Author: Jasmine Kumar

Categories
Neurocognitive Disorders Neurodegenerative Disorders

What is Parkinson’s Disorder?

Parkinson’s disorder is a neurodegenerative disorder that primarily affects movement. However, this neurodegenerative disorder is rare in young adults, and normally appears in adults aged 60 or older. Symptoms of Parkinson’s disorder often occur gradually, and different symptoms may appear in different people. Regardless, these symptoms progressively worsen overtime. Symptoms of Parkinson’s disorder may include tremors that usually occur or begin in the limb area or fingers and hands, slowed movement, also called bradykinesia, rigid or stiff muscles, impaired posture and balance, loss of automatic or unconscious movements, changes in speech, and difficulty writing. Early signs and symptoms of Parkinson’s disorder may go unnoticed since they can be mild to detect, and symptoms usually begin on one side of the body and continue to worsen on that side, even after symptoms begin to affect both sides (Parkinson’s disease – Symptoms and causes). 

Typically, Parkinson’s disorder occurs in stages ranging from one to five. Stage one consists of mild symptoms that do not interfere with daily activities as much, and these include tremors or other movement symptoms that typically occur on one side of the body. Additionally, stage one consists of changes in posture, facial expressions, and walking that are often mild. Stage two consists of worsened tremors, rigidity in muscles, and movement symptoms that affect both sides of the body. During stage two, daily tasks start to become more difficult to perform and take longer to do so. Stage three consists of a loss of balance, bradykinesia, and an increase in falls. Throughout stage three, the individual can still live independently and perform tasks independently. However, symptoms tend to make daily tasks such as dressing and eating a bit more difficult. Stage four consists of limiting and severe symptoms to an extent where the individual may require a walker, and the individual needs assistance with daily activities of living, so the individual cannot live independently. Lastly, stage five consists of stiffness in the legs that make it impossible to stand or walk, hallucinations or delusions, and the individual may be bedridden or require a wheelchair. Stage five normally requires consistent nursing care (Treatment).

Parkinson’s disorder is caused by the gradual breakdown or death of neurons, which are known to produce a chemical neurotransmitter called dopamine. This decrease in dopamine levels results in abnormal brain activity that leads to impaired movement as well as the non-motor symptoms of Parkinson’s disorder (Parkinson’s disease – Symptoms and causes). The specific neurons that are lost are called dopaminergic neurons (Tysnes and Storstein, 2017). Although the exact cause of this loss in neurons is unknown, there are many factors that seem to play a role in their loss, including genetic mutations, exposure to environmental toxins, the presence of lewy bodies, and alpha-synuclein found in lewy bodies (Parkinson’s disease – Symptoms and causes). Researchers believe that clumps called lewy bodies, especially those filled with the protein alpha synuclein, are markers of Parksinson’s disorder (Tysnes and Storstein, 2017). 

The cure for Parkinson’s disorder is unfortunately unknown. Additionally, treatment for Parkinson’s varies based on the symptoms the individual experiences. For instance, some people may benefit and alleviate some symptoms through lifestyle changes such as exercise and more rest, whereas others may be recommended medication or surgical therapy (Treatment). Luckily, advances in Parkinson’s research are being made and may improve future course of treatments. 

 

References

Tysnes, O. and Storstein, A., 2017. Epidemiology of Parkinson’s disease. Journal of Neural Transmission, 124(8), pp.901-905.

Mayo Clinic. n.d. Parkinson’s disease – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055> [Accessed 26 April 2021].

Parkinson’s Foundation. n.d. Treatment. [online] Available at: <https://www.parkinson.org/Understanding-Parkinsons/Treatment> [Accessed 26 April 2021].

Categories
Depression Tic Disorders

Depression and Tourette’s Syndrome

Depression is one of the most common mood disorders in the United States that affects all ages. There are several different kinds of depressive disorders including persistent depressive disorder, postpartum depression, psychotic depression, and seasonal affective disorder. Common signs and symptoms of all these forms of depression include feeling persistent sadness, hopelessness, and irritability. There is also a loss of interest and pleasure in hobbies, as well as restlessness, aches and pains, heachaches, cramps, digestive problems, difficulty sleeping, and difficulty concentrating. Not all people affected by depression experience the same symptoms, and some individuals may experience only a few of these symptoms while others experience multiple ( NIMH » Depression ). Causes behind depression may include changes within the brain, function and effect of neurotransmitters, and hormonal balance. Research has demonstrated that depression tends to be more common in individuals who have a family history of the mood disorder. Additionally, there can be multiple risk factors of depression including low self-esteem, traumatic or stressful events, family history of depression, having a past medical history of other mental health disorders, drug or alcohol abuse, serious to chronic physical illnesses, and certain medications’ side effects. Some prevention methods or treatments for depression can include healthy stress management strategies, medications such as antidepressants, and psychotherapy, all of which should be discussed beforehand with a medical professional (Depression (major depressive disorder) – Symptoms and causes). 

Tourette’s Syndrome is a neurodegenerative disorder that causes individuals to experience tics, which are sudden twitches, movements, or sounds that are done or made repetitively and can be difficult to voluntarily stop. Tics usually begin in children around the ages of five to ten, and the frequency and types of tics a person may experience could change a lot overtime. It has been commonly demonstrated that tics tend to decrease into adolescence and early adulthood, or may even completely disappear. Although a decline in tics in adulthood is common, some people may experience tics worsening into adulthood. Although there is no cure for Tourette’s syndrome, there are multiple methods to manage tics such as medication or behavioral therapy ( What is Tourette Syndrome? ). 

