Your Brain, Explained by Marc Dingman explores the weird and interesting ways in which our brains work. The author aims to find a happy medium between complex neuroscience and brain talk dumbed down to the point that it’s inaccurate, and I think he achieved that goal. The author also aims to spark curiosity. He writes, […]Book Review: Your Brain, Explained — Mental Health @ Home
The ketogenic diet for epilepsy (KDE) is a special diet that has helped many children and some adults achieve better (or even full) control of their seizures. It’s a first-line treatment for a few specific epilepsy syndromes, such as epilepsy due to mutations in GLUT-1 or pyruvate dehydrogenase deficiency.
The ketogenic diet for epilepsy was developed in the 1920s by a Michigan doctor named Hugh Conklin. However, once effective medications were developed, the diet was used less and less frequently.2
It has regained recognition and has become a standard backup plan for children whose epilepsy symptoms are difficult to control with medication.1 With more than 470,000 children living with seizure disorders in the United States (according to Centers for Disease Control and Prevention statistics), it’s an important addition to the arsenal of treatments for epilepsy.
Researchers are also beginning to see how it might help adults with epilepsy and people with a variety of neurologic disorders.
What It Entails
The ketogenic diet for epilepsy is a very high-fat diet with just enough protein for body maintenance and growth, and very low amounts of carbohydrate.
When fats are broken down for energy, the body goes into what’s called a ketogenic state, in which the body generates molecules called ketones. The goal of the KDE is for the brain to use ketones for energy rather than glucose (sugar) as much as possible.
Ketones are (largely) water-soluble, so they are easily transported to the brain. The brain cannot use fatty acids for energy, but it can use ketones for a large portion of its energy requirements.1
The KDE is usually begun in a hospital setting and often begins with a one- to two-day fasting period, though there may be a trend away from both of these requirements.3
After determining the proper amount of protein (depending on age, etc.), the diet is structured as a ratio of fat grams to protein grams, plus carb grams. It usually begins with a 4 to 1 ratio and can be fine-tuned from there. The diet is often calorie and fluid-limited.4 Additionally, no packaged low-carb foods (shakes, bars, etc.) are allowed for at least the first month.
Because a gram of fat has more than twice the calories of a gram of protein or carbohydrate, this equation means that at least 75% of the calories in the diet come from fat. This is a very strict diet, and it takes time to learn how to put together meals that fit the formula. All food must be weighed and recorded.
Weaning off the diet is often attempted after two years, though some children are kept on it for longer.
Why It Works
Researchers are beginning to understand why the ketogenic diet works to lower seizure frequency. According to a 2017 review of studies, it appears that several mechanisms may be at work, including the following.
- The diet appears to alter ketone metabolism in the brain in a way that enhances the brain’s ability to produce the neurotransmitter GABA, which has a calming effect on the brain.1
- The diet has significant anti-inflammatory and anti-oxidative impacts, which appear to alter the way some genes involved in epilepsy are expressed.
- Certain fatty acids featured in the diet have anticonvulsant effects and have even been shown to boost the effects of valproic acid—a common anti-seizure medication.
- Polyunsaturated fatty acids in the diet may prevent brain cells from becoming overexcited.
- Decanoic acid, which is part of the diet as well, appears to have a direct inhibitory reaction on the AMPA receptors in the brain. These receptors are believed to play a role in epilepsy and are the target of some epilepsy medications.
- Effects on a key sensor of cellular energy appear to help prevent excessive firing of brain cells.
- The diet may impact circadian activities and the expression of a growth factor in the brain in a beneficial way.5
Studies generally show that about a third of children with epilepsy who follow the ketogenic diet will have at least a 90% reduction in seizures, and another third will experience a reduction of between 50% and 90%.46
This is remarkable, considering that these patients are generally those whose seizures are not well-controlled with medications.
A growing number of studies have been done on the KDE and modified Atkins Diet in adults with seizure disorders, and the results are similar to studies with children.
One 2014 study reported that 45% of adolescent and adult participants saw a reduction of seizure frequency of 50% or greater. Tolerability appeared better in those with symptomatic generalized epilepsy.
