MT 2:The Brain

1. MT 2:The Brain By: Adriana Lopez

2. Sections of the Brain • 4 Lobes • Temporal Lobe • Hearing, Advanced vision processing • Occipital Lobe • vision • Frontal Lobe • Planning of movements, memory on events that happened recently • Parietal Lobe • Body sensations

3. Sections of the Brain continued Left hemisphere Right hemisphere • Controls the right side of the body • Controls language and verbal reasoning • Controls the left side of the body • Controls spatial understanding

4. Tests to study the brain • Magnetic Resonance Imaging (MRI) • Computerized Tomography (CT) • Electroencephalography (EEG) • Positron Emission Tomography (PET) • Brainstem Auditory Evoked Response (BAER)

5. Magnetic Resonance Imaging (MRI) • Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. • MRI also may show problems that cannot be seen with other imaging methods. • The area of the body being studied is placed inside a special machine that contains a strong magnet. • Pictures from an MRI scan are digital images that can be saved and stored on a computer for more study. The images also can be reviewed remotely, such as in a clinic or an operating room. • In some cases, “contrast material ”may be used during the MRI scan to show certain structures more clearly.

6. Computerized Tomography (CT) • CT Scan: • Is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. • CT scanning can identify normal and abnormal structures and be used to guide procedures. • CT scanning is painless. • Iodine-containing contrast material is sometimes used in CT scanning. • Blood clots, skull fractures ,tumors, and infections can be identified. • Can be used to accurately measure the density of bone.

7. Electroencephalography (EEG) • It’s a test used to measure the electrical activity of the brain. • Flat metal disks called electrodes are placed all over your scalp. • The disks are held in place with a sticky paste. The electrodes are connected by wires to a speaker and recording machine. • The recording machine changes the electrical signals into patterns that can be seen on a computer. • It looks like a bunch of wavy lines. • You will need to lie still during the test with your eyes closed because movement can change the results. But, you may be asked to do certain things during the test. • such as breathe fast and deeply for several minutes or look at a bright flashing light. • Avoid all food and drinks containing caffeine for 8 hours before the test. • Sometimes you may need to sleep during the test, so you may be asked to reduce your sleep time the night before. • It can help diagnose seizures, Abnormal changes in body chemistry that affect the brain, or brain diseases such as Alzheimer’s disease.

8. Positron Emission Tomography (PET) • Shows how organs and tissues are working. • Show the structure of and blood flow to and from organs. • A PET scan uses a small amount of radioactive material (tracer). • The  tracer is given through a vein (IV), most often on the inside of your elbow.  • The tracer travels through your blood and collects in organs and tissues. • This helps the radiologist see certain areas of concern more clearly. • You will need to wait nearby as the tracer is absorbed by your body. This takes about 1 hour. • You will lie on a narrow table that slides into a large tunnel-shaped scanner. The PET picks up detects signals from the tracer. A computer changes the signals into 3-D pictures. The images are displayed on a monitor for your doctor to read. • You must lie still during the test. Too much movement can blur images and cause errors. • How long the test takes depends on what part of the body is being scanned.

9. Brainstem Auditory Evoked Response (BAER) BAER Test Personal Case • This is a test to measure the brain wave activity that occurs in response to clicks or certain tones. • Can be performed with or without sedation. • Reasons: • Help diagnose nervous system problems and hearing loss (especially in newborns and children) • Determine how well the nervous system works

10. Parkinson’s Disease What is it? Symptoms • PD is chronic and progressive, neurodegenerative disease that belongs to the group of conditions called motor system disorders. • PD cannot yet be cured and sufferers get worse over time as the normal bodily functions, including breathing, balance, movement, and heart function worsen. • Parkinson’s disease most often occurs after the age of 50 and is one of the most common nervous system disorders of the elderly. • The disease is caused by the slow deterioration of the nerve cells in the brain, which create dopamine. Dopamine is a natural substance found in the brain that helps control muscle movement throughout the body. • Although Parkinson's disease can't be cured, medications may markedly improve your symptoms. In occasional cases, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms. • Parkinson’s disease is one of the most common disorders of the midbrain. • It develops gradually, sometimes starting with a barely noticeable tremor in just one hand (an involuntary quivering movement). • Commonly causes stiffness or slowing of movement. • In early stages of Parkinson's disease, your face may show little or no expression, or your arms may not swing when you walk. • Your speech may become soft or slurred. • Parkinson's disease symptoms worsen as your condition progresses over time.