Many studies have found that there is an association between Tourette’s Syndrome and depression. One study had found that in a form of Tourette’s, Gilles de la Tourette’s syndrome (GTS), depression is common amongst these patients and is significantly associated with GTS patients, depending on factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety (Rizzo, Gulisano, Martino & Robertson, 2017). Another study had similar results, and found that screening for depression amongst patients with Tourette’s Syndrome was higher in adolescents, children, and adults with severe tics (Marwitz & Pringsheim, 2018). This association between Tourette’s syndrome and depression indicates that there is a need to emphasize the importance of routinely screening for depression amongst Tourette’s syndrome patients to implement appropriate screening. Additionally, it is important that patients with Tourette’s syndrome who have comorbidity of ADHD, anxiety, and severe tics, should receive proper care and treatment for these comorbidities and severe tics, so that the patient does not pose a greater threat of experiencing depression. Fortunately, such results from these two studies indicate that there is greater hope that future patients with Tourette’s syndrome will have better care that incorporates mental health. 

 

References

NIMH » Depression. (2021). Retrieved 13 April 2021, from https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145396

Depression (major depressive disorder) – Symptoms and causes. (2021).Mayo Clinic. Retrieved 13 April 2021, from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

What is Tourette Syndrome?.(2021). CDC. Retrieved 13 April 2021, from https://www.cdc.gov/ncbddd/tourette/facts.html

Marwitz, L., & Pringsheim, T. (2018). Clinical Utility of Screening for Anxiety and Depression in Children with Tourette Syndrome. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 27(1), 15–21.

Rizzo, R., Gulisano, M., Martino, D., & Robertson, M. (2017). Gilles de la Tourette Syndrome, Depression, Depressive Illness, and Correlates in a Child and Adolescent Population. Journal Of Child And Adolescent Psychopharmacology, 27(3), 243-249. doi: 10.1089/cap.2016.0120

Depression. (2018). [Image]. Retrieved from https://i0.wp.com/digitallyliterate.net/wp-content/uploads/2018/05/180510-depression-al-1509_8b5188e45e5aed500291d9c30689f57f.focal-1000×500.jpg?fit=1000%2C500&ssl=1

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Lewy Body Dementia

Lewy body dementia (LBD) is the second most common form of dementia after Alzheimer’s disease dementia (Lewy body dementia – Symptoms and causes ). LBG specifically results from a deposit of protein alpha-synuclein in the brain in abnormal quantities.These deposits are known as lewy bodies. Alpha-synuclein plays important roles in the functioning of a healthy brain, especially within neurons and synapses. However, as a result of alpha-synuclein clumping in the neurons of areas of the brain that control memory and movement, neuronal death can eventually occur. Additionally, lewy bodies affects multiple brain regions such as the cerebral cortex, limbic cortex, hippocampus, midbrain and basal ganglia, as well as the brain stem. As a result, LBD can result in problems that involve thinking, movement, behavior, and mood (LBD ). 

The exact cause of LBD is unknown, however there has been research focused on its biology and genetics to learn more about the precise causes. Lewy body accumulation results in neuronal death of certain neurons that are often involved in the production of two neurotransmitters. One of these neurotransmitters is acetylcholine, which is important for memory and learning. Other information researchers have gathered regarding the possible risk factors for LBD include age, Parkinson’s disorder, REM sleep behavior disorder, and even genetics. Individuals over the age of 50 tend to be at a higher risk for onset of LBD. Although LBD is not a genetic disease, variants in the genes APOE, SNCA, and GBA have been linked to having an increased risk for LBD (LBD ).  Additionally, it has been shown that males are more likely to be affected by LBD than females (Lewy body dementia – Symptoms and causes ). 

There are two diagnoses of LBD, including dementia with lewy bodies (9DLB) and Parkinson’s disease dementia (PDD) (LBD). Both DLB and PDD have similar symptoms, and have the same biological changes in the brain, however they differ in the early signs of onset. LBD results in cognitive impairments in attention and executive and visuo-perceptual abilities. Patients with LBD present with a variety of neuropsychiatric symptoms, such as visual hallucinations, systematised delusions, apathy, aggression, anxiety and depression. Other symptoms that many DLB patients experience include motor difficulties (Taylor, McKeith and Burn, 2019). 

Due to the variation in the types of symptoms LBD patients may experience, LBD treatment and care can involve a variety of care takers, especially because LBD cannot be prevented or cured. For instance, physical therapists can assist with motor difficulties, speech therapists can assist with swallowing difficulties or voice projection, occupational therapists can assist in carrying out everyday activities such as eating and bathing, music or art therapists can assist by providing therapeutic activities that can help patients overcome anxiety and depression, and mental health counselors can help patients with neuropsychiatric symptoms as well (LBD ). Other than relying on support provided by healthcare workers and care takers, certain symptoms can be treated utilizing prescribed medication. Studies have shown that the cholinesterase inhibitors (ChEI) donepezil and rivastigmine medications were similarly effective in both DLB and PDD for improving cognition (Taylor, McKeith and Burn, 2019). From medications to having a support team, there are many hopes in assisting patients with LBD so that they can better manage their symptoms.

 

References

Mayo Clinic. n.d. Lewy body dementia – Symptoms and causes.

National Institute on Aging. n.d. What Is Lewy Body Dementia?.

Taylor, J., McKeith, I. and Burn, D., 2019. New evidence on the management of Lewy body dementia. Lancet Neurology, [online] pp.1-9.

