of "pins and needles" -- at some time in their lives when they have sat with legs crossed for too long, or fallen asleep with an arm crooked under their head. It happens when sustained pressure is placed on a nerve. The feeling quickly goes away once the pressure is relieved.

Chronic paresthesia is often a symptom of an underlying neurological disease or traumatic nerve damage. Paresthesia can be caused by disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), ,multiple sclerosis

Dysesthesia

04.11.2006 12:20

From Multiple Sclerosis Glossary
Definition: Altered feelings such as burning, wetness, electric shock, pins and needles, itching, creepy-crawly sensation caused by neurological malfunction.
Examples: Though dysesthesia can mimic an allergy, it cannot be treated with corticosteroid ointments.

Intention Tremor

26.10.2006 10:23

Intention Tremor, also known as Kinetic, Action and Cerebellar Tremor, is a condition where goal-directed movements produce shaking in the moving body parts - most noticeably in the hands.

When you move your finger to perform a fine task, for example putting a key in a lock, you tell your arm muscles to move by sending nerve transmissions down the motor nerve pathways. The brain gets feedback about the movement from sensors in the joints and muscles which it uses to control the movement and gently guide the key into the lock.

People with intention tremor get the feedback more slowly, send corrective transmissions to the muscles more slowly, process the whole thing more slowly in the cerebellum (the part of the brain responsible for coordination) or any combination of the three. This makes the hand constantly overshoot the target resulting in tremor. Intention Tremor is more obvious when performing delicate fine movements than broad sweeping ones.

Intention Tremor is quite common in Multiple Sclerosis though it is associated with a number of other conditions including Parkinson's disease, trapped peripheral nerves and some drug treatments. Intention Tremor is related to Ataxia and in MS it is often caused by lesions in the cerebellum.

Intention Tremor is commonly detected by neurologists using finger to nose tests. The neurologist holds up his or her finger and you move your finger from your nose to his or her finger and back to your nose.

Intention Tremor is quite difficult to treat - Isoniazid, Zofran (Ondansetron), Propranolol and Primodone are drugs that have been tried with moderate results. Some people with MS find that cannabis is effective for tremors. Physical Therapy is often useful and wearing wrist weights can often mask out the effects.

Deep Brain Stimulation with a "gamma knive" (focused radiation) to stimulate or destroy parts of the brain (particularly the thalmus) has been tried in Parkinson's Disease and Multiple Sclerosis. Such options are radical and only used as a last resort for very severe tremors which do not respond to other treatments.

Intention Tremor Links:
NINDS Tremor Information Page
Classification of Tremor and Update on Treatment
The many forms of tremor

Babinski sign

07.12.2006 17:02

Extension of the great toe when the lateral aspect of the sole is stroked sharply, as seen in neurological conditions such as Multiple Sclerosis

Lumbar Puncture

07.12.2006 17:20

Puncture of the spinal canal, in the subarachnoid space, usually between the third and fourth vertebrae, for the removal of cerebrospinal fluid, especially for diagnostic purposes, or for the introduction of medications.

Romberg Test

08.12.2006 08:34

The Romberg Test is a neurological test to detect poor balance. Specifically, it detects the inability to maintain a steady standing posture with the eyes closed. The test is named after the 19th century German Ear Specialist, Moritz Heinrich Romberg (1795-1873).

The test consists of standing with your feet together and your eyes closed. The neurologist will often push you slightly to check whether you are able to compensate and regain your posture. He or she should also stand close by to catch you if you sway excessively or fall. A positive Romberg is excessive swaying or even falling over and is sometimes called Romberg's Sign. There are several variants of Romberg's Test - some involve different positions of the feet, for example, standing heel-to-toe - others use mechanical devices to quantify the dysfunction.

