Cerebral Palsy in Children

WHAT IS CEREBRAL PALSY?

Cerebral Palsy is a term used to cover several neurological conditions.

These conditions are caused beforeduring or shortly after birth as a result of injury to the brain due to any of the following reasons:Limited or interrupted oxygen supply to the brainA bleed within the baby’s brain
A premature or difficult birth processThe mother catching an infection whilst pregnantChanges in genes which affect the development of the brain 
Cerebral Palsy can affect muscle control, coordination, and tone, reflexes, posture and balance. Often a person with Cerebral Palsy will display signs of the condition, but the effects can vary greatly from person to person
‘Cerebral Palsy’ comes from the Latin words ‘Cerebrum’ and ‘Paralysis’

WHAT ARE THE DIFFERENT TYPES OF CEREBRAL PALSY?

The NHS describes three different categories of Cerebral Palsy, it is also possible to have a combination of categories which is referred to as ‘Mixed Cerebral Palsy’.

Spastic Cerebral Palsy
This affects muscle stiffness or weakness. Click here to learn more.
Athetoid Cerebral Palsy
This affects muscle tone, causing involuntary spasms. Click here to learn more.
Ataxic Cerebral Palsy
This affects balance and coordination. Click here to learn more.

The affect Cerebral Palsy has on individuals ranges from the very mild, to more severe cases that can make it difficult for people to control their limbs.

How Dyspraxia Differs from Other Development Delays in Children

Dyspraxia definition

Dyspraxia is a brain-based motor disorder. It affects fine and gross motor skills, motor planning, and coordination. It’s not related to intelligence, but it can sometimes affect cognitive skills.

Dyspraxia is sometimes used interchangeably with developmental coordination disorder. While some doctors may consider these separate conditions, due to a lack of formal definition, others consider them the same.

Children born with dyspraxia may be late to reach developmental milestones. They also have trouble with balance and coordination.

Into adolescence and adulthood, symptoms of dyspraxia can lead to learning difficulties and low self-esteem.

Dyspraxia is a lifelong condition. There’s currently no cure, but there are therapies that can help you effectively manage the disorder.

Dyspraxia symptoms in children

If your baby has dyspraxia, you might notice delayed milestones such as lifting the head, rolling over, and sitting up, though children with this condition may eventually reach early milestones on time.

Other signs and symptoms can include:

  • unusual body positions
  • general irritability
  • sensitivity to loud noises
  • feeding and sleeping problems
  • a high level of movement of the arms and legs

As your child grows, you might also observe delays in:

Dyspraxia makes it hard to organize physical movements. For example, a child might want to walk across the living room carrying their schoolbooks, but they can’t manage to do it without tripping, bumping into something, or dropping the books.

Other signs and symptoms may include:

  • unusual posture
  • difficulty with fine motor skills that affect writing, artwork, and playing with blocks and puzzles
  • coordination problems that make it difficult to hop, skip, jump, or catch a ball
  • hand flapping, fidgeting, or being easily excitable
  • messy eating and drinking
  • temper tantrums
  • becoming less physically fit because they shy away from physical activities

Although intelligence isn’t affected, dyspraxia can make it harder to learn and socialize due to:

  • a short attention span for tasks that are difficult
  • trouble following or remembering instructions
  • a lack of organizational skills
  • difficulty learning new skills
  • low self-esteem
  • immature behavior
  • trouble making friends

Dyspraxia symptoms in adults

Dyspraxia is different for everyone. There are a variety of potential symptoms and they can change over time. These may include:

  • abnormal posture
  • balance and movement issues, or gait abnormalities
  • poor hand-eye coordination
  • fatigue
  • trouble learning new skills
  • organization and planning problems
  • difficulty writing or using a keyboard
  • having a hard time with grooming and household chores
  • social awkwardness or lack of confidence

Dyspraxia has nothing to do with intelligence. If you have dyspraxia, you may be stronger in areas such as creativity, motivation, and determination. Each person’s symptoms are different.

Dyspraxia versus apraxia

Though these two terms sound familiar and are both brain-based conditions, dyspraxia and apraxia are not the same.

Dyspraxia is something that someone is born with. Apraxia can develop following a stroke or brain injury at any point in life, though certain types may have genetic components.

There are several types of apraxia which affect different motor functions. It’s often thought to be a symptom of a neurological, metabolic, or other type of disorder.