Categories
Tic Disorders

Tic Disorder in Media

There are three main types of tic disorder which are Tourette’s syndrome (TS), persistent (chronic) motor or vocal tic disorder, and provisional tic disorder. TS affects children who are younger than 18 years old and have at least two motor tics or 1 vocal tic that has been continuing for more than 1 year. Persistent motor or vocal tic disorder consists of motor or vocal tics that have been present for more than one year, but individuals cannot have both. Lastly, provisional tic disorder consists of motor and/or vocal tics that have been present for more than 1 year but do not meet the criteria for TS or persistent motor or vocal tic disorder. Tics are typically experienced from ages 5 to 7, increasing in frequency and severity between the ages of 8 to 12, but most people with TS experience improvements in late adolescence, and some become tic-free. However, a minority of individuals with TS continue to have frequent or severe tics into adulthood. The causes of tic disorder remain unknown. However, research has demonstrated that familial, genetic, environmental, and developmental factors may also be involved (What is Tourette ). Although there are no treatments available for tic disorder, there are therapies available to manage tics (Tics and Tourette Syndrome). 

A study seared international internet movie databases using the term “Tourette’s,” “Tourette’s Syndrome,” and “tics” to generate a list of all movies and television programs that had characters or scenes with TS or a person imitating TS. A total of 37 movies and TV shows were reviewed from 1976 to 2010, and although times and the media have changed since then, people still view these movies and shows. Most of the content viewed in the study misrepresented TS in multiple ways including characters being portrayed as having only autism spectrum disorder (ASD) instead of ASD with TS, coprolalia being overrepresented as a tic, as well as other examples (Calder-Sprackman, Sutherland and Doja, 2014).

Coprolalia is known as a vocal tic that specifically involves involuntary swearing and utterance of derogatory remarks. From the study it was found that of the characters imitating TS, 73% exhibited coprolalia, feeding into the misconception to viewers that it is the most common form of tic or symptom of TS. However, in reality, coprolalia is found in only 8.5% of individuals with TS. Additionally, when coprolalia was portrayed by actors, it was done so in a comedic manner. Combined with the comedic effect and overrepresentation of the media’s portrayal of coprolalia, a common negative and false stereotype of TS that may have been interpreted by viewers is TS as the “cursing disease” (Calder-Sprackman, Sutherland and Doja, 2014).

Another major misrepresentation in the media that was found in this study was that many characters who were portraying TS were made to have an “eccentric” appearance. However, in reality, children with TS do not appear physically different from others. The issue with falsely representing the appearance of individuals with TS lies in the fact that it inaccurately represents TS and promotes stigmatization towards individuals who have TS or other tic disorders (Calder-Sprackman, Sutherland and Doja, 2014). 

In recent times, new stereotypes can be created or old ones can be reinforced on social media platforms such as Tik Tok, Instagram, Facebook, and more. Therefore, it is absolutely essential to educate individuals about tic disorders and types of tics while destigmatizing stereotypes by eradicating desensitizing language or behaviors in scripts and other forms of media. Although the media can misrepresent TS and tic disorders, it can still be a useful tool for educating the public and representing those who have tics. For instance, it was found that some movies and TV shows such as South Park and Harvie Krumpet accurately portrayed tics as uncontrollable urges that can be suppressible in certain situations or worsened in stressful situations (Calder-Sprackman, Sutherland and Doja, 2014). This accurate depiction gives hope that the general public can become educated and less likely to promote stereotypes and misrepresentations to others. Thus, social media and other forms of media can be used in a positive way as well, and that is something our generation can look forward to.

 

References

Tourette Association of America. n.d. What is Tourette – Tourette Association of America. [online] Available at: <https://tourette.org/about-tourette/overview/what-is-tourette/#1461071540054-f0944fbc-3f2b>.

Cdc.gov. n.d. [online] Available at: <https://www.cdc.gov/ncbddd/tourette/documents/tics-and-tourette-fact-sheet-final.pdf> [Accessed 8 March 2021]. 

Calder-Sprackman, S., Sutherland, S. and Doja, A., 2014. The Portrayal of Tourette Syndrome in Film and Television. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 41(2), pp.226-232.

Categories
Neurocognitive Disorders Neurodegenerative Disorders Uncategorized

What is Neuropathy?

Neuropathy, or peripheral neuropathy, results from damaged or dysfunctioning nerves. It is also commonly known as peripheral neuropathy because it can damage your peripheral nervous system. The peripheral nervous system is the network of nerves that exist outside of one’s brain and spinal cord. More specifically, neuropathy occurs as a result of damaged or destroyed nerve cells, called neurons, which disrupt synaptic transmission, or the communication of signals within the brain. It can also simultaneously take place in multiple body parts, such as one’s hands or feet  (Neuropathy (Peripheral Neuropathy). 

Neuropathy can be classified as mononeuropathy, the dysfunction of one nerve or nerve type, multifocal neuropathy, the dysfunction of a combination of nerves in a specific area, or polyneuropathy, the dysfunction of many peripheral nerves all throughout the body (Neuropathy (Peripheral Neuropathy) ). Symptoms that span across all classifications of peripheral neuropathy include gradual numbness, tingling in one’s feet or hands, sharp, throbbing, or burning pain, sensitivity to touch, lack of coordination, muscle weakness, and, if motor nerves are affected, paralysis. However, if the autonomic nerves that control blood pressure, heart rate, digestion, and bladder function are affected, symptoms such as heat intolerance, excessive or lack of sweating, digestive problems, and dizziness due to changes in blood pressure can occur as well (Peripheral neuropathy – Symptoms and causes ). 

