What is West Syndrome?

This is a very rare to uncommon epileptic syndrome in infants. It was first described in medical literature by an English physician W.J. West who described this syndrome first in his own son. Other names for this syndrome include:

• Infantile Epileptic Encephalopathy
• Generalized Flexion Epilepsy
• Jackknife convulsions
• Infantile Myoclonic Encephalopathy
• Massive Myoclonia
• Salaam spasms

The name “infantile spasms” may be used to designate the precise seizure exhibition in the syndrome but it may also be used as an alternative expression for the syndrome itself. This syndrome is a triad of a pathognomonic EEG pattern – called hypsarrhythmia, mental retardation, and infantile spasms

This syndrome is related to age, usually happening amid the 3rd and the 12th month, usually displaying about the 5th month. There are various causes.

Symptoms

Symptoms for this syndrome include:

Infantile spasms

More often with this sort of seizure the baby will suddenly bend frontward at the waist and the arms, legs and body get stiff. This is often referred to as “jackknife” seizure. With selected infants they might bob their heads, or arch their backs, or cross arms across their body as if they are embracing themselves. The spasms last only several seconds occurring in groups of anywhere from two (2) to one hundred (100) spasms at one time. Some babies have loads of these groups of spasms in a day. These spasms more frequently occur after the baby wakes up in the morning or after a nap.

Hypsarrhythmia

An EEG or electroencephalogram records electrical action in the brain as brain waves. An infant with this syndrome will have chaotic, abnormal patterns of brain waves referred to as hypsarrhythmia.

Mental retardation

This is caused by the brain injury which caused the syndrome. Other symptoms can be evident because of the disorder that is underlying the causes of this syndrome. Other disorder neurologically for instance cerebral palsy can also be present.

This is known as the triad of symptoms.

Causes

West syndrome has many causes for instance:

• Severe brain injury at birth
• Brain malformations
• Metabolic disease
• Chromosomal abnormalities
• Genetic condition referred to as Tuberous Sclerosis

In about twenty-five (25) of children affected, the cause cannot be established.

Treatment

Infantile spasms are normally treated either with a course of Prednisolone – oral steroid – or often a course of ACTH – making the body create extra steroid. If other kinds of seizures occur there are a huge number of other anti-epileptic medications that can be tried. With this syndrome, as in all types of epilepsy, the medication’s effect on a specific child cannot be foretold in advance so they may need to try several and some children may need more than one medication at a time. Dependent on the underlying cause, surgery of the brain might also be a possibility for a small number of children. As with all children having disabilities with learning, education and therapies – physio/speech/occupational – should be scheduled for the child as this will ensure that he/she is assisted in reaching their full potential as well as live life to the fullest, however severe or mild their problems are.

Prognosis

It isn’t possible to make a general prognosis for development due to the unpredictability of causes, the differing sorts of etiology and symptoms. Every case needs to be individually considered.

The prognosis for those with idiopathic syndrome is more positive than those with the symptomatic or cryptogenic forms.

Idiopathic cases are less likely to show indications of problems with development before the attacks start, the attacks can be easily and effectively treated and there is a lower rate of relapse.

Those with this type of syndrome are less likely to go on to cultivate other forms of epilepsy; around 3 in every 5 progressing at the same rate as children who are healthy.

In other cases, treatment of West syndrome is difficult and results of therapy dissatisfying.

About half of all children can become totally free of attacks with the aid of medication. Treatment is satisfactory in about 3 out of 10 cases with 1 in every 25 showing motoric and cognitive development evolving more or less normally.

Up to 90% suffer severe cognitive and physical impairments even if treatment is successful. This is not because of epileptic fits but rather the causes behind them such as cerebral anomalies or degree of severity of their location.

Life Expectancy

Five out of every 100 with West syndrome do not survive beyond 5 years age – some due to the syndrome and others because of medication.

What is Amotivational Syndrome?

This is a mental condition linked with the weakened motivation to contribute in social circumstances and happenings, with gaps in unconcern caused by an outside condition, event, material or lack of, relationship or other cause. While many have denied that the continuing cannabis use develops this syndrome in certain users, studies that are empirical advocate that there is no such entity as “amotivational syndrome”, as such, but that continuing cannabis inebriation can lead to apathy and amotivation.

