Diagnosis & Treatment of Neurological Conditions

Amyotrophic lateral sclerosis (ALS) affects the parts of the nervous system that control voluntary muscle movement. Also known as Lou Gehrig's disease, named after the baseball player who had the disease, ALS causes motor neurons to die gradually and no longer signal the muscles to move. As a result, muscles atrophy and become progressively weaker. 

Diagnosing ALS

ALS can be difficult to diagnose because symptoms may resemble other neurological disorders. A conclusive diagnosis is based on a careful medical history, a physical exam of the nervous system and tests of nerve and muscle function.

Treatment for ALS

There's no known treatment for reversing the course of ALS. Therapies mainly work to slow the progression of symptoms and make patients more comfortable and independent. ALS symptoms treated include fatigue, muscle cramps, pain, excessive salivation, and depression. Therapies include:

• Medications 
• Physical therapy 
• Occupational therapy
• Speech therapy
• Palliative care

Alzheimer’s disease is caused by the destruction of nerve cells (neurons) in the brain. The destruction of neurons also reduces neurotransmitters, substances made by neurons responsible for message transmission in the brain. Because Alzheimer's causes both structural and chemical deficits, the disease interferes with the way parts of the brain work together. As a result, a person with Alzheimer’s has a steady loss of memory and other cognitive abilities.

Diagnosing Alzheimer's disease

While Alzheimer's disease is the most common cause of dementia, diagnosing it requires ruling out other potential causes. Careful medical evaluation helps exclude other conditions linked to dementia, such as thyroid and vascular disorders, medications, untreated depression, and hearing loss. The diagnostic process for Alzheimer's usually includes:

• A physical exam and medical history  
• Neuropsychological testing  
• Brain imaging 

Treatment for Alzheimer’s disease

Currently there is no cure for Alzheimer's disease. The goals of treatment are to slow the progression of the disease and improve or stabilize symptoms. Therapies include: 

• Medications
• Herbs (ginkgo biloba) and supplements (vitamin B9, vitamin B12, and vitamin E)

Carpal tunnel syndrome is characterized by numbness or tingling on the palm side of the thumb and fingers. The wrist may ache, with pain spreading to the fingers and the forearm. As carpal tunnel syndrome progresses, numbness may worsen, and pinch and grip strength may weaken.

Diagnosing carpal tunnel syndrome

• Wrist-flexion test (Phalen's Maneuver)
• X-ray, MRI, and ultrasound to rule out other conditions
• Nerve conduction velocity test

Treatment for carpal tunnel syndrome

Options may include:

• Minimizing extreme wrist flexion and extension
• Nighttime wrist splint
• Corticosteroid injection for pain
• Outpatient surgery

Cerebrovascular disease is a group of conditions that affect blood flow to the brain, including stroke, cerebral arteriovenous malformation, brain aneurysm, carotid artery disease, cerebral cavernous malformations, and transient ischemic attack (TIA).

Diagnosing cerebrovascular disease

• Imaging tests, such as MRI and CT scan

Treatment for cerebrovascular disease

• Stereotactic radiosurgery, a noninvasive radiation technology to treat brain tumors, arteriovenous malformations and other neurological disorders
• Neurointerventional procedures, such as endovascular surgery, a minimally invasive technique to treat conditions affecting blood vessels 
• Neurosurgery procedures to address conditions affecting blood vessels in the brain and neck
• Vascular surgery procedures to treat conditions of the neck, such as carotid endarterectomy

Guillain-Barré syndrome (GBS) is a rare disorder that involves inflammation of the peripheral nerves (those outside the brain and spinal cord). It’s characterized by the rapid onset of weakness and often paralysis of parts of the body, including the legs, arms, face, and breathing muscles. The cause of GBS is unknown. Many cases, around 50%, occur shortly after a viral infection. Most patients recover, but many have long-term disabilities of varying severity.

Diagnosing GBS

• Neurological exam
• Blood test
• Spinal tap
• Electromyography (EMG)

Treatment for GBS

• Hospitalization to monitor breathing and other body functions
• Plasma exchange and intravenous immunoglobulin therapy

A movement disorder is a type of disease that affects the brain's ability to produce and control movement. These neurological conditions can cause the lack of spontaneous movement or involuntary movements, ranging from shaking or jerky movements to prolonged muscle contractions. Common movement disorders include dystonia, essential tremor, Huntington's disease, muscle spasticity, Parkinson’s disease, and restless legs syndrome.

Diagnosing movement disorders

• Neurological exam

Treatment for movement disorders

• Drug regimens 
• Deep brain stimulation (DBS), an implantable device effective for controlling involuntary movement

Multiple sclerosis (MS) is a disorder in which the body's immune system destroys the protective sheath that covers nerve fibers. This interferes with the communication between your brain and other parts of the body. Nerve impulses are not transmitted as quickly or efficiently, resulting in symptoms such as numbness, tingling, weakness, unsteadiness, vision loss, double vision, fatigue, and partial or complete paralysis.

Diagnosing MS

• Blood analysis to help determine if another infectious or inflammatory disease may be causing MS-like symptoms
• Lumbar fluid analysis to check for abnormal levels of white blood cells or proteins and rule out infections or other causes 
• MRI to identify lesions on the brain or spine
• Evoked potential tests to measure electrical activity in certain areas of the brain in response to visual, auditory and sensory stimulation

Treatment for MS

• Medications to prevent further nerve damage
• Intrathecal pumps implanted under the skin to deliver medications for pain and to relieve spasticity (muscle rigidity and spasms)
• Physical therapy to help mobility problems
       

Seizure disorders like epilepsy are brain disorders in which a person has repeated seizures over time. This neurologic event is associated with episodes of uncontrolled and abnormal firing of brain cells that may cause changes in attention or behavior. 

Diagnosing seizure disorders

• MRI to evaluate the structure of the brain
• Electroencephalogram (EEG) to monitor brain waves
• Cardiac tests to evaluate heart conditions that might mimic seizures from the brain
• Blood tests
• Spinal tap
• Liver and kidney function tests

Treatment for seizure disorders

• Medications
• Vagal nerve stimulation (VNS), including a small implantable device that can predict and prevent seizures

Your Virginia Mason Franciscan Health team will use information from your physical exam and imaging tests to evaluate and diagnose:

• Acoustic neuroma
• Anoxia
• Apraxia
• Back pain
• Blood vessel abnormalities
• Bone spurs
• Brain tumors (benign and malignant)
• Cerebral embolism
• Chiari malformation
• Complex regional pain syndrome
• Dementia
• Diabetic neuropathy
• Episodic headache (cluster)
• Headaches
• Herniated disc
• Hydrocephalus
• Ischemic stroke
• Intracerebral hemorrhage
• Lumbar disc disease
• Memory disorders
• Migraine
• Multi-infarct dementia
• Muscular dystrophy
• Myasthenia gravis
• Myopathy
• Neck pain
• Peripheral neuropathy
• Pinched nerve
• Pituitary tumors
• Polyneuropathy
• Post-concussive syndrome
• Post-polio syndrome
• Progressive supranuclear palsy
• Radiculitis (lumbar and cervical)
• Repetitive motion disorders
• Spinal cord injuries
• Spinal stenosis (neck and back)
• Spine tumors
• Subarachnoid hemorrhage
• Tardive dyskinesia
• Tethered cords
• Thoracic outlet syndrome
• Torticollis
• Traumatic brain injury
• Trigeminal neuralgia