Although there are three main classifications of neuropathies, there are also different subtypes. A major cause of a certain subtype of neuropathy called distal symmetric polyneuropathy is diabetes. Distal symmetric polyneuropathy is characterized by a loss in sensory function in the lower extremities. At least 50% of diabetics will develop distal symmetric polyneuropathy, making it an epidemic in places such as India. The physiology known so far behind distal symmetric polyneuropathy involves the retraction of the terminal sensory axons in the periphery, while the perikarya, or cell bodies, remain preserved. Experimental evidence has also demonstrated that the entire neuron may be targeted with diabetes, however, this evidence remains to be debated. A study has found that the incidence of distal symmetric polyneuropathy is higher in those with type II diabetes than those with type I diabetes, mainly due to greater glucose control in those with type I diabetes compared to those with type II. When examining trends in the incidence of distal symmetric polyneuropathy, however, one must also consider the duration of diabetes, hemoglobin levels, hypertension, obesity, drug abuse, gender, impaired renal function, and more (Feldman et al., 2019).

 Distal symmetric polyneuropathy is one of many types of neuropathies making diabetes an important risk factor. Other risk factors include alcohol abuse, vitamin B deficiencies, genetics, and certain infections such as Lyme disease, shingles, Epstein-Barr virus, HIV,  and Hepatitis B and C. Although there are many diverse risk factors of neuropathy, there are some beneficial prevention methods, including medications such as antidepressants, anti-seizure medications, topical and narcotic medications, physical therapy, occupational therapy, surgery of resulting conditions such as a herniated disc or carpal tunnel syndrome, and more (Peripheral neuropathy – Symptoms and causes ). 

References

Feldman, E., Callaghan, B., Pop-Busui, R., Zochodne, D., Wright, D., & Bennett, D. et al. (2019). Diabetic neuropathy. Nature Reviews Disease Primers, 5(1). doi: 10.1038/s41572-019-0097-9

Cleveland Clinic. (2019). Neuropathy (Peripheral Neuropathy). https://my.clevelandclinic.org/health/diseases/14737-neuropathy 

Mayo Clinic. (2019). Peripheral Neuropathy-Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061 

Categories
Neurocognitive Disorders Neurodegenerative Disorders

Amyotrophic Lateral Sclerosis

When some people hear of amyotrophic lateral sclerosis (ALS), they think of the unfortunate passing of theoretical physicist Stephen Hawking in 2018. Hawking’s death was symbolic of prevailing against the unfortunate statistics of significantly shortened longevity amongst those diagnosed with ALS. Hawking was diagnosed with ALS around age 21 and was expected to live no longer than his 25th birthday. However, Hawkings beat all odds and lived a long, inspiring, and successful life till the age of 76. Hawking’s accomplishments regarding his articulation of the black hole and his contributions to other ideas within theoretical physics, such as quantum gravity, are just some of the many elements that make him such an inspiration to the world. Battling and living with ALS for almost 55 years has definitely inspired and given hope to many others around the world, especially those of us living with ALS and those of us who know a loved one with ALS (Harmon, 2020).  

Many know that Hawking unfortunately died of ALS, but what exactly is ALS? Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that affects motor neurons in the brain and spinal cord, resulting in a loss of muscle control (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). Specifically, ALS affects both upper and lower motor neurons. This neurodegenerative disease is commonly classified to exist in either a sporadic or familial form. “More than 30 different genes have been linked to the familial form of ALS” (van Es et al., 2017). The familial form of ALS is due to genetic mutations, and approximately 10% of patients are diagnosed with familial ALS. A common mutation that accounts for 30-40% of familial ALS diagnosis is an increase in the G4C2 hexanucleotide repeats on gene C9orf72, beyond the normal repeat range of 30 to several hundred or thousands (Oskarsson, Gendron and Staff, 2018). 

The symptoms of ALS could differ depending on what neurons are specifically affected (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). If one were to experience the loss of lower motor neurons which extend from the spinal cord to the muscles, symptoms such as muscle weakness, cramps, and fasciculations or muscle twitches could occur. Loss of lower motor neuron features contribute to higher mortality rates compared to symptoms caused by the loss of upper motor neurons in the brain, which include spasticity, clumsiness, brisk reflexes, and functional limitations (Oskarsson, Gendron and Staff, 2018). Overall, the general symptoms someone with ALS may experience include difficulty walking, tripping and falling, leg or feet weakness, slurred speech, trouble swallowing, muscle twitching or cramps that occurs in the arms, tongue, or shoulders, cognitive and behavioral changes, and inappropriate laughing, crying, or yawning (Amyotrophic lateral sclerosis (ALS) – Symptoms and causes). 

There is a lot of variation amongst the various diagnoses of ALS. For instance, some individuals who are known to have “classical ALS” only experience the majority of ALS symptoms impacting motor involvement. However, around half of ALS patients demonstrate some degree of cognitive impairment and behavioral changes, which is also known as executive dysfunction. There are those patients who are diagnosed as having ALS-esi, which is when there is evidence of executive dysfunction, ALS-neci. when there is no executive dysfunction but there is some impairment in memory or other cognitive aspects, and ALS-bi, when only behavioral changes are present. A small fraction of ALS patients (around 5-10% of patients) may also have frontotemporal dementia (FTD) (van Es et al., 2017). Other variations in diagnosis include progressive muscular atrophy (PMA) and primary lateral sclerosis (PLS). PMA is a variation of ALS that is mostly isolated to the lower motor neurons that are impacted, whereas PLA is mostly isolated to the upper motor neurons (Harmon, 2020). This variation in diagnosis of ALS explains how individuals like Hawking can live so long despite the common statistical odds of a lifespan limited to 5 years after being diagnosed (Harmon, 2020). However, the unfortunate reality is that there are very few patients diagnosed with variations of ALS that progress as slowly as it did in Hawking. This means that this variation can be both good news for few and bad news for the majority. Nevertheless, it is better to look at this in a positive light and think of it this way: there is hope for slow progression due to all this variation in diagnosis, so there is hope for beating statistical odds as well.