Apraxia may go away on its own within weeks, especially if it’s the result of stroke.

It’s possible to have both dyspraxia and apraxia.

Dyspraxia causes

The exact cause of dyspraxia isn’t known.

It could have to do with variations in the way neurons in the brain develop. This affects the way the brain sends messages to the rest of the body. That could be why it’s hard to plan a series of movements and then carry them out successfully.

Dyspraxia risk factors

Dyspraxia is more common in males than females. It also tends to run in families.

Risk factors for developmental coordination disorders may include:

It’s not unusual for a child with dyspraxia to have other conditions with overlapping symptoms. Some of these are:

Although some symptoms are the same, these other conditions don’t involve the same fine and gross motor skill issues of dyspraxia.

Other conditions like cerebral palsymuscular dystrophy, and stroke can cause physical symptoms similar to dyspraxia. That’s why it’s so important to see a doctor to get the correct diagnosis.

Diagnosing dyspraxia

The severity of symptoms can vary a lot from child to child. It may not be apparent that your child isn’t developing certain skills for several years. A diagnosis of dyspraxia may be delayed until a child is 5 years or older.

If your child often runs into things, drops things, or struggles with physical coordination, it doesn’t mean they have dyspraxia. These symptoms could be a sign of a number of other conditions — or nothing at all.

It’s important to see their pediatrician for a thorough evaluation. A doctor will assess such factors as:

  • medical history
  • fine motor skills
  • gross motor skills
  • developmental milestones
  • mental abilities

There are no specific medical tests to diagnose dyspraxia. The diagnosis may be made if:

  • motor skills are significantly below what’s expected for their age
  • a lack of motor skills has a persistent negative effect on day-to-day activities
  • symptoms began early in development
  • other conditions with similar symptoms have been ruled out or diagnosed

Dyspraxia is more often diagnosed as developmental coordination disorder (DCD).

Dyspraxia treatment

For a small number of children, symptoms resolve on their own as they age. That’s not the case for most children, though.

There’s no cure for dyspraxia. However, with the right therapies, people with dyspraxia can learn to manage symptoms and improve their abilities.

Because it’s different for everybody, treatment must be tailored to individual needs. The treatment plan will depend on a number of factors. The severity of your child’s symptoms and other coexisting conditions are key to finding the right programs and services.

Some of the healthcare professionals you may work with are:

  • behavior analysts
  • occupational therapists
  • pediatric specialists
  • physical therapists
  • psychologists
  • speech and language therapists

Some children do well with minor interventions. Others need more intense therapies to show improvement. Whatever therapies you choose, they can be adjusted along the way.

Your healthcare team can help identify problem areas. Then they can work on breaking tasks down into manageable pieces.

With regular practice, your child can learn how to better manage tasks such as:

  • tying shoes or self-dressing
  • using eating utensils properly
  • using the toilet
  • walking, running, and playing
  • organizing an approach to schoolwork

Therapy can help your child gain confidence, which may also help them socially. Your child’s school can provide special services and accommodations to make learning easier.

Adults can benefit from occupational therapy as well. This can help with practical, everyday matters involving small motor skills and organizational skills.

Cognitive behavioral therapy, or talk therapy, can help modify thinking and behavior patterns that shake your confidence and self-esteem.

Even if you have physical difficulties, it’s still important to exercise regularly. If this is a problem, ask a doctor for a referral to a physical therapist or look for a qualified personal trainer.

Takeaway

Dyspraxia is a developmental coordination disorder. This lifelong condition affects gross and fine motor skills, and sometimes cognitive function.

It shouldn’t be confused with an intellectual disorder. In fact, people with dyspraxia can have average or above average intelligence.

There’s no cure for dyspraxia, but it can be successfully managed. With the right therapies, you can improve organizational and motor skills so you can live life to the fullest.

