Biomedicine NERVOUS SYSTEM Part II

Copyright CNM – College of Naturopathic Medicine 1 Regeneration and repair of Nervous tissue

• Plasticity: The ability for the NS to change based on experience – Sprouting new dendrites, changes in synaptic contacts • But… Neurons have limited powers of regeneration • In the PNS - If the Schwann cell and cell body are intact, and scarring doesn’t happen too quickly, regeneration may occur. • In the CNS, cut axons do not regenerate

2 CNS Brain & Spinal cord

3 Protective Covering of the Brain & Spinal cord

SPINAL CORD • Protected by the Vertebral Column

BRAIN • Protected by the Cranium, • Cranial Meninges • Cerebro-Spinal fluid (CSF)

• Blood Brain Barrier 4

MENINGES 3 layers of CT that cover the brain and spinal cord 1. Dura mater (tough mother) - The dura mater in the brain has two layers that create some venous sinuses that allow blood to drain out of the brain into the jugular veins. Subdural Space = Interstitial Fluid

2. Arachnoid mater (similar to spider) - Collagen and elastic fibres Subdural space between arachnoid mater (2) and Dura mater (1) filled with interstitial fluid.

Sub-arachnoid Space = Cerbro Spinal Fluid

3. Pia mater (delicate) - Contains blood vessels that supply the spinal cord. Between the Pia mater and Arachnoid mater is the sub- arachnoid space filled with CSF

5 Arrangement of the Meninges/ Membranes covering the Brain & Spinal cord 1. Skull 2. Dura mater

Subdural space filled with Interstitial Fluid

3. Arachnoid mater

Sub-arachnoid space filled with CSF

4. Pia mater 5. Artery 6. Brain 7. Cerebrospinal fluid 6 Cerebrospinal Fluid - CSF

Clear liquid that protects the brain & spinal cord from trauma and chemical injuries. • CSF is made from filtered blood & is mostly water with ions & glucose. • Blood cells are too large to filter through the blood vessels, so CSF is transparent and colourless. • The CSF occupies the Subarachnoid Space & the Ventricles (Irregular shaped cavities) in the Brain, as well as the Central Canal of the Spinal Cord. • CSF is secreted continuously and produced at a rate of 500 ml/day. • Since the brain can only contain about135 - 150 ml, large amounts are gradually absorbed back into the blood after circulating around the brain and spinal cord. 7 http://www.riverarunsthroughit.com/2012/08/from-60-to-16.html

CSF • Functions of CSF 1. Supports & Protects the Brain & Spinal Cord = ‘Shock absorber’ 2. Maintains Uniform Pressure round the brain- In case of brain enlargement compensation occurs by reduction of CSF 3. Keeps brain and spinal cord moist 4. Circulates nutrients and waste

8 BLOOD BRAIN BARRIER • Blood flows to the brain from the vertebral and carotid arteries • Brain uses 20% of all oxygen and glucose in the body at rest • Lack of supply for 4 mins will cause injury!

• The BBB protects the brain from toxins, harmful substances and bacteria that enter the bloodstream, by maintaining tightness of the capillaries and the junctions between cells.

•The BBB is maintained by Astrocytes 9 TRANSPORT across Blood Brain Barrier • Lipid soluble substances cross easily eg. Alcohol, Anaesthetics • Glucose crosses by Active transport • Gasses diffuse easily eg. oxygen, carbon dioxide. • Other ions etc diffuse slowly across • Proteins and some drugs do not pass at all across

the barrier 10 THE BRAIN

1. BRAIN STEM: (Continuous with the spinal cord) Midbrain, Pons, Medulla oblongata 2. DIENCEPHALON: Thalamus, Hypothalamus, Epithalamus 3. CEREBELLUM: (Little Brain) 4. CEREBRUM