 

References

Mayo Clinic. 2020. Amyotrophic Lateral Sclerosis (ALS) – Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022> [Accessed 23 November 2020]. 

van Es, M., Hardiman, O., Chio, A., Al-Chalabi, A., Pasterkamp, R., Veldink, J. and van den Berg, L., 2017. Amyotrophic lateral sclerosis. The Lancet, 390(10107), pp.2084-2098. 

Oskarsson, B., Gendron, T. and Staff, N., 2018. Amyotrophic Lateral Sclerosis: An Update for 2018. Mayo Clinic Proceedings, 93(11), pp.1617-1628. 

Harmon, K., 2020. How Has Stephen Hawking Lived Past 70 With ALS?. [online] Scientific American. Available at: <https://www.scientificamerican.com/article/stephen-hawking-als/> [Accessed 23 November 2020]. 

Categories
Neurodegenerative Disorders Sleep-Wake Disorders

Sleep Disorders and Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that gradually affects the nervous system and an individual’s overall movement. The age of onset for Parkinson’s is typically around middle or later life, typically around 60 years old. As an individual gets older, their risk to develop Parkinson’s increases as well. Some symptoms include tremors in one’s hands or fingers, bradykinesia (slowed movement), rigid muscles or muscle stiffness, impaired posture and balance, trouble performing automatic movements such as blinking or smiling, as well as speech and writing changes. Along with these symptoms, there are additional problems that individuals with Parkinson’s may experience, such as sleep disorders. Unfortunately, there is no cure for Parkinson’s disease, but there are medications available that can slightly improve symptoms (Parkinson’s disease – Symptoms and causes). 

Common sleep disorders amongst individuals with Parkinson’s include insomnia and excessive daytime sleepiness. “Insomnia is the inability to fall asleep or maintain sleep” (Sleep and Parkinson’s Disease | Parkinson’s Disease). Individuals with insomnia may struggle with getting to sleep, staying asleep, moving around in bed, or waking up to go to the bathroom. Although the physiological explanation behind insomnia being common amongst those with Parkinson’s is not fully understood, many research studies have indicated that a Parkinson specific treatment, which mainly includes dopaminergic drugs, may be responsible for such symptoms. A particular study had a five year drug-naive group of patients with Parkinson’s, in other words these individuals were not treated with the dopaminergic drugs upon Parkinson incidence. Over the course of these five years, it was found that there was no significant increase in the prevalence of insomnia amongst these patients. However, when these same individuals were followed for five years after the original study was conducted and had initiated taking dopaminergic medication to treat their Parkinson’s disease, a significant increase in the occurrence of sleep insomnia symptoms was recorded (Stefani and Högl, 2019). Excessive daytime sleepiness can occur as a result of many factors amongst those with Parkinson’s disease, including being sleep deprived due to sleep disorders and problems experienced at night, or may be a symptomatic result of Parkinson’s disease treatment medications (Sleep and Parkinson’s Disease | Parkinson’s Disease). However, research related to Parkisnon’s disease dopamine agonist medications causing excessive daytime sleepiness is quite controversial. Nevertheless, research suggests that such treatment medications for Parkinson’s disease play a relevant role in causing excessive daytime sleepiness compared to pathophysiological mechanisms (Stefani and Högl, 2019). Whether experiencing insomnia or excessive daytime sleepiness amongst individuals with Parkinson’s disease, the importance of continuing research on the side effects or symptoms of certain treatment medications has been extensively stressed. 

Circadian rhythms include rhythms such as the sleep-wake cycle, which are controlled by a “clock” or time-keeping mechanism in the brian. The sleep-wake cycle is heavily influenced by external parameters such as environmental light-dark cycles, time-zone shifts, aging, exercise, and melatonin. In general, older individuals’ circadian rhythms, specifically the sleep-wake cycle, tend to be affected in many ways. For instance, older individuals tend to go to bed earlier and wake up earlier (Sleep and Parkinson’s Disease | Parkinson’s Disease). For individuals with Parkinson’s disease, not only does the sleep-wake cycle get modified, but other circadian rhythms that affect motor, autonomic, cognitive, and psychiatric symptoms also are affected. Research studies have demonstrated that the circadian melatonin secretion rhythm is often reduced in those with Parkinson’s. Additionally, it is suspected that these reductions in melatonin rhythms may be due to insufficient exposure to light during the day. Individuals with Parkinson’s also experience similar modifications to their sleep-wake cycles similar to that of older individuals, and these modifications can also result in excessive daytime sleepiness. Research studies have suspected that these modifications to their sleep-wake cycle may be a result of dopaminergic drugs used to treat parkinson’s disease (Stefani and Högl, 2019). 

Another common sleep disturbance amongst those with Parkinson’s disease is periodic leg movements of sleep (PLMS) and restless legs syndrome (RLS). RLS is an uncomfortable sensation in one’s leg that can be alleviated by moving your leg and PLMS is a jerking movement in the leg that typically occurs during sleep and often wakes the individual up (Sleep and Parkinson’s Disease | Parkinson’s Disease). Research studies have demonstrated that RLS may be a result of other Parkinson’s disease related symptoms including dystonia, which results in muscular spasms and abnormal posture, painful neuropathy, and nocturnal hypokinesia which is the inability to move during sleep resulting in difficulty getting up or laying down (Stefani and Högl, 2019). Additionally, RLS and PLMS may be a side effect of Parkinson treatment medications such as dopamine agonists (Sleep and Parkinson’s Disease | Parkinson’s Disease). 

