Neurological disorder

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Neurological disorders represent a complex array of medical conditions that fundamentally disrupt the functioning of the nervous system. These disorders affect the brain, spinal cord, and nerve networks, presenting unique diagnosis, treatment, and patient care challenges. At their core, they represent disruptions to the intricate communication systems within the nervous system, stemming from genetic predispositions, environmental factors, infections, structural abnormalities, or degenerative processes.

Contents

The impact of neurological disorders is profound and far-reaching. Conditions like epilepsy create recurring seizures through abnormal electrical brain activity, while multiple sclerosis damages the protective myelin covering of nerve fibers, interrupting communication between the brain and body. Parkinson's disease progressively affects movement through the loss of dopamine-producing nerve cells, and strokes can cause immediate and potentially permanent neurological damage by interrupting blood flow to the brain. Diagnosing these disorders requires sophisticated medical techniques. Neuroimaging technologies like MRI and CT scans and electroencephalograms provide crucial insights into the intricate changes occurring within the nervous system. Treatment approaches are equally complex, involving multidisciplinary strategies, including medications to manage symptoms, control brain activity, or slow disease progression, coupled with neurological rehabilitation to help patients develop compensatory strategies.

Neurological disorder
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Neurons in person with epilepsy, 40x magnified
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg

Ideally, A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord , or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain, tauopathies, and altered levels of consciousness. There are many recognized neurological disorders; some are relatively common, but many are rare.

Interventions for neurological disorders include preventive measures, lifestyle changes, physiotherapy or other therapy, neurorehabilitation, pain management, medication, operations performed by neurosurgeons, or a specific diet. [1] [2] The World Health Organization estimated in 2006 that neurological disorders and their sequelae (direct consequences) affect as many as one billion people worldwide and identified health inequalities and social stigma/discrimination as major factors contributing to the associated disability and their impact. [3]

Causes

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Part of the causal chain leading to Alzheimer's disease

Although the brain and spinal cord are surrounded by tough membranes, enclosed in the bones of the skull and spinal vertebrae, and chemically isolated by the blood-brain barrier, they are very susceptible if compromised. Nerves tend to lie deep under the skin but can still become exposed to damage. Individual neurons, the neural circuits, and the nerves into which they form are susceptible to electrochemical and structural disruption. Neuroregeneration may occur in the peripheral nervous system and thus overcome or work around injuries to some extent, but it is thought to be rare in the brain and spinal cord.[ citation needed ]

The specific causes of neurological problems vary but can include genetic disorders, congenital abnormalities or disorders, infections, lifestyle, or environmental health problems such as pollution, malnutrition, brain damage, spinal cord injury, nerve injury, or gluten sensitivity (with or without intestinal damage or digestive symptoms). [2] [4] Metal poisoning, where metals accumulate in the human body and disrupt biological processes, has been reported to induce neurological problems, at least in the case of lead. [4] The neurological problem may start in another body system that interacts with the nervous system. For example, cerebrovascular disease involves brain injury due to problems with the blood vessels (cardiovascular system) supplying the brain; autoimmune disorders involve damage caused by the body's own immune system; lysosomal storage diseases such as Niemann–Pick disease can lead to neurological deterioration. The National Institute for Health and Care Excellence recommends considering the evaluation of underlying coeliac disease in people with unexplained neurological symptoms, particularly peripheral neuropathy or ataxia. [5]

In a substantial minority of cases of neurological symptoms, no neurological cause can be identified using current testing procedures, and such "idiopathic" conditions can invite different theories about what is occurring.[ citation needed ] Generally speaking, a substantial number of neurological disorders may have originated from a previous clinically not recognized viral infection. For example, it is thought that infection with the Hepatitis E virus, which is often initially asymptomatic may provoke neurological disorders, [6] but there are many other examples as well.