ADHD and Diabeties

The children of parents who have type 1 diabetes are at a greater risk of developing attention deficit hyperactivity disorder (ADHD), a study has suggested.
While the findings indicate an association between the two conditions, there is no evidence to explain this link, and further research is planned.
Scientists from the Center for Primary Health Care Research at Lund University in Sweden identified more than 15,600 children who all had parents with type 1 diabetes. Their health outcomes were then compared to a group of 1,380,829 young people who did not have the condition in the family.
They discovered the ADHD risk was 29 per cent higher among children who had a parent with type 1 diabetes compared to the group where diabetes did not exist.
Just like type 1 diabetes, ADHD is often identified in childhood between the ages of six and 12. No one can yet explain exactly why the condition develops, but it is believed being born prematurely, having a low birthweight and the mother smoking, taking drugs or drinking large quantities of alcohol during pregnancy might contribute toward the diagnosis.
Currently there is no cure for the condition, but it can be managed with medication and appropriate educational support for both the parent and the child.
Boys were more likely to be diagnosed with ADHD than girls and the risk of the condition increased if it already existed in the family.
The researchers wrote: “An important strength of this study is that it is a nationwide study, and the number of individuals with a parental diagnosis of [type 1 diabetes] is large enough so that we have sufficient study power to look at associations.
“All data were retrieved from Swedish registers that are of high quality and have national coverage. The prospective study design and the completeness of the follow-up of patients are other major advantages of the current study.”
The findings appear online in Diabetes Care.

Complex Partial Seizures

Overview

A complex partial seizure is also known as a focal impaired awareness seizure or a focal onset impaired awareness seizure. This type of seizure starts in a single area of the brain. This area is usually, but not always, the temporal lobe of the brain.

While it’s most common in people with epilepsy, this type of seizure has been known to occur in people with cerebral palsy. It includes uncontrolled movement of limbs or other body parts. These seizures are usually very short, and the person having the seizure will be unaware of their surroundings. They may also become unconscious for a brief period of time.

Complex partial seizures and epilepsy

For those with epilepsy, this is the most common type of seizure. But while complex partial seizures are often related to epilepsy, this is not the only reason for someone to have seizures.

Symptoms of complex partial seizures

A complex partial seizure can have multiple possible symptoms. However, these symptoms may occur during one seizure and not another. Complex partial seizures normally only last a few minutes. Seizures beginning in the frontal lobe area of the brain are usually shorter than those that start in the temporal lobe area.

Symptoms will often start abruptly, and the person experiencing the seizure may not know they have had one. The person may:

  • stare blankly or look like they’re daydreaming
  • be unable to respond
  • wake from sleep suddenly
  • swallow, smack their lips, or otherwise move their mouth repetitively
  • pick at things like the air, clothing, or furniture
  • say words repetitively
  • scream, laugh, or cry
  • perform actions that can cause potential danger to themselves, like walking in front of moving cars or removing all or portions of their clothing
  • perform movements like they are riding a bicycle
  • be unaware, either partially or totally, of their surroundings
  • hallucinate
  • try to hurt themselves
  • experience confusion when the seizure ends
  • be unable to remember the seizure when it’s over

Causes of complex partial seizures

While epilepsy is one of the most common causes, there are other conditions that can cause a complex partial seizure. Some of these conditions are:

  • psychological distress or trauma
  • neurologic conditions
  • extreme stress
  • anxiety and depression
  • autism
  • other medical conditions related to the brain
  • damage caused prior to birth
  • neurofibromatosis

Common triggers

A complex partial seizure can happen anytime and usually without much warning. They can even occur when the person is in the middle of an activity. Sometimes the person will have an aura right before having a complex partial seizure. An aura is also called a simple partial seizure. It can act as a warning signal that a bigger seizure is coming.

There are some additional factors that can trigger a seizure, including:

  • flashing lights
  • low blood sugar
  • high fever
  • reactions to some medications

Diagnosing a complex partial seizure

Before deciding on treatment, a doctor will need to confirm that a person is having complex partial seizures. The doctor will need as many details as possible from the person having the seizures as well as from someone who has seen these episodes on a number of occasions. The doctor will need to know what happens before, during, and after each episode.

If a doctor suspects a complex partial seizure, they will usually order a diagnostic test to confirm. An electroencephalogram (EEG) may be done initially. However, the EEG will usually need to record a seizure to be accurate. Other tests that may be given to look for any potential cause of the seizures are a CT scan and an MRI. A blood test and neurological exam may be done as well. These may help the doctor find a cause (if there is a recognizable cause) without seeing an actual seizure while testing.

How are they treated and managed?

There are various types of treatment for complex partial seizures once the condition has been diagnosed. The following are some of the possible treatment options:

The type of treatment used is determined by the cause of the seizures, other medical conditions, and other factors.

