Digital Scrapbook- Disorders of the Nervous System

Progressing Brain Research: Brain Damage Pathophysiology The Wonders of Neuroscience Tehrrence Abangan, Gayle Dineros, Sarah El Hadad, Marc Tan, Aia Teves

Table of Contents Alzheimer's Disease........................... 1 Causes and Risk Factors.........................................................2 Signs of Alzheimers.................................................................3 Treatment of Alzheimers.......................................................4 Pathophysiology of Alzheimers............................................5 Parkinson's Disease........................... 6 Causes and Complications....................................................7 Drug Therapy..........................................................................8-9 Pathophysiology of Parkinson's..........................................10 Huntington's Disease......................... 11 Causes and Complications...................................................12 Drug Therapy..........................................................................13 Pathophysiology of Huntington's.......................................14

Table of Contents Epilepsy..............................................15 What is a Seizure....................................................................16 Causes of Epilepsy.................................................................17 Treatment of Epilepsy...........................................................18 Pathophysiology of Epilepsy................................................19 ALS......................................................2 S0WymhapttComaussaens dADLSis?e..a..s..e...........................................................21 Management..........................................................................22 Cerebral Palsy.................................... 2WD3ihsaetaCseauMsaens aCgPe?m...e..n..t.....................................................................................................................2234 Multiple Sclerosis............................... 25 Causes and Risk Factors.......................................................26 Treatment Plan.......................................................................27 Pathophysiology of MS.........................................................28

People with Alzheimer's disease Alzheimer's may: Alzheimer's disease is the most common Repeat statements and type of dementia. The disease gradually questions over and over starts with mild memory loss and Forget conversations, potentially progresses to the inability to appointments or events, communicate and the lack of and not remember them environmental awareness. The brain later regions that are responsible for thought, Routinely misplace memory, and language are highly affected possessions, often by Alzheimer's disease. putting them in illogical locations Alzheimer's is thought to be caused by an Get lost in familiar places abnormal protein build-up within and around Eventually forget the the brain cells. Amyloid is one of the proteins names of family involved, wherein the deposits create plaques members and everyday around brain cells. The other protein objects resposible is tau, which builds up inside brain Have trouble finding the cells and form tangles. right words to identify objects, express thoughts or take part in conversations 11

Causes and Risk Factors 2 Ageing is the biggest recognized risk Other risk factors you factor for dementias like Alzheimer's, may be able to although these diseases are not a influence: normal part of aging. While age increases risk, it is not a direct cause of Head Injury: Head injury and the chance of Alzheimer's. developing dementia later in life are Family history is another significant related. Wear your seatbelt, wear a helmet risk factor. A person is more likely to when playing sports, and \"fall-proof\" your acquire Alzheimer's if they have a home to protect your brain. family member who has the Heart-head connection: This relationship condition. If more than one family is critical because the heart is in charge of member is affected, the risk rises. pumping blood through the brain's blood Either heredity (genetics), arteries, which is one of the body's richest environmental factors, or both may networks of blood vessels. play a role when diseases tend to run in families. Overall healthy ageing: Maintaining Research suggests that genes have a healthy brain function can potentially role in Alzheimer's. Risk genes and lower the chance of dementia and deterministic genes are two types of Alzheimer's disease. Precautions include genes that affect a person's likelihood maintaining a nutritious diet, participating of developing a disease. Alzheimer’s in social activities, abstaining from alcohol genes have been discovered in both and cigarette use, and engaging in physical categories and mental exercise.

3 What Are the Signs of Alzheimer's Disease? Mild AD Moderate AD Severe AD Memory loss that disrupts Increased confusion and Inability to communicate daily life memory loss, such as No awareness of recent Poor judgment, leading to forgetting events or personal experiences or bad decisions history surroundings Loss of spontaneity and Inability to learn new things Weight loss with little sense of initiative Difficulty with language and interest in eating Losing track of dates or problems with reading, Seizures knowing current location writing, and working with General physical decline, Taking longer to complete numbers including dental, skin, and normal daily tasks Difficulty organizing thoughts foot problems. Repeating questions or and thinking logically Difficulty swallowing forgetting recently learned Shortened attention span Groaning, moaning, or information Problems coping with new grunting Challenges in planning or situations Increased sleeping solving problems Difficulty carrying out Loss of bowel and bladder Wandering and getting lost familiar, multistep tasks, such control Losing things or misplacing as getting dressed them in odd places Hallucinations, delusions, and Difficulty completing tasks paranoia such as bathing Impulsive behavior, such as undressing at inappropriate times or places.