11 12 BRAIN STEM

1. MEDULLA OBLONGATA: Controls vital body functions, contains Respiratory and Cardiac Centres, controls Reflexes such as Vomiting, Sneezing & Hiccupping. Contains 5 cranial nerves. 2. PONS: Helps to control Breathing, four pairs of cranial nerves 3. MIDBRAIN: Eye reflexes and tracking, Subconscious muscle activities, Auditory Tracts, movement of head and neck

Orientation in space 13 DIENCEPHALON

1. THALAMUS - Relay Centre – relays sensory info. to the cerebrum, regulates Autonomic activities & Consciousness 2. HYPOTHALAMUS - Sense of smell, Hormone regulation and Homeostasis, sensory info, control of the ANS, regulation of Emotional and Behavioural patterns, regulation of Eating and Drinking, control of Body Temp, regulation of Circadian Rhythms 3. EPITHALAMUS - Contains the Pineal Gland which secretes melatonin, olfactory

sensation 14

CEREBELLUM

Functions: 1. Tracks Motor functions 2. Co-ordinates movements 3. Posture and Balance 4. Cognition (the process of thought) 5. Language Processing 6. Processing of Sensory information

15 CEREBRUM

Two Hemispheres • Superficial Part: Grey Matter = Cerebral cortex

• Multiple foldings or furrows

• Deeper Layer: White matter

16 CEREBRUM

Functions:

• Sensory Perception • Motor Control of Skeletal Muscles (Movement) • Cognition • Speech

17 Why the each side of the Brain co-ordinate the OPPOSITE side of the Body? In the internal capsule: • Motor fibres form pyramidal tracts • Cross over at the Medulla Oblongata (Decussating) • This means the left side of the Brain co- ordinates the right side of the Brain & Right side of brain co-ordinates

Left side of the body 18 Functional Areas of the Cerebrum Scientists revealed these different Functional Areas by researching/ Studying The Effects of injuries eg. Broca’s Area and through Electric Stimulation

19 • In the Motor and Sensory areas of the brain, the body is represented according to the importance of the parts Motor representation Sensory representation

20 Blood Supply to the Brain

• Constant supply of oxygen and glucose is necessary • Brain receives about 15% of cardiac output (about 750 ml per minute)

21 CRANIAL NERVES • The brain also contains 12 pairs of cranial nerves each responsible for specific functions in the body: i. Olfactory nerve– Sense of Smell ii. Optic nerve – Vision iii. Oculomotor – Eye movements, eyelid opening, proprioception, Pupil size iv. Trochlear – Eye movements, proprioception v. Trigeminal – Facial sensations, chewing vi. Abducens – Eye movements and proprioception 22 CRANIAL NERVES Cont’d vii. Facial – Taste, facial expressions viii. Vestibulocochlear / Auditory– Hearing, balance ix. Glossopharyngeal – Taste, swallowing, tongue sensations x. Vagus – Swallowing, taste, senses from epiglottis, monitoring BP and CO2 and O2, sensations from abdomen and viscera xi. Accessory / Spinal – Neck and shoulder muscles movt, swallowing xii. Hypoglossal – Tongue movement and speech

23 24 Worksheet

• Please complete the exercise in your handout using the information in the slides

25 CSF & MENINGEAL PATHOLOGIES

http://health-7.com/Atlas%20of%20Pediatric%20Physical%20Diagnosis/Signs%20%26amp%3B%20Symptoms/4 26 Increased Intracranial Pressure ↑ICP Cerebral Oedema or Inflammation

Cause: • Haemorrhage • Hypoglycaemia • Hypoxia • Infections, abscesses • Inflammation of the brain or meninges • Infarcts • Tumours • Traumatic injury

27 ICP Signs & Sx: • Pupil fixed +/ dilated, Impaired Eye movement • Impaired Motor Function  Abnormal Posture • Changes in Speech • Changes in Vital Signs:  ↑ Systolic Blood Pressure  ↓Pulse  Irregular Respiratory Pattern • Vomiting/Nausea • Headache • Changes in behaviour • Progressively ↓ consciousness • Lethargy • Seizures = Abnormal neuron activity in the brain 28 ICP Rx: • Critical condition !!! • Intensive care • Frequently measured neurological and Vital signs Complication: • Permanent neurological problems • Seizures • Death

29 HYDROCEPHALUS

An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles or other cavities of the brain caused by blocked circulation or absorption of CSF.

