[dropcap]A[/dropcap]pathy is an abnormal emotional state that is characterized by indifference to things which others find interesting, moving or exciting, and diminished motivation to perform regular daily activities.
The neural mechanisms of apathy are postulated to involve the brainstem and forebrain circuits that regulate goal-directed behavior.1
What Is Apathy In Celiac Disease and/or Gluten Sensitivity?
[dropcap]I[/dropcap]nability to concentrate is a mental dysfunction characterized by trouble fixing the mind on one subject to the exclusion of all other thoughts.
What Is Inability To Concentrate In Celiac Disease and/or Gluten Sensitivity?
[dropcap]A[/dropcap]nxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic.
Q: What causes anxiety?
A: Anxiety can be a normal response to stress such as making an important decision, illness, divorce, problems at work or preparing for an exam.
In a dangerous situation, profound physiological changes rapidly prepare us for a “fight or flight” response by release of adrenalin hormone. Adrenalin speeds up metabolism to make available quick energy, tightens muscles in readiness, and speeds up the heartbeat and breathing so that more oxygen is made available to the brain and muscles.
Anxiety becomes a maladaptive disorder when it is excessive, unrealistic, or not provoked and impairs the ability to lead a normal life.
Anxiety that is part of a person’s personality is called “trait anxiety.” Anxiety that comes and goes is “state anxiety,” as in state of mind, and is usually due to unresolved stress or an underlying health problem.
[dropcap]T[/dropcap]remors are repetitive patterns of involuntary muscle contraction and relaxation originating from disorder in the basal ganglia of the brain. See image of hand tremor (to left) courtesy of Antonio Piedade.
Rythmic shaking may affect various parts of the body including hands, arms, legs, trunk, tongue, or vocal cords.1
Causes include malnutrition, drug adverse effects especially antipsychotics, environmental toxins, and conditions such as Parkinson disease and thyroid disease, which causes toxic levels of thyroid hormone.
What Are Tremors In Celiac Disease and/or Gluten Sensitivity?
What Is Attention Deficit Hyperactive Disorder (ADHD)?
[dropcap]A[/dropcap]ttention deficit hyperactive disorder (ADHD) is a maladaptive behavioral disorder characterized by a persistent pattern of inattention and impulsivity, or both, that are developmentally (age) inappropriate. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child’s age and development.
Inattention results from difficulty concentrating which gives the impression of not listening. The person’s speech or writing, such as when telling stories, can be disorganized.
Most children with ADHD also have at least one other developmental or behavioral problem. Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should be carefully examined by a doctor to rule out possible other conditions or reasons for the behavior.
An MRI (magnetic resonance imaging) study investigating whole-brain cortical thickness (outer layer of the brain) in male and female children, adolescents, and adults with ADHD supports the hypothesis that brain abnormalities in ADHD represent abnormal brain development rather than developmental delay.
Q: What is the abnormal development problem?
4 lobes of the human brain making up each hemisphere (side). In this drawing, the frontal is blue, the parietal is yellow, the temporal is green, and the occipital lobe is pink. Courtesy Wikimedia
A: Differences occur in the right side of the brain only. Reduced cortical thickness in people of all ages with ADHD was observed predominantly in the frontoparietal region (forehead and top). However, increased cortical thickness was observed predominantly in the occipital lobe (back). The brain thickness differences were correlated with severity of ADHD.1
ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 – 5% of school aged children and is diagnosed much more often in boys than in girls.2
What Is ADHD In Celiac Disease and/or Gluten Sensitivity?
Sources:
Almeida Montes LG, Prado Alcántara H, Martínez García RB, De La Torre LB, Avila Acosta D, Duarte MG. Brain cortical thickness in ADHD: age, sex, and clinical correlations. J Atten Disord. 2013 Nov;17(8):641-54. doi: 10.1177/1087054711434351. [↩]
[dropcap]C[/dropcap]erebral vasculitis, also called vasculitis of the central nervous system (CNS), is an autoimune attack against elastin fibers in the walls of arteries that bring blood to the head. Early recogniton may reduce poor outcomes.1
Cerebral vasculitis is characterized by inflammation of large, medium, or small blood vessels which is often segmental with scattered foci (sites) of intense inflammation, and results in necrosis (death) of affected tissues with scarring that occludes, or blocks, blood flow.
Q: What happens when an artery is occluded by scarring?
A: When an artery is occluded by scarring, blood cannot flow through it thus preventing the body tissues it supplies with oxygen and nutrition. Depending on vessels that are affected, blindness, TIA (transient ischemic attack) or stroke may result from blockage or rupture (hemorrhage).
Blood flow through arteries can be seen by angiography procedure. The diagnosis is made by biopsy. Additionally, contrast-enhanced MRI, proven to be sensitive to extradural arteritis, for the identification of intracranial vessel wall inflammation shows that wall thickening and intramural contrast uptake are frequent findings in patients with active cerebral vasculitis affecting large brain arteries.2
Vasculitis may develop with autoimmune diseases, such as celiac disease, lupus eythematosis and rheumatoid arthritis due to immune complexing, and possibly severe infection and drug sensitivity.
What Is Cerebral Vasculitis In Celiac Disease and/or Gluten Sensitivity?