Demyelination

08.12.2006 08:37

Demyelination is the major underlying factor responsible for the symptoms of multiple sclerosis (MS). Demyelination is the destructive removal of myelin, an insulating and protective fatty protein which sheaths nerve cells (neurons). More specifically, the myelin is wrapped around the long extensions of neurons called axons. During MS relapses, patches of white matter in the central nervous system that normally contain tracts of myelinated neurons become inflamed and lose their myelin. These patches of demyelination are known as lesions.

Fatigue

08.12.2006 08:39

Fatigue is probably the most common symptom of multiple sclerosis and the majority of people with MS experience it at some point in their disease course, often chronically and for the entire course of the disease.

Fatigue in multiple sclerosis can take two forms :mental and physical.

Mental fatigue usually follows a daily pattern and, in this respect, differs from the constant fatigue associated with depression. Many people with MS report that they feel fine during the first few hours of the day but, by afternoon or early evening, feel completely exhausted. Often a nap or a short period of rest will help them recover.

Mental fatigue can vary between mild and severely disabling and is usually exacerbated by exercise, increased bodily or ambient temperature

Physical fatigue can be easily induced in MS by a short walk or other physical activity. For some reason, also not fully understood, the efficiency of demyelinated nerves deteriorates very rapidly with use. Almost everyone whose physical functioning has been disturbed through MS finds that their ability to do things reduces as they do them.

Mental fatigue is often associated with physical fatigue and all you want to do after physical exercise is to collapse on a bed and sleep.

L'Hermitte's Sign

08.12.2006 08:42

L'Hermitte's sign describes electrical buzzing sensations in the limbs and body brought on by movement of the neck. These sensations are known as paraesthesia and include tingling, buzzing, electrical shocks, partial numbness and sharp pains. L'Hermitte's is most often triggered by lowering the head so that the chin touches the chest. The sensations usually only last for a second or two. It has been called the "barber shop" symptom because it is often evoked when the hairdresser asks you to lower your head when he or she shaves the back of your neck.

L'Hermitte's is associated with a number of conditions including arthritis, cervical spondylosis, disc compression, pernicious anaemia, tumours and multiple sclerosis. In many cases, the cause cannot be found.

Because the cervical spinal cord is a frequent target for multiple sclerosis it is a very common symptom of MS. Aproximately two thirds of people with multiple sclerosis experience L'Hermitte's symptom at some point during the course of their disease.

In MS, L'Hermitte's is an indicator of lesions in the cervical spine (the part of spine in the neck). Movement of the neck causes the damaged nerves (the demyelinated neurons) to be stretched and send erroneous signals. The symptoms can occur anywhere below the neck and many people with MS find that it moves around their body from one day to the next.

Magnetic Resonance Imaging (MRI)

08.12.2006 08:45

Magnetic Resonance Imaging (MRI), a type of Nuclear Magnetic Resonance (NMR), is a method of obtaining cross-sectional images (slices) of internal soft bodily tissue. Invented in 1977, it has allowed much more accurate diagnoses of neurological conditions like multiple sclerosis because it allows doctors to "see" right into the human brain and other organs. It can readily differentiate between normal and demyelinated white brain matter, something that was very difficult to accomplish on older technologies like CT scanners. MRI scanners are also far less harmful than CT scanners.

Basically, MRI works by applying an extremely powerful electromagnet over a central core in which the patient lies. The magnetic field makes water molecules (which have a slight magnetic charge polarity) wobble like a miniature child's top. This, in conjunction with radio waves can be used to produce very detailed and high definition images (slices) of the brain. MRI scanners can also be used to image the spinal cord, but it is much harder to obtain images of lesions here due to obstruction from the vertebrae and the much smaller diameter of the spinal cord.