Interestingly, it was more difficult to keep adults on the diet, since they obviously have more control over what they eat. Research is still limited in this area and more trials are needed.7
A 2017 report on use of these diets during pregnancy suggests they may be an effective way to control seizures and could possibly allow pregnant women to use lower doses of epilepsy medication. However, the safety of this still needs to be examined.8
Work With Your Medical Team
It is vital that anyone using this diet for a seizure disorder do it under the supervision of an experienced physician and dietitian. Many individual variations can influence the exact diet recommendations for each person, and coordinating this eating plan with medications can be tricky. It’s not something you should ever attempt on your own.
A Typical Day’s Menu
Below is a shortened description of a menu appearing in the 2015 Pediatric Annals article, “The Ketogenic Diet: A Practical Guide for Pediatricians.” It’s meant to give the idea of what children eat on the diet, not serve as an exact prescription. Remember, all of these foods are carefully weighed and measured.
- Breakfast: Eggs made with heavy cream, cheese, and butter; small serving of strawberries, pineapple, or cantaloupe
- Lunch: Hamburger patty topped with cheese; cooked broccoli, green beans, or carrots with melted butter; whipped heavy cream
- Dinner: Grilled chicken breast with cheese and mayonnaise; cooked vegetables with butter; whipped heavy cream
- Snacks: Whipped heavy cream, small servings of fruit, sugar-free gelatin
Variations substitute coconut oil or MCT oil for some of the heavy cream and butter.
Eating While at School
With a school-aged child, keeping them on the diet during the school day is difficult but essential. Thinking and planning ahead can help you be successful. You may want to try some of the following strategies:
- Talk to your child: Make sure your child understands the diet and why sticking to it is essential. Let them know they shouldn’t trade food with other kids. As hard as it is, they also shouldn’t eat food from vending machines or treats handed out in class.
- Talk to the school: The teacher, guidance counselor, nurse, and administration all need to be aware of your child’s special dietary needs (as well as other health-related matters). You’ll want to have regular conversations with them, and you may want to have a 504 plan or individualized education plan (IEP) in place as well.
- Become a planner: Gather several recipes for appropriate meals that can make convenient, easy-to-pack lunches. If possible, you may want to provide appropriate treats for your child for holiday parties and other special events that you may know about ahead of time. The Charlie Foundation and Clara’s Menu are good resources for child-friendly keto recipes.
- Educate family members: It’s important that family members and any regular caregivers know how to prepare a meal for the child with epilepsy.
- Establish routines: The timing of meals and snacks needs to be consistent in order for your child’s glucose levels to remain as stable as possible. You may need to work with your child’s teacher(s) on this.
- Involve a friend: Having a friend at school who understands the importance of your child’s diet may help them feel less awkward about being “different” and give them someone to lean on for support when needed. Make sure your child is OK with this and give them input on which friend to choose.
You’ll also want to make parents of your child’s friends aware of the special diet and that what some people may consider “a little harmless cheating” may not be harmless at all. It’s a good idea to provide food for your child to take to parties and playdates.How to Raise Kids Who Are on a Special Diet
Alternatives to the Super-Strict Ketogenic Diet
The Modified Atkins Diet is a popular alternative that helps many who find the ketogenic diet too difficult to adhere to. This diet is far less restrictive, as calories, fluids, and protein are not measured.9
The diet begins with 10 grams of carbohydrate per day for the first month, which slowly increases to 15 or 20 grams. It is similar to the very strict induction phase of the standard Atkins diet.
One 2014 study reported that 45% of adolescent and adult participants saw a reduction of seizure frequency of 50% or greater. Tolerability appeared better in those with symptomatic generalized epilepsy.
A friend of mine on Facebook came across this poem on the Epilepsy Society group page.