Symptoms

The symptoms and signs listed in various sources for Amotivational syndrome includes those listed below:

• Reduced attentiveness
• Reduce energy
• Apathy
• Reduced motivation
• Desire to participate in social interactions is impaired
• Reduce desire to compete
• Introversion
• Passivity
• Lethargy
• Reduced desire to work
• Reduced concentration
• Reduced desire to participate in meaningful activities

Causes

This syndrome, which is an assortment of visible concerns of heavy marijuana use including, lethargy, apathy, lowered intelligence, reduced concentration and an absence of desire to participate in significant activities of mobility that is upwards; has certainly not been confirmed clinically as real or factual.

Challengingly, the difficulties that are vital in verifying a casual link amid the usage of marijuana and such a collection of wide behavioral changes forbids a clinically obvious bond, and some users of marijuana, even smokers who are heavy, do not appear to show the typical qualities of the amotivational syndrome.

There is little doubt that most individuals who are young have transformed from clean, upwardly mobile, and aggressive self-starters into the type of individual just defined at around the identical time as when they became a smoker of marijuana. What is never conclusive, yet, is a contributory connection between the forfeiture of middle class incentives and cannabis. Which is first, the defeat of motivations or marijuana? This is not an easy situation to answer. Actually, there can be no clear answer. To start with, all we truly know about this amotivational syndrome is a consequence of only a few case histories. This data does not answer questions such as:

1. Whether marijuana actually causes the behavior change
2. How common the syndrome is or
3. If the alteration is due to marijuana, is it best defined as a disparity in all motivations, precise motivations, or rather other than motivation, like aptitude or personality.

It doesn’t look as though this syndrome is that common amid marijuana smokers. One survey, a study group of approximately 2000 students in college was studied. There was not any change in grades and success between the nonusers and marijuana users, but the smokers had more struggle determining goals for a career, and a number that is smaller were seeking advanced degrees. On the one hand, there have been other studies that have shown averages that are lower in school and dropout rates that are higher amid users than nonusers. At any rate these changes are not abundant. If there is such a syndrome as amotivational its affects seem to be limited to only a small number of individuals possibly the very small percentage of those who turn out to be heavy users.

Lab studies offer added evidence on the causal association between marijuana and motivation. The Mendelson experiment where volunteers were hospitalized and worked on operational assignments to make money as well as earn marijuana for a period of 26 days, established that the amount of marijuana that was smoked had no influence on the quantity of work accomplished by both the group of casual-users or the group of heavy-users; all stayed inspired to earn and went home with a considerable sum of money in addition to the work they do for the marijuana and had no effect on loss of motivation.

While marijuana doesn’t precisely reduce motivation, it seems clear that the effects of cannabis disturbs memory and attention and these are intellectual capacities usually deliberated as essential for success in institutions of education. We recognize that a substantial tolerance develops to these effects and they may be stifled willingly at low doses, but smoking consistent higher amounts of marijuana essentially obstructs an academic career being successful. Actually, motivation for achievement must be highly defined in any individual who linked high amounts of cannabis use with an academic career that was prosperous.

Since the majority of reports of amotivational syndrome initiated during the sixties in North America, they seem to define an inclination for students in college to ‘drop out’ and undertake a way of life that castoffs traditional motivations of achievement of the generation of their parents. In an effort to comprehend this rejection it was quite easy to be certain that it was pharmacological and to dismiss it as being ‘amotivational syndrome’.

Treatment

For a user to stay totally free of drugs, follow up-treatment, with psychiatric help and using community resources is critical. Changes in life-style for instances avoiding places, people and anything linked to the use of cannabis needs to be encouraged.

The early psychosocial treatment needs to stress the confrontation of denial, learning the disease perception of addictions, promoting an identity as a person in recovery, recognizing of the negative concerns of cannabis abuse, avoiding intrapsychic and situational signs that bring on cravings, and designing of support plans.