Trigeminal Neuralgia

18.12.2006 16:16

Trigeminal Neuralgia (TN), also known as tic douloureux, is an acute, piercing, electric shock-like pain in the those regions of the face served by the Trigeminal (5th) Cranial Nerve (CN V). CN V serves three areas of the face the forehead and eye, the cheek and the jaw. TN can affect some or all of these areas usually on one side of the face although more rarely (in about 5% of cases) it is bilateral. Episodes of TN can last anything from a few seconds to a few minutes or very occasionally longer and can be triggered by a number of factors including laughing, chewing, brushing the teeth, talking, wind on the face or even touching the face.
Trigeminal Neuralgia is not an uncommon symptom of multiple sclerosis although there are a number of other causes. In MS, TN is often accompanied by feelings of numbness or Paraesthesia. In multiple sclerosis, the most likely cause of Trigeminal Neuralgia is lesion damage to the Pons region of the Brainstem where the 5th cranial nerve arises.

Visually Evoked Potential Test (VEP)

08.12.2006 08:51

Visually Evoked Potential test (VEP), is a test for Optic Neuritis or other demyelinating events along the Optic Nerve or further back along the optic pathways.

The test involves watching a black and white checkered pattern on a TV screen in a darkened room. The black and white squares alternate on a regular cycle which generates electrical potentials along the optic nerve and into the brain. These can be detected with electro-encephalographical (EEG) sensors placed at specific sites on the top of the head (the occipital scalp). Each eye is tested independently while an eye patch is worn on the other eye.

VEPs are very sensitive at measuring slowed responses to visual events and can often detect dysfunction which is undetectable through clinical evaluation and the person is unaware of any visual defects.

Because of their ability to detect silent lesions and historic demyelinating episodes, they are very useful diagnostic tools. A definite diagnosis of multiple sclerosis requires at least two distinct demyelinating episodes, in two different central nervous system sites which are separated by at least one month. VEPs can often provide evidence of such episodes when other tests, even MRI, cannot.

Vertigo

08.12.2006 08:53

Vertigo is a dizzy sensation where the world spins uncontrollably and is often accompanied by nausea and vomiting. The sensation is similar to acute sea-sickness or having drunk much too much alcohol. Vertigo in multiple sclerosis is usually accompanied by partial or complete loss of balance (vestibular ataxia) which is aggravated by fast turning movements. Vertigo is often most acute when the person is deprived of other senses especially sight, touch and proprioception (positional feedback from sensors all over the body).

Vertigo is a relatively common symptom of multiple sclerosis and can be caused by damage to the pons region of the brain stem where the acoustic cranial nerve (CN VIII) arises. CN VIII divides to serve both the acoustic and balance (vestibular) functions of the ear, and it is the balance portion of this nerve that is implicated in vertigo. Vertigo can also be caused by lesions in the cerebellum.

Other forms of dizziness, that are not described as vertigo, are also often associated with multiple sclerosis and usually involve dysfunction of the eyes muscles implying damage to cranial nerves III, IV and VI. Some of the drugs used to treat the specific symptoms of MS, such as Baclofen and tricyclic antidepressants can aggravate vertigo.

Tysabri

28.07.2007 19:22

Natalizumab is a prescription drug co-marketed by Biogen Idec and �lan as Tysabri. It was previously named Antegren.

Natalizumab is administered by infusion and has proven effective in the treatment of multiple sclerosis and Crohn's disease.

Three months after its approval by the FDA, the drug was voluntarily withdrawn after being linked to adverse events including one death.

After an intensive safety evaluation, the drug was re-approved by the FDA as a potentially significant advancement over existing therapies and returned to the marketplace under a program of restricted distribution and regular patient evaluations.

Natalizumab

28.07.2007 19:51

Natalizumab ( Tysabri ) is a prescription drug co-marketed by Biogen Idec and �lan as Tysabri. It was previously named Antegren. Natalizumab is administered by infusion and has proven effective in the treatment of multiple sclerosis and Crohn's disease

Three months after its approval by the FDA, the drug was voluntarily withdrawn after being linked to adverse events including one death.

After an intensive safety evaluation, the drug was re-approved by the FDA as a potentially significant advancement over existing therapies and returned to the marketplace under a program of restricted distribution and regular patient evaluations.