I have a best friend She lives in my brain
She takes me away again and again
She makes my head foggy And makes me confused
We always argue and I always loose
She turns out the lights And makes it all dark
She takes all my memories and my spark
She hurts me a lot She can make me bleed
When she’s with me I don’t know where life will lead
She takes away my breath And tries to stop my heart
From my life she tries to make me part
It makes me sad That she lives in my head
She won’t even stop when I’m asleep in bed
Sometimes she’s loud Others she’s quiet
But not for to long as she rules my empire
She has broken bones She has broken skin
Our life long fight and I never win
She makes me nervous When we go out in public
I wish she wouldn’t I wish she would stop it
She is badly behaved And out out of control
Sometimes my own personal Facebook troll
She makes me sick Makes me poorly
She pushes away those who adore me
She likes us alone Just her and I
We’ve been together since I was Nine
I’ve tried to contain her With medication and such
But she brakes out of her cage and makes me feel rough
She hates flashing lights And hates exercise
From a lot of things she makes me hide
She hates my emotions And she hates a pub drink
But that last one isn’t such a bad thing She won’t let me drive
She won’t let me dance
And if I disobey her she will put me in a trance
She makes my world cloudy
There is no middle ground
There is never an up side there is only a down
Like a never ending spiral That goes around and round
I feel like I’m lost never to be found
To talk to someone about epilepsy, our helpline team offer information and emotional support to anyone affected by the condition. You can call them on 01494 601 400, Monday – Friday 9-4pm and Wednesday 9-7.30pm. or contact https://www.epilepsyscotland.org.uk/ or call https://www.epilepsy.org.uk/
Chiari malformation (kee-AH-ree mal-for-MAY-shun) is a condition in which brain tissue extends into your spinal canal. It occurs when part of your skull is abnormally small or misshapen, pressing on your brain and forcing it downward.
Chiari malformation is uncommon, but increased use of imaging tests has led to more frequent diagnoses.
Doctors categorize Chiari malformation into three types, depending on the anatomy of the brain tissue that is displaced into the spinal canal and whether developmental abnormalities of the brain or spine are present.
Chiari malformation type I develops as the skull and brain are growing. As a result, signs and symptoms may not occur until late childhood or adulthood. The pediatric forms, Chiari malformation type II and type III, are present at birth (congenital).
Treatment of Chiari malformation depends on the form, severity and associated symptoms. Regular monitoring, medications and surgery are treatment options. In some cases, no treatment is needed.
Many people with Chiari malformation have no signs or symptoms and don’t need treatment. Their condition is detected only when tests are performed for unrelated disorders. However, depending on the type and severity, Chiari malformation can cause a number of problems.
The more common types of Chiari malformation are:
- Type I
- Type II
Although these types are less serious than the more rare pediatric form, type III, signs and symptoms still can be life disrupting.
Chiari malformation type I
In Chiari malformation type I, signs and symptoms usually appear during late childhood or adulthood.
Headaches, often severe, are the classic symptom of Chiari malformation. They generally occur after sudden coughing, sneezing or straining. People with Chiari malformation type I can also experience:
- Neck pain
- Unsteady gait (problems with balance)
- Poor hand coordination (fine motor skills)
- Numbness and tingling of the hands and feet
- Difficulty swallowing, sometimes accompanied by gagging, choking and vomiting
- Speech problems, such as hoarseness
Less often, people with Chiari malformation may experience:
- Ringing or buzzing in the ears (tinnitus)
- Slow heart rhythm
- Curvature of the spine (scoliosis) related to spinal cord impairment
- Abnormal breathing, such as central sleep apnea, which is when a person stops breathing during sleep
Chiari malformation type II
In Chiari malformation type II, a greater amount of tissue extends into the spinal canal compared with Chiari malformation type I.
The signs and symptoms can include those related to a form of spina bifida called myelomeningocele that nearly always accompanies Chiari malformation type II. In myelomeningocele, the backbone and the spinal canal haven’t closed properly before birth.
Signs and symptoms may include:
- Changes in breathing pattern
- Swallowing problems, such as gagging
- Quick downward eye movements
- Weakness in arms
Chiari malformation type II is usually noted with ultrasound during pregnancy. It may also be diagnosed after birth or in early infancy.
Chiari malformation type III
In one of the most severe types of the condition, Chiari malformation type III, a portion of the lower back part of the brain (cerebellum) or the brainstem extends through an abnormal opening in the back of the skull. This form of Chiari malformation is diagnosed at birth or with an ultrasound during pregnancy.
This type of Chiari malformation has a higher mortality rate and may also cause neurological problems.
When to see a doctor
If you or your child has any of the signs and symptoms that may be associated with Chiari malformation, see your doctor for an evaluation.
