Best Doctors: 15 Brain Conditions Explained
What It Is: This age-related, irreversible brain disorder is the most common cause of dementia. After abnormal protein deposits form in the brain, many believe those deposits may disrupt neurons’ communication with muscles and organs. These once-healthy cells stop functioning and waste away. Eventually patients are unable to function independently, suffering from chronic memory loss, changes in personality and delusions.
The Treatment: There’s no cure for Alzheimer’s. Physicians have had some success treating memory loss with FDA-approved cholinesterase inhibitors that boost levels of a chemical messenger involved in memory making. Much is still unknown about what triggers the illness, beyond that patients with a family history of Alzheimer’s have a higher likelihood of developing it. “There is not much in the way of preventing Alzheimer’s, like changing your diet, exercise or the things you do to avoid heart disease,” says Dr. Marc Winkelman, a MetroHealth neurologist.
Amyotrophic lateral sclerosis (ALS)
What It Is: This rapidly progressive, degenerative neurological disease attacks nerve cells that control muscles used for speaking, eating, walking and other voluntary movement. Cognitive ability isn’t typically affected, making patients feel trapped in their own body. The causes behind ALS, or Lou Gehrig’s disease, are not fully understood. As it progresses, people experience difficulty swallowing, loss of mobility and the ability to breathe on one’s own. ALS works fast, with an average prognosis of three years after initial symptoms arise.
The Treatment: ALS is a terminal disease. The key is managing symptoms through medication and therapy. Respirator technology has advanced in recent years, and ALS patients no longer require invasive tracheostomies. There’s been some success with Riluzole, a medication that can lengthen survival by delaying the need for a respirator by two to three months, but possible liver and lung side effects require more testing. Still, “it offers hope that something may be found that would be more effective for ALS,” says Winkelman.
What It Is: There’s usually no warning before an aneurysm ruptures. “The first symptoms may be a sudden, severe headache, and that’s usually the aneurysm already leaking to cause a brain hemorrhage,” says Dr. Cathy Sila, chair of neurology at University Hospitals. A ballooning blood vessel in the brain caused by a weakened artery wall, a ruptured aneurysm can also cause immediate nausea, double vision, seizures and death. A ruptured aneurysm is a medical emergency.
The Treatment: Risk factors include high blood pressure, smoking and aging. Once formed, doctors may be able to spot an aneurysm before it ruptures in a MRI or CT scan. After breaking, doctors typically try to close off aneurysms through surgical clipping or less invasive catheter-based procedures.
What It Is: A mental illness characterized by chronic, obsessive worrying about daily life, difficulty focusing and sometimes panic attacks, anxiety’s anatomic source may be linked to our primitive fight-or-flight instincts. “It’s a full body response,” says Dr. Susan Stagno, a University Hospitals psychiatrist. “When people have anxiety, they breathe faster, their heart rate increases, their body is getting ready for something.” Types include generalized anxiety disorder, panic disorder and phobias. According to the Anxiety and Depression Association of America, it’s the most common mental illness in the U.S, affecting 40 million adults age 18 and older.
The Treatment: Certain drugs can increase serotonin levels, a “chemical messenger” that carries signals between brain cells and helps regulate mood and panic symptoms. Different therapy practices include trauma-informed care that examines how trauma changes the brain’s function and chemistry, and cognitive behavioral therapy that helps assuage debilitating negative beliefs. Self-care helps too. “There are a lot of great skills that can be learned to help like yoga, mindfulness and regular exercise,” Stagno says.
Brain Cancers And Tumors
What It Is: While the World Health Organization recognizes more than 120 types of brain tumors, they generally fall into two categories: malignant and benign. Caused by abnormal cells forming in the brain and spinal cord tissues, malignant tumors can spread cancer throughout the brain, while benign tumors can grow and cause brain damage. Both can result in seizures, paralysis and speech difficulties. Cancer patients can develop brain cancer when these cells spread to the brain from other affected organs.
The Treatment: Treatment varies depending on the type of tumor, though even benign masses should be surgically removed to prevent brain damage. For cancer, treatment plans might also include chemotherapy, radiation or specialized neurosurgery on the spinal cord.