Drug tests with urine should be used to ensure there is compliance.

Educating individuals on the amotivational syndrome and other difficulties of abuse of cannabis can discourage many from the use of cannabis. Often the patients do not completely understand the full range of his own amotivational syndrome pending stopping the use of the drug and seeing the signs of improvement.

It is possible that there are some heavy users of cannabis, like any other heavy drug users, suffering from depression, chronic anxiety, or feelings of inadequacy. With these cases, the abuse of drugs is a symptom rather than the problem that is central. These cases may benefit from psychoanalysis.

Psychoanalysis is very helpful when focused on the explanations behind the patient’s drug abuse. The abuse of drugs itself (past, present and future concerns) – must be given strong prominence. Including a cooperative and interested spouse or parent in conjoint therapy is usually very beneficial.

With the adolescent, dependence on cannabis often is hiding depression, poor self-esteem, severe family problems, as well as learning problems. These matters need to be talked about in therapy. Usually, a nonjudgmental, steady, honest and strong attitude is required with adolescence.

Behavior therapy helps the user of cannabis learn other methods of reducing anxiety. Relaxation training, self-control skills, training in assertiveness, and new tactics to control the situation are stressed.

What is Sinus Tarsi Syndrome?

This is a solitary ailment that brings about ongoing problems following a strain of the ankle joint.

This syndrome is really a hole in the boney tissue in the middle of two bones with the hind part of the foot beneath the ankle joint. The structures that are in between these two bones will have also been sprained during a twisted out ankle joint strain. But at first this will get missed or will not be identified.

The soreness of this syndrome is able to be palpated on the outside of the ankle joint in front of the lateral or external rear foot bone. A CT scan may show an extreme amount of fluid in the cavity of the sinus tarsi.

Another cause of this syndrome is a pronated or fallen foot. This may create difficulties when the ankle is stretched to its end range of flexibility. This type of bone tissue with bone pressure is very unpleasant.

Symptoms

This individual usually goes to the physician with pain along the top or/and outside of the ankle and foot. This pain is frequently defined as a sharp sensation of pinching of the foot when toes are pulled closer to the shin for instance when walking-up stairs. Individuals with sinus tarsi syndrome usually complain of back of the foot being unstable while walking on uneven ground.

The symptoms and signs of this syndrome consist of the following:

• Tarsal pain increasing with time on the feet
• Tarsal pain located deep in the subtalar joint
• Tarsal pain that rises with forced inversion
• Localized pain in front of the bony bit on the ankle’s outside
• Pain that is comforted by rest
• Impassive inversion of the subtalar joint – joint under the talus

Causes

Usually overuse by repetitive movements of the sinus tarsi from over pronation or an ankle sprain that is inverted are the two (2) reasons causing this area of pain. Both cause irritation and traumatic injury to the tissues that are located in the sinus tarsi.

Treatment

The symptoms of sinus tarsi syndrome may often be relieved with an injection of local anesthetic in the sinus tarsi.

• An injection that is anesthetic into the sinus tarsi which is very painful will confirm the diagnosis by getting rid of pain and allowing function to return to normal.
• A MRI test may identify unnecessary fluid in the sinus tarsi
• Orthotics will support the foot and correct over pronation
• Anti-inflammatory medications will also help

Very infrequently surgery is specified and if necessary there are two (2) methods:

• Open surgery – through an incision
• Closed surgery – via arthroscopy

Outstanding outcomes should be anticipated but remember any surgery is not a cure-all and should be only reflected on as a last resort.

What is Sundown Syndrome?

This refers to the beginning of agitation and confusion that normally affects individuals with cognitive impairment or dementia and usually happens around sunset. Many individuals, though, use this terminology very loosely to describe increased confusion and agitation that may happen anytime but is usually obvious in the afternoon or very early evening.

Even though medical researchers equate this syndrome with dementia, individuals without dementia often develop agitated behavior or delirious while in the hospital as a response to pain, infection, or medical procedures.