Causes: • Small Children: Infection often before birth. • Older Children and adults: Tumours, Trauma etc. • Possible in Older People: Circulation problems

30 HYDROCEPHALUS

• May lead to ↑ ICP inside the skull and progressive enlargement of the head, convulsion & mental disability. • Hydrocephalus can also cause death!! Rx: • Shunt / Ventricular Catheter/ Tube • Lumbar Puncture

31 MENINGITIS

Def: Infection or inflammation of the membranes covering the brain and spinal cord

Cause: • Mostly Bacterial Infection (usually Haemophilus influenzae & Streptococcus pneumoniae) • Also viral infection (less severe) eg. Herpes Simplex virus • May also be fungal or parasitic microorganisms

32 MENINGITIS S: • Can be Life threatening when it leads to Increased ICP!!! So the condition is classified as a MEDICAL EMERGENCY!!! • Petechiae: Small purple / red spots on the skin as a result of tiny haemorrhages. The spots are Non-blanching i.e. the redness does not disappear when pressed with a finger or a glass tumbler. • Sudden onset of severe headache, photophobia, stiff neck, vomiting, • Kernig's sign - Resistance to leg extension when lying with the hips flexed, • Brudzinski sign (neck flexion causes flexion of hip and knee)

33

MENINGITIS

Diagnosis: • Lumbar Puncture (Withdraw CSF from Spinal Canal, region L4-L5 )

Rx: Antibiotics, Antivirals & Corticosteroids Complication: Brain /Nerve Damage DIAGNOSTIC: Collect CSF for analysis e.g to detect meningitis

THERAPEUTIC: To reduce ICP 34 BRAIN PATHOLOGY

35 HEAD INJURIES

Symptoms: Vary (Mild to Severe) • Unconsciousness • Amnesia • Headaches • Seizures • Leaking CSF or blood from ear or nose • Fever Rx: • Always 999, A&E !! • Arnica 200C in addition to calling Emergency Services

36 Head Injuries: CONCUSSION

• Reversible head injury which usually results from a significant BLOW to the head causing a sudden movement of the Brain & disrupting Neurological Function

• Symptoms: Vary (Mild to Severe): –Loss of consciousness –Memory loss (amnesia) of events surrounding the injury –Headache 37 Head Injuries: CONCUSSION Rx: • Arnica 200C, in addition to calling Emergency Services • Rest • If consciousness was lost, that person should avoid any vigorous activity for ~ 3 months.

Complication: • Intracerebral Haemorrhage

• Brain Injury 38 Head Injuries: CONTUSION

Bruising of the Brain with ruptured Blood vessels and Oedema • Usually caused by a blunt blow to the head • Residual damage depends on force of the blow and amount of tissue injury

39 Head Injuries: FRACTURES

• Varying degrees of severity depending on whether the brain is exposed or damaged

BASILAR FRACTURE = Fracture at the base of the skull. • Often accompanied by CSF leakage through ears & nose. • Results in damage to Cranial Nerves. • Common in car accidents Post Mortem Magnetic when someone’s head hits Resonance Imaging (MRI) of a fatal head injury the windscreen 40 Head Injuries: CONTRECOUP INJURY

• Damage to the Brain at a site contra- lateral to site of direct damage/ trauma

• Damage occurs as the brain bounces off the skull

41 Cerebrovascular Accident (CVA) AKA Stroke Infarction of brain tissue by occlusion or rupture of blood vessel. 4 min of ischaemia = Irreversible Cell Damage. Causes: • Embolus • Atheroma • Rupture of Blood vessel (Aneurysm)

Risk factors: Hypertension, Atherosclerosis 42 Cerebrovascular Accident

Symptoms: • Sudden weakness, numbness or tingling • Loss of speech or comprehension, confusion F • Loss of vision A • Sudden severe headaches • Unsteadiness S T Outcome: Depends on Severity & Location • Death • Paralysis • Less severe and transient problems 43 Cerebrovascular Accident

Diagnosis: • CT scan • MRI scan

MRI scan

Rx: Hospital, reduction of inflammation, collateral circulation.