Associated health conditions

A complex partial seizure can happen to anyone. However, there are some medical conditions that are more prone to these types of seizures. These medical conditions include:

  • epilepsy (most common)
  • cerebral palsy
  • infection in the brain
  • brain injury
  • tumor in the brain
  • stroke
  • some heart conditions

Sometimes a complex partial seizure will happen to someone without any known medical conditions. There is not always a cause that can be determined in some cases of complex partial seizures.

Outlook

Once diagnosed, seizures — including complex partial seizures — can be managed through a variety of treatment options. In some cases, children will outgrow the seizures.

If you think that you or someone you know is having seizures, it’s important to talk to a doctor for proper diagnosis and treatment.

You should contact a medical professional immediately if someone you know is having a seizure and any of the following is true:

  • this is the person’s first seizure
  • the seizure lasts more than five minutes
  • the person has a high fever
  • the person does not become conscious after the seizure is over
  • the person has diabetes
  • the person is or might be pregnant

Last medically reviewed on June 1, 2017

Down syndrome

Photo by Cliff Booth on Pexels.com

Overview

Down syndrome is a genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21. This extra genetic material causes the developmental changes and physical features of Down syndrome.

Down syndrome varies in severity among individuals, causing lifelong intellectual disability and developmental delays. It’s the most common genetic chromosomal disorder and cause of learning disabilities in children. It also commonly causes other medical abnormalities, including heart and gastrointestinal disorders.

Better understanding of Down syndrome and early interventions can greatly increase the quality of life for children and adults with this disorder and help them live fulfilling lives.

Symptoms

Each person with Down syndrome is an individual — intellectual and developmental problems may be mild, moderate or severe. Some people are healthy while others have significant health problems such as serious heart defects.

Children and adults with Down syndrome have distinct facial features. Though not all people with Down syndrome have the same features, some of the more common features include:

  • Flattened face
  • Small head
  • Short neck
  • Protruding tongue
  • Upward slanting eye lids (palpebral fissures)
  • Unusually shaped or small ears
  • Poor muscle tone
  • Broad, short hands with a single crease in the palm
  • Relatively short fingers and small hands and feet
  • Excessive flexibility
  • Tiny white spots on the colored part (iris) of the eye called Brushfield’s spots
  • Short height

Infants with Down syndrome may be average size, but typically they grow slowly and remain shorter than other children the same age.

Intellectual disabilities

Most children with Down syndrome have mild to moderate cognitive impairment. Language is delayed, and both short and long-term memory is affected.

When to see a doctor

Children with Down syndrome usually are diagnosed before or at birth. However, if you have any questions regarding your pregnancy or your child’s growth and development, talk with your doctor.

Causes

Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from your father, the other from your mother.

Down syndrome results when abnormal cell division involving chromosome 21 occurs. These cell division abnormalities result in an extra partial or full chromosome 21. This extra genetic material is responsible for the characteristic features and developmental problems of Down syndrome. Any one of three genetic variations can cause Down syndrome:

  • Trisomy 21. About 95 percent of the time, Down syndrome is caused by trisomy 21 — the person has three copies of chromosome 21, instead of the usual two copies, in all cells. This is caused by abnormal cell division during the development of the sperm cell or the egg cell.
  • Mosaic Down syndrome. In this rare form of Down syndrome, a person has only some cells with an extra copy of chromosome 21. This mosaic of normal and abnormal cells is caused by abnormal cell division after fertilization.
  • Translocation Down syndrome. Down syndrome can also occur when a portion of chromosome 21 becomes attached (translocated) onto another chromosome, before or at conception. These children have the usual two copies of chromosome 21, but they also have additional genetic material from chromosome 21 attached to another chromosome.

There are no known behavioral or environmental factors that cause Down syndrome.

Is it inherited?

Most of the time, Down syndrome isn’t inherited. It’s caused by a mistake in cell division during early development of the fetus.

Translocation Down syndrome can be passed from parent to child. However, only about 3 to 4 percent of children with Down syndrome have translocation and only some of them inherited it from one of their parents.

When balanced translocations are inherited, the mother or father has some rearranged genetic material from chromosome 21 on another chromosome, but no extra genetic material. This means he or she has no signs or symptoms of Down syndrome, but can pass an unbalanced translocation on to children, causing Down syndrome in the children.