What It Is: When brain cells die in the cerebral cortex, the brain layer responsible for thoughts, memories and personality, the result is dementia, a severe decline in mental acuity that often includes memory loss and disorientation. “Dementia is a symptom, not a disease,” explains Winkelman, likening it to blindness. “There are a lot of different reasons a person might be blind, and there are many reasons a person may develop dementia.” To wit, dementia is a symptom of both Alzheimer’s disease and strokes, though not all people with dementia have those illnesses.
The Treatment: There are treatable forms of dementia: head injuries, brain tumors, infections such as meningitis and hormone disorders including hypoactive thyroid disorder. However, most dementia disorders are degenerative, and irreversible. Like Alzheimer’s disease, symptoms such as memory loss may be helped by cholinesterase inhibitors.
What It Is: More than feeling blue, depression is the leading cause of disability among people ages 15 to 44, a debilitating mood disorder whose symptoms can include extreme hopelessness, irritability, insomnia, appetite changes and suicidal thoughts. Nearly half of those diagnosed also suffer from anxiety. “There’s an awful lot of overlap,” says Stagno. “It’s pretty common for someone who starts out with an anxiety disorder to suffer from a depressive order in their future.”
The Treatment: Beyond talk therapy and medications including antidepressants, antipsychotics and mood stabilizers, there have been a number of treatment innovations. For those with chronic treatment-resistant depression, deep-brain stimulation surgically implants paired electrodes in the part of the brain that regulates mood. But a Journal of General Internal Medicine study revealed that among patients with newly diagnosed depression, only one-third seek treatment. “There are so many people who go untreated and suffer needlessly,” says Stagno.
What It Is: Epilepsy refers to seizure disorders that can be unpredictable and trigger other concerns. It has a myriad of causes, including genetic conditions, abnormalities that occur as the cerebral cortex develops, head injuries or any brain diseases that cause neurological lesions, such as multiple sclerosis or cancer. “Basically, a seizure is your brain’s response to stress,” says Dr. Stephen Hantus, a Cleveland Clinic neurologist.
The Treatment: Sixty-six percent of patients respond well to anti-seizure medications. The third that don’t are candidates for surgery or an implantable device. “With an accurate diagnosis and treatment, patients can get their lives back,” says Hantus, explaining that epilepsy can inhibit a person’s ability to work, drive and engage in daily life. “The biggest challenge can be memory,” he adds. “The more seizures you have, the more your memory is affected, so the sooner you treat them, the better.”
What It Is: This terminal genetic disorder causes a progressive breakdown of nerve cells in the brain, caused by the “Huntington’s disease gene.” A child with an affected parent has a 50% chance of developing Huntington’s. The disease essentially has two parts, Winkelman says. First comes dementia, along with “chorea,” involuntary movements that can affect the entire body. “A person’s arms may twitch or move in a riveting sort of way, their face might distort into an expression that can result in a striking appearance,” he says. In the very early stages, most with Huntington’s disease can continue their daily lives, Winkelman says. But, as it progresses, patients may experience personality changes, mood swings, depression and anxiety. Over time, the disease results in slurred speech, difficulty swallowing and significant weight loss.
The Treatment: Medication can be used to reduce involuntary movement. Psychiatric symptoms can be treated through therapy and medication.
What It Is: If you’re experiencing headaches, fever and the telltale stiff neck, you may have meningitis. These symptoms are caused by the membranes surrounding your brain and spinal cord becoming inflamed and swollen. Generally stemming from infections, the most common types of meningitis are bacterial, viral and fungal. If the disease is bacterial, it can result in brain damage, hearing loss, learning disabilities and death.
The Treatment: Bacterial meningitis must be treated early with medications such as intravenous antibiotics. There are also vaccinations for three types of bacteria that cause meningitis. Viral meningitis is not as serious, and may go away on its own, but should be treated by a physician if symptoms persist, according to the Centers for Disease Control. Fungal meningitis, a rare type that occurs when fungus spreads through the blood to the spinal cord, is mostly treated with intravenous antifungal medications.
What It Is: Ever had a headache so awful, you start to see things? This is a common side effect of migraines, which often cause people to experience an “aura,” or changes in vision including blurring or the appearance of star shapes and squiggly lines. “We now understand that migraines are a brain disease,” says Dr. Ronald Riechers, a neurologist at Louis Stokes Cleveland Veterans Affairs Medical Center. Migraines can be seriously disruptive, with a recent Journal of American Medicine study finding that 25% of sufferers missed work or school in the last three months.
