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CHAPTER 5

Neurologic Disorders Toy S. Biederman, PharmD

LEARNING OBJECTIVES KEY TERMS AND DEFINITIONS After completing this chapter, you should be able to — a drug that helps to reduce the tendency of the 1. Describe how lesions in the and peripheral are related brain to have a . Although PART to neurological diseases their primary use is for , are also used to treat 2 2. List the causes, symptoms, and expected course of the following illnesses: psychiatric disorders, syndromes, ● —, cluster, and tension and migraines. ● — a sensory experience that ● Parkinson’s disease precedes a neurologic event, such as a migraine or seizure. During an aura, ● the patient may see, smell, or hear ● Epilepsy something unusual, or have a strange ● feeling, such as déjà vu (the feeling ● Neuropathic pain that one has been in a new place previously). In the case of , ● Sleep disorders the aura is actually a simple partial 3. Describe the psychosocial consequences for patients and families of patients with seizure. neurologic disorders Seizure — a neurological event 4. State the generic and brand names of used to treat neurologic disorders, caused by abnormal electrical activity in the brain. Seizures come in many along with dosage forms and available doses types. Some cause a patient to fall 5. List the mechanism of action, common adverse effects, and special precautions of and thrash about on the fl oor, and medications used to treat neurologic disorders others cause a loss of awareness without falling. Spasm — a strong, unexpected, often painful muscle contraction. eurologic disorders tend to be chronic illnesses, many of which are progres- — an involuntary, fast N sive in the decline of function. They include conditions ranging from those musculoskeletal movement. as common as migraine to rare genetic diseases. Some diseases affect can be due to neurological conditions, such as Parkinson’s memory and reasoning, such as Alzheimer’s disease. Others, such as multiple disease and multiple sclerosis, sclerosis and amyotrophic lateral sclerosis, cause deterioration in the body while excessive intake of stimulants, such as , or may be a harmless the mind is mostly intact. And many, such as epilepsy, are subject to social stigma, genetic condition, such as essential due to the sudden and often frightening onset of seizures or the muscle rigidity tremor. Tremors may affect the and hallucinations associated with Parkinson’s disease. Many of these conditions hands, chin, and other parts of the body. cause stress not only for the patient but also for the caregivers and loved ones. Occasionally, medications can cause neurologic defi cits.

In the past 30 years, there has been an enormous increase in the availability of medications to treat many of these diseases but none to cure them. Often, medica- tions are only effective in delaying the progression and other medications are used to help manage the symptoms of the disease. People with neurologic diseases may have a life span close to normal but with 20 years or more of progressing . Patients with neurologic diseases and their families are in need of health workers who understand the diffi culties of their problems.

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So what causes neurologic disorders? As the name implies, there are problems within the nervous system—the brain, , and peripheral that communicate with every part of the body. When this system is working well, we can multiply, remember old songs, walk a balance beam, hit a target with an arrow, and carry on a normal conversation. Our chewing and swallowing are coordinated so that we don’t choke. Our bowels and bladders do their jobs without stubbornly balking at their tasks. Our fi ngers can feel hot and cold objects, and we can feel a pebble in our shoe. We can pick up a quarter from the fl oor without falling over. We readily fall asleep when we are tired at night and wake up rested in the morning. Any of these systems can be thrown off by disease. Sometimes the disease attacks the nerves themselves. Sometimes there is a particular area of the brain that is affected. Often particular neurotransmitters—chemicals that carry messages from one to another—are out of balance. Many of the medications used to treat neurologic disorders are specifi c to a certain disease. Others are prescribed for several different conditions. Some medications used to treat epilepsy are also used to treat pain conditions, migraine headaches, and mood disor- ders. Some medications used to treat are also used to treat pain and migraine. There are many overlapping characteristics of neurologic diseases and psychiatric diseases (Chapter 7). Neurologic disorders are more likely to be detected by a physical examination and diagnostic procedures, such as MRI (magnetic resonance imaging) scans and EEGs (electroencephalograms). Psychiatric diseases are more likely to be diagnosed by the patients’ descriptions of their emotions, thoughts, and behavior. There is often overlap— patients with neurologic disorders frequently experience depression, for example.

Headache

CASE STUDY

R. B. is a 32-year-old woman who goes to her doctor because of a 6-month history of throbbing headaches on the right side of her head. She has been having these head- aches once or twice a week. Before the headache starts, she sees beams of light that come together to form a fi gure that looks like the letter c, which fl oats around changing position and color. When she has the headaches, she also feels sick to her stomach and cannot stand to be around any light or noise. She has to go into a dark room and sleep. The headache is not relieved by two tablets of either 325 mg or 200 mg and generally lasts all day unless she is able to lie in a dark room and sleep. The headaches usually interfere with her ability to continue work. R. B. does not know what triggers her headaches but says she gets more headaches the week before her period. She says that both her mother and grandmother had “sick headaches.”

Headache disorders are one of the most common neurologic conditions we encounter. Many conditions can cause headaches, and we must not treat this condition lightly. In addi- tion, the overuse of over-the-counter (OTC) headache medications can lead to a condition of What kind of headache does chronic daily headache, which is diffi cult to manage. Patients who describe frequent head- R. B. most likely have? aches, headaches that accompany certain activities (for example, coughing or sex) or a new headache that is the worst they have ever had, should see a doctor for evaluation. See Medi- cation Table 5-1 ( Tables are located at the end of the chapter after the Summary). For occasional tension headaches, OTC acetaminophen, ibuprofen, or is usu- ally suffi cient. (These medications are covered in detail in other chapters; please consult

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