Although many individuals with Parkinson’s disease experience sleep disturbances, there is hope within future research to progress treatment medications without such side effects. Additionally, there are many tips such as maintaining a regular bedtime and rise time, getting bright light daytime exposure, taking shorter naps, avoiding heavy exercise six hours before sleep, avoiding heavy late night meals, and more to help individuals overcome sleep disturbances (Sleep and Parkinson’s Disease | Parkinson’s Disease). 

 

References

Parkinson’s Disease – Symptoms And Causes. Mayo Clinic. 2020. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055> [Accessed 25 October 2020].

Sleep And Parkinson’s Disease. Parkinson’s Disease Clinic and Research Center. 2014[online] Available at: <https://pdcenter.ucsf.edu/sleep-and-parkinsons-disease> [Accessed 25 October 2020]. 

Simsek, L., 2020. Man In Black Jacket Sitting On Chair. [image] Available at: <https://www.pexels.com/photo/man-in-black-jacket-sitting-on-chair-3616835/> [Accessed 25 October 2020].

Stefani, A. & Högl, B., 2019. Sleep in Parkinson’s disease. Neuropsychopharmacology, 45(1), pp.121-128. https://doi.org/10.1038/s41386-019-0448-y 

Categories
Neurocognitive Disorders Neurodegenerative Disorders

What is Spinal Muscular Atrophy?

Approximately one in 10,000 live births have a case of Spinal Muscular Atrophy (SMA) (Lunn & Wang, 2020). Unfortunately, despite being the leading genetic cause of infant deaths, SMA is not well known. SMA is an autosomal recessive disorder, meaning there is a genetic defect in both copies of an autosomal gene (Torgerson & Ochs, 2014). This disorder is a result of deteriorating, or degenerating, motor neurons, which are nerve cells that control voluntary muscle movement located in the spinal cord (Lunn & Wang, 2020 and Spinal Muscular Atrophy (SMA)). This leads to individuals with SMA experiencing atrophy, or the weakening and shrinking of their muscles (Spinal Muscular Atrophy (SMA)). Additionally, individuals with SMA often face hypotonia, or the reduction of tension in their muscles while they stretch, resulting in muscle fatigue and weakness (Lunn & Wang, 2020). SMA normally occurs in children at any age, however, children from infancy to early childhood often experience worsened symptoms of the disorder. It is possible, however, for patients to develop SMA later in childhood, adolescence, and into adulthood, but in these cases individuals tend to have a more positive prognosis (Spinal Muscular Atrophy (SMA)). 

There are four types of SMA that are caused due to a genetic mutation in the survival motor neuron 1 gene (SMN1) located on the fifth chromosome. Type I, or Werdnig-Hoffmann disease, is the most severe and common type. It often occurs before six months of infancy and unfortunately oftentimes results in death within the first two years of the child’s life. Patients diagnosed with type one SMA experience hypotonia, lack of control of head movement, inability to sit up without support, weakened intercostal muscles, and paradoxical breathing. Paradoxical breathing is reverse breathing, so as one breathes in, their chest contracts, and as one breathes out it expands (Lunn & Wang, 2020). 

Type II SMA is of intermediate severity and normally occurs between seven to eighteen months. Patients are able to sit up without support, and some are able to walk with supporting leg braces. Unfortunately, no patients can walk without support, and there may also be difficulty with coughing, fine tremors, as well as kyphoscoliosis. Kyphoscoliosis is when the spine curves in an outward direction (Lunn & Wang, 2020). 

SMA patients with type III, or Kugelberg-Welander disease, tend to have less severe symptoms, and are mostly able to walk independently. Individuals with type III SMA often experience muscle weakness as a result of joint overuse and may develop scoliosis as well. Patients with type IV SMA are often diagnosed in their twenties or thirties and are able to walk independently as adults without experiencing too much motor impairment (Lunn & Wang, 2020). Lastly, other forms of SMA that occur are not caused by the genetic mutation on the SMN1 gene. Some of these types of SMA include “spinal muscular atrophy with respiratory distress (SMARD), spinal and bulbar muscular atrophy (Kennedy’s disease), and distal spinal muscular atrophy” (Lunn & Wang, 2020). 

Unfortunately, there are no current medications or treatments to cure SMA. However, there are supporting methods to lessen the severity of symptomatic pains. For instance, braces and wheelchairs are often used to assist patients in walking or other types of muscle movement. Patients can also receive support for muscle movement through physical and occupational therapy. Lastly, ventilation assistance helps for patients with symptoms such as breathing difficulties (Spinal Muscular Atrophy (SMA)). Although there are no medications and permanent treatments for SMA as of now, there remains hope for further advances in the future as many medications are currently in clinical trials. As more people are educated about SMA, more research advances will be attempted and progress for treatments will be made. 

 

References

Johns Hopkins Medicine. 2020. Spinal Muscular Atrophy (SMA). [online] Available at: <https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-muscular-atrophy-sma> [Accessed 11 October 2020]. 

Lunn, M.R. & Wang, C.H., 2008. Spinal muscular atrophy. Lancet, 371, pp. 2120-2133.

Oquendo, C., 2019. Low Angle Shot Of A Child Held by Woman and Man On Each Hand Walking On An Unpaved Pathway Outdoors. [image] Available at: <https://www.pexels.com/photo/low-angle-shot-of-a-child-held-by-woman-and-man-on-on-each-hand-walking-on-an-unpaved-pathway-outdoors-3038455/> [Accessed 11 October 2020]. 

