SOME COMMON NEUROLOGICAL CONDITIONS:

Migraine is far the most common type of disabling, recurring headache. Typical features of migraine include:

• Migraine is sometimes one-sided
• Maybe moderate to severe in intensity, and associated with sensitivity to light, noise, smells, nausea and vomiting
  
• Up to ¼ of patients have migraine with aura
  
• The most common aura is visual (shimmering, zigzag, flashing light), others may experience numbness, confusion, dizziness and speech disturbance
  
• Some people develop auras without headaches
  
• There is usually a family history of migraine
  

Most migraines can be very effectively managed with appropriate medications.

Dizziness may mean different thing to different people – either a sensation of spinning, swaying or tilting (vertigo), or that of lightheadedness and the feeling of passing out (faint).

Vertigo can be caused by various problems involving the inner ear or the brain. Some of these problems are not serious while others can be life threatening.

The most common causes of vertigo include:

1. Inner ear problems (vestibular system)

• BPPV (Benign paroxysmal positional vertigo)  is a type of vertigo that develops due to displacement of calcium crystals in the inner ear. 
• Meniere disease is caused by a buildup of fluid in the inner ear, causing repeated spells of vertigo, ringing in the ears and hearing loss.
• Vestibular neuritis is believed to be caused by a viral infection of the inner ear,  causing  sudden and severe vertigo, associated with nausea, vomiting and difficulty walking or standing up, usually lasting 24-72 hours.

2. Migraine associated vertigo / migraine-variant dizziness—may occur with or without a history of migraine headaches. There are effective medications to help these unpleasant symptoms.

3. Brain problems – particularly affecting the parts of the brain called the brainstem and cerebellum. Causes include tumour, inflammation or multiple sclerosis, infection, stroke or TIA (transient ischaemic attack).

It is important to distinguish more sinister causes from those benign ones. There are effective treatment to relieve the symptoms of vertigo in some of these conditions.

Parkinson’s Disease typically affects people over 60 years of age. It is a progressive brain disorder that affects movement. Symptoms may include:

• A slow, shuffling and awkward gait, rigid limbs, tremor and loss of balance
• Loss of facial expression and speech problems
  
• Risk of developing restless leg syndrome and periodic limb movement disorder
  
• Non-motor symptoms may include confusion, hallucination (seeing things that are not there), cognitive impairment/dementia, anxiety and depression, constipation, sleep disturbance, fatigue and pain
  
• People may report a loss of sense of smell, chronic constipation, and REM sleep behavior disorder (acting out dreams during sleep) sometimes 10-20 years before motor symptoms
  

There is a gradual loss of cells that secrete dopamine (a neurotransmitter) in the brain in Parkinson’s disease.There is no treatment for slowing or reversing this process, but there are drugs to treat the symptoms. These therapies can dramatically improve the quality of life for people with Parkinson's disease.

Multiple sclerosis (MS) is a progressive immune disorder of the central nervous system (CNS), affecting about 25,000 Australians. It is a disorder with either be a relapsing-remitting (intermittent course), or a progressive form that shows a steady decline. Patient may suffer various symptoms depending on the part of CNS affected:

• optic nerve - blurred vision, and pain in one eye 
  
• brain - loss of language, numbness, weakness
• brainstem - vertigo, double vision, unsteady gait, poor coordination
• spinal cord - loss of sensation or weakness in the limbs, paralysis, bowel and bladder issues

Effective treatments (disease modifying agents) have been available in the last 20 odd years, with newer therapies becoming available more recently. Treatments are effective only in relapsing forms of MS, and there is good evidence that early treatment is associated with less relapses, less disability and better long-term outcomes. 

In addition to disease modifying agents, it is important to address and manage symptoms commonly associated with MS including fatigue, pain, spasticity, cognitive, bowels and bladder issues and depression. 

Alzheimer disease (AD) is the most common cause of dementia in adults over the age of 60. It is a progressive neurodegenerative disorder of largely unknown cause. The hallmark and the earliest problem in AD is selective memory loss. Typical symptoms may include:

• Poor memory 
• ​Poor judgement  
• Impaired problem solving and difficulties with multitasking
• Difficulties completing familiar tasks 
• ​Behavioural and psychological problems - may include agitation and hallucinations
• ​Mood and personality change
  

The diagnosis maybe made through cognitive and neuropsychological assessment. There is no cure or disease-modifying therapy (treatment that slows the course of the illness) currently available, but treatments are available that can relieve some symptoms of the illness. The disease inevitably progresses in all patients. An important part of the management is education, planning for the future, addressing issues pertaining to driving, wills, future living arrangement as well as support for caregivers. atigue, pain, spasticity, cognitive, bowels and bladder issues and depression.