44 Transient Ischaemic Attack

Temporary reduction of blood flow. • Can be warning sign for a full blown stroke

Sx: • Transient impaired functions, resolves within 24 hours • Depends on area of brain affected 45 HEADACHES Common type of Head Pain with many causes. Common Causes: • Congested sinuses http://askdrmakkar.com/migraine.htm • Muscle tension/spasms N.B. These serious • Jaw joint problems conditions often start • Tension SUDDENLY, and can • Climate affect the PUPILS. • Hypoglycaemia • Caffeine withdrawal etc.

Rx: Depending on cause

DD: Serious conditions like Stroke, Meningitis, Tumours, Head Injury 46 MIGRAINE

Def: Form of severe Vascular Headache Cause: Abnormal Blood Flow and Metabolism in the Brain Sx: – May begin with ‘Aura’ = Unusual visual, olfactory or other sensory experiences that are a sign that the migraine will soon occur – Incapacitating Pain, beginning on One Side – Then Headache with Visual Disturbances, Sensory Hypersensitivity – Nausea & Vomiting – Longer Recovery Period. http://www.medicalook.com/reviews/Almotriptan.html 47 MIGRAINE Rx: • Diet • Medication • Herbs (Feverfew & Butterbur) • Turmeric • CoQ10, Magnesium • Botox (NHS approved 11th May 2012) • Acupuncture

DD: Brain Tumour, Stroke, Meningitis, Head Injury etc.

• Watch Pupils, Watch out for constant Pains! 48 BRAIN TUMOURS

Even Benign Tumours can be life threatening – Increased ICP. Often Secondary Malignant Tumours.

Sx: • Often Morning Headaches, Increasing in Frequency, maybe Vomiting, • Uneven Pupils (not always dangerous!!)

49 EPILEPSY

Abnormal and intense electrical activity in the brain resulting in Recurrent fits or seizures. Lasting for seconds or minutes

Seizures = Abnormal neuron activity in the Brain

C: Sx: • Idiopathic • Petit Mal Seizures • After Brain • Grand Mal Seizures Damage,

• Head injuries, • Medication (Larium) 50 http://epilepsyassociation.com/aggression-children-epilepsy/ Petit Mal Seizures

• ‘Absences’, seen mainly in Children • Last 10-30 seconds • Abnormal & Intense Electrical Activity in the Brain • Usually NO Lingering Confusion • Can be Idiopathic or due to Birth Trauma, Brain injury or Family tendency.

51 Grand Mal Seizures

• Also known as a Tonic- Clonic Seizure • Tonic Phase – Contraction of all body muscles • Clonic Phase – Rapid Contraction & Relaxation of Muscles, causing ‘Spasming’ • Usually lasts around one minute • Recovery Time varies

52 EPILEPSY

Rx: • Drugs – Anti- convulsants such as Gabapentin, Sodium valproate (Epilum) • Emergency Care

• Ketogenic Diet – It is unknown how Ketosis suppresses seizures http://www.efepa.org/living-with-epilepsy/ 53 Reminder:

Bell’s Palsy = Mononeuropathy

Temporary facial paralysis resulting from damage or trauma of the Facial nerve (Cranial nerve VII)

54 SPINAL NERVES

• BRAIN STEM: Connects the Spinal Cord to other parts of the Brain. • The SPINAL CORD branches out into Nerve fibres which pass out through the intervertebral foramen known as Rami (Ramus singular form) • SPINAL CORD: Carries Nerve Impulses between the Brain and Spinal Nerves.