Numerous examples have been described of neurological disorders that are associated with mutated DNA repair genes (for reviews see [7] ). Inadequate repair of DNA damages can lead directly to cell death and neuron depletion as well as disruptions in the pattern of epigenetic alterations required for normal neuronal function.[ citation needed ]

DNA damage

Neurons are highly oxygenated cells and as a consequence DNA damage caused by chronic exposure to endogenous reactive oxygen species is a substantial challenge for neurons. [8] Germline mutations deficient in the repair of DNA damages cause neuronal dysfunction and are etiologically linked to many neurological disorders. [8] For example, the neurological disorders, amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are linked to DNA damage accumulation and DNA repair deficiency. [9]

Classification

Deaths due to neurological conditions per million persons 2012
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18-52
53-68
69-84
85-99
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Deaths due to neurological conditions per million persons 2012
  18-52
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  132-157
  158-186
  187-243
  244-477
  478-1,482

Neurological disorders can be categorized according to the primary location affected, the primary type of dysfunction involved, or the primary type of cause. The broadest division is between central nervous system disorders and peripheral nervous system disorders. The Merck Manual lists brain, spinal cord disorders, and nerve disorders in the following overlapping categories: [10]

Nervous system
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Human nervous system
Identifiers
MeSH D009422
Anatomical terminology

Many of the diseases and disorders listed above have neurosurgical treatments available, such as Tourette syndrome, Parkinson's disease, and essential tremor.[ citation needed ]

Neurological disorders in non-human animals are treated by veterinarians. [11] [12]

Mental functioning

A neurological examination can, to some extent, assess the impact of neurological damage and disease on brain function in terms of behavior, memory, or cognition. Behavioral neurology specializes in this area. In addition, clinical neuropsychology uses neuropsychological assessment to precisely identify and track problems in mental functioning, usually after some sort of brain injury or neurological impairment.[ citation needed ]

Alternatively, a condition might first be detected through the presence of abnormalities in mental functioning, and further assessment may indicate an underlying neurological disorder. There are sometimes unclear boundaries in the distinction between disorders treated within neurology, and mental disorders treated within the other medical specialty of psychiatry, or other mental health professions such as clinical psychology. In practice, cases may present as one type, but be assessed as more appropriate to the other. [13] Neuropsychiatry deals with mental disorders arising from specific identified diseases of the nervous system.[ citation needed ]

One area that can be contested is in cases of idiopathic neurological symptoms - conditions where the cause cannot be established. It can be decided in some cases, perhaps by exclusion of any accepted diagnosis, that higher-level brain/mental activity is causing symptoms, referred to as functional symptoms, rather than the symptoms originating in the area of the nervous system from which they may appear to originate. Cases involving these symptoms are classified as functional disorders ("functional" in this context is usually contrasted with the old term "organic disease"). For example, in functional neurologic disorder (FND), those affected present with various neurological symptoms such as functional seizures, numbness, paresthesia, and weakness, among others. Such cases may be contentiously interpreted as being "psychological" rather than "neurological." conversion disorder, If the onset functional symptoms appear to be causally linked to emotional states or responses to social stress or social contexts, it may be referred to as conversion disorder. [14]

On the other hand, dissociation refers to partial or complete disruption of the integration of a person's conscious functioning, such that a person may feel detached from one's emotions, body and/or immediate surroundings. In extreme cases, this may be diagnosed as depersonalization-derealization disorder. There are also conditions viewed as neurological where a person appears to consciously register neurological stimuli that cannot possibly be coming from the part of the nervous system to which they would normally be attributed, such as phantom pain or synesthesia, or where limbs act without conscious direction, as in alien hand syndrome.

Some of the fields that contribute to understanding mental functioning Cognitive science heptagram.svg
Some of the fields that contribute to understanding mental functioning

Conditions that are classed as mental disorders, learning disabilities, and forms of intellectual disability, are not themselves usually dealt with as neurological disorders. Biological psychiatry seeks to understand mental disorders in terms of their basis in the nervous system, however. In clinical practice, mental disorders are usually indicated by a mental state examination, or other type of structured interview or questionnaire process. At the present time, neuroimaging (brain scans) alone cannot accurately diagnose a mental disorder or tell the risk of developing one; however, it can be used to rule out other medical conditions such as a brain tumor. [15] In research, neuroimaging and other neurological tests can show correlations between reported and observed mental difficulties and certain aspects of neural function or differences in brain structure. In general, numerous fields intersect to try to understand the basic processes involved in mental functioning, many of which are brought together in cognitive science. The distinction between neurological and mental disorders can be a matter of some debate, either in regard to specific facts about the cause of a condition or in regard to the general understanding of brain and mind.[ citation needed ]