How is Alzheimer's Acetylcholinesterase inhibitors Treated? Acetylcholine, a chem ical that facilitates Currently, Alzheimer's diseases has no nerve cell communication in the brain, is cure. However, medication is available in produced in greater quantities as a result of order to temporarily reduce the symptoms. these medications. Support is also available to make daily Memantine living easier for those who have the illness, and to help their families cope It functions by blocking the effects of an with the situation. excessive amount of glutamate in the brain. Memantine is used for moderate or severe Alzheimer's disease. Side effects can include headaches, dizziness and constipation but these are usually only temporary. Donepezil galantamine and rivastigmine can be prescribed for people with early- to mid- stage Alzheimer's disease. If coping mechanisms are ineffective, a 4 consultant psychiatrist may recommend antipsychotic drugs such as risperidone or haloperidol for people who exhibit extreme distress or persistent aggressiveness. Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.

Pathophysiology of Alzheimer's 5 Pathophysiology of AD CHOLINERGIC OXIDATIVE HYPERPHOSPHORYLATED METAL ION HYPOTHESIS STRESS TAU PROTEIN HYPOTHESIS HYPOTHESIS REDUCTION IN HYPOTHESIS METAL AchE FREE RADICAL EXTRACELLULAR DYSHOMEOSTASIS PRODUCTION DEPOSITION OF AMYLOID NEURONAL PROTEINS LOSS ATROPHY IN TEMPOROFRONTAL CORTEX INFLAMMATION PLAQUES NFT ALZHEIMER'S DISEASE The two pathologic hallmarks of Alzheimer disease are Extracellular beta-amyloid deposits (in senile plaques) Intracellular neurofibrillary tangles (paired helical filaments) The loss of synapses and neurons caused by beta-amyloid deposition and neurofibrillary tangles causes gross atrophy of the damaged parts of the brain, which normally begins in the mesial temporal lobe.

6 Parkinson's Disease People with Parkinson's All About Parkinson's Disease may Disease experience: Parkinson's Disease is a disease of the basal Tremors that occur at rest ganglia characterized by a slowing down in the Stiffness of extremities initiation and execution of movement Akinesia (bradykinesia), increased muscle tone (rigidity), Cogwheel Rigidity tremor at rest, and impaired postural reflexes. Bradykinesia Coordination Problems Parkinson's disease is a degenerative brain disorder Loss of smell associated with aging that results in the Blank facial expression deterioration of the brain tissue. The main Constipation symptoms are slowed movements, tremors, poor Depression balance, and others. The majority of instances are Freezing caused by unknown factors, but some are hereditary.

7 Causes and Complications Risk factors for Parkinson's disease include: Parkinson's disease is caused by the loss of nerve cells in the part of the Age. Parkinson's disease is a rare brain called the substantia nigra. The occurrence among young adults. It nerve cells that are part of the brain usually starts in middle or late life, are responsible for producing a and the risk gets higher as you get chemical called dopamine. Dopamine older. The disease typically strikes acts as a messenger between the people at age 60 or older. Making parts of the brain and nervous system family planning decisions may be that help control and coordinate body aided by genetic counseling if a movements. young person is diagnosed with Parkinson's disease. If these nerve cells die or become damaged, the amount of dopamine in Heredity.The likelihood that you'll the brain is reduced.Many of the develop Parkinson's disease increases complications of Parkinson's disease if you have immediate family are caused by the progressive members who have the condition. deterioration and loss of spontaneity Unless you have a large number of of movement. Swallowing may family members who suffer from become difficult, leading to Parkinson's disease, your risks are malnutrition or aspiration. Mobility is still minimal. greatly decreased. The gait is usually consists of rapid, short, shuffling Sex. Men are more likely to develop ministeps, The lack of mobility may Parkinson's disease than women. lead to constipation, ankle edema. Exposure to toxins. Your risk of developing Parkinson's disease may increase if you are constantly exposed to pesticides and herbicides.