Risk factors

Some parents have a greater risk of having a baby with Down syndrome. Risk factors include:

  • Advancing maternal age. A woman’s chances of giving birth to a child with Down syndrome increase with age because older eggs have a greater risk of improper chromosome division. A woman’s risk of conceiving a child with Down syndrome increases after 35 years of age. However, most children with Down syndrome are born to women under age 35 because younger women have far more babies.
  • Being carriers of the genetic translocation for Down syndrome. Both men and women can pass the genetic translocation for Down syndrome on to their children.
  • Having had one child with Down syndrome. Parents who have one child with Down syndrome and parents who have a translocation themselves are at an increased risk of having another child with Down syndrome. A genetic counselor can help parents assess the risk of having a second child with Down syndrome.

Complications

People with Down syndrome can have a variety of complications, some of which become more prominent as they get older. These complications can include:

  • Heart defects. About half the children with Down syndrome are born with some type of congenital heart defect. These heart problems can be life-threatening and may require surgery in early infancy.
  • Gastrointestinal (GI) defects. GI abnormalities occur in some children with Down syndrome and may include abnormalities of the intestines, esophagus, trachea and anus. The risk of developing digestive problems, such as GI blockage, heartburn (gastroesophageal reflux) or celiac disease, may be increased.
  • Immune disorders. Because of abnormalities in their immune systems, people with Down syndrome are at increased risk of developing autoimmune disorders, some forms of cancer, and infectious diseases, such as pneumonia.
  • Sleep apnea. Because of soft tissue and skeletal changes that lead to the obstruction of their airways, children and adults with Down syndrome are at greater risk of obstructive sleep apnea.
  • Obesity. People with Down syndrome have a greater tendency to be obese compared with the general population.
  • Spinal problems. Some people with Down syndrome may have a misalignment of the top two vertebrae in the neck (atlantoaxial instability). This condition puts them at risk of serious injury to the spinal cord from overextension of the neck.
  • Leukemia. Young children with Down syndrome have an increased risk of leukemia.
  • Dementia. People with Down syndrome have a greatly increased risk of dementia — signs and symptoms may begin around age 50. Having Down syndrome also increases the risk of developing Alzheimer’s disease.
  • Other problems. Down syndrome may also be associated with other health conditions, including endocrine problems, dental problems, seizures, ear infections, and hearing and vision problems.

For people with Down syndrome, getting routine medical care and treating issues when needed can help with maintaining a healthy lifestyle.

Life expectancy

Life spans have increased dramatically for people with Down syndrome. Today, someone with Down syndrome can expect to live more than 60 years, depending on the severity of health problems.

Prevention

There’s no way to prevent Down syndrome. If you’re at high risk of having a child with Down syndrome or you already have one child with Down syndrome, you may want to consult a genetic counselor before becoming pregnant.

A genetic counselor can help you understand your chances of having a child with Down syndrome. He or she can also explain the prenatal tests that are available and help explain the pros and cons of testing.

Bulimia nervosa prt 2

Diagnosis

If your primary care provider suspects you have bulimia, he or she will typically:

  • Talk to you about your eating habits, weight-loss methods and physical symptoms
  • Do a physical exam
  • Request blood and urine tests
  • Request a test that can identify problems with your heart (electrocardiogram)
  • Perform a psychological evaluation, including a discussion of your attitude toward your body and weight
  • Use the criteria for bulimia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Your primary care provider may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

Treatment

When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.

Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

Here’s a look at bulimia treatment options and considerations.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health professional. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:

  • Cognitive behavioral therapy to help you normalize your eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Family-based treatment to help parents intervene to stop their teenager’s unhealthy eating behaviors, to help the teen regain control over his or her eating, and to help the family deal with problems that bulimia can have on the teen’s development and the family
  • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it’s beneficial in treating bulimia.

Medications

Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you’re not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition. Eating regularly and not restricting your food intake is important in overcoming bulimia.

Hospitalization

Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.

Treatment challenges in bulimia

Although most people with bulimia do recover, some find that symptoms don’t go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.

If you find yourself back in the binge-purge cycle, follow-up sessions with your primary care provider, dietitian and/or mental health professional may Dechelp you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.

If you’ve had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team immediately.

