Mini Cases in Movement Disorders, Case Study Example

Kenny

In the case of Kenny there are two conditions for which he exhibits symptoms.  These conditions include, Tourette syndrome and Obsessive Compulsive Disorder.  Kenny clearly displays several symptoms of Tourette syndrome. According to the American Association of Neurological Surgeons, Tourette is a neurological condition that becomes evident between ages six through fifteen. The symptoms of Tourette consist of repeated movements that happen involuntarily and uncontrollable outbursts of vocalizations. The vocalizations called tics, can appear as grunting, shouting, throat clearing, or barking. Control of the tics sometimes improve as the child ages and learns to control the tics better. Kenny has many of the symptoms that started appearing when he was young, therefore Tourette is the best diagnosis. Another possible condition Kenny might have is obsessive compulsive disorder. Information from the Mayo Clinic, defines obsessive compulsive disorder as a condition characterized by irrational thoughts and fears that manifests compulsive repetitive behaviors. According to the Mayo Clinic, examples of OCD may be washing hands until they are raw, counting, checking, and following a strict routine. They consider OCD a lifelong condition and it is known to worsen in times of stress. In this case, OCD repetitions could also explain why Kenny is so musically talented on the drums. Kenny has many symptoms of OCD, therefore it is a good diagnosis. The symptoms caused by the Tourette and OCD that Kenny is experiencing may have been inherited, but the parents would have been aware of that, so more than likely the symptoms are caused by damage to an area in the brain.

The movement disorders may have been caused by an abnormality in the basal ganglia. The basal ganglia, a group of specialized brain cells, are responsible for all involuntary movements, learning, and also emotion. These cells are located deep within the telencephalon area of the brain. Normally, the basal ganglia receives a large degree of input from cerebral cortex, and after processing, sends it back to cerebral cortex by way of the thalamus. These movement disorders Kenny is experiencing could be happening because there is a disruption in this loop of processing information.

Kenny received exposure therapy and medications for his movement disorders. Exposure therapy refers to being exposed to the thoughts, images, objects and situations that causes a person to have anxiety and start becoming obsessive.  Exposure therapy silences fear neurons in the brain. The drug treatments block the neurotransmitter dopamine in the brain. Both treatments simply reduce the frequency of the incidents occurring.

Harry

In the case of Harry, the condition is amyotrophic lateral sclerosis.  According to the National Institute of Neurological Disorders and Strokes, amyotrophic lateral sclerosis (ALS), Lou Gehrig’s disease, is a rapidly progressive, and sometimes fatal neurological disease that attacks the nerve cells responsible for controlling voluntary muscles, like those in the arms, legs, and face. NINDS give symptoms of Lou Gehrig’s disease as having an elevated glutamate level, having difficulty with tasks that require manual dexterity such as buttoning a shirt, experiencing stumbling or awkwardness when walking or climbing stairs, and having problems with speech.  Harry has many of these symptoms, so this is most likely the right diagnosis. There isn’t a specific cause why some people get Lou Gehrig’s disease and others don’t, but there may be a genetic disposition.

This is a disease that attacks the neurons of the brain, brain stem, and spinal cord. Lou Gehrig’s may be caused by a mutation in the gene that produces the SOD1 enzyme, according to NINDS. Normally, SOD1 keep cells safe from metabolic waste. This mutation could happen from a simple mistake in the genetic code replication process.

The treatments recommended for ALS in Harry’s case were both drugs and physical therapy, with speech therapy later. The prescribed medications can affect a chemical messenger in the brain called acetylcholine or reduce a chemical messenger in the brain called glutamate. The physical therapy will help to strengthen muscles.

The symptoms of ALS are mostly caused by an over balance of glutamate.

Alice

In the case of Alice, she is suffering from ataxia, particularly cerebellar ataxia. Promises Treatment Center states that in cerebellar ataxia certain medications, pesticides, and alcohol can cause bleeding in the brain.  The cerebellum plays an essential role in the body by acting as the center for processing sensory information, controlling muscle movement, and overall body coordination. If this center is disrupted it can produce symptoms that include, a state of muscular looseness or floppiness, loss of the coordination and effective use of the muscles and joints, a reduced ability to control movements in the extremities and eyes, and a loss of the ability to make rapidly shifting body movements. Also, the condition can improve with the discontinuation of the trigger. Alice, exhibits most of these symptoms and improved when the triggers stopped.  In Alice’s case, this is caused by excessive exposure to toluene.

