Posts Tagged Behavioral

[BOOK] The Comorbidities of Epilepsy – Google Books

The Comorbidities of Epilepsy

Front Cover
Marco Mula
Academic PressApr 20, 2019 – Medical – 413 pages

Epilepsy is one of most frequent neurological disorders affecting about 50 million people worldwide and 50% of them have at least another medical problem in comorbidity; sometimes this is a the cause of the epilepsy itself or it is due to shared neurobiological links between epilepsy and other medical conditions; other times it is a long-term consequence of the antiepileptic drug treatment.

The Comorbidities of Epilepsy offers an up-to-date, comprehensive overview of all comorbidities of epilepsy (somatic, neurological and behavioral), by international authorities in the field of clinical epileptology, with an emphasis on epidemiology, pathophysiology, diagnosis and management. This book includes also a critical appraisal of the methodological aspects and limitations of current research on this field. Pharmacological issues in the management of comorbidities are discussed, providing information on drug dosages, side effects and interactions, in order to enable the reader to manage these patients safely.

The Comorbidities of Epilepsy is aimed at all health professionals dealing with people with epilepsy including neurologists, epileptologists, psychiatrists, clinical psychologists, epilepsy specialist nurses and clinical researchers.

  • Provides a comprehensive overview of somatic, neurological and behavioral co-morbidities of epilepsy
  • Discusses up-to-date management of comorbidities of epilepsy
  • Written by a group of international experts in the field

 

via The Comorbidities of Epilepsy – Google Books

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[Factsheet] Understanding TBI: Part 2 – Brain injury impact on individuals functioning – Model Systems Knowledge Translation Center (MSKTC)

Father teaching child with blocks

Written by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the MSKTC

 

A traumatic brain injury interferes with the way the brain normally works. When nerve cells in the brain are damaged, they can no longer send information to each other in the normal way. This causes changes in the person’s behavior and abilities. The injury may cause different problems, depending upon which parts of the brain were damaged most.

There are three general types of problems that can happen after TBI: physical, cognitive and emotional/ behavioral problems. It is impossible to tell early on which specific problems a person will have after a TBI. Problems typically improve as the person recovers, but this may take weeks or months. With some severe injuries changes can take many years.

Structure and function of the brain

The brain is the control center for all human activity, including vital processes (breathing and moving) as well as thinking, judgment, and emotional reactions. Understanding how different parts of the brain work helps us understand how injury affects a person’s abilities and behaviors.

Left vs. Right Brain

  • The brain is divided into two halves (hemispheres). The left half controls movement and sensation in the right side of the body, and the right half controls movement and sensation in the left side. Thus, damage to the right side of the brain may cause movement problems or weakness on the body’s left side.
  • For most people, the left half of the brain is responsible for verbal and logical functions including language (listening, reading, speaking, and writing), thought and memory involving words.
  • The right half is responsible for nonverbal and intuitive functions such as putting bits of information together to make up an entire picture, recognizing oral and visual patterns and designs (music and art), and expressing and understanding emotions.

Brain Areas & Associated Functions

The brain is made up of six parts that can be injured in a head injury. The effect of a brain injury is partially determined by the location of the injury. Sometimes only a single area is affected, but in most cases of TBI multiple areas have been injured. When all areas of the brain are affected, the injury can be very severe.

Image of Brain with Lobe Information

Six parts Functions
Brain Stem
  • Breathing
  • Heart Rate
  • Swallowing
  • Reflexes for seeing and hearing
  • Controls sweating, blood pressure, digestion, temperature
  • Affects level of alertness
  • Ability to sleep
  • Sense of balance
Cerebellum
  • Coordination of voluntary movement
  • Balance and equilibrium
  • Some memory for reflex motor acts
Frontal Lobe
  • How we know what we are doing within our environment
  • How we initiate activity in response to our environment
  • Judgments we make about what occurs in our daily activities
  • Controls our emotional response
  • Controls our expressive language
  • Assigns meaning to the words we choose
  • Involves word associations
  • Memory for habits and motor activities
  • Flexibility of thought, planning and organizing
  • Understanding abstract concepts
  • Reasoning and problem solving
Parietal Lobe
  • Visual attention
  • Touch perception
  • Goal directed voluntary movements
  • Manipulation of objects
  • Integration of different senses
Occipital Lobes
  • Vision
Temporal Lobes
  • Hearing ability
  • Memory aquisition
  • Some visual perceptions such as face recognition and object identification
  • Categorization of objects
  • Understanding or processing verbal information
  • Emotion

Physical Problems

Most people with TBI are able to walk and use their hands within 6-12 months after injury. In most cases, the physical difficulties do not prevent a return to independent living, including work and driving.