Because many symptoms of Chiari malformation can also be associated with other disorders, a thorough medical evaluation is important.
Chiari malformation type I occurs when the section of your skull containing a part of your brain (cerebellum) is too small or is deformed, thus putting pressure on and crowding your brain. The lower part of the cerebellum (tonsils) is displaced into your upper spinal canal.
Chiari malformation type II is nearly always associated with a form of spina bifida called myelomeningocele.
When the cerebellum is pushed into your upper spinal canal, it can interfere with the normal flow of cerebrospinal fluid that protects your brain and spinal cord.
This impaired circulation of cerebrospinal fluid can lead to the blockage of signals transmitted from your brain to your body, or to a buildup of spinal fluid in the brain or spinal cord.
Alternatively, the pressure from the cerebellum on the spinal cord or lower brainstem can cause neurological signs or symptoms.
There’s some evidence that Chiari malformation runs in some families. However, research into a possible hereditary component is still in its early phase.
In some people, Chiari malformation can become a progressive disorder and lead to serious complications. In others, there may be no associated symptoms, and no intervention is necessary. The complications associated with this condition include:
- Hydrocephalus. An accumulation of excess fluid within your brain (hydrocephalus) may require placement of a flexible tube (shunt) to divert and drain the cerebrospinal fluid to another area of your body.
- Spina bifida. Spina bifida, a condition in which your spinal cord or its covering isn’t fully developed, may occur in Chiari malformation. Part of the spinal cord is exposed, which can cause serious conditions such as paralysis. People with Chiari malformation type II usually have a form of spina bifida called myelomeningocele.
- Syringomyelia. Some people with Chiari malformation also develop a condition called syringomyelia, in which a cavity or cyst (syrinx) forms within the spinal column.
- Tethered cord syndrome. In this condition, your spinal cord attaches to your spine and causes your spinal cord to stretch. This can cause serious nerve and muscle damage in your lower body.
To diagnose your condition, your doctor will review your medical history and symptoms and conduct a physical examination.
Your doctor will also order imaging tests to diagnose your condition and determine its cause. Tests may include:
- Magnetic resonance imaging (MRI). An MRI is often used to diagnose Chiari malformation. An MRI uses powerful radio waves and magnets to create a detailed view of your body.This safe, painless test produces detailed 3D images of structural abnormalities in your brain that may be contributing to your symptoms. It can also provide images of your cerebellum and determine whether it extends into your spinal canal.An MRI can be repeated over time, and it can be used to monitor the progression of your disorder.
- Computerized tomography (CT) scan. Your doctor may recommend other imaging techniques such as a CT scan.A CT scan uses X-rays to obtain cross-sectional images of your body. A CT scan can help to reveal brain tumors, brain damage, bone and blood vessel abnormalities, and other conditions.
Treatment for Chiari malformation depends on the severity and the characteristics of your condition.
If you have no symptoms, your doctor likely will recommend no treatment other than monitoring with regular examinations and MRIs.
When headaches or other types of pain are the primary symptom, your doctor may recommend pain medication.
Reducing pressure with surgery
Doctors usually treat symptomatic Chiari malformation with surgery. The goal is to stop the progression of changes in the anatomy of your brain and spinal canal, as well as ease or stabilize your symptoms.
When successful, surgery can reduce pressure on your cerebellum and spinal cord, and restore the normal flow of spinal fluid.
In the most common surgery for Chiari malformation, called posterior fossa decompression, your surgeon removes a small section of bone in the back of your skull, relieving pressure by giving your brain more room.
In many cases, the covering of your brain, called the dura mater, may be opened. Also, a patch may be sewn in place to enlarge the covering and provide more room for your brain. This patch may be an artificial material, or it could be tissue harvested from another part of your body.
Your doctor may also remove a small portion of the spinal column to relieve pressure on your spinal cord and allow more space for the spinal cord.
The surgical technique may vary, depending on whether a fluid-filled cavity (syrinx) is present, or if you have fluid in your brain (hydrocephalus). If you have a syrinx or hydrocephalus, you may need a tube (shunt) to drain the excess fluid.
Surgical risks and follow-up
Surgery involves risks, including the possibility of infection, fluid in your brain, cerebrospinal fluid leakage or problems with wound healing. Discuss the pros and cons with your doctor when deciding whether surgery is the most appropriate treatment for you.