55 SPINAL NERVES

•Arising from the Rami, a group of nerves come together to form a PLEXUS which then feeds into an area of the body •Some nerves do not form a plexus, so communicate directly into the area, especially the intercostal nerves

Areas on the skin surface supplied by nerve fibres from One Spinal Root are called DERMATOMES 56 SPINAL NERVES

The Spinal Nerves include:

• Cervical Nerves (8 pairs) These nerves supply the head, neck, shoulders, arms, and hands. • Thoracic Nerves (12 pairs) Connects portions of the upper abdomen and muscles in the back and chest areas. • Lumbar Nerves (5 pairs) Feeds the lower back and legs. 5 • Sacral Nerves (5 pairs) Supplies the buttocks, legs, feet,

anal and genital areas of the body. 5 • Coccygeal Nerve

SPINAL NERVES

http://www.families-and-chronic-pain.com/symptomsofnervedamage.html 1. Cervical Plexus

• Under Sternocleidomastoid, made up of nerves originating between C1-4 • Supplies the skin & muscles of the head and neck as well as the top of the chest and shoulders • The Phrenic nerve of the diaphragm also arises from the

cervical plexus 59

2. Brachial Plexus

• Nerves originating from C5-8 plus T1 • Supply skin and muscles of Upper Limbs

Main Nerves of the Brachial Plexus: 1. Axillary - C5,6 2. Radial - C5-8, T1 3. Musculocutaneous nerve - C5-7 4. Median - C5-8, T1 5. Ulnar - C7-8, T1 6. Medial cutaneous C8, T1

60 61 3. Lumbar Plexus

• Spinal nerves from L1-L4 • Supplies Abdominal Wall, External Genitals and parts of the Lower Limbs

62 4. Sacral Plexus

• Made up of nerves for L4, L5 and S1-S4 • Supplies the Buttock Perineum and Lower Limbs • Nerves from L4-S3 (L4,5, S1,2,3) join to form the Sciatic Nerve

63 SPINAL CORD - Physiology

WHITE MATTER • Made up of Nerve Tracts = Highways of the spinal cord i) Motor Nerve Tracts – Voluntary and involuntary muscle movement (Coordination, Posture, Balance) P ii) Sensory Nerve Tracts – Transmit impulses form the skin (Sensory receptors) – Transmit impulses from tendons, muscles & A joints (Proprioceptors - stimulated by stretch & movement)

GREY MATTER • Receives and integrates incoming and outgoing information i) Posterior Column – Receives Sensory impulses ii) Anterior Column – Sends out Motor impulses http://brainyinfo.com/neuron/ 64 Posterior (Dorsal) Column = Sensory Impulses

Ganglion /

Dorsal

Sensory Neuron

Motor Ventral Neuron

Anterior (Ventral) Column = Motor Impulses

http://brainyinfo.com/neuron/ 65 Reflex Arcs

• A ‘REFLEX’ is a fast, automatic, unplanned sequence of actions that occurs in response to stimulus. • If the integration takes place in the spine it is known as a Spinal Reflex

A Reflex Arc is made of:

1. Sensory Receptor 2 4

2. Sensory Neuron 3 3. Integrating Centre (interneuron) 1 4. Motor Neuron 5 5. Effector Organ

66 1 Sensory / Column

2

3

4

5 / Column

67 CNS Neurological Examination • REFLEX ARCS For further info on reflex testing have a look at http://medicine.ucsd.edu/clinicalmed/neuro3.htm

• TWO PRONG TOUCH TESTING / TWO-POINT DISCRIMINATION • GENTLE TOUCH TESTS • GAIT AND POSTURAL ANALYSIS • MRI’S • ELECTRO-ENCEPHALO GRAMS

68 Examining Reflexes

• Normal Reflex Arcs can be tested to see if there is anything wrong with particular Nerve Functions

The most common ones are: 1. The Knee Jerk (Patellar reflex) 2. The Ankle Jerk (Achilles reflex) 3. Plantar Reflex /Babinski Sign 4. Abdominal Reflex

69 1. Knee Jerk Reflex / Patellar Reflex (Spinal Reflex) • Tapping the Patella Tendon triggers a Stretch Reflex to stimulate contraction of the Quadriceps Muscles • This is as protective mechanism to stop excessive joint movement which may damage tendons ligaments or muscles • A missing reflex can indicate: - An intervertebral disc prolapse or

- Paralysis 70 2. Ankle Jerk Reflex / Achilles Reflex

• Tapping the Achilles Tendon triggers a Stretch Reflex to stimulate Plantar flexion of the Foot.