11. Stages of PD • Stage one: During this initial phase of the disease, a patient usually experiences mild symptoms. These symptoms may inconvenience the day-to-day tasks the patient would otherwise complete with ease. Typically these symptoms will include the presence of tremors or experiencing shaking in one of the limbs. • Also during stage one, friends and family can usually detect changes in the Parkinson's patient including poor posture, loss of balance, and abnormal facial expressions. • Stage two: In the second stage of Parkinson's disease, the patients symptoms are bilateral, affecting both limbs and both sides of the body. The patient usually encounters problems walking or maintaining balance, and the inability to complete normal physical tasks becomes more apparent. • Stage three: Stage three symptoms of Parkinson's disease can be rather severe and include the inability to walk straight or to stand. There is a noticeable slowing of physical movements in stage three. • Stage four: This stage of the disease is accompanied by severe symptoms of Parkinson's. Walking may still occur, but it is often limited and rigidity and bradykinesia are often visible. During this stage, most patients are unable to complete day-to-day tasks, and usually cannot live on their own. The tremors or shakiness that take over during the earlier stages however, may lessen or become non-existent for unknown reasons during this time. • Stage five: The last or final stage of Parkinson's disease usually takes over the patients physical movements. The patient is usually unable to take care of himself or herself and may not be able to stand or walk during this stage. A patient at stage five usually requires constant one-on-one nursing care.

12. 10 early signs of PD • Tremor or shaking • A slight shaking or tremor in your finger, thumb, hand, chin or lip. Your leg shaking when you sit down or relax. • Twitching or shaking of limbs is a common early sign of Parkinson’s disease. • What is normal? Shaking can be normal after lots of exercise, if you have been injured, or could be caused by a medicine you take. • Small handwriting • Your handwriting suddenly gotten much smaller than in it was in the past. You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. A sudden change in handwriting is often a sign of Parkinson’s disease. • What is normal? Sometimes writing can change as you get older, if you have stiff hands or fingers or poor vision, but this happens over time and not suddenly. • Loss of smell • You notice you no longer smell certain foods very well. • If  you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinson’s disease • What is normal? Your sense of smell can be changed by a cold, flu or a stuffy nose, but it should come back after you are better. • Trouble sleeping • Thrashing around in bed or kicking and punching while you are deeply asleep. • You might notice that you started falling out of bed while asleep. Sometimes, your spouse will notice, or will want to move to another bed. Sudden movements during sleep may be a sign of Parkinson’s disease. • What is normal? It is normal for everyone to have a night when they ‘toss and turn’ instead of sleeping. • Trouble moving or walking • Feeling stiffness in your body, arms or legs. • Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. Y • You might notice that your arms don’t swing when you walk, or maybe other people have said you look stiff. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem ‘stuck to the floor.’ • What is normal? If you have injured your arm or shoulder, you may not be able to use it as well until it is healed or another illness like arthritis might cause the same symptom.

13. 10 early signs of PD Continued • Constipation • Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinson’s disease and you should talk to your doctor. • What is normal? If you do not have enough water or fiber in your body, it can cause problems in the bathroom. Also some medicine will cause constipation too. If there is no other reason such as diet or medicine that would cause you to have trouble moving your bowels, you should speak with your doctor. • A low or soft voice • Have other people told you that your voice is very soft when you speak in a normal tone, or that you sound hoarse? If there has been a change in your voice you should see your doctor about whether it could be Parkinson’s disease. Sometimes you might think other people are losing their hearing, when really you are speaking more softly. • What is normal? A chest cold or other virus can cause your voice to sound different but you should go back to sounding the same when you get over your cough or cold. • Masked face • Have you been told that you have a serious, depressed or mad look on your face more often, even when you are not in a bad mood? This serious looking face is called masking. Also, if you or other people notice that you have a blank stare or do not blink your eyes very often, you should ask your doctor about Parkinson’s disease. • What is normal? Some medicines can cause you to have the same type of serious or staring look, but you would go back to the way you were after you stopped the medication. • Dizziness or fainting • Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be signs of low blood pressure and can be linked to Parkinson’s disease. • What is normal? Everyone has had a time when they stood up and felt dizzy, but if it happens on a regular basis you should see your doctor. • Stooping or hunching over • Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease. • What is normal? If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.

14. Who is at risk for Parkinson's disease? • Age is the largest risk factor for the development and progression of Parkinson's disease. Most people who develop Parkinson's disease are older than 60 years of age. • Men are affected about 1.5 to 2 times more often than women. • A small number of individuals are at increased risk because of a family history of the disorder. • Head trauma, illness, or exposure to environmental toxins such as pesticides and herbicides may be a risk factor.

15. Can Parkinson's disease be prevented? • Scientists currently believe that Parkinson's disease is triggered through a complex combination of genetic susceptibility and exposure to environmental factors such as toxins, illness, and trauma. • Since the exact causes are not known, Parkinson's disease is at present not preventable.

