Assignment 2: LASA 1: Case Studies Presentation
Case Study 1
Isaac is a fifty-nine-year-old man. Several months ago, he noticed a slight tremor in his hands. He assumed this to be a normal consequence of aging. The tremor, however, gradually worsened, along with some muscular stiffness and slowness in initiating movement. The tremor was more pronounced when he was not voluntarily moving. Isaac was referred to a neurologist, who diagnosed him with Parkinson’s disease. After visiting the neurologist, Isaac and his family ask you to further explain this disorder. Isaac also asks about L-dopa as a treatment—the neurologist had mentioned L-dopa as an effective medication but had instead prescribed selegiline:
What are the symptoms of Parkinson’s disease?
What are the possible causes? Be sure to discuss both hereditary and environmental factors thought to contribute to this disease.
What parts of the brain does this disease affect?
Why do you think the neurologist prescribed selegiline instead of L-dopa?
Parkinson’s Disease is A neurodegenerative disease characterized by motor problems (rigidity, tremors) and caused by destruction of dopamine neurons in the brain. Named after James Parkinson who first described it in 1817. It is more often found in men than in women, and it affects between 0.5 and 1 percent of people between ages 65 and 69 and 1 to 3 percent of people over 80 (Toulouse & Sullivan, 2008)
Parkinson’s Other Symptoms
Swallowing problems. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.
Sleep problems and sleep disorders. People with Parkinson’s disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.
People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems.
Bladder problems. Parkinson’s disease may cause bladder problems, including being unable to control urine or having difficulty urinating.
Constipation. Many people with Parkinson’s disease develop constipation, mainly due to a slower digestive tract.
The causes of Parkinson’s disease are not clear, although both genetic and environmental factors are suspected. Genetic factors may be more important in cases where the Parkinson’s disease develops earlier in life, and environmental factors may be more relevant in later onset cases (Wirdefeldt et al., 2011).
Genes- Researchers have identified specific genetic mutations that can cause Parkinson’s disease, but these are uncommon except in rare cases with many family members affected by Parkinson’s disease. However, certain gene variations appear to increase the risk of Parkinson’s disease but with a relatively small risk of Parkinson’s disease for each of these genetic markers.
Environmental triggers- Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.
The Brain Effected
Normally, there are brain cells (neurons) in the human brain that produce dopamine. These neurons concentrate in a particular area of the brain, called the substantia nigra. Dopamine is a chemical that relays messages between the substantia nigra and other parts of the brain to control movements of the human body. Dopamine helps humans to have smooth, coordinated muscle movements. When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinson’s disease appear. This process of impairment of brain cells is called neurodegeneration.
The symptoms of Parkinson’s disease can be temporarily reduced by medications, such as Mirapex (pramipexole), that increase the availability of dopamine in the brain. However, once the medications wear off, the symptoms return. Another treatment approach that is now being tried is deep brain stimulation (described in Chapter 16). In the future, stem cell research may also offer some hope for patients with this disease.
Carbidopa-levodopa. Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa (Rytary, Sinemet), which protects levodopa from premature conversion to dopamine outside your brain, which prevents or lessens side effects such as nausea.
Selegiline Vs L-Dopa
Selegiline (Eldepryl™, Selgene™, Apo-Selegiline™) was introduced as adjunctive therapy for Parkinson’s disease. In the 1980s it was thought that selegiline was neuroprotective and slowed the progression of Parkinson’s disease, hence it was widely prescribed. It is now apparent that selegiline does not alter the long-term outlook of Parkinson’s disease. In addition, data have recently been published that suggest that selegiline may increase mortality in some patients. It is timely, therefore, to review the place of selegiline in the treatment of Parkinson’s disease.
Selegiline has been used since 1975 as adjunctive therapy for Parkinson’s disease.1 It blocks the enzyme monoamine oxidase type B, which forms one of the metabolic pathways for dopamine in the brain. It was predicted that selegiline would prolong the effect of native or endogenous dopamine, and also prolong the effect of dopamine formed from therapeutically administered levodopa.
Case Study 2
Sabrina is a twenty-seven-year-old woman who recently underwent a corpus callosotomy. Initially after surgery, when given a verbal command, Sabrina demonstrated marked apraxia of the left hand. However, the extent of this issue diminished over time. Answer the following questions about this client:
What disorder was most likely being treated by this operation, and how is the surgery performed?
In what way is the surgery expected to help Sabrina?
What are the risks and benefits of the surgery? Compare these to the risks and benefits of an alternative treatment. If the decision were yours, which would you recommend? Explain your decision.
What was the cause of the apraxia?
What does the reduction in apraxia symptoms tell us about hemispheric specialization?