Sources:
Salvarani C, Brown RD Jr, Calamia KT, Christianson TJ, Weigand SD, Miller DV, Giannini C, Meschia JF, Huston J 3rd, Hunder GG. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol. 2007 Nov;62(5):442-51. [↩]
Küker W, Gaertner S, Nagele T, Dopfer C, Schoning M, Fiehler J, Rothwell PM, Herrlinger U. Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis. Cerebrovasc Dis. 2008;26(1):23-9. doi: 10.1159/000135649. Epub 2008 May 30. [↩]
PET scan showing schizophrenia. Courtesy Wikimedia.
What Is Schizophrenia?
[dropcap]S[/dropcap]chizophrenia is a thought disorder characterized by psychotic symptoms and inappropriate and bizarre behavior.
Schizophrenia involves dysfunction in any of these areas:
Cognition which are thinking skills that include intellect, language, mathematical ability, memory, perception, reasoning, judgment, learning, and imagination.
Interpersonal relationships.
Ability to work or attend education.
Ability to take care of physical and financial needs.
Q: What are psychotic symptoms?
A: In psychosis the symptoms vary but include loss of contact with reality shown by hallucinations, delusions, disorganized speech, and disorientation. Some may be depressed or manic. Some may be withdrawn and mute while others may become violent if frustrated or thwarted.
In hallucinations, affected persons see what is not real such as a burgler in the process of robbing them but which is not really happening or hear voices that are not real.
In delusions, affected persons may express strange ideas, claim to read minds or that they are a famous person living or dead.
Early-onset schizophrenia with onset before age 18 is defined by the same diagnostic criteria as in adults because it is continuous with adult schizophrenia. The onset before age 12 years comprises less than 1% of adult cases, and onset from age 12–18 years constitutes about 12–33% of all adult cases of schizophrenia.1
What Is Schizophrenia In Celiac Disease and/or Gluten Sensitivity?
Sources:
Pagsberg AK, Tarp S, Glintborg D, Stenstrøm AD, Fink-Jensen A, Correll CU, Christensen R. Antipsychotic treatment for children and adolescents with schizophrenia spectrum disorders: protocol for a network meta-analysis of randomised trials. BMJ Open. 2014 Oct 10;4(10):e005708. doi: 10.1136/bmjopen-2014-005708. [↩]
View of Progressive Multifocal Leukoencephalopathy. Courtesy quizlet.com.
What Is Progressive Multifocal Leukoencephalopathy?
[dropcap]P[/dropcap]rogressive multifocal leukoencephalopathy is a progressive demyelinating disorder of the central nervous system (brain) caused by JC virus that leads to rapid death.
Progressive multifocal leukoencephalopathy usually occurs as an opportunistic infection in patients with underlying depression of cell-mediated immunity. It has been recognized that the JC virus is highly prevalent in the adult population, with 50–90% of healthy individuals having been exposed to the virus. Approximately 85% of the population has antibodies to JC virus. The virus’ purported site of latency in the human body is currently under debate.1
Progressive multifocal leukoencephalopathy is characterized by tissue loss of subcortical white matter (brain tissue) and active perivascular inflammatory foci (locations in blood vessels) with numerous eosinophilic granulocytes (white blood cells).
Q: What is demyelinating?
A: Demyelinating means there is damage to the myelin sheath of nerve cells called oligodendrites in the brain. In this disorder the damaged, irregular areas caused by the infection get progressively bigger.
The myelin sheath is a fatty substance that surrounds and protects nerve cells and enhances the transmission of nerve impulses much like the covering of a lamp cord keeps the electricity flowing within it from the plug to the light bulb. Damage to the myelin sheath impairs transmission of nerve impulses in the way that fraying an electric cord impairs the flow of electricity.
What Is Progressive Multifocal Leukoencephalopathy In Celiac Disease and/or Gluten Sensitivity?
Sources:
Gourineni VC, Juvet T, Kumar Y, Bordea D, Sena KN. Progressive multifocal leukoencephalopathy in a 62-year-old immunocompetent woman. Case Rep Neurol Med. 2014;2014:549271. doi: 10.1155/2014/549271. [↩]
[dropcap]P[/dropcap]rogressive myoclonic ataxia is a movement disorder characterized by defective muscular coordination of a muscle group with its origin in the brain.
Myoclonus in a context of progressive ataxia suggests one clinical form of the Ramsay-Hunt syndrome (progressive myoclonic ataxia, PMA), whose most frequent causes are: celiac disease, mitochondriopathies, some spino-cerebellar degenerations, and some late metabolic disorders.2
What Is Progressive Myoclonic Ataxia In Celiac Disease and/or Gluten Sensitivity?
Sources:
Bhatia KP, Brown P, Gregory R, et al. Progressive myoclonic ataxia associated with coeliac disease. The myoclonus is of cortical origin, but the pathology is in the cerebellum. Brain. Oct 1995;118(Pt 5):1087-93. [↩]
Borg M. Symptomatic myoclonus. Neurophysiol Clin. 2006 Sep-Dec;36(5-6):309-18. [↩]
[dropcap]C[/dropcap]horea is a movement disorder characterized by brief, jerky, purposeless or writhing involuntary movements of the distal limbs, head, and face that may occur during voluntary movement or at rest.
Chorea has a large number of causes, including metabolic, structural, pharmacologic, genetic, and autoimmune factors. Despite extensive investigations, many patients remain undiagnosed.1
What Is Chorea In Celiac Disease and/or Gluten Sensitivity?
Sources:
Walker RH. Further Evidence for Celiac Disease-associated Chorea. Tremor Other Hyperkinet Mov (N Y). 2011;1. pii: tre-01-32-96-3. [↩]
What Is Apathy?