Some physicians theorize that it is a buildup of the entire sensory stimulus from the day that starts to overpower and causes stress. Others speculate that this syndrome is caused by imbalances of hormones that happen at night. Still others consider that the beginning of symptoms in the afternoon is due merely to fatigue, while many think it has to do with the apprehension triggered by the failure to see as well in the dark.

Symptoms

Individuals with this syndrome may exhibit any amount of symptoms. Obviously, the significant thing to remember is that any symptoms happen in the afternoon or early evening, or in circumstances of those with extremely severe dementia, the symptoms or signs get worse at night. These symptoms are also the same symptoms as Alzheimer’s disease and other forms of dementia.

In fact these symptoms can in some cases be hazardous, for both the individual with the syndrome as well as for others around them.

You can find that your loved one is suddenly seeing angels or devils in the room or believe that you have stolen something. They might not recognize you or become scared at the thought of your leaving even if for a moment. This behavior of course is irrational and illogical but keep in mind that someone with this syndrome cannot control their behaviors.

Wandering is another symptom and is specifically dangerous since the individual with Sundowner’s will just suddenly become missing and might now even know where he or she is going or why. Without any identification, individuals with this syndrome become lost and are unable to find their way home.

Symptoms and signs can include:

• Rapid changes of mood
• Crying
• Anger
• Agitation
• Fear
• Pacing
• Stubbornness
• Depression
• Rocking
• Restlessness

The symptoms that are more difficult to take care of include:

• Hiding things
• Hallucinations
• Violence
• Paranoia
• Wandering

Individuals with this syndrome might also “shadow” you, following you everywhere and also doing everything you do. They may ask you the same questions over and over or interrupt when you are speaking with another person. They can lose full language skills and thoughts that are theoretical can become particularly difficult for them to understand.

Remember that if somebody has a hallucinatory or paranoid episode, there is no reason in even trying to persuade them they are wrong. It will simply not work, and they will more likely not even remember the incident in the morning.

Causes

Medical scientists do not exactly know what causes this syndrome. But there are studies that have revealed a link between Sundown syndrome and fluctuations in the internal clock among those individuals with dementia. This inner clock – ruled by the circadian rhythms – maintains control over waking and sleeping, is linked to how active individuals are at various times of the day, and impacts changes in the body that control behavior. Research suggests that this clock that is biological changes in individuals with forms of dementia and that change can make some individuals with any sort of dementia more prone to develop Sundown syndrome.

If an individual is confused and has any problems with vision, it can affect how the individual sees things around him as day shifts into twilight and then night.

Treatment

Besides drugs, there are a couple of treatments that may be tried for this syndrome. Music is frequently used in nursing homes and has been for many years to aid in helping calm down individuals with agitated behavior. Additional sounds that often aid are cassettes of singing birds or waves from the ocean.

Medical studies have shown that touch which is soothing can be used to calm an individual and does seem to work with individual who were not violent or angry. Try hand massage, hand holding, or affectionate touch if the individual is not in an angry state.

Some individuals have even tried aromatherapy to calm agitation and more and more nursing facilities are bring in animals to interact with the residents. The results have been very positive. Talk with your loved one can also be supportive as long as it arouses positive memories from the past.

Herbs for instance St. John’s Wort and Ginkgo Biloba and have been useful in assisting individuals with dementia and Sundown syndrome as has Vitamin E, but these may or may not offer decrease in symptoms and is very subtle. This treatment is dependent on the individual.

Light therapy may also be helpful for individuals with this syndrome although again, it may or may not lower symptoms, dependent on the individual. Light boxes are available that imitate sunlight. The individual with Sundowners need to sit close to this light for a period of time. They can do this while reading, watching TV, or eating. The light box is possibly best used in the morning and can make a big difference if the Sundown individual also suffers from depression.

What is MELAS Syndrome?

This is an uncommon and rare type of dementia. MELAS is an acronym that stands for:

ME – Mitochondrial Encephalopathy

LA – Lactic Acidosis

S – “Stroke-like” episodes.

This usually is a syndrome that arises in childhood; commonly between the ages of two (2) and fifteen (15) years of age and mainly affects muscles and the nervous system.