The Corpus Callosum is a nerve bridge which connects the two halves of the brain and integrates its functions. Sectioning, or separating, the corpus callosum was first reported in the medical literature in 1940. A corpus callosotomy may be performed when partial seizures secondarily generalize and it is not possible to identify a single epileptic focus or when resection of a localized focus would cause a pronounced neurological deficit. Uncontrolled generalized seizures, especially atonic seizures (drop attacks), may also be treated with this type of surgery.
By separating the cerebral hemispheres, the spread of an epileptic discharge can be confined to one cortex, reducing generalized seizures. Some type of seizure activity on one or both sides will continue after the operation, but the effects are generally less severe than the repeated drop attacks or convulsions. The operation may be done in two steps. The first operation partially separates the two halves of the brain, but leaves some connections in place. If the generalized seizures stop, no further surgery is done. If they continue, a second operation to complete the separation may be performed.
Corpus Collosotomy Risk’s & Side Effects
The following symptoms may occur after having a corpus collosotomy, although they generally go away on their own:
Feeling tired or depressed
Difficulty speaking, remembering things, or finding words
Paralysis, weakness, loss of sensation
Change in personality
Medications- there are many drugs that one can use to try to control seizures. However, although there are new drugs available all the time, people who have not responded to them early have a smaller chance of responding with each new drug tried. This means that there is only a small chance of drugs controlling your seizures long term.
Vagus nerve stimulation (VNS) is a procedure that stimulates the vagus nerve with electrical impulses. Vagus nerve stimulation can be used to treat epilepsy when other treatments haven’t worked. There’s one vagus nerve on each side of your body, running from your brainstem through your neck to your chest and abdomen. With vagus nerve stimulation, a device is surgically implanted under the skin on your chest. A wire is threaded under your skin connecting the device to the left vagus nerve. When activated, the device sends electrical signals along the vagus nerve to your brainstem, which then sends signals to certain areas in your brain.
Surgical complications with vagus nerve stimulation are rare and are similar to the dangers of having other types of surgery. They include:
Pain where the cut (incision) is made to implant the device
Vocal cord paralysis, which is usually temporary, but can be permanent
VNS Side Effects
Side effects after surgery
Some of the side effects and health problems associated with vagus nerve stimulation can include:
Breathing problems, especially during exercise
Abdominal pain or nausea
Tingling or prickling of the skin
Apraxia & Corpus Collosotomy
Apraxia is an impairment in performing voluntary skilled movements or purposeful acts despite intact motor (movement) abilities. Thus, the person with apraxia can still comprehend what needs to be done and has the muscular strength, coordination, and knowledge to do an activity (e.g., use a pair of scissors), but cannot do it when attempted. Apraxia is caused by acquired brain damage or disease. People with apraxia often do not know that they have such a problem because the area where the brain injury occurs causes a lack of insight into their condition.
Damage to the corpus callosum can also cause apraxia. The corpus callosum is a group of nerve fibers that connect both sides of the brain and allow them to communicate. Apraxia is often divided into two types: ideational and ideomotor. Ideational apraxia is a disturbance of voluntary movement in which a person misuses objects because he/she has difficulty identifying the concept (idea) or purpose behind the objects. Ideomotor apraxia is a disturbance of voluntary movement in which a person cannot translate an idea into movement. The two types of apraxia often co-occur.
Butcher, J. N., Hooley, J. M., Mineka, S. M. (07/2013). Abnormal Psychology, 16th Edition. [VitalSource Bookshelf Online]. Retrieved September 16, 2015, from http://digitalbookshelf.argosy.edu/#/books/9781269939485/
NHS. (2015, April 29). Corpus callosotomy. Retrieved September 16, 2015, from http://www.gosh.nhs.uk/medical-information/procedures-and-treatments/corpus-callosotomy
NPF. (2015, November 8). Environmental Factors and Parkinson’s. Retrieved September 16, 2015, from http://www.parkinson.org/understanding-parkinsons/what-is-parkinsons/Environmental-Factors-and-Parkinsons
Pinel, J. P. (2013-10-01). Biopsychology, 9th Edition. [VitalSource Bookshelf Online]. Retrieved September 16, 2015, from http://digitalbookshelf.argosy.edu/#/books/9781323123058/
Senelick, R. (2014, July 14). Corpus Callosotomy Surgery: Uses, Effects, Recovery, and More. Retrieved September 16, 2015, from http://www.webmd.com/epilepsy/guide/corpus-callosotomy?page=2#4
Snow, B. (1999, November 18). Selegiline in Parkinson’s Disease. Retrieved September 16, 2015, from http://www.medsafe.govt.nz/profs/PUarticles/selegiline.htm
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