Impacts

The consequences of neurological disorders extend beyond medical diagnosis. They profoundly affect patients' psychological well-being, social interactions, and overall life trajectory. Families and caregivers face significant challenges in supporting individuals with these conditions, often requiring extensive resources and emotional resilience (Nur & Kung, 2023). Ongoing research continues to push the boundaries of understanding. Advances in genetic research, neuroimaging, and treatment technologies offer hope for more effective interventions. Emerging fields like neuroplasticity research demonstrate the brain's remarkable ability to adapt, opening new possibilities for treatment and rehabilitation. As medical science progresses, the approach becomes increasingly personalized, recognizing the unique neurological profile of each patient and the incredible complexity of the human nervous system.

See also

Related Research Articles

<span class="mw-page-title-main">Motor neuron diseases</span> Group of neurological disorders affecting motor neurons

Motor neuron diseases or motor neurone diseases (MNDs) are a group of rare neurodegenerative disorders that selectively affect motor neurons, the cells which control voluntary muscles of the body. They include amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP), pseudobulbar palsy, progressive muscular atrophy (PMA), primary lateral sclerosis (PLS), spinal muscular atrophy (SMA) and monomelic amyotrophy (MMA), as well as some rarer variants resembling ALS.

<span class="mw-page-title-main">Central nervous system</span> Brain and spinal cord

The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all parts of the bodies of bilaterally symmetric and triploblastic animals—that is, all multicellular animals except sponges and diploblasts. It is a structure composed of nervous tissue positioned along the rostral to caudal axis of the body and may have an enlarged section at the rostral end which is a brain. Only arthropods, cephalopods and vertebrates have a true brain, though precursor structures exist in onychophorans, gastropods and lancelets.

<span class="mw-page-title-main">Myelin</span> Fatty substance that surrounds nerve cell axons to insulate them and increase transmission speed

Myelin is a lipid-rich material that surrounds nerve cell axons to insulate them and increase the rate at which electrical impulses pass along the axon. The myelinated axon can be likened to an electrical wire with insulating material (myelin) around it. However, unlike the plastic covering on an electrical wire, myelin does not form a single long sheath over the entire length of the axon. Rather, myelin ensheaths the axon segmentally: in general, each axon is encased in multiple long sheaths with short gaps between, called nodes of Ranvier. At the nodes of Ranvier, which are approximately one thousandth of a mm in length, the axon's membrane is bare of myelin.

<span class="mw-page-title-main">Neuron</span> Electrically excitable cell found in the nervous system of animals

A neuron, neurone, or nerve cell is an excitable cell that fires electric signals called action potentials across a neural network in the nervous system. They are located in the brain and spinal cord and help to receive and conduct impulses. Neurons communicate with other cells via synapses, which are specialized connections that commonly use minute amounts of chemical neurotransmitters to pass the electric signal from the presynaptic neuron to the target cell through the synaptic gap.

<span class="mw-page-title-main">Nerve</span> Enclosed, cable-like bundle of axons in the peripheral nervous system

A nerve is an enclosed, cable-like bundle of nerve fibers in the peripheral nervous system.

Myelitis is inflammation of the spinal cord which can disrupt the normal responses from the brain to the rest of the body, and from the rest of the body to the brain. Inflammation in the spinal cord can cause the myelin and axon to be damaged resulting in symptoms such as paralysis and sensory loss. Myelitis is classified to several categories depending on the area or the cause of the lesion; however, any inflammatory attack on the spinal cord is often referred to as transverse myelitis.

<span class="mw-page-title-main">Somatic nervous system</span> Part of the peripheral nervous system

The somatic nervous system (SNS), also known as voluntary nervous system, is a part of the peripheral nervous system (PNS) that links brain and spinal cord to skeletal muscles under conscious control, as well as to sensory receptors in the skin. The other part complementary to the somatic nervous system is the autonomic nervous system (ANS).

Paresthesia also known as Pins and Needles is an abnormal sensation of the skin with no apparent physical cause. Paresthesia may be transient or chronic, and may have many possible underlying causes. Paresthesias are usually painless and can occur anywhere on the body, but most commonly occur in the arms and legs.