The Treatment: While over-the-counter medications can alleviate the immediate symptoms of migraines, regular use may cause rebound headaches that are more difficult to treat, Riechers says. Instead, work with your doctors to identify the root cause and customize a care plan. Many new migraine medications are entering the market, including some targeting CGRP, a protein responsible for the pain associated with migraines. Avoiding triggers such as caffeine, processed foods containing nitrites and MSG and sleep deprivation can also help.
What It Is: A progressive, potentially disabling disease that occurs when the immune system attacks myelin, the protective sheath around nerve fibers, no two cases of multiple sclerosis are the same. The most common type is relapsing-remitting MS, characterized by symptom flare-ups, or “relapses,” which can include numbness, stiff muscles, heat sensitivity, trouble balancing and weakness, depending on the part of the brain or spine that’s damaged. These flare-ups are often followed by long periods of recovery, where a patient may feel completely healthy. However, eventually, some MS patients may need crutches or wheelchairs for life.
The Treatment: Special diets and exercise can alleviate some MS symptoms. The latest treatment is B-cell therapy, also used for rheumatoid arthritis and lymphoma. “With MS, we are repurposing drugs used for other diseases, and it has enhanced our understanding of the science itself, which is interesting,” says Dr. Robert Bermel, a Cleveland Clinic neurologist. “It may be a lesson we can apply to other neurological disorders as we explore treatments.”
What It Is: For a person with Parkinson’s, raising an arm may require herculean effort, until a tremor causes it to shake uncontrollably. As nerve cells in the brain and spine that control motor function break down and die, patients experience stiffness, slowed movement, speech changes and tremors. The lack of movement can result in “masked face” or a lack of expression. “That doesn’t mean their emotions aren’t there,” Winkelman says. “Yet, their face looks as if they are emotionless. That’s part of the illness.” It can be fatal and the disease significantly impacts daily life.
The Treatment: Medications, healthy diet, physical therapy and surgical procedures can help. Because the disease is caused by a lack of dopamine in the brain, treatments that elevate this chemical in the body early in the disease can be effective, Winkelman says. But for now, therapies address symptoms, but do not slow disease progression.
What It Is: When identifying a stroke, act FAST. A common test to diagnose the disease, the acronym pinpoints face drooping, arm weakness and slurred speech as symptoms that mean its time to call 911. A blockage or interruption of blood to the brain, strokes generally peak in a person’s 60s or 70s, but can occur at any age, Sila says. Stroke victims can suffer paralysis, trouble speaking and thinking, headaches, comas or death. The top risk factors include blocked arteries and high blood pressure. Today, that means the benchmark is 120/80 for all ages.
The Treatment: Treatments for mini-strokes, or attacks that only last a few minutes, include a healthy diet, regular exercise and blood thinners that reduce the risk of blood clots. As for major strokes that are sudden and severe, these patients need immediate emergency care. A CT scan will produce a brain image to help physicians determine the cause, whether it be a blocked artery or bleeding in the brain. Clot-buster medicines may be given immediately. If care is given in a timely manner, there may be no permanent damage. Surgery might be necessary to clear the blocked artery, and physical therapy and medications may follow.
Traumatic Brain Injury
What It Is: Despite the lighthearted saying, getting your bell rung can have serious consequences. Usually resulting from a violent blow or strike to the head that impacts or penetrates brain tissue, traumatic brain injuries’ severity can range from mild to severe, each with its own set of symptoms. Concussions are typically classified as mild TBIs, often accompanied by dizziness, headache and irritability. More serious brain injuries can impact other body systems, since the brain is the hub of the body’s function, and can include loss of consciousness, fatigue, comas or death.
The Treatment: Treatment varies depending on the severity of the injury. “Sleep is a critical piece for recovery,” Riechers says, noting that the prescription for concussion is rest. “You want to give the brain muscle a rest, similar to how you’d rest a strained ligament or muscle in the body.” With more serious injuries, anti-seizure medications, surgical probes to relieve pressure and rehabilitation may be necessary.
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8:00 AM EST
July 29, 2019