The cerebellum is the area affected from the damage of white matter by the toluene. Normally, the cerebellum is the area where dopamine is produced, which plays a part in coordination and movement.

The treatments in this case was to prevent Alice from huffing paint. This gives the brain time to heal and repair as much damage as possible.

Damage to the cerebellum reduces the neurotransmitter, dopamine.

Vic

In the case of Vic, he seems to be affected by Carotid Artery Disease. According to John Hopkins Medicine, carotid artery disease occurs when the main blood vessels (carotid arteries) that carry oxygen rich blood to the brain becomes blocked and narrowed. The narrowing is commonly referred to as atherosclerosis. The symptoms of carotid artery disease include, sudden weakness or paralysis of arms and/or legs on one side of the body and inability to speak or slurred speech. Since Vic experienced both of these symptoms, also had a buildup of plaque, and was grabbed around the neck, carotid artery disease is most likely the condition. Vic’s lack of movement seems to be caused from this.

The veins and arteries of the brain is affected by this disease. Carotid artery disease specifically affects the front part of the brain.  Normally, the carotid artery supplies oxygen rich blood to the brain, but if it is narrowed or blocked, the blood will not be able to reach the brain, resulting in a stroke or an embolism.

The treatment in this case was in the form of medications. These medications serve to remove and decrease the amount of plaque buildup, to reduce the amount of cholesterol before it becomes plaque, and act as a blood thinner.

Vic’s symptoms are simply from the buildup of plaque which reduced brain oxygenation.

Keith

From the symptoms described, Keith may be experiencing symptoms of Parkinson’s disease. According to the Mayo Clinic, Parkinson disease is a movement disorder that is chronic and continually worsens over time. Symptoms of Parkinson include tremors, bradykinesia, rigidity, and postural instability, and delusions or dementia. Keith has experienced all of these symptoms, so the diagnosis must be Parkinson. Keith’s movement disorder is caused by a malfunction of dopamine in the brain.

Parkinson is thought to occur from damage or loss of the neurons that produce the neurotransmitter, dopamine. Dopamine plays a role in the way our brain controls our movements. It also plays a part in the basal ganglia loop. The cause is unknown, but may also involve heredity.

The recommended treatments were antipsychotics and botulism. The antipsychotics increased dopamine levels and the botulism serves to reduce spasms.

The reduction of the neurotransmitter dopamine is what causes Parkinson.

Jim

In the case of Jim, he is affected by the condition, essential tremors. The Mayo Clinic defines essential tremor as a nervous system disorder that causes rhythmic shaking, especially when doing certain tasks, such as drinking from a glass and writing. Essential tremor can run in families, and affect the head, voice, arms or legs. This condition is aggravated by stress and caffeine. This is what Jim has. This is thought to be caused by a gene mutation.

Jim’s movement disorders may be caused by degeneration to parts of the cerebellum. Also, there may be a deficiency of the neurotransmitter, GABA.

The treatments recommended for essential tremor include medications and deep brain stimulation. Medications affect the brain by reducing spasms and anxiety. Deep brain stimulation works by sending electric pulses to the thalamus.

The reduction of the neurotransmitter, GABA, may be the cause of essential tremor disorder.

Kenny

American Association of Neurological Surgeons (2013). Movement Disorders. Web. Retrieved from http://www.aans.org/patient%20information/conditions%20and%20treatments/movement%20disorders.aspx

The Mayo Clinic. (2013). Obsessive Compulsive Disorder. Web. Retrieved from http://www.mayoclinic.org/diseases-conditions/ocd/basics/symptoms/con-20027827

Harry

National Institute of Neurological Disorders and Stroke. Web. Retrieved from http://www.ninds.nih.gov/disorders/amyotrophiclateralsclerosis/detail_ALS.htm

Alice

Promises Treatment Center. (2013). Alcoholism and Ataxia. Web. Retrieved from  http://www.promises.com/articles/alcoholism/alcoholism-and-ataxia/

Vic

John Hopkins University. (1997). Department of Neuroscience. Web. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases /carotid_artery_disease_85,P08248/

Keith

The Mayo Clinic. (2013). Diseases and Conditions. Web. Retrieved from http://www.mayoclinic.org/parkinsonism/expert-answers/FAQ-20058490

Jim

The Mayo Clinic. (2013). Diseases and Conditions. Web. Retrieved from http://www.mayoclinic.org/diseases-conditions/essential-tremor/basics/definition/con-20034509