<span class="mw-page-title-main">Human brain</span> Central organ of the human nervous system

The brain is the central organ of the human nervous system, and with the spinal cord, comprises the central nervous system. It consists of the cerebrum, the brainstem and the cerebellum. The brain controls most of the activities of the body, processing, integrating, and coordinating the information it receives from the sensory nervous system. The brain integrates the instructions sent to the rest of the body. The brain is contained in, and protected by, the skull of the head.

Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery. Neurapraxia is derived from the word apraxia, meaning “loss or impairment of the ability to execute complex coordinated movements without muscular or sensory impairment”.

Neural engineering is a discipline within biomedical engineering that uses engineering techniques to understand, repair, replace, or enhance neural systems. Neural engineers are uniquely qualified to solve design problems at the interface of living neural tissue and non-living constructs.

<span class="mw-page-title-main">Neurological examination</span> Assessment to determine if the nervous system is impaired

A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities. If a problem is found either in an investigative or screening process, then further tests can be carried out to focus on a particular aspect of the nervous system.

Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers, are present in skin, peripheral nerves, and organs. The role of these nerves is to innervate some skin sensations and help control autonomic function. It is estimated that 15–20 million people in the United States have some form of peripheral neuropathy.

Neuroregeneration is the regrowth or repair of nervous tissues, cells or cell products. Neuroregenerative mechanisms may include generation of new neurons, glia, axons, myelin, or synapses. Neuroregeneration differs between the peripheral nervous system (PNS) and the central nervous system (CNS) by the functional mechanisms involved, especially in the extent and speed of repair. When an axon is damaged, the distal segment undergoes Wallerian degeneration, losing its myelin sheath. The proximal segment can either die by apoptosis or undergo the chromatolytic reaction, which is an attempt at repair. In the CNS, synaptic stripping occurs as glial foot processes invade the dead synapse.

Pallesthesia, or vibratory sensation, is the ability to perceive vibration. This sensation, often conducted through skin and bone, is usually generated by mechanoreceptors such as Pacinian corpuscles, Merkel disk receptors, and tactile corpuscles. All of these receptors stimulate an action potential in afferent nerves found in various layers of the skin and body. The afferent neuron travels to the spinal column and then to the brain where the information is processed. Damage to the peripheral nervous system or central nervous system can result in a decline or loss of pallesthesia.

<span class="mw-page-title-main">Central nervous system disease</span> Disease of the brain or spinal cord

Central nervous system diseases or central nervous system disorders are a group of neurological disorders that affect the structure or function of the brain or spinal cord, which collectively form the central nervous system (CNS). These disorders may be caused by such things as infection, injury, blood clots, age related degeneration, cancer, autoimmune disfunction, and birth defects. The symptoms vary widely, as do the treatments.

Nervous system diseases, also known as nervous system or neurological disorders, refers to a small class of medical conditions affecting the nervous system. This category encompasses over 600 different conditions, including genetic disorders, infections, cancer, seizure disorders, conditions with a cardiovascular origin, congenital and developmental disorders, and degenerative disorders.

The following outline is provided as an overview of and topical guide to the human brain:

<span class="mw-page-title-main">Neurogenic bowel dysfunction</span> Human disease involving inability to control defecation

Neurogenic bowel dysfunction (NBD) is the inability to control defecation due to a deterioration of or injury to the nervous system, resulting in faecal incontinence or constipation. It is common in people with spinal cord injury (SCI), multiple sclerosis (MS) or spina bifida.

<span class="mw-page-title-main">Cerebellar degeneration</span> Medical condition

Cerebellar degeneration is a condition in which cerebellar cells, otherwise known as neurons, become damaged and progressively weaken in the cerebellum. There are two types of cerebellar degeneration; paraneoplastic cerebellar degeneration, and alcoholic or nutritional cerebellar degeneration. As the cerebellum contributes to the coordination and regulation of motor activities, as well as controlling equilibrium of the human body, any degeneration to this part of the organ can be life-threatening. Cerebellar degeneration can result in disorders in fine movement, posture, and motor learning in humans, due to a disturbance of the vestibular system. This condition may not only cause cerebellar damage on a temporary or permanent basis, but can also affect other tissues of the central nervous system, those including the cerebral cortex, spinal cord and the brainstem.

References

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