Lifestyle and home remedies

In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan. Don’t skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
  • Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get the right nutrition. If you aren’t eating well or you’re frequently purging, it’s likely your body isn’t getting all of the nutrients it needs. Talk to your primary care provider or dietitian about appropriate vitamin and mineral supplements. However, getting most of your vitamins and minerals from food is typically recommended.
  • Stay in touch. Don’t isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart and that nurturing, caring relationships are healthy for you.
  • Be kind to yourself. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
  • Be cautious with exercise. Talk to your primary care provider about what kind of physical activity, if any, is appropriate for you, especially if you exercise excessively to burn off post-binge calories.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

Weight-loss and other dietary supplements don’t need approval by the Food and Drug Administration (FDA) to go on the market. And natural doesn’t always mean safe. If you choose to use dietary supplements or herbs, discuss the potential risks with your primary care provider.

Coping and support

You may find it difficult to cope with bulimia when you’re hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. So how do you cope with a disease that can be deadly when you’re also getting messages that being thin is a sign of success?

  • Remind yourself what a healthy weight is for your body.
  • Resist the urge to diet or skip meals, which can trigger binge eating.
  • Don’t visit websites that advocate or glorify eating disorders.
  • Identify troublesome situations that trigger thoughts or behaviors that may contribute to your bulimia, and develop a plan to deal with them.
  • Have a plan in place to cope with the emotional distress of setbacks.
  • Look for positive role models who can help boost your self-esteem.
  • Find pleasurable activities and hobbies that can help distract you from thoughts about bingeing and purging.
  • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement.

Get support

If you have bulimia, you and your family may find support groups helpful for encouragement, hope and advice on coping. Group members can truly understand what you’re going through because they’ve been there. Ask your doctor if he or she knows of a group in your area.

Coping advice for parents

If you’re the parent of someone with bulimia, you may blame yourself for your child’s eating disorder. But eating disorders have many causes, and parenting style is not considered a cause. It’s best to focus on how you can help your child now.

Here are some suggestions:

  • Ask your child what you can do to help. For example, ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Listen. Allow your child to express feelings.
  • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating.
  • Let your teenager know any concerns you have. But do this without placing blame.

Remember that eating disorders affect the whole family, and you need to take care of yourself, too. If you feel that you aren’t coping well with your teen’s bulimia, you might benefit from professional counseling. Or ask your child’s primary care provider about support groups for parents of children with eating disorders.

Preparing for your appointment

Here’s some information to help you get ready for your appointment, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment, make a list of:

  • Your symptoms, even those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins, herbal products, over-the-counter medications or other supplements you’re taking, and their dosages
  • Questions to ask your doctor, so you can make the most of your time together

Some questions to ask your primary care provider or mental health professional include:

  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you’re prescribing for me?
  • How will treatment affect my weight?
  • Are there any brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional will likely ask you a number of questions. He or she may ask:

  • How long have you been worried about your weight?
  • Do you think about food often?
  • Do you ever eat in secret?
  • Have you ever vomited because you were uncomfortably full?
  • Have you ever taken medications for weight loss?
  • Do you exercise? If so, how often?
  • Have you found any other ways to lose weight?
  • Are you having any physical symptoms?
  • Have any of your family members ever had symptoms of an eating disorder, or have any been diagnosed with an eating disorder?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

Brain Cancer and Brain Tumours

Understanding the brain

The main parts of the brain include:

The cerebrum. This is divided into the right side (right hemisphere) which controls the left side of the body, and the left hemisphere which controls the right side of the body. Each hemisphere is divided into various subsections, the main divisions being the frontal lobe, temporal lobe, parietal lobe and occipital lobe. The cerebrum is also where you think and store your memory.

The cerebellum. This lies behind and below the cerebrum. One of its main functions is to help control balance and co-ordination.

The brain stem. This helps to control basic bodily functions such as the heartbeat, breathing and blood pressure. Nerves from the cerebrum also pass through the brainstem to the spinal cord.

The meninges. These are thin layers of tissue which separate the skull from the brain. The outer layer next to the skull is called the dura. The next layer is called the arachnoid. Under the arachnoid tissue is the cerebrospinal fluid (CSF) which bathes the brain and spinal cord.

The pituitary gland. This releases various hormones into the bloodstream.

The main type of cell in the brain is called a neuron. There are millions of neurons in the brain. Neurons have long thin nerve fibres which enable them to send messages to other parts of the brain and down the spinal cord to all parts of the body. The brain also contains glial cells. These provide support, nourishment and protection for neurons. There are various types of glial cells, including astrocytes, oligodendrocytes and ependymal cells.