In the long term the TBI may reduce coordination or produce weakness and problems with balance. For example, a person with TBI may have difficulty playing sports as well as they did before the injury. They also may not be able to maintain activity for very long due to fatigue.

Cognitive (Thinking) Problems

  • Individuals with a moderate-to-severe brain injury often have problems in basic cognitive (thinking) skills such as paying attention, concentrating, and remembering new information and events.
  • They may think slowly, speak slowly and solve problems slowly.
  • They may become confused easily when normal routines are changed or when things become too noisy or hectic around them.
  • They may stick to a task too long, being unable to switch to different task when having difficulties.
  • On the other hand, they may jump at the first solution they see without thinking it through.
  • They may have speech and language problems, such as trouble finding the right word or understanding others.
  • After brain injury, a person may have trouble with all the complex cognitive activities necessary to be independent and competent in our complex world. The brain processes large amounts of complex information all the time that allows us to function independently in our daily lives. This activity is called executive function because it means being the executive or being in charge of one’s own life.

Emotional/Behavioral Problems

Behavioral and emotional difficulties are common and can be the result of several causes:

  • First, the changes can come directly from damage to brain tissue. This is especially true for injuries to the frontal lobe, which controls emotion and behavior.
  • Second, cognitive problems may lead to emotional changes or make them worse. For example, a person who cannot pay attention well enough to follow a conversation may become very frustrated and upset in those situations.
  • Third, it is understandable for people with TBI to have strong emotional reactions to the major life changes that are caused by the injury. For example, loss of job and income, changes in family roles, and needing supervision for the first time in one’s adult life can cause frustration and depression.

Brain injury can bring on disturbing new behaviors or change a person’s personality. This is very distressing to both the person with the TBI and the family. These behaviors may include:

  • Restlessness
  • Acting more dependent on others
  • Emotional or mood swings
  • Lack of motivation
  • Irritability
  • Aggression
  • Lethargy
  • Acting inappropriately in different situations
  • Lack of self-awareness. Injured individuals may be unaware that they have changed or have problems. This can be due to the brain damage itself or to a denial of what’s really going on in order to avoid fully facing the seriousness of their condition.

Fortunately, with rehabilitation training, therapy and other supports, the person can learn to manage these emotional and behavioral problems.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the TBI Model Systems.

Authorship

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the University of Alabama TBIMS, Baylor Institute for Rehabilitation, New York TBIMS, Mayo Clinic TBIMS, Moss TBIMS, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

via Understanding TBI: Part 2 – Brain injury impact on individuals functioning | Model Systems Knowledge Translation Center (MSKTC)

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[WEB SITE] Transcranial electrical stimulation shows promise for treating mild traumatic brain injury

 

Credit: copyright American Heart Association

Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers at the University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS) and collaborators elsewhere, report significantly improved neural function in participants with mild traumatic brain injury (TBI).

Their findings are published online in the current issue of the journal Brain Injury.

TBI is a leading cause of sustained physical, cognitive, emotional and behavioral problems in both the civilian population (primarily due to , sports, falls and assaults) and among military personnel (blast injuries). In the majority of cases,  is deemed mild (75 percent of civilians, 89 percent of military), and typically resolves in days.

But in a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioral impairment.

Much about the pathology of mild TBI is not well understood, which the authors say has confounded efforts to develop optimal treatments. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial  (LIP-tES), has shown promise.

In their pilot study, which involved six participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The  effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex).

“Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild  (concussions), with about 85 percent sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said senior author Roland Lee, MD, professor of radiology and director of Neuroradiology, MRI and MEG at UC San Diego School of Medicine and VASDHS. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”

The researchers found that the brains of all six participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores.

“For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said first author Ming-Xiong Huang, PhD, professor in the Department of Radiology at UC San Diego School of Medicine and a research scientist at VASDHS. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic injuries.”

Source: Transcranial electrical stimulation shows promise for treating mild traumatic brain injury

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[WEB SITE] Neuropsychiatric Effects of Traumatic Brain Injury

From time to time every psychiatrist comes across patients whose problems are at least in part related to the neuropsychiatric consequences (behavioral, cognitive, and emotional) of traumatic brain injury (TBI). TBI affects approximately 2 of every 1000 persons per year. Those who are vulnerable to mental illness (eg, persons with alcohol abuse or antisocial personality disorder) are particularly at risk. Patients with TBI often have poor insight and may need hospitalization for their own safety. The neuropsychiatric and other sequelae are long-term; a head injury is for life.