DRUG THERAPY: DRUG SYMPTOMS SIDE EFFECTS AND RELIEVED PRECAUTIONS DOPAMINERGIC Bradykinesia, tremor, Nausea, dyskinesia, hypotension, levodopa (L-dopa) rigidity palpitations, arrhythmias; agitation, hallucianations; avoidance of vitamin levodopa-carbidopa same as above pills and high diet in vitamin B, (Sinemet) contraindicated in narrow-angle glaucoma. amantadine Rigidity, akinesia (Symmetrel) Less nausea but greater chance in dyskinesia, confusion, hallucination; Anticholinergic periodic check of BUN, AST, WBCs, Tremor Hct; contraindicated in melanoma, trihexyphenidyl (Artane) narrow-angleglaucoma, combination with MAO inhibitors, resepine, methyldopa, guanthidine, cycrimine (Pagitane) antipsychosis. procyclidine (Kemadrin) Nervousness, insomnia, confusion, hallucinations, dry mouth, nausea, benztropine (Cogentin) edema, orthostatic hypotension. biperiden (Akineton) Dry mouth, blurred vision, constipation, delirium, anxiety, agitation, hallucinations; avoidance of drugs with similar actions, including over-the-counter drugs containing scopolamine or anthihistamines. 8

DRUG THERAPY: DRUG SYMPTOMS SIDE EFFECTS AND RELIEVED PRECAUTIONS Anthihistamine Tremor, rigidity Sedation, same precautions diphenhy dramine as for anticholinergic drugs (Benadryl) orphenadrine (Dispal) chlorphenoxamine (Phenoxene) phenindamine (Thephorin) Monoamine Bradykinesia, rigidity, Similar to dopaminergic Oxidase Inhibitor tremor drugs. selegline By blocking COMT, this Similar to dopaminergic (Eldepryl, Carbex) drug slows down the drugs; works only when used breakdown of levodopa, in combination with Sinemet. Catechol-O-Methly thus prolonging the action Transferase (COMT) of levodopa. 9 Inhibitor entacapone (Comtan) tolcapone (Tasmar)

Pathophysiology of Parkinson's 10 Disease

11 Huntington's Disease Huntington's Disease (HD)is a condition Huntington's disease is a rare, genetic that stops parts of the brain from working condition that results in the progressive properly over time. HD is a genetically destruction of nerve cells in the brain. transmitted, autosomal dominant The functional abilities of a person are disorder that affects both men and significantly impacted by Huntington's women of all races. The offspring of a disease, which typically causes mobility, person with this disease have a 50% risk cognitive, and psychological of inheriting it.Like Parkinson's disease, issues.Huntington's disease symptoms the pathologic process of HD involves often first appear when people are in the basal ganglia and the extrapyramidal their 30s or 40s. motor system. Difficulty concentrating and memory lapses Depression Stumbling and clumsiness Involuntary jerking or fidgety movements of the limbs and body Mood swings and personality changes Problems swallowing, speaking and breathing Difficulty moving

Huntington's disease is caused by a faulty gene that results in Causes & Complications parts of the brain becoming gradually damaged over time. It is an autosomal dominant disorder, which means that a person 12 needs only one copy of the nontypical gene to acquire the disorder.You're usually only at risk of developing it if one of your parents has or had it. Both men and women can get it. Huntington’s Disease (HD) is not fatal in itself. People with HD have a shorter life expectancy and die of other life-threatening complications related to this disease. Pneumonia and heart disease are the two leading causes of death for people with HD. Additionally, HD patients have higher incidence of choking and respiratory complications, gastrointestinal diseases (such as cancer of the pancreas ), and suicide than the non-HD population. The clinical depression linked with Huntington's disease may increase the risk of suicide. Research suggests that the highest rate of suicide occurs before a diagnosis is made and in the middle stages of the disease when a person starts to lose independence Common causes of death include: Pneumonia or other infections Injuries related to falls Complications related to the inability to swallow

DRUG THERAPY: 13 DRUG SYMPTOMS SIDE EFFECTS AND RELIEVED PRECAUTIONS Drugs to control movement involuntary jerking and drowsiness, restlessness, and writhing movements the risk of worsening or tetrabenazine (chorea) triggering depression or (Xenazine) other psychiatric conditions. treating chorea deutetrabenazine may worsen involuntary (Austedo) contractions (dystonia), restlessness and drowsiness. Antipsychotic drugs haloperidol fluphenazine olanzapine (Zyprexa) aripiprazole (Abilify)

Pathophysiology of Huntington's Disease 14 In Huntington disease, the caudate nucleus atrophies, the inhibitory medium spiny neurons in the corpus striatum degenerate, and levels of the neurotransmitters gamma-aminobutyric acid (GABA) and substance P decrease.