Torgerson, T. & Ochs, H., 2014. Autosomal Recessive Disorders. Stiehm’s Immune Deficiencies 5th Edition.

Categories
Autism Spectrum Disorder Neurocognitive Disorders

Adjusting to Online Learning During the Pandemic for Students with Autism

As of spring 2020, school closures due to the coronavirus pandemic have affected at least 55.1 million students in both public and private schools across the U.S. (Map: Coronavirus and School Closures in 2019-2020). As schools started in the U.S. this fall, many students have engaged in fully remote learning. Life, for elementary school children used to having recess or college undergraduates used to in-person lectures, has completely shifted. While these adjustments have been difficult for all students in terms of education, they have been especially challenging for students who experience Autism Spectrum Disorder. 

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder related to brain development, and impacts an individual’s social and communication skills, as well as behavior (Autism spectrum disorder – Symptoms and causes). Repetitive behaviors, having trouble expressing needs using typical words or motions, having trouble adapting when a routine changes, having trouble relating to others, having trouble understanding other people’s feelings or talking about their own feelings, and avoiding eye contact are some of the symptoms that individuals with ASD may experience. Detection of ASD can occur as early as 18 months. Even though there is currently no cure for ASD, early intervention therapy can assist children with ASD in focusing, walking, talking, and interacting with others (What is Autism Spectrum Disorder?). 

General challenges that many students, parents, and educators have faced during remote learning throughout the pandemic include concerns about technological security, workplace environment, privacy, increasing feelings of isolation, and limitations in engagement throughout remote learning (Online learning concerns that shouldn’t be ignored). However, children and older students with ASD or other learning disabilities couple these concerns with other challenges as well. Specifically, students with ASD that may have trouble communicating in classrooms may find it more difficult to communicate virtually since social engagement is profoundly reduced via remote learning. Many of these students, especially younger children, have aides that assist them in social engagement and attentional issues in classroom environments, and they may not be able to have their aide support them in person with quarantine and social distancing measures in place. Students with ASD who received “related services” or school therapists and behaviorists that monitored and assisted them with behavioral difficulties may no longer receive them (Coronavirus: What happens to students with disabilities when schools close?). Additionally, many students with ASD often process information and learn differently from their peers. For instance, many students with ASD have trouble working independently, struggle with time management, are more likely to have difficulties in tasks  involving language and communication, and experience high levels of anxiety which may be worsened due to the stress of remote learning. Oftentimes, individuals with ASD associate specific tasks with locations, and thus may resist doing school work at home (Webster, 2020).  

Despite such challenges, there are some tips to help students with ASD adjust to remote learning. Some tips include creating a learning space to associate with school work and a routine that allows them to not become overwhelmed with the sudden changes happening. Children with ASD may have trouble engaging in independent tasks, something that has exponentially increased due to limited opportunity for social interaction in remote learning. Therefore, independent tasks such as completing homework may be challenging for students with ASD. However, research has demonstrated that creating a homework plan with clear communication between the parent and educator about which content should be prioritized as the main “takeaway” from lessons makes the individual task less anxiety inducing or overwhelming to the student, while being equally educational and effective. For instance, instead of writing an essay on the story or history of early settlers, students with ASD can use puppets to tell this history since they may have trouble thinking about what goes on in someone’s mind or relating to someone else’s story. Thus, this method would make the individualized tasks less overwhelming, more engaging, and helpful to the student in overcoming any hardships that may exist when it comes to understanding or relating to someone else (Webster, 2020). 

Additionally, there are some positives to remote learning that can benefit students with ASD. Technology can offer students with ASD the opportunity to learn a wide range of academic skills by presenting educational content in a way that better fits the students’ learning style, which is oftentimes visual learning. In particular, apps that are specifically designed to improve language and literacy skills for different learning styles can be of use to students with ASD who often learn and process information differently from their peers (Webster, 2020). The Learning App Guide to Autism and Education is a useful resource for parents, educators, and students with ASD because it contains reviews for learning apps categorized by skill areas and age groups.  For instance, Babnoor, the first Arabic language app, will launch in UAE to help children with ASD and other neurodevelopmental disorders by teaching children how to create sentences using symbols or images (Dawodi et al., 2020). Overall, online learning apps and platforms can be engaging through educational games or presenting learning styles for different types of learners, including students with ASD. 

Coming together and relying on different resources has been helping all students continue to make the best out of the education they receive everyday. Students with ASD may experience additional challenges relating to adjusting to remote learning, but there are many tips, resources, and positives to look forward to. At the end of the day, no one can stop students from learning. In the words of Albert Einstein, “Intellectual growth should commence at birth and cease only at death.”

 

References

Dawodi, A., Alzahrani, S., Almumtin, R., Alshyban, S., Alshabanah, M., Alrajhi, D., Alsmadi, M. and Almarashdeh, I., 2020. Developing and Implementing an Online Learning Platform for Children with Autism. International Journal of Scientific Research in Science and Technology, pp.176-188.

Webster, A.A., 2020. 5 tips to help parents navigate the unique needs of children with autism learning from home. The Conversation, 4, pp.1-5. 

Usatoday.com. 2020. [online] Available at: <https://www.usatoday.com/story/opinion/2020/03/21/coronavirus-what-happens-students-disabilities-when-schools-close-column/2867856001/> [Accessed 4 October 2020].