Crohn�s disease

28.07.2007 19:49

Crohn's disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining in between).

Crohn's disease is a type of inflammatory bowel disease (IBD) and can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn's disease vary between affected individuals.

The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody), and weight loss. Crohn's disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.

Urinary incontinence

28.07.2007 22:00

Urinary incontinence is the involuntary excretion of urine from one's body. It is often temporary, and it almost always results from an underlying medical condition.

In this article, the term "incontinence" will be used to mean urinary incontinence.

Continence and micturition involve a balance between urethral closure and detrusor muscle activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. The proximal urethra and bladder are both within the pelvis. Intraabdominal pressure increases (from coughing and sneezing) are transmitted to both urethra and bladder equally, leaving the pressure differential unchanged, resulting in continence. Normal voiding is the result of changes in both of these pressure factors:urethral pressure falls and bladder pressure rises.

Fecal incontinence

28.07.2007 22:03

Fecal incontinence is the inability to control one's bowels. When one feels the urge to have a bowel movement, they may not be able to hold it until they can get to a toilet, or stool may leak from the rectum unexpectedly.

People who have fecal incontinence may feel ashamed, embarrassed, or humiliated. Some do not want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation may be reduced because treatment can improve bowel control and make incontinence easier to manage.

It affects people of all ages: children as well as adults. Fecal incontinence is more common in women than in men and more common in older adults than in younger adults. It is not, however, a normal part of aging.

Neurological

28.07.2007 22:32

This article is about the branch of medicine. For the official journal of the American Academy of Neurology, see Neurology.

Neurology is a branch of medicine dealing with disorders of the nervous system. Medical professionals (such as Biomedical Doctors and Physicians) specializing in the field of neurology are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults with neurological disorders. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research.

Balo concentric sclerosis

02.08.2007 18:15

Balo concentric sclerosis is one of the borderline forms of multiple sclerosis.

Balo concentric sclerosis is a demyelinating disease similar to standard Multiple sclerosis, but with the particularity that the demyelinated tissues form concentric layers. Scientists used to believe that the prognosis was similar to Marburg multiple sclerosis, but now they know that patients can survive, or even have spontaneous remission and asymptomatic cases.

It is also common that the clinic course is primary progressive, but a relapsing-remitting course has been reported. It seems that the course gets better with prednisone therapy, although evidence of this is anecdotal and such conclusions are difficult to accept given that there are cases where patients spontaneously recover whether the patient was on steroid therapy or not.

Immune System

02.08.2007 18:23

An immune system is a collection of mechanisms within an organism that protects against infection by identifying and killing pathogens and tumor cells. It detects pathogens ranging from viruses to parasitic worms and distinguishes them from the organism's normal cells and tissues. Detection is complicated as pathogens adapt and evolve new ways to successfully infect the host organism.

To survive this challenge, several mechanisms have evolved that recognize and neutralize pathogens. Even simple unicellular organisms such as bacteria possess enzyme systems that protect against viral infections. Other basic immune mechanisms evolved in ancient eukaryotes and remain in their modern descendants, such as plants, fish, reptiles, and insects. These mechanisms include antimicrobial peptides called defensins, pattern recognition receptors, and the complement system. More sophisticated mechanisms, however, developed relatively recently, with the evolution of vertebrates.

Demyelinating disease

02.08.2007 18:34

A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. This impairs the conduction of signals in the affected nerves, causing impairment in sensation, movement, cognition, or other functions depending on which nerves are involved.

Chronic (medicine)

02.08.2007 18:33

In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development.

Hoffman�s Sign

04.10.2007 20:13

Hoffman's sign is a neurological sign in the hand which is an indicator of problems in the spinal cord. It is associated with a loss of grip.

The test for Hoffman's sign involves tapping the nail on the third or forth finger. A positive Hoffman's is the involuntary flexing of the end of the thumb and index finger - normally, there should be no reflex response.