15 What is Epilepsy Epilepsy Who is affected by Epilepsy is a central nervous system Epilepsy? (neurological) disorder in which brain activity becomes abnormal, causing Anyone can develop seizures or periods of unusual epilepsy. Epilepsy affects behavior, sensations and sometimes both males and females of loss of awareness. all races, ethnic backgrounds and ages. Epilepsy, which is sometimes called a seizure disorder, is a disorder of the brain. A person is diagnosed with epilepsy when they have had two or more seizures.

What is a seizure? 16 Seizures A seizure is a short change in normal brain activity. Seizures are the main sign of epilepsy. Some seizures can look like staring spells. Other seizures cause a person to fall, shake, and lose awareness of what’s going on around them. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. Symptoms of Epilepsy Seizure signs and symptoms may include: Temporary confusion A staring spell Stiff muscles Uncontrollable jerking movements of the arms and legs Loss of consciousness or awareness Psychological symptoms such as fear, anxiety or deja vu Managing Pediatric Seizures Usually, a seizure lasts from a few seconds to a few minutes. It depends on the type of seizure. At least two seizures without a known trigger (unprovoked seizures) that happen at least 24 hours apart are generally required for an epilepsy diagnosis.

17 Causes of Epilepsy What causes Epilepsy? Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including: Genetic Influence Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures. Brain abnormalities. Abnormalities in the brain, including brain tumors or vascular malformations such as arteriovenous malformations (AVMs) and cavernous malformations, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35. Prenatal injury Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy. Head trauma and developmental disorders Head trauma as a result of a car accident or other traumatic injury can cause epilepsy. Epilepsy can sometimes be associated with developmental disorders, such as autism.

Treatment for Epilepsy 18 Treatment can help most people with epilepsy have fewer seizures, or stop having seizures completely. Deep Brain Stimulation Deep brain stimulation (DBS) is similar to VNS. But the device placed in the chest is connected to wires that run directly into the brain. Bursts of electricity sent along these wires can help prevent seizures by changing the electrical signals in the brain. Medicines called anti-epileptic drugs (AEDs) AEDs are the most commonly used treatment for epilepsy. They help control seizures in around 7 out of 10 of people. AEDs work by changing the levels of chemicals in your brain. They do not cure epilepsy, but can stop seizures happening. Common types include: Sodium valproate, Carbamazepine, Lamotrigine, Levetiracetam, Topiramate Surgery to remove a small pa rt of the brain that's causing the seizures Surgery to remove part of your brain may be an option if: AEDs are not controlling your seizures Tests show that your seizures are caused by a problem in a small part of your brain that can be removed without causing serious effects A procedure to put a small electrical device inside the body that can help control seizures Vagus nerve stimulation (VNS) is where a small electrical device similar to a pacemaker is placed under the skin of your chest. The device is attached to a wire that goes under your skin and connects to a nerve in your neck called the vagus nerve. Bursts of electricity are sent along the wire to the nerve.

Pathophysiology of Epilepsy 19 A seizure is a situational clinical event that can be brought on by a variety of extrinsic or intrinsic triggering circumstances. It causes an excessive, hypersynchronous discharge of a cortical neuronoglial population and can either exhibit locally or more widely throughout the brain. There are over 40 different epileptic syndromes that are known to exist because of the abnormal activity that interferes with one or more brain networks' normal operation and causes seizures.

20 Amyotrophic lateral sclerosis What is Amyotrophic lateral Amyotrophic lateral sclerosis sclerosis? (ALS), also known as motor neuron disease (MND) or Lou It is a progressive nervous system disease Gehrig's disease, is a that affects nerve cells in the brain and neurodegenerative disease spinal cord, causing loss of muscle control. that results in the progressive loss of motor neurons that ALS is often called Lou Gehrig's disease, control voluntary muscles. after the baseball player who was ALS is the most common diagnosed with it. type of motor neuron disease. Half of the people with ALS develop at least mild difficulties with thinking and behavior, and about 15% develop frontotemporal dementia. Most people experience pain. The affected muscles are responsible for chewing food, speaking, and walking. Motor neuron loss continues until the ability to eat, speak, move, and finally the ability to breathe is lost. ALS eventually causes paralysis and early death, usually from respiratory failure.