A telling illustration from 1937 by Courville, a neuropathologist, nicely demonstrates why TBI is of interest to psychiatrists (see figure 1 in Fleminger 20091). The illustration is a composite of the location of contusions found in 50 patients who died of TBI.
The sites of specific vulnerability to contusions are the medial orbital frontal lobe and the anterior temporal lobes (Figure 1). Areas where contusions rarely occur include the primary motor, somato-sensory, and visual cortex. Therefore, areas of the brain concerned with social function and decision making are particularly vulnerable. It is unsurprising that neuropsychiatric sequelae outstrip neurophysical sequelae as the major cause of disability after TBI.

The neuropathology of TBI

Contusions are areas of cerebral bruising particularly involving gray matter, whereby blood leaks into the extravascular space. The contusion results in cell death and local loss of tissue. Diffuse axonal injury affects white matter anywhere throughout the cerebrum and brain stem. It may be followed by generalized atrophy with ventricular enlargement (Figure 2); this may take a few weeks or months to develop. Diffuse axonal injury in the brain stem is usually responsible for the slurred speech and severe ataxia that are seen in some severely disabled patients after TBI. Contusions and diffuse axonal injury may be complicated by anoxic brain injury that may occur soon after trauma because of poor cerebral perfusion secondary to raised intracranial pressure and focal strokes. In some patients, localized infarction occurs (Figure 3).

Neuropsychiatric assessment

The neuropsychiatric assessment starts by evaluating the severity of brain injury. In this way, the likely outcomes attributable to direct effects of brain injury can be determined, and any mismatch between these and what is observed can be attributed to psychological reactions or independent events. So, for example, in somebody with a severe psychotic illness that develops 3 months after an injury with no loss of consciousness, one can be fairly confident that the illness is not a direct consequence of the effects of brain injury on delusion formation. It is possible that the psychological trauma of the injury has allowed an acute psychotic reaction, or even that the injury was irrelevant and that the person was on the path to becoming schizophrenic anyway. On the other hand, it is likely that the psychotic illness is a direct effect of the brain injury in somebody in whom a delusional misidentification syndrome develops 3 months after an injury that was followed by coma for a week and delirium for several weeks.

The severity of brain injury is measured by the following:

  • Glasgow Coma Scale (used soon after injury)
  • Duration of loss of consciousness
  • Duration of posttraumatic amnesia (PTA), ie, the interval between the injury and the return of continuous day-to-day memories

The duration of PTA is particularly useful as a measure of the severity of the brain injury because it can be measured retrospectively, eg, in the clinic years after injury, and it is a good predictor of outcome.3 As a rule, if PTA lasts less than 1 week, a reasonably good outcome is expected. If PTA lasts longer than 1 month, significant disability is likely; a good proportion of those affected will not be able to return to work or to independent living. In general, younger individuals (those in their late teens or 20s) tend to do much better.

An MRI scan is essential in cases where the extent of damage is unclear because it may show unexpected brain injury. Gradient echo sequences are the most sensitive and should be undertaken, particularly in those with mild injury. A normal MRI scan does not rule out brain injury, but it does make significant disability as a direct effect of severe brain damage unlikely. Electroencephalography is usually not helpful, even as a predictor of posttraumatic epilepsy.

Neuropsychometric assessment can be useful in defining the severity of cognitive impairment and any areas of particular impairment. Such tests as the North American Adult Reading test are available and provide an estimate of the patient’s preinjury IQ. Such assessment is necessary for the accurate interpretation of a patient’s postinjury performance. Also, make sure that tests of executive function have been done. Note, though, that normal neuropsychometric test results do not rule out brain injury as the cause of problems with executive functions in everyday life.

Continue —> Neuropsychiatric Effects of Traumatic Brain Injury | Psychiatric Times

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[WEB SITE] Coping with Behavior Problems after Head Injury | Family Caregiver Alliance

…Head injury survivors may experience a range of neuro­psychological problems following a traumatic brain injury. Depending on the part of the brain affected and the severity of the injury, the result on any one individual can vary greatly. Personality changes, memory and judgement deficits, lack of impulse control, and poor concentration are all common. Behavioral changes can be stressful for families and caregivers who must learn to adapt their communication techniques, established relationships, and expectations of what the impaired person can or cannot do.

In some cases extended cognitive and behavioral rehabilitation in a residential or outpatient setting will be necessary to regain certain skills. A neuropsychologist also may be helpful in assessing cognitive deficits. However, over the long term both the survivor and any involved family members will need to explore what combination of strategies work best to improve the functional and behavioral skills of the impaired individual…

μέσω Coping with Behavior Problems after Head Injury | Family Caregiver Alliance.

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