Hoffman's sign is an indicator of a number of neurological conditions including Cervical Spondylitis, other forms of spinal cord compression and Multiple Sclerosis. In MS, a positive Hoffman's sign is usually caused by lesions in the motor nerve pathways on or above the place in the spinal cord where the nerves that control the hands exit (C5).

Clonus

04.10.2007 20:14

Clonus (from the Greek for "violent, confused motion") is a series of involuntary muscular contractions due to sudden stretching of the muscle. Clonus is a sign of certain neurological conditions, and is particularly associated with so-called upper motor neuron lesions such as amyotrophic lateral sclerosis (ALS), stroke, multiple sclerosis or spinal cord damage. Unlike the small, spontaneous twitching known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex.

Allodynia

04.10.2007 20:13

Allodynia (Al-oh-DIN-ee-ah) is pain from something that shouldn't be painful," such as "a soft touch, the weight of bed covers, or even a cool breeze."

Electromyography (EMG)

21.10.2007 20:04

Electromyography (EMG) is a technique for evaluating and recording physiologic properties of muscles at rest and while contracting. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle cells when these cells contract, and also when the cells are at rest.

Uhtoffs syndrome

25.10.2007 09:43

A transient temperature-dependent numbness, weakness, or loss of vision. conduction stops in any nerve if the temperature gets too high. In a damaged nerve, e.g., by demyelinization, this shutdown temperature is lowered, and may approach normal body temperature. Transient neurological dysfunction may then appear with a hot shower, exercise, or fever.

Cerebrospinal fluid (CSF)

02.12.2007 01:38

Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space and the ventricular system around and inside the brain.

More specifically the CSF occupies the space between the arachnoid mater (the middle layer of the brain cover, meninges) and the pia mater (the layer of the meninges closes to the brain). Moreover it constitutes the content of all intra-cerebral (inside the brain, cerebrum) ventricles, cisterns and sulci (singular sulcus), as well as the central canal of the spinal cord.

It is an approximately isotonic solution and acts as a "cushion" or buffer for the cortex, providing also a basic mechanical and immunological protection to the brain inside the skull.

Injection (medicine)

02.12.2007 03:19

An injection is a method of putting liquid into the body with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body. An injection follows a parenteral route of administration, that is, its effect is not necessarily local to the area in which the injection is administered; it is systemic.

There are several types of injections or infusions, including intradermal, subcutaneous, and intramuscular injections, and intravenous or intraosseous infusions. Long-acting forms of subcutaneous/intramuscular injections are available for various drugs; these are called depot injections.

Subcutaneous injection

02.12.2007 03:19

A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis. Subcutaneous injections are highly effective in administering vaccines and such medications as insulin, morphine, diacetylmorphine or goserelin.

A person with Type I diabetes mellitus typically injects insulin subcutaneously. Places on the body where people can inject insulin most easily are:

* The outer area of the upper arm.
* Just above and below the waist, except the area right around the navel (a 2-inch circle).
* The upper area of the buttock, just behind the hip bone.
* The front of the thigh, midway to the outer side, 4 inches below the top of the thigh to 4 inches above the knee.

These areas can vary with the size of the person. Changing the injection site keeps lumps or small dents called lipodystrophies from forming in the skin. However, people should try to use the same body area for injections that are given at the same time each day-for example, always using the abdomen for the morning injection or an arm for the evening injection. Using the same body area for these routine injections lessens the possibility of changes in the timing and action of insulin.

Intramuscular injection

02.12.2007 03:18

Intramuscular injection is the injection of a substance directly into a muscle. In medicine, it is one of several alternative methods for the administration of medications (see Route of administration). It is used for particular forms of medication that are administered in small amounts. Depending on the chemical properties of the drug, the medication may either be absorbed fairly quickly or more gradually. Intramuscular injections are often given in the deltoid, vastus lateralis, ventrogluteal and dorsogluteal muscles. When the gluteal muscles are used, injections should be made on the upper, outer quadrant of the buttock to avoid damaging the sciatic nerve.