Amyotrophic lateral sclerosis 21 WHAT CAUSES ALS? The causes of ALS are unknown at present, but researchers are focusing on several possible theories, including gene mutations, overabundance of the neurotransmitter glutamate (which can be toxic to nerve cells), autoimmune response (in which the body’s immune system attacks normal cells) and the gradual accumulation of abnormal proteins in nerve cells. ALS may be inherited in 5‒10 percent of cases (familial ALS), but the rest of the patients who contract the disease seem to do so at random (sporadic ALS). Most patients diagnosed with ALS do not have a history of ALS in any of their immediate family members ALS affects the nerve cells that control voluntary muscle movements such as walking and talking (motor neurons). ALS causes the motor neurons to gradually deteriorate, and then die. Motor neurons extend from the brain to the spinal cord to muscles throughout the body. When motor neurons are damaged, they stop sending messages to the muscles, so the muscles can't function.

22 Amyotrophic lateral sclerosis Symptoms of ALS Muscle twitches in the arm, leg, shoulder, or tongue Muscle cramps Tight and stiff muscles (spasticity) Muscle weakness affecting an arm, a leg, the neck, or diaphragm Slurred and nasal speech Difficulty chewing or swallowing Disease Management Currently there is no cure for ALS, yet patients suffering from the disease can be made more comfortable with the following options: heat or whirlpool therapy to relieve muscle cramping. exercise, although recommended in moderation, may help maintain muscle strength and function. physical therapy to maintain mobility and ease the discomfort of muscle stiffness, cramps and fluid retention. nutritional counseling to promote good nutrition and offer other dietary options when swallowing becomes difficult. speech therapy and communication training to maintain as many verbal communication skills as possible. Communication training also indicates non-verbal techniques. devices such as splints, corrective braces, grab bars, reach-extenders, etc. to help with daily activities such as dressing, eating, using the toilet and bathing. special equipment such as wheelchairs, electric beds or mattresses to maximize functional independence.

23 Cerebral Palsy The main symptoms of What is Cerebral cerebral palsy are problems Palsy? with movement, coordination, and Cerebral palsy (CP) is a group of disorders development. that highly affects a person's mobility, balance, and posture. The most typical motor Possible signs in a child include: impairment in children is cerebral palsy. • delays in reaching Cerebral refers to something involving the development milestones – for brain. Palsy refers to muscle weakness or example, not sitting by 8 functional issues. months or not walking by 18 months What causes CP? • seeming too stiff or too floppy (hypotonia) Cerebral palsy (CP) is caused by abnormal • weak arms or legs development of the brain or damage to the • fidgety, jerky or clumsy developing brain that affects a child’s ability to movements control his or her muscles. There are several • random, uncontrolled possible causes of the abnormal development movements or damage. People used to think that CP was • muscle spasms mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

Children and adults with cerebral palsy may require lifelong care Disease Managament with a medical care team. Besides a pediatrician or physical medicine and rehabilitation specialist (physiatrist) and possibly a pediatric neurologist to oversee your child's medical care, the team might include a variety of therapists and mental health specialists. These experts give special attention to needs and issues that are more common in people with cerebral palsy and can work together with your primary care provider. Together you can develop a treatment plan. There is no cure for cerebral palsy. However, there are many treatments options that may help improve your child's daily functioning. Selecting care will depend on his or her specific symptoms and needs, and needs may change over time. Early intervention can improve outcomes. Treatment options can include medications, therapies, surgical procedures and other treatments as needed. 24

Multiple Sclerosis Multiple sclerosis (MS) is a disease that affects the brain and spinal cord, resulting in a variety of symptoms such as problems with vision, arm or leg movement, sensation, or balance. it is a chronic condition that can sometimes cause severe disability but can also be mild. Symptoms can be treated in many cases. People with MS have a slightly lower average life expectancy. Types of Multiplesclerosis Relapsing Remitting MS. Someone It is most commonly with relapsing remitting MS will have diagnosed in people in their twenties, thirties, and forties, episodes of new or w orsening but it can occur at any age. It is two to three times more symptoms, known as relapses. These common in women than in typically worsen over a few days, last men. for days to weeks to months, then slowly improve over a similar time MS is one of the most period. common causes of disability in younger adults. Primary Progressive MS. Primary progressive MS causes symptoms to worsen and accumulate over time, with no periods of remission, though people frequently experience periods when their condition appears to stabilize. 25