Strauss, V., 2020. Five Concerns About The Mass Rush To Online Learning That Shouldn’T Be Ignored.. [online] Washingtonpost.com. Available at: <https://www.washingtonpost.com/education/2020/03/30/five-concerns-about-mass-rush-online-learning-that-shouldnt-be-ignored/> [Accessed 4 October 2020]. 

Education Week. 2020. Map: Coronavirus And School Closures In 2019-2020. [online] Available at: <https://www.edweek.org/ew/section/multimedia/map-coronavirus-and-school-closures.html> [Accessed 4 October 2020].

Centers for Disease Control and Prevention. 2020. Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC. [online] Available at: <https://www.cdc.gov/ncbddd/autism/facts.html> [Accessed 4 October 2020].

Mayo Clinic. 2020. Autism Spectrum Disorder – Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-causes/syc-20352928> [Accessed 4 October 2020].

Cameron, J., 2020. Photo Of Child Sitting At Computer. [image] Available at: <https://www.pexels.com/photo/photo-of-child-sitting-by-the-table-while-looking-at-the-imac-4145153/> [Accessed 27 September 2020]. 

Categories
Tic Disorders

Fine Motor Control and Tic Disorder

It is difficult enough for parents to receive phone calls from teachers that their child is “disruptive” or “disobedient” in class, but some parents may receive more concerning phone calls from their children’s teachers as they are told their child’s behavior may be a result of a neurodevelopmental condition.. In the case of children with tic disorder, this concern of disruptive behavior could be alarming and may point to a larger issue the child may be facing, over which they have no control over. In addition to facing the stereotypes of exhibiting disruptive behavior, many young children who have tic disorder are consequently discriminated against. According to the CDC, children with tic disorder, especially those who experience severe tics, are more likely to be bullied than children without tic disorder (Tourette Syndrome and Bullying).  

Tic disorder is a neurodevelopmental disorder that is characterized by repetitive and uncontrollable bodily movements, known as motor or vocal tics. The age of onset for most tic disorders in children spans from ages four to six. However, many of those who are affected by tic disorder see a great decline in their tics as they grow older (Leckman et al., 2014). This decline varies based on the different types of diagnosed tic disorders. Specifically, provisional tic disorder affects young children in their early school years, and the tics have a tendency to substantially diminish in less than one year. However, they may become worse under certain conditions including anxiety and fatigue. Children who experience chronic tics that may last a year or more are often diagnosed with Tourette’s syndrome, another severe tic disorder (Tic Disorders).  

Although more research on Tourette’s syndrome is needed, a few studies have shed light on the connections between fine motor movements and Tourette’s syndrome. A study examined the differences between fine motor skills in individuals with Tourette’s syndrome and individuals without it, and the results indicated that individuals with Tourette’s syndrome exhibited a lower performance in the categories of hand steadiness and aiming their right hands in comparison to individuals without Tourette’s syndrome. Results also demonstrated that right hand steadiness had a significantly lower performance than left hand steadiness in individuals with Tourette’s syndrome. Conclusions from the study indicated that this reduced control of fine motor skills in individuals with Tourette’s syndrome may be due to alterations in the subcortical and cortical components of one’s brain (Neuner et al., 2012). 

This evidence suggests that individuals with Tourette’s syndrome that engage in activities to improve their fine motor skills through their constant application may be able to limit the occurrence of their motor tics. In fact, older studies have concluded that by focusing concentration on improving these fine motor control skills and movements may be linked to a reduction in motor tics. Children and individuals can improve their fine motor control skills by playing musical instruments that require immense focus in exhibiting fine motor skills by plucking strings and pushing buttons. Other helpful activities include participating in dance or sports (Leckman et al., 2013). In fact, professional soccer players with tic disorder, David Beckham and Tim Howard, are some of the many talented people that have engaged in such activities that improve fine motor skills. 

Although much research regarding the connection between engaging in activities to improve fine motor skills and reduce motor tics is still needed, this finding provides hope for improving future treatments for tic disorder. For instance, current treatments for tic disorder include behavioral therapy to replace a tic with another behavior, like placing one’s hands on one’s knees, to prevent the tic from happening. Although there have not been any treatments created involving improving fine motor skills to reduce the occurrence of tics, increasing research within this area can eventually lead to the creation of such a treatment. Improvement of treatment in reducing tics will substantially help children focus better in classrooms.

 

References

American Academy of Child & Adolescent PsychiatryTic Disorders.(2017). Tic Disorders. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Tic-Disorders-035.aspx 

Centers for Disease Control and Prevention. (2020, May 13th). Tourette’s Syndrome: Help stop bullying. https://www.cdc.gov/ncbddd/tourette/features/tourette-bullying.html 

Cottonbro, P.(2020). [Photo of a toddler playing a ukulele] [Photograph]. Pexels. https://www.pexels.com/photo/a-girl-holding-brown-ukulele-3662750/

Leckman, J.F., Bloch, M.H., Sukhodolsky, D.G., Scahill, L., & King, R.A.(2013) Phenomenology of tics and sensory urges: The self under siege. Tourette Syndrome Oxford: Oxford University Press,3–25. 

Leckman, J.F., King R.A., & Bloch, M.H. (2014) Clinical features of Tourette Syndrome and tic disorders. J Obsessive Compuls Relat Disord, 3(4), 372–379.doi:10.1016/j.jocrd.2014.03.004

Neuner, I., Arrubla, J., Ehlen, C., Janouschek, H., Nordt, C., & Fimm, B.(2012). Fine motor skills in adult Tourette patients are task-dependent. BMC Neurology, 12(120). doi:doi.org/10.1186/1471-2377-12-120