Thrombocytopenia (low platelet counts) and coagulopathy (bleeding tendency) are contraindications for intramuscular injections, as they may lead to hematomas.

Mannatech

11.04.2008 00:40

Glyconutrient is a term used by the multi-level marketing company Mannatech, and other supplement vendors, to describe dietary supplements that contain a blend of simple sugars (monosaccharides) which are found in glycoproteins.

As Mannatech uses the term in labeling many of its products, glyconutrient refers to mixtures of polysaccharides, such as exudate tree gums and high molecular weight aloe vera extracts containing fermentable dietary fiber and plant extracts, as well as simple sugars or starch.[citation needed] The company's SEC filing more precisely identifies the contents of Ambrotose, its lead product, as "a glyconutritional dietary supplement ingredient consisting of a blend of monosaccharides, or sugar molecules."In the marketing literature, these sugars are said to be a blend and the precursors of the following eight simple sugars: Xylose, Fucose, Galactose, Glucose, Mannose, N-acetylgalactosamine, N-acetylglucosamine, and N-acetylneuraminic acid.

The below link is well worth a read!

Mannatech Dubious dealings.

Xango - Mangosteen

06.03.2008 22:22

XanGo, LLC, an international multi-level marketing company based in Lehi, Utah, was founded in 2002.

Its main product is a multi-fruit beverage called XanGo Juice, which is promoted as a dietary supplement. Containing an unspecified percentage of mangosteen juice, Xango Juice has a suggested retail price of approximately $37.50 per bottle.

In 2007, the company initiated the XanGo Goodness charitable program featuring the "XanGo Goodness Meal Pack", a soluble powder containing many nutrients but no components of mangosteen. The corporation also said it would explore development of products for skin care.

In May 2004, the company was granted a United States patent[4] which, a year later, was declared invalid by the United States Patent and Trademark Office.[5] The company is appealing the ruling.[6][7] As of 2007, the company's annual revenue is about $360,000,000.

Kalawalla - Phlebodium aureum

06.03.2008 22:20

Phlebodium aureum (Golden polypody, Golden serpent fern or Cabbage palm fern; syn. Polypodium aureum, Polypodium leucotomos) is an epiphytic fern native to tropical and subtropical regions of the Americas. It is confined to the eastern side of the continents, extending north into the United States to Florida and the extreme southeast of Georgia, and south through the Caribbean (the Bahamas, Puerto Rico, and Lesser Antilles), and northern and eastern South America to Paraguay. It is the only species of Phlebodium found in North America, the other ten or so species all confined to South America. Other common names include Calaguala (among Spanish speaking peoples), Kalawalla, Samambia, and Anapsos.

It is a rhizomatous fern, with the creeping rhizome 8-15 mm (rarely 30 mm) in diameter, densely covered in the golden-brown scales that give the species its name. The fronds are large and pinnatifid (deeply lobed), from 30-130 cm long and 10-50 cm broad, with up to 35 pinnae; they vary in color from bright green to glaucous green and have undulate margins. Several round sori run along each side of the pinna midrib, and the minute spores are wind-dispersed. The fronds are evergreen in areas with year-round rainfall, semi-evergreen or briefly deciduous in areas with a marked dry season.

Glossopharyngeal nerve

24.02.2008 12:23

The glossopharyngeal nerve is the ninth of twelve pairs of cranial nerves. It exits the brainstem out from the sides of the upper medulla, just rostral (closer to the nose) to the vagus nerve.

Neuralgia

24.02.2008 12:15

Neuralgia is a painful disorder of the nerves. Under the general heading of neuralgia are trigeminal neuralgia (TN), atypical facial pain, and postherpetic neuralgia (caused by shingles or herpes). Neuralgia is also involved in disorders such as sciatica and Brachial Plexopathy with Neuropathia.