• A Missing reflex indicates: - Nerve Damage or a - Subarachnoid Haemorrhage • An Exaggerated reflex may indicate: - Cervical cord Compression or - A lesion of the Sacral Motor Tracts

71 3. Plantar Reflex / Babinski Sign

• Stroking outer margin of the Sole of the foot causes the Big Toe to Dorsiflex and the other toes to Fan • Normal in children younger than 1 ½ years due to incomplete myelination of nerve fibres • Abnormal after this age – A positive reflex indicates: Pyramidal Tract Damage, MS,ALS etc.

72 4. Abdominal Reflex

• Contraction of abdominal muscles in response to stroking the sides of the abdomen

• A missing reflex can show MS, Pyramidal Please work with a partner and practise these tract damage, Spinal techniques on each other! nerve problems etc.

73 Spinal Nerve PATHOLOGIES

74 BRACHIAL PLEXUS INJURIES Erb’s Palsy

• Injury at C5/C6 (Axillary, Radial, Musculocutaneous, Median) • Cause: Forceful pulling away of head from shoulder E.g. Stretching of the neck during childbirth • “Waiter’s tip”

75 BRACHIAL PLEXUS INJURIES

KLUMPKE'S PALSY • “Claw hand” • Ulnar Nerve Damage • Hitting your ‘funny bone’ in your elbow

APE HAND • Median Nerve Damage

76 BRACHIAL PLEXUS INJURIES Wrist Drop / “Saturday Night Palsy”

• Radial Nerve Damage • The term Saturday Night Palsy refers to nerve damage that can occur if a drunk person falls asleep with the back of their arms compressed by a bar edge, bench back, or like object.

77 Herniated / Prolapsed Disc (Slipped Disc)

Herniation /Prolapsing of the Intervertebral Disc, causing Pressure on Spinal Nerve Root or Spinal Cord

Fibrocartilage

http://www.patient.co.uk/health/Prolapsed-Disc-%28Slipped-Disc%29.htm 78 Herniated / Prolapsed Disc (Slipped Disc)

Sx: DD: 1. Pain at the location + • MS, radiating usually unilaterally • Spinal Tumours 2. Positive Lasegue Test • Borreliosis (Lyme disease) 3. Shooting pain when sneezing (lumbar slip) Lasegue Test A Lasegue test, also known as Straight-leg Raising Test (SLR), is performed. The patient lies down, the knee is extended, and the hip is flexed (and dorsiflexion of the ankle) If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed. 79 SCIATICA Sciatic Nerve = Longest and Widest single nerve in the human body.

‘Sciatica’ is the term given to pain down the leg, which is caused by irritation of the sciatic nerve. Sgs & Sxs: • Pain in the lower back, buttock and/or various parts of the leg and foot, almost always one sided. Caused by general compression /irritation of one of five nerve roots or of the sciatic nerve itself • Can lead to pins and needles feeling / Burning & Tingling • Weak calf muscles, • Possible lack of Achilles tendon reflex (Foot drop). • Difficulty in moving or controlling the leg • In severe cases sensory and motor problems (paralysis of toes, urinary incontinence) 80 SCIATICA

Cause: Diagnosis: 1. Mostly disc 1.Lasegue Test herniation in L4/L5 2.See if Px can stand on heels & toes: If the 2. Tumours in patient cannot stand the pelvis, on his heels = L5 3. Constipation If they cannot stand 4. Pregnancy on their toes = S1 5. Cold 3.Achilles Tendon 6. Injury Reflex may be lacking

