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Treatment

There is no cure for Parkinson’s disease but, in most cases, medication can help relieve symptoms and slow the progression of the disease. Doctors frequently prescribe a combination of levodopa and carbidopa, which the brain uses to make dopamine. Because this treatment becomes less effective after several years, doctors often prescribe drugs that enhance the effects of dopamine (called dopamine agonists) in an attempt to extend the treatment period. Sometimes these drugs are given before the person starts taking levodopa and carbidopa. A doctor also may prescribe an anticholinergic medication (a drug that blocks the effects of acetylcholine) such as benztropine to reduce trembling.

If symptoms become severe and unresponsive to treatment, a doctor may recommend a surgical procedure in which wires are implanted in the brain to stimulate a specific area with a mild electric current to help control the tremors. Less frequently, a surgical procedure called pallidotomy or thalamotomy is done in which the small area of brain tissue that is causing the symptoms is destroyed. A stem cell transplant (see page 624) of cells that can mature to make dopamine is being tried in some people. The stem cells are taken from the person’s adrenal glands or from human embryos.

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s disease, is a progressive disease of the motor neurons (nerve cells that control muscle movement). In ALS, motor neurons gradually deteriorate, causing muscles to weaken and waste away, which eventually leads to paralysis. ALS usually occurs after age 40 and affects more men than women. Its cause is not known.

Symptoms

In ALS, the affected parts of the body become increasingly weak, with twitching and cramping in the muscles. The person has difficulty swallowing, breathing, and walking. The disease eventually affects all of the body’s motor functions. In the final stages of ALS, a person is unable to speak or move, but his or her intellect and awareness are unchanged.

Diagnosis

Diagnosis of ALS is based on the symptoms and the results of diagnostic tests such as an electromyogram (an evaluation of the electrical activity of muscle tissue) and a muscle biopsy (a diagnostic test in which samples of muscle cells are examined under a microscope). An MRI (see page 113) and blood tests may be done to rule out other conditions that can cause similar symptoms.

Treatment

ALS cannot be prevented or cured. Treatment focuses on relieving the discomfort and helping the person remain as mobile and independent as possible for as long as possible. Doctors may prescribe a medication called riluzole to help slow the course of the disease. Specialized ALS treatment centers in many states offer comprehensive support services and treatment to help relieve symptoms; ask your doctor to recommend one. A person may eventually need a ventilator to assist with breathing, and feeding through a tube when he or she can no longer swallow. Most people with ALS die within 5 years of diagnosis.

Infections of the Brain and Nervous System

Infections of the brain and nervous system are less common than infections in other parts of the body because the brain and spinal cord have no direct contact with the environment. However, infections in the nervous system can cause severe symptoms and can be life-threatening. The bacteria, viruses, and other organisms that cause these infections gain entry to the brain and nervous system through the sinuses, the air spaces in the ears, the bloodstream, or fractures in the skull. Early treatment can prevent long-term damage to the nervous system and can be lifesaving.

Meningitis

Meningitis is inflammation of the meninges (the membranes that surround and protect the brain and spinal cord), usually caused by a viral or bacterial infection. The severity of meningitis depends on the infection-causing microorganism. The infection may have traveled to the brain from a localized infection (such as a sinus