In the case of trigeminal neuralgia the affected nerves are responsible for sensing touch, temperature sensation and pressure sensation in the facial area from the jaw to the forehead. The disorder generally causes short episodes of excruciating pain, usually for less than two minutes and on only one side of the face. The pain can be described in a variety of ways such as "stabbing," "sharp," "like lightning," "burning," and even "itchy". In the atypical form of TN, the pain can also present as severe or merely aching and last for extended periods. The pain associated with TN is recognized as one of the most excruciating pains that can be experienced.

Simple stimuli such as eating, talking, washing the face, or any light touch or sensation can trigger an attack (even the sensation of a gentle breeze). The attacks can occur in clusters or as an isolated attack. Some patients will have a muscle spasm which led to the original term for TN of "tic douloureux" ("tic", meaning 'spasm', and "douloureux", meaning 'painful', in French).

Neuralgia is a form of chronic pain and can be extremely difficult to diagnose. Patients usually show no physical abnormalities, and with the attacks generally lasting a very short time, it can be difficult to reach a doctor before the attack is over. Postherpetic neuralgia is the easiest to diagnose because it follows an obvious cause (shingles).

Neuralgia is rare, especially in those under 30. Women are more likely to be affected than men, and those over 50 are at the greatest risk. In some cases, multiple sclerosis is related to nerve damage, causing the pain, so doctors will likely ask about family history to help diagnose. Nothing unusual can be seen in brain scans, so diagnosis is usually based on the description of the symptoms.

Medication for seizures has shown promise in managing neuralgia, and some people have found relief with surgery, though not always permanent relief.

Glossopharyngeal neuralgia

06.03.2008 22:19

Glossopharyngeal nueralgia is a rare form of nueralgia that is associated with MS as well as brain tumours of the brain stem. It affects the pharynx part of the throat on one side only and can also affect a portion of the tongue. It is caused by damage to the 9th cranial nerve housed within the brain stem. This nueralgia is the mother of all nueralgia's, it's chronic and severe.

Attacks can last from a few seconds to many minutes. The intensity of a longer attacks can actually cause you to pass out as your pulse drops. The nueralgia can come in the form of stabbing or burning or a combination of both. Swallowing, eating, drinking, clearing of the throat, talking and spicy or sweet foods can trigger the attacks. The attacks can come in the form of every few minutes to every few hours on and off. Sometimes you can have an attack and it leaves the body never to return, but then there's also the possibility of living with it long term from permanent damage to that particular nerve. To test whether you actually have this neuralgia, an ENT specialist sprays your throat with local anaesthetic and then will touch the area and if you experience pain you know it's the neuralgia. Believe me from personal experience you feel it. Local doesn't deaden the pain at all that's why pain killers have no effect on this pain except for maybe bombing you out in order not to be as aware.

To date there's no real effective treatment. Pain killers don't work. Endone, a form of morphine is often prescribed to dull the pain but really doesn't have much effect (see above). Epileptic drugs such as Lyrica and Nuerontin are often used to try and block the signals from the brain with mixed results. Nerves can be severed but the neuralgia usually re-appears again on average in 5 years. The reason for this is unclear but may be due to scar tissue. This is often as a last resort as severing the nerve leads to numbness of the area and can sometimes result in loss of ability to talk.

Personal experience below

A note: From my own personal experience with this I always feel like I've got a lump inside my throat that feels dry and is very irritating. From research that I have undertaken they say that spicy foods seem to trigger the attacks but in my case sweet food triggers it for me, which is a damn nuisance let me tell you, as I love my chocolate and sweet treats and can no longer have it. I've tried to overpower my brain with saying it's not sweet really and attempt to eat and end up in agony. I shall not give up though. The mind is very powerful and if I can convince it somehow that what I'm eating isn't sweet, I'll be one happy person. I also notice that my tastebuds are rather large on my tongue during the attacks. Even the ENT specialist has noticed that. It feels like a real sandpaper effect in your mouth. Whether this is what other sufferers feel I'm not sure but it's what happens to me.