Rx: Depending on Cause = Warmth, Massage, Chiropractic, Osteopathy, Acupuncture 81 SPINA BIFIDA

• Congenital malformation of the Neural Canal/ Tube + Spinal Cord

Prevention: • Folic acid during pregnancy

82 Genetic Abnormalities

83 Recall: SPINA BIFIDA

• Congenital malformation of the neural canal + spinal cord

Prevention: • Folic acid during pregnancy

84 Recall: Huntington’s Disease /Chorea

• Inherited Neurodegenerative disorder affecting brain/basal ganglia which affects muscle coordination and some cognitive functions, • It is the most common Genetic cause of abnormal involuntary writhing movements called Chorea • Inherited lack of GABA • ~30-50 yrs. (Often gene passed on by then to child)

85 PHENYLKETONURIA

Genetic defect, creating a deficiency of Phenylalanine Hydroxylase, which converts phenylalanine to tyrosine. This ultimately causes accumulation of toxic metabolic product: phenylalanine = amino acid Accumulated Phenylalanine is toxic to brain tissue.

Sx: Very fair hair, Eczema, Mousy odour of the urine and skin, and progressive Cognitive impairment. If untreated, Brain damage & Mental retardation within months.

Rx: Life-long LOW exposure to phenyalanine Phenylalanine-free diet – avoid soy, cheese, legumes, nuts, pork, lamb, turkey, aspartame. 86 Phenylketonuria

• Prevention: Screening New-borns. • Blood is routinely drawn from new-born infants for testing. • Blood is obtained by “Heel Stick” Test • Routine testing usually includes Phenylketonuria, Typically performed at least 12 Thyroid function, hours and generally 24–28 Haemoglobin S (sickle hours after birth, using samples cell disease), and may drawn by Neonatal heel prick = test for other disorders. Neonatal Heel Stick Test 87 ASPARTAME • A non- carbohydrate artificial sweetener 200 times sweeter than sugar • Brand names: Equal, NutraSweet • Used in approximately 6000 foods and drinks • The subject of much controversy http://www.tuberose.com/Aspartame.html 88 Aspartame and Health

• Aspartame is a Neuro-toxin • It has Neuro-excitatory properties • Linked to wide-spread neurological damage and a variety of symptoms • Gulf War Syndrome • MS, Parkinson’s, dizziness, fainting

Aspartame Websites www.aspartamekills.com www.holisticmed.com/aspartame www.aspartame.org www.sweetpoison.com 89 The Nervous System & Homeostasis The nervous system work with the endocrine system to provide communication and regulation of most body functions Integumentary system • SNS controls sweating and contraction of smooth muscle attached to hair follicles Skeletal system • Pain receptors in bone tissue warn of trauma or damage Muscular system • Motor neurons stimulate muscular contractions • The cerebellum co-ordinates skilled movements 90 The nervous system and homeostasis

Endocrine system • Hypothalamus regulates hormone secretions from the pituitary • ANS regulate hormone release from the adrenals and pancreas Cardiovascular system • Medulla oblongata is the home of the CV control centre. It provides impulses to the ANS which governs cardiac output and regulates blood pressure

91 The nervous system and homeostasis Lymphatic and immune system • Certain neurotransmitters help regulate immune response Respiratory • Respiratory areas in the brain stem control breathing rate and depth • ANS regulates airway diameter Digestive system • ANS and enteric nervous system regulate digestion • PNS stimulates digestive processes 92

The nervous system and homeostasis Urinary System • ANS regulate blood flow to the kidneys • CNS govern emptying of the urinary bladder Reproductive system • Hypothalamus and limbic system govern sexual behaviour • ANS governs erection and ejaculation • Hypothalamus regulates the release of pituitary hormones which influence the gonads • Nerve impulses elicited by suckling cause the release of oxytocin and milk ejection in nursing mothers

93