16. Normal brain Vs. Brain diagnosed with PD

17. Causes of PD • PD is caused by the progressive loss of dopamine brain cells (neurons) in a part of the brain called the substantia nigra, which produces the chemical dopamine. • Despite intense research efforts around the world, the molecular causes of Parkinson’s disease are still unclear. What doctors and scientists do know is that, as the cells die, less dopamine is produced and transported to the striatum, the area of the brain that co-ordinates movement. • Parkinson’s disease symptoms begin when the loss of dopamine reaches a critical point, typically when 50 to 80 percent of dopamine neurons have died. • The dramatic loss of dopamine neurons by the time the disease is diagnosed, it extremely difficult for doctors and scientists to research PD at its earliest stages. • Much of the research done on PD uses animal models that most closely mirror the onset of PD in humans. • The question of why dopamine neurons degenerate is being intensely investigated by scientists in our labs, and all over the world. • While there is still no definitive answer, it is now widely accepted that there is no single “cause” that triggers the disease. • Parkinson’s disease likely results from a confluence of inherited (genetic / familial) and environmental factors that interact in complex ways to set disease processes in motion. Around 5 percent of cases are hereditary in the classic sense that if one or both parents have it, their children are at higher risk. But in the vast majority of cases, no obvious familial link is present. Instead, it is believed that there are a variety of triggers, including exposure to toxins and severe head injuries.  Also, individuals may inherit a degree of susceptibility to the disease, which only causes Parkinson’s disease when other factors are present

18. Is PD deadly? • Most doctors say that Parkinson’s disease itself is not fatal. You die with Parkinson's disease, not from it. • As symptoms worsen they can cause incidents that result in death. • For example, in advanced cases, difficulty swallowing can cause Parkinson’s patients to aspirate food into the lungs, leading to pneumonia or other pulmonary conditions. • Loss of balance can cause falls that result in serious injuries or death. • The seriousness of these incidents depends greatly on the patient's age, overall health and disease stage.

19. Living with PD Physical Complications Management & Treatment • Head bends forward • Tremors of the head, hands, mouth. • Mask-like facial expressions • Drooling • Rigidity • Stooped posture • Weight loss • Loss of postural reflexes • Bone demineralization • Slow steps • Treatments are available only for the symptoms of Parkinson’s disease. None of the currently available treatments can halt or even slow the loss of neurons in Parkinson’s disease. • One of the most effective and widely used treatments for the symptoms of PD is carbidopa-levodopa. Levodopa, also called L-dopa, is a drug that is converted into dopamine in the brain. Levodopa is often combined with carbidopa, which improves the action of levodopa and reduces some of its side effects, particularly nausea. • Physical therapy to help loosen joints and improve movement • Implanted pulse generator • Warm baths and massages to help relax muscles • Client and family education • Self-help devices to help meet daily needs

20. PD Continued

21. Surgery for Parkinson's disease • Based on the severity of the condition and the medical profile, the physician may recommend surgery as one treatment option for Parkinson's disease. • There are several types of surgery that may be performed that can help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of Parkinson's disease. • There are three types of surgeries that may be performed for Parkinson's disease, including the following: • Lesion surgery (burning of tissue)In this procedure, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help control movement. The surgery may be done while the patient is awake to help determine the exact placement of the lesion. The lesion is placed to help control, or stop, the area of the brain that is causing the tremor. • Deep brain stimulation (DBS)With this type of surgery, a small electrode is placed in the critical parts of the brain that help to control movement. The electrode is attached to a small battery in the chest wall and is connected by wires that are placed under the skin. The stimulator is then turned on and interrupts the normal flow of information in the brain and can help to decrease symptoms of Parkinson's disease. • Neural grafting or tissue transplantsExperimental research is being done to find a replacement for the part of the brain that functions improperly in Parkinson's disease. • It is important to remember that surgery may help with symptoms of Parkinson's disease, but does not cure the disease or stop the progression of the disease.

22. Work Cited • Parkinson's Disease Foundation. (n.d.). <i>What is Parkinson's Disease?</i>. Retrieved November 8, 2013, from http://www.pdf.org/about_pd • BAER - brainstem auditory evoked response: MedlinePlus Medical Encyclopedia. (n.d.). <i>U.S National Library of Medicine</i>. Retrieved November 8, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/003926.htm • Stages of Parkinson's: Stages 1-5 Symptoms. (n.d.). <i>WebMD</i>. Retrieved November 8, 2013, from http://www.webmd.com/parkinsons-disease/guide/parkinsons-stages • What is a PET scan?. (n.d.). Medical News Today. Retrieved November 8, 2013, from http://www.medicalnewstoday.com/articles/154877.php • 10 Early Warning Signs of Parkinson's Disease. (n.d.). <i>National Parkinson Foundation -</i>. Retrieved November 8, 2013, from http://www.parkinson.org/Parkinson-s-Disease/PD-101/10-Early-Warning-Signs-of-Parkinson-s-Disease • Brain components - Anatomy Video: MedlinePlus Medical Encyclopedia. (n.d.). <i>U.S National Library of Medicine</i>. Retrieved November 8, 2013, from http://www.nlm.nih.gov/medlineplus/ency/anatomyvideos/000016.htm