Symptoms

The more common symptoms in the beginning include:

• Seizures
• Recurrent headaches
• Recurrent vomiting
• Loss of appetite

Stroke-like incidents with momentary weakness of muscle on only one side of the body – hemiparesis – might likewise occur and this frequently leads to:

• Hearing and vision loss
• Altered consciousness
• Motor skills loss
• Intellectual disability

Causes

MELAS syndrome is triggered by transmutations in the gene material – DNA – in the mitochondria. While the majority of DNA is situated in the chromosomes in the cell nucleus, some DNA is in another important structure referred to as the mitochondrion – plural mitochondria.

Mitochondria are situated outside the nucleus in the cytoplasm of the cell. Every mitochondrion owes a chromosome consisting of DNA and is very diverse from the best identified chromosomes located in the nucleus. The chromosome in mitochondrial is very small and round – where the normal chromosomes are rod shaped – there are numerous copies of the “mitochondrial chromosome” in each cell; and no matter if it is female or male, we receive our mitochondrial chromosome from our mother.

Most DNA in the mitochondria is needed to create proteins intricate in the vital function of mitochondria – creating energy and powering the cells of our body.

Treatment

There is not any recognized treatment for the disease that is underlying and is normally progressive and fatal. Individuals are treated by which areas of the body are affected at a specific time. Vitamins and antioxidants have been used, but there has been no successes consistently reported.

Prognosis

There is currently no known treatment for the underlying disease which is usually progressive and fatal. Individuals are managed according to what areas of the body are affected at any particular time. Enzymes, amino acids, vitamins and antioxidants have been used but there has been no reliable successes described.

There have been no controlled studies on long-term aids of dietary manipulations, but the below supplements have presented some promise and have offered hope to MELAS individuals.

• CoQ10 has been helpful. Nicotinamide has been used due to complex acceptance of electrons from NADH with ultimate transference of electrons to CoQ10.
• Riboflavin has been described as improving the patient functioning with complex/deficiency and the 3350T-C mutation.
• L-arginine has been administrated during the serious as well as the interictal periods and might represent a probable new management for this syndrome to diminish brain damage because of diminished vasodilation in intracerebral arteries owing to nitric oxide reduction.

There has been no evidence from studies with animals that resveratrol or other SIRT1 activators can be used to treat this syndrome by the increase of mitochondrial biogenesis and function.

There is also a case study where succinate provided successful when used to treat out of control convulsions is MELAS patients, but this treatment modality is yet to be investigated or widely recommended.

Life Expectancy

It is not at this time known how many individuals have developed MELAS thru out the world. The syndrome touches all ethnic groups and both females and males. It is believed that the genetic flaw is most often complex in MELAS and is passed down thru the mother’s side of the family.

Current life expectancy for individuals with MELAS at the onset of symptoms is approximately five (5) years.

What is Wellens Syndrome?

This is a sign or occasionally warning that shows in an ECG occurring during periods of chest-pain free in individuals with angina that is unstable, signifying serious, proximal left anterior descending artery – LAD – stenosis.

Symptoms

Although looking healthy and normal, there are individuals in the world who naively have a hypothetically deadly cardiac disorder. These individuals are unmindful that they have a problem that can be lethal. This is also true of children with definite family types of failing ion channels of their heart cells.

Countless individuals die instantly from an arrhythmia that is deadly or fatal myocardial infarction.

There are divulging signs or symptoms that are noticeably evidence on their EKG or cardiac monitor that divulge these situations, long before substantial symptoms appear. These are lives that can be saved.

Often the cause of these arrhythmias that are deadly is a minute strip of conductive tissue only millimeters long. But, once discovered, a comparatively simple process can correct it forever.

Angina can have variable appearances, but classically these individuals will described the following:

• Chest pain designated as tightness, heaviness, or pressure
• Pain typically induced by activity, relieved with rest
• Pain that radiates to the shoulder, neck or jaw

May experience multiple associated symptoms, including:

• Diaphoresis
• Nausea
• Vomiting
• Fatigue

Occurs mostly in elderly, diabetic and female individuals are these individuals are more like to have these atypical symptoms.