The original site where a tumour first develops is called a primary tumour. Cancerous (malignant) tumours may also spread to other parts of the body to form secondary tumours (metastases). These secondary tumours may then grow, invade and damage nearby tissues and spread again.

Primary malignant brain tumours

A primary malignant brain tumour is a cancer which arises from a cell within the brain. The cells of the tumour grow into and damage normal brain tissue. Also, like non-cancerous (benign) brain tumours, they can increase the pressure inside the skull. However, unlike most other types of malignant tumours, primary brain tumours rarely spread (metastasise) to other parts of the body.

There are various types of primary malignant brain tumour. The different types develop from different types of cell in the brain. As a general guide, each type is graded on a scale of 1-4. Grade 1 and grade 2 tumours are said to be low-grade; grade 3 and grade 4 are termed high-grade. The higher the grade, the more aggressive the tumour tends to be and the faster it tends to grow. The treatment options and outlook (prognosis) can vary depending on the type and grade of the tumour.

Secondary malignant brain tumours

A secondary malignant brain tumour means that a cancer which started in another part of the body has spread to the brain. Many types of cancer can spread to the brain. The most common types that do this are cancers of the breastlungbowelkidney and skin (melanoma).

See the separate leaflet called Cancer for more general information about cancer

There are many types of non-cancerous (benign) brain tumours and primary cancerous (malignant) brain tumours. Many are very rare. The following is a brief description of the most common types.

Meningioma

Meningiomas are usually benign. They grow from cells in the tissues that surround the brain (the meninges).

Medulloblastoma

These are high-grade malignant tumours that grow in the cerebellum. They are uncommon in adults but are one of the two most common brain tumours in children. The other is astrocytoma in the cerebellum.

Gliomas

These are malignant primary brain tumours that arise from glial cells. There are various types, depending on the cell of origin – for example:

  • Astrocytomas (originating from astrocyte cells.) There are various types of astrocytoma. They include:
    • Low-grade astrocytomas.
    • Anaplastic astrocytoma. This is a high-grade tumour.
    • Glioblastoma multiforme. This is a high-grade tumour which tends to grow quite quickly. It is the most common type of primary malignant brain tumour in adults.
  • Oligodendrogliomas (originating from oligodendrocytes). These can vary in their grade.
  • Ependymoma (originating from ependymal cells). These are rare but are usually low-grade.

Primitive neuroectodermal tumours (PNETs)

These are very similar to medulloblastomas and mainly occur in children.

Pituitary tumours

There are various types of tumour which arise from the different cells in the pituitary gland. They tend to be benign. However, the cells of the tumour may produce large quantities of hormones which can cause various symptoms. As they grow, they may also cause pressure symptoms. The nerves of sight (optic nerves) are near to the pituitary gland and so a growing pituitary gland tumour may press on an optic nerve and affect vision.

Acoustic neuroma

An acoustic neuroma (schwannoma) is a benign tumour which arises from Schwann cells which cover the nerve that goes to the ear. Symptoms can include deafness on the affected side and dizziness with a spinning sensation (vertigo).

Other

There are various other rare types of benign and primary malignant brain tumours.

The cause of most non-cancerous (benign) brain tumours and primary cancerous (malignant) brain tumours is not known.

Genetic factors may be a risk for some people – perhaps in about 1 in 20 cases. For example, people with the hereditary diseases called neurofibromatosis type 1, Turcot’s syndrome, Li-Fraumeni cancer syndrome, and tuberous sclerosis have a higher-than-average risk of developing a glioma. When people with these diseases develop a glioma, it tends to occur in childhood or early adult life. However, these cases are only a small proportion of all glioma tumours.

Note:

  • Most gliomas occur in older adults and inherited (genetic) factors are not thought to be involved.
  • Previous radiotherapy to the brain is thought to increase the risk of a brain tumour.
  • There is no strong evidence that using mobile phones increases the risk of brain tumours.
  • Secondary (metastatic) brain tumours arise from various cancers of the body. These have various causes. See the separate leaflets about these other cancers.

Non-cancerous (benign) brain tumours and cancerous (malignant) primary brain tumours are uncommon. Overall they occur in about 12 in 100,000 people each year.

The most common types in adults are benign meningioma and a glioma called glioblastoma multiforme. Some types are very rare.

Brain tumours can occur at any age. Some types (such as medulloblastoma) are more common in children and some are more common in adults. Generally, the tumours that tend to occur in adults become more common with increasing age.