Causes and Risk factors It is unknown what causes Multiple Sclerosis. Scientists, on the other hand, believe that four factors can increase a person's risk of developing the disease. Risk factors Other risk factors are: Immune system - MS is frequently described as an Sex - According to the NMSS, autoimmune disease. In an autoimmune disease, females are at least two to three the immune system incorrectly recognizes times more likely than males to components of healthy tissue as belonging to a develop relapsing-remitting multiple foreign invader such as a bacterium or virus. This sclerosis (RRMS). Males and females causes the immune system to react and attack develop primary progressive healthy tissue. multiple sclerosis (PPMS) at roughly equal rates. Genes - genes are thought to play a role in MS, and Age - RRMS typically affects people having a close relative with the disease, such as a between the ages of 20 and 50. parent or sibling, increases your risk slightly. If you PPMS typically manifests itself 10 have a parent or sibling who has MS, your lifetime years later than relapsing forms. risk is estimated to be around 3%. The average Smoking - Smokers are twice as likely person's chances of developing MS are between 0.1 as nonsmokers to be diagnosed with and 0.3 percent. Many people with MS have a close MS and are more likely to be relative who also has MS. diagnosed with PPMS. The risk increases as a person smokes more. The environment - Environmental factors are things Obesity - According to some that you come into contact with in your daily life. research, having obesity as a child or adolescent increases the risk of MS. MS risk has been linked to a variety of environmental risk factors. Some examples are: low vitamin D or low sun exposure air pollution exposure to organic solvents Infection - There is some evidence that certain viral infections can increase the risk of MS. Epstein-Barr virus is one type of infection that has received a lot of research attention (EBV). More examples are: human herpes virus-6 (HHV-6), which leads to conditions such as roseola varicella zoster virus (VZV), which causes chickenpox cytomegalovirus (CMV) human endogenous retroviruses (HERVs) 26

27 Treatment plan for MS Multiple sclerosis has no Doctors may recommend: known cure. Treatment typically focuses on Blood Tests. to assist in ruling out other accelerating recovery diseases with similar symptoms to MS. from attacks, slowing Tests to discover specific biomarkers disease progression, and associated with MS that are currently managing MS symptoms. under development and may also aid in Some people's symptoms diagnosis of the condition are so mild that no treatment is required. Spinal tap (lumbar puncture) Your spinal canal is punctured to extract a small sample of cerebrospinal fluid for testing at a lab. A spinal tap can also help rule out infections and other illnesses with symptoms similar to MS. This sample can reveal abnormalities in antibodies that are associated with MS. MRI. reveal the regions of your brain and spinal cord that have MS lesions. To emphasize lesions that show your disease is active, you might have an intravenous injection of a contrast substance.

Pathophysiology for Multiple sclerosis Genetic Environmental Infectious Factors Factors Triggers Activation of myelin-reactive Th1/17 cells Infiltration into the CNS BBB Breakdown, Immune cell recruitment CNS Tissue Damage Neurological Dysfunction 28

References Alzheimer’s disease - Symptoms and causes. (2022, February 19). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers- disease/symptoms-causes/syc-20350447 Amyotrophic lateral sclerosis (ALS) - Symptoms and causes. (2022, October 13). Mayo Clinic. https://www.mayoclinic.org/diseases- conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc- 20354022 Causes and Risk Factors of Cerebral Palsy | CDC. (2021, November 30). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/cp/causes.html Cerebral palsy - Diagnosis and treatment - Mayo Clinic. (2021, September 1). https://www.mayoclinic.org/diseases- conditions/cerebral-palsy/diagnosis-treatment/drc-20354005 Heller, L. (2019, June 11). ALS Treatment, Amyotrophic Lateral Sclerosis, Lou Gehrig’s disease. https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_cli nics/als/conditions/als_treatment.html Magnifico, L. A. (2021, June 7). Multiple Sclerosis (MS) Causes and Risk Factors. Healthline. https://www.healthline.com/health/multiple- sclerosis/possible-causes Multiple sclerosis - Diagnosis and treatment - Mayo Clinic. (2022, January 7). https://www.mayoclinic.org/diseases-conditions/multiple- sclerosis/diagnosis-treatment/drc-20350274 Multiple sclerosis - Symptoms and causes. (2022, January 7). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/multiple- sclerosis/symptoms-causes/syc-20350269 NHS website. (2021, November 18). Symptoms. nhs.uk. https://www.nhs.uk/conditions/cerebral-palsy/symptoms/