The surgery reduces symptoms in most people, but if nerve injury in the spinal canal has already occurred, this procedure won’t reverse the damage.
After the surgery, you’ll need regular follow-up examinations with your doctor, including periodic imaging tests to assess the outcome of surgery and the flow of cerebrospinal fluid.
Preparing for your appointment
You’re likely to start by seeing your family doctor. However, when you call to set up an appointment, you may be referred to a doctor trained in brain and nervous system conditions (neurologist).
Because appointments can be brief, and because there’s often a lot to talk about, it’s a good idea to be well prepared for your appointment. Here’s some information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance.
- Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. For example, even though your primary complaint may be headaches, your doctor will want to know about any changes you may have noticed in your vision, speech or coordination.
- Write down key personal information, including any major stresses and recent life changes.
- Make a list of your key medical information, including other conditions you’re being treated for and the names of the medications that you’re taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to recall all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Prepare a list of questions so that you can make the most of your limited time with your doctor. List your questions from most important to least important in case time runs out. For Chiari malformation, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Do I need treatment?
- If you don’t think I need to be treated now, how will you monitor me for changes in my condition?
- If you recommend surgery, what should I expect from my recovery?
- What is the risk of complications from surgery?
- What is my long-term prognosis after surgery?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- If you experience head and neck pain, is it made worse by sneezing, coughing or straining?
- How severe is your head and neck pain?
- Have you noticed any change in your coordination, including problems with balance or with hand coordination?
- Do your hands and feet feel numb or do they tingle?
- Have you developed any difficulty swallowing?
- Do you experience episodes of dizziness or faintness? Have you ever passed out?
- Have you developed any problems with your eyes and ears, such as blurred vision or a ringing or buzzing in your ears?
- Have you had problems with bladder control?
- Has anyone ever noticed that you stop breathing during sleep?
- Have you been taking pain relievers or using other approaches to relieve your discomfort? Does anything seem to work?
- Do you have any additional symptoms, such as hearing loss, fatigue, or changes in your bowel habits or appetite?
- Have you been diagnosed with any other health conditions?
- Has anyone in your family been diagnosed with Chiari malformation?
Exactly why someone develops multiple sclerosis (MS) isn’t known. It’s not caused by anything you’ve done and it’s not clear whether it can be prevented.
What is known so far suggests it’s caused by a combination of genetic and environmental factors.
What happens in MS
MS is an autoimmune condition, which means your immune system mistakes part of your body for a foreign substance and attacks it.
In the case of MS, it attacks the myelin sheath in the brain and/or spinal cord. This is the layer that surrounds your nerves, protecting them and helping electrical signals travel from the brain to the rest of the body.
The attacks cause the myelin sheath to become inflamed in small patches (plaques or lesions), which can be seen on a magnetic resonance imaging (MRI) scan.
These patches of inflammation can disrupt the messages travelling along the nerves. It can slow them down, jumble them, send them the wrong way, or stop them from getting through completely. This disruption leads to the symptoms and signs of MS.
When the inflammation goes away, it can leave behind scarring of the myelin sheath (sclerosis). These attacks, particularly if frequent and repeated, can eventually lead to permanent damage to the underlying nerves.
Why do people get MS?
It’s not clear what causes the immune system to attack the myelin sheath.
It seems likely that it’s partly caused by genes you inherit from your parents and partly by outside factors that may trigger the condition.
Some of the factors that have been suggested as possible causes of MS include:
- your genes – MS isn’t directly inherited, but people who are related to someone with the condition are more likely to develop it; the chance of a sibling or child of someone with MS also developing it is estimated to be around 2-3%
- lack of sunlight and vitamin D – MS is more common in countries far from the equator, which could mean that a lack of sunlight and low vitamin D levels may play a role in the condition, although it’s not clear whether vitamin D supplements can help prevent MS
- smoking – people who smoke are about twice as likely to develop MS compared to those who don’t smoke
- viral infections – it has been suggested that infections, particularly those caused by Epstein-Barr virus (responsible for glandular fever), might trigger the immune system, leading to MS in some people
More research is needed to further understand why MS occurs and whether anything can be done to prevent it.