Secondary (metastatic) brain tumours are more common than benign brain tumours and malignant primary brain tumours.

General symptoms

Early symptoms may include headaches and feeling sick. These are due to increased pressure within the skull (raised intracranial pressure). These symptoms may come and go at first and tend to be worse in the morning. Coughing, sneezing and stooping may make the headaches worse. Epileptic seizures (convulsions) sometimes occur. Increasing drowsiness may occur as the tumour enlarges.

Note: most people who have headaches or epilepsy do not have a brain tumour.

Symptoms due to the location in the brain

As a tumour grows it can damage the nearby brain tissue. The functions of the different parts of the body are controlled by different parts of the brain. Therefore, the symptoms vary from case to case, depending on which part of the brain is affected and on the size of the affected area. For example, one or more of the following may develop:

These symptoms tend to develop gradually.

A doctor will examine you if a brain tumour is suspected from the symptoms. This will include checking on the functions of the brain and nerves (movements, reflexes, vision, etc).

A magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan of the head is the common test done to confirm or rule out the presence of a brain tumour. See the separate leaflets called MRI Scan and CT Scan for more details. If a tumour is identified, further more detailed scans and tests may be done. For example, a PET scan or a cerebral angiogram are sometimes done to obtain more information about the tumour.

small tissue sample (a biopsy) may be needed to be sure of the type of tumour. The sample is then examined under the microscope to look for abnormal cells. To obtain a biopsy from a brain tumour you need to have a small operation, usually done under anaesthetic. A small hole is bored in the skull to allow a fine needle through to obtain a small sample of tissue. By examining the cells obtained by the biopsy, the exact type of tumour can be identified. If it is cancerous (malignant), the tumour grade can be determined (see above).

Blood tests and other tests on other parts of the body may be done if the tumour is thought to be a secondary (metastatic) tumour. For example, it is quite common for a lung cancer to spread to the brain. Therefore, a chest X-ray may be done if this is suspected. Various hormone tests may be done if a pituitary gland tumour is suspected. 

The main treatments used for brain tumours are surgery, chemotherapy, radiotherapy and medication to control symptoms such as seizures. The treatment or combination of treatments advised in each case depends on various factors – for example:

  • The type of brain tumour.
  • The grade of the tumour if it is cancerous (malignant).
  • The exact site of the tumour.
  • Your general health.

Surgery

Surgery is often the main treatment for non-cancerous (benign) brain tumours and primary cancerous (malignant) tumours. The aim of surgery is to remove the tumour (or even some of the tumour) whilst doing as little damage as possible to the normal brain tissue. Your specialist will advise on whether surgery is a possible option.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying. See the separate leaflet called Radiotherapy for more details.

Radiotherapy is sometimes used instead of surgery when an operation is not possible for a malignant brain tumour. Sometimes it is used in addition to surgery if it is not possible to remove all the tumour with surgery or to kill cancerous cells which may be left behind following surgery.

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer medicines to kill cancer cells, or to stop them from multiplying. See the separate leaflet called Chemotherapy for more details. It may be used in addition to other treatments such as surgery or radiotherapy; again, depending on various factors such as the type of tumour.

Medication to control symptoms

If you have seizures caused by the tumour then anticonvulsant medication will usually control the seizures. Painkillers may be needed to ease any headaches. Steroid medication is also commonly used to reduce inflammation around a brain tumour. This reduces the pressure inside the skull, which helps to ease headaches and other pressure symptoms.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects and other details about the possible treatment options for your type of brain tumour.

You should also discuss with your specialist the aims of treatment. For example:

  • In some cases, treatment aims for a cure. If a benign tumour can be removed by surgery then a cure is likely. The chance of a cure for malignant tumours varies, depending on the type of tumour, grade and other factors such as the location in the brain. Note: when dealing with malignant tumours, doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.
  • In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it may be possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
  • In some cases, treatment aims to ease symptoms (palliative treatment). For example, if a cancer is advanced then you may require painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

It is difficult to give an overall outlook (prognosis). Every case is different. For example, if you have a non-cancerous (benign) meningioma which is in a suitable place for surgery, the outlook is excellent.

For primary cancerous (malignant) brain tumours, the outlook will vary, depending on the type, grade and location in the brain.

The outlook is often poor if you have a secondary (metastatic) malignant brain tumour.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your type and stage of cancer is likely to respond to treatment.