Treatment

Since Wellens syndrome happens due to stenosis of the LAD, these individuals stereotypically present with chest pain as unstable angina. During pain episodes, they should be treated in the same manner as any individuals with chest pain thought to be cardiac in nature, which includes the following:

1. Arrangements for transport immediately to the nearest hospital
2. Attention to breathing, airway and circulation
3. While transporting, efforts need to be made to do the following:

• Supplemental oxygen
• Vital signs
• Aspirin
• Intravenous access
• ECG, when available pre-hospital
• For persistent pain – nitroglycerin, morphine according to local protocols

Patients presenting with symptoms dependable with unstable angina should normally receive medications that may help elude a myocardial infarction. Typically, this would include the following:

• Intravenous access
• Supplemental oxygen
• Telemetry monitoring
• ECG
• Chest radiography
• Laboratory studies
• Care needs be given in providing aspirin, nitroglycerin, heparin, morphine, clopidogrel, beta-blocker therapy, and glycoprotein IIB/IIA inhibitors.
• ECG changes in Wellens syndrome are characteristically only existent when the individual is chest pain free.

Management

After the individual with Wellens syndrome is stable, a cardiac consultation needs to be obtained from a cardio-vascular surgeon. This condition can be corrected with a surgical procedure. In the meantime, the individual needs to be managed as listed above in order to avoid a myocardial infarction.

What is Irritable Male Syndrome?

Also referred to as IMS this syndrome is demarcated as the state of anxiety, hypersensitivity, anger and frustration in males and is linked with changes in biochemicals, loss of male identity, hormonal fluctuations, as well as stress. This syndrome covers symptoms thought to be due to a descent in levels of testosterone in male animals. It is a very prominent aspect in mammals with periodic breeding configurations at the finish of the season of mating.

Symptoms

Symptoms of this syndrome in males that are caused by a drop in the male testosterone hormone include:

• Social withdrawal
• Anger
• Hypersensitivity
• Irritability
• Anxiety
• Mood swings
• Depression
• Lack of libido
• Hot flashes
• Head and back aches
• Sarcastic
• Tense
• Argumentative
• Frustrated
• Demanding
• Sad
• Impatient
• Hostile
• Unloving
• Withdrawn
• Defensive

Causes

Even though Irritable Male syndrome is in most cases affected by stress that is high and/or low testosterone; high levels of estrogen may also cause men to be irritable. The major source of this imbalance is a level of testosterone that is declining associated with andropause and aging. Other issues may add to the andropause-related swing of moods in male such as gaining of weight. This generates fat cells that create estrogen from testosterone. The greater the level of estrogen and the lower the levels of testosterone the larger is the probability of irritability in males. Additionally, high levels of the hormone for stress cortisol reduce testosterone levels, triggering the increased likelihood of swinging of moods in men. Certain drugs can also cause imbalances of hormones.

Treatment

Men who are experiencing this syndrome are often in denial and try to find fault everywhere except where it really is– themselves. With men, it is hard to recognize as well as admit that there is anything wrong with them or that there is something that needs to be treated. Usually males believe hormonal problems to only be a woman thing. The truth of this matter is that the individual male is not crazy, something is wrong and there is something that can be done to fix it. Hormone testing for males is the very first step in determining levels of hormones. Bio-identical therapy with hormones together with special tailored nutrition and exercise program has been the best way to treat this syndrome for males. Feeling good again is just within the individuals grasp.

Cure

Unlike the much maligned, PMS; however Irritable Male syndrome is not only confined to a single week out of the month. Without treatment, it is much like having PMS 24/7 without the binging on chocolate and with overwhelming urge to cry during sentimental commercials on TV. Sounds terrible doesn’t it? But by getting the hormones back in order – everything will be fine because there is a cure.

Unlike the hormone drop occurring with women thru menopause, the hormone changes in men “occur gradually – over a period of many years” – at least the experts at Mayo Clinic believe. That said, the reality is that a man’s hormones will change. Male testosterone declines – only slower – and replacing these hormones is a cure for this problem.