About multiple sclerosis
Multiple sclerosis (MS) is a condition which can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild. In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
It’s estimated that there are more than 100,000 people diagnosed with MS in the UK.
It’s most commonly diagnosed in people in their 20s and 30s, although it can develop at any age. It’s about two to three times more common in women than men.
Symptoms of MS
The symptoms of MS vary widely from person to person and can affect any part of the body.
The main symptoms include:
- difficulty walking
- vision problems, such as blurred vision
- problems controlling the bladder
- numbness or tingling in different parts of the body
- muscle stiffness and spasms
- problems with balance and co-ordination
- problems with thinking, learning and planning
Depending on the type of MS you have (see below), your symptoms may come and go in phases, or get steadily worse over time (progress).
Read more about the symptoms of MS
Getting medical advice
See your GP if you’re worried you might have early signs of MS.
The early symptoms often have many other causes, so they’re not necessarily a sign of MS. Let your GP know about the specific pattern of symptoms you’re experiencing.
If you GP thinks you could have MS, you’ll be referred to a neurologist (a specialist in conditions of the nervous system), who may suggest tests such as a magnetic resonance imaging (MRI) scan to check for features of MS.
Read more about diagnosing MS
Types of MS
MS starts in one of two general ways: with individual relapses (attacks or exacerbations) or with gradual progression.
More than 8 out of every 10 people with MS are diagnosed with the “relapsing remitting” type.
Someone with relapsing remitting MS will have episodes of new or worsening symptoms, known as “relapses”. These typically worsen over a few days, last for days to weeks to months, then slowly improve over a similar time period.
Relapses often occur without warning, but are sometimes associated with a period of illness or stress.
The symptoms of a relapse may disappear altogether, with or without treatment, although some symptoms often persist, with repeated attacks happening over several years.
Periods between attacks are known as periods of “remission”. These can last for years at a time.
After many years (usually decades), many, but not all people, with relapsing remitting MS go on to develop secondary progressive MS. In this type of MS, symptoms gradually worsen over time without obvious attacks. Some people continue to have infrequent relapses during this stage.
Around half of people with relapsing remitting MS will develop secondary progressive MS within 15-20 years, and the risk of this happening increases the longer you have the condition.
Primary progressive MS
Just over 1 in 10 people with the condition start their MS with a gradual worsening of symptoms.
In primary progressive MS, symptoms gradually worsen and accumulate over several years, and there are no periods of remission, though people often have periods where their condition appears to stabilise.
What causes MS?
MS is an autoimmune condition. This is when something goes wrong with the immune system and it mistakenly attacks a healthy part of the body – in this case, the brain or spinal cord of the nervous system.
In MS, the immune system attacks the layer that surrounds and protects the nerves, called the myelin sheath. This damages and scars the sheath, and potentially the underlying nerves, meaning that messages travelling along the nerves become slowed or disrupted.
Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors is involved.
Read more about the causes of MS
Treatments for MS
There’s currently no cure for MS, but a number of treatments can help control the condition.
The treatment you need will depend on the specific symptoms and difficulties you have. It may include:
- treating relapses with short courses of steroid medication to speed up recovery
- specific treatments for individual MS symptoms
- treatment to reduce the number of relapses with medicines called disease-modifying therapies
Disease-modifying therapies may also help to slow or reduce the overall worsening of disability of MS in people with relapsing remitting MS, and in people with secondary progressive MS who are still having relapses.
Unfortunately, there’s currently no treatment that can slow the progress of primary progressive MS or secondary progressive MS in the absence of relapses. Many therapies aiming to treat progressive MS are currently being researched.
MS can be a challenging condition to live with, but new treatments over the past 20 years have considerably improved the quality of life of people with the condition.
MS itself is rarely fatal, but complications may arise from severe MS, such as chest or bladder infections, or swallowing difficulties.
The average life expectancy for people with MS is around 5 to 10 years lower than average, and this gap appears to be getting smaller all the time.
There is some debate concerning the causes of depression. On the one hand, it is considered a physiological disorder of the brain. Signals are sent through the brain–and in fact the entire nervous system–by special chemicals called neurotransmitters. There are many of these, but the ones which seem to have the greatest impact on a person’s mood are serotonin, norepinephrine, and dopamine. Depression appears to involve a reduced amount of one or more of these, hindering brain signals and in turn causing the various symptoms of depression. MRI’s and brain tissue samples of depressed patients shows that these neurotransmitters are below normal.
While this is true, however, there are usually circumstantial influences as well. Depression almost always follows some upsetting or terrible event in someone’s life (it can come immediately or after some length of time). Cases in which people become depressed solely because of brain physiology, are exceedingly rare. Depression also goes hand-in-hand with low self-esteem, which is often an integral part of the depression (in other words, it can be a symptom, or a cause, or even both).
Thus, it’s evident that both physiology and circumstance cause depression. What is unknown is, the relationship between them. Do bad things happen to people, making them sad or distraught, which reduces their neurotransmitters, and allows “true” depression to set it? Or, are the neurotransmitters already reduced, so that when something upsetting happens, it triggers a “true” depression?
There’s no clear answer to this, yet. At the moment, most in the psychiatric community lean toward the first explanation.
In any case, it’s important to note that no one is to blame for depression. In many–but by no means all–cases, depression results from harmful childhood experiences. However, it is nonproductive and even incorrect to “blame” one’s parents, family, friends, etc. for the depression. Why? Because many people have unpleasant childhoods, but not all of them develop depression. It is not the sole cause. Depression can also follow divorce, bereavement, etc. but this does not mean that these things “caused” the depression all by themselves. There are a great number of factors, including physiology (which I’ve already mentioned). Once again, depression is an illness. If you got the flu, would you blame it on someone else? Of course not, that would be silly! Depression is exactly the same.
An EEG, or electroencephalogram, is a test that records the electrical signals of the brain by using small metal discs (called electrodes) that are attached to your scalp. Your brain cells communicate with each other using electrical impulses. They’re always working, even if you’re asleep. That brain activity will show up on an EEG recording as wavy lines. It’s a snapshot in time of the electrical activity in your brain.
EEGs are used to diagnose conditions like:
- Brain tumors
- Brain damage from a head injury
- Brain dysfunction from various causes (encephalopathy)
- Inflammation of the brain (encephalitis)
- Seizure disorders including epilepsy
- Sleep disorders
An EEG may also be used to determine if someone in a coma has died or to find the right level of anesthesia for someone in a coma.
EEGs are safe. If you have a medical condition, talk with the doctor about it before your test.
If you have a seizure disorder, there’s a slight risk that the flashing lights and deep breathing of the EEG could bring on a seizure. This is rare. A medical team will be on hand to treat you immediately if this happens.
In other cases, a doctor may trigger a seizure during the test to get a reading. Medical staff will be on hand so the situation is closely monitored.
Preparing for an EEG
There are some things you should do to prepare for EEG:
- Don’t eat or drink anything with caffeine for 8 hours before the test.
- Your doctor may give you instructions on how much to sleep if you’re expected to sleep during the EEG.
- Eat normally the night before and day of the procedure. Low blood sugar could mean abnormal results.
- Let your doctor know about any medications — both prescription and over-the-counter — and supplements you’re taking.
- Wash your hair the night before the test. Don’t use any leave-in conditioning or styling products afterward. If you are wearing extensions that use glue, they should be removed.
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.
Primary or secondary tumours?
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 breast, lung, bowel, kidney and skin (melanoma).
Different types of brain tumour
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.
Meningiomas are usually benign. They grow from cells in the tissues that surround the brain (the meninges).
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.
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.
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.
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).
There are various other rare types of benign and primary malignant brain tumours.
What causes 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.
- 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.
How common are brain tumours?
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.
What are the symptoms of a brain tumour?
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:
- Weakness of muscles in an arm, leg, part of the face, or eyes.
- Problems with balance, co-ordination, vision, hearing, speech, communication or swallowing.
- Loss of smell.
- Dizziness or unsteadiness.
- Numbness or weakness in a part of the body.
- Personality changes.
- Symptoms related to hormonal changes if you have a pituitary tumour.
These symptoms tend to develop gradually.
How are brain tumours diagnosed and assessed?
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.
A 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.
What are the treatments for brain tumours?
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 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 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 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.
What is the outlook?
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.