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NeuroPsychological Evaluation

Note:
I moved the section on Multiple Sclerosis History.


Hi Karen,

>>MS is not only a chronic depressing condition, it is also the direct
>>cause of Depression & Mood Swings.

>
>Wow oh wow.  *That* FACT does not seem to be widely known by MS'rs.
>.........I believe it's the first time I read it in either JJ's or TheForum.

>
>I *know* there are some, maybe many, who will really appreciate this
>information, as do I!

>
I wonder.......?  Depression has been tossed around so much, I thought we
all knew it and were kinda tired, annoyed, and just plain upset with it all.
The neuros are mostly ignorant of anything they cannot see, or feel.

I think they're stymied, as there's little they can actually do, and they don't
see the management of MS as being included in their "expertise".

Kim does have some good MS Depression abstracts - a bit wordy and
not fun reading either.   /:->

 

=============================

Arch Neurol 1992 Jun;49(6):641-3

The prevalence of sleep difficulties was three times higher in the patients with
Multiple Sclerosis than the control group (25.2% vs 8.2%). Moreover, the
presence of sleep complaints was associated with higher levels of Depression.

Three lesion sites that subserve supplemental motor areas were significantly
related to the presence of sleep complaints.

These findings suggest that, for some patients with MS, sleep disturbance and
accompanying increases in Depression may be a function of
the lesion site
resulting in Nocturnal Spasms
.

=======================

Arch Neurol 1992 Mar;49(3):238-44

There were no differences in Expanded Disability Status Scale when subjects
were more depressed. Evaluation of a single subject revealed that Ia+ and
transferrin-receptor-positive Lymphocytes increased 3 months before
distress increased.

It was concluded that distress is associated with Immune Dysregulation in
Multiple Sclerosis, although the mechanisms of this association have yet to
be delineated.

========================

Clin Neurol NeuroSurg 1992;94 Suppl:S144-6

A patient is presented with clinically and laboratory supported definite
Multiple Sclerosis who developed severe Depression followed by mental
deterioration.

Magnetic Resonance Imaging MRI demonstrated multiple hemispherical
lesions. It is suggested that the psychiatric and cognitive signs and symptoms
observed in this patient are due to severe Cerebral DeMyelination.

=========================================

This next post is from a new chat provider with free homepage!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tripod: Ask The Doctor - MS
http://www.tripod.com/

Multiple Sclerosis is a disease in which the Immune System is integrally involved.
It is becoming increasingly apparent that one's state of mind and
emotions play
a significant role in the functioning of the Immune System, and this has been
borne out in MS patients.

Patient morale appears to be very important in affecting outcome, and the value
of supportive friendships and community as well as a hopeful perspective cannot
be over emphasized.

Knowing as much as possible about MS is usually of tremendous value as well. I
would strongly recommend finding a health care
provider with whom you feel very
comfortable and cultivating that relationship.

===============================
>>
>> Where the actual plaques are located in the Brain determine which
>> symptoms are produced. In most MS cases, the plaques are only in
>> the White Matter (myelinated areas) of the CNS - on the Axons and
>> Nerves which connect the various Nerve centers of the Brain itself.
>>
>>
>> MS plaques are normally located centrally, deep in the Brain's
>> interior, around the Ventricles and the junction of the Pons,
>> Medulla,  and the Cerebellum ( PeriVentricular Region).
>
>
>YES!
>
> Pons
>
>YES!
>
> Medulla
>
>YES!
>
>> & MesenCephalon (MidBrain).
>
>Not sure about *that one*. I know the above are affected,
>by reading my MRI report. The report also refers to the
>"white matter
" [of the Brain]. What is *that* and what does
>it do? I wish I could scan the report and ask you to interpret
>it, in
your spare time of course, ha ha.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
White Matter in the Brain (CNS), is the common term used for "Myelin". It actually constitutes a larger percentage of the "Brain" than the Neurons or Cell Bodies (Gray Matter), are slightly pigmented because they contain traces of metals.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

John Hopkins Atlas of Human Functional Anatomy- 1977

The Cerebrum is the newest part of the Brain, and that part which is responsible for higher mental functions. The outermost surface is composed of nerve cells and is called the Cortex.

The Processes (Axons) of these nerve cells passing upwards and downwards comprise the White Matter, which is the greatest volume of the Brain.

Deep inside the Brain, just above the BrainStem, are several masses of nerve cells with very important functions.

The most important of these is the Thalamus , which is a way station for relay of messages to the Cortex and has important functions in processing information as well.

Another of these buried areas of Gray Matter is the HypoThalamus, which has important connections in behavior and in hormone function.

The third of these areas of nerve cells is called the Basal Ganglia, which are very important in coordination of motor movement.

The Cerebrum sits on the BrainStem, and the Cerebellum - especially
important in coordination of motor movement, is located in the angle between the BrainStem and Cerebrum.

The BrainStem has many vital function.

Most of the Cranial Nerves come from the BrainStem, and all of the nerve tracts passing up and down from Peripheral Nerves and the Spinal Cord to higher parts of the Brain must transverse the BrainStem.

The BrainStem is particularly important in control of subconscious and reflex activities such as breathing, heart rate, and blood pressure.



Physiology of The Human Body
by: JR McClintic, PhD. 1985

The outer surface of the Cerebrum is covered with a 2.5 to 4.0 mm thick layer of Neuron containing Gray Matter, termed the Cerebral Cortex. Most of the rest of the Hemisphere consists of myelinated nerve fiber tracts, the White Matter (Medullary Body).

The Cortex, because it contains the greatest number of Neurons, acts as the region giving appreciation of Sensations, serves as the source of Motor Activity, and contains areas responsible for Moral and Social Values.


Functions

Much evidence about function is provided by direct Brain stimulation during surgical procedures or by associating symptoms of pathology with lesions of the Brain. Our Brains, like our Faces, contain basic regions but also like our faces, they are not identical to one another.

The Frontal Lobe:
The Primary Motor Area is an area conferring Voluntary control over movement in humans. Different Cortical regions project ultimately to specific muscles in a particular body part.

The Supplementary Motor Area is on the medial aspect of each Hemisphere. Body representation is more crude here, stimulation bringing contraction of larger groups of muscles.

The Axons from cells in these motor areas constitute 40 to 45% of the fibers giving voluntary control over muscular activity. Lastly, Efferent fibers control muscles primarily on the opposite side of the body, since they cross in the (Pons) BrainStem.

The Premotor Area provides input which causes contraction of muscles only if the Primary Motor area is intact and, is particularly concerned with movements of the head, neck, and trunk.

Some degree of learned motor activity may lie in this area, because lesions here interfere with performance even though no voluntary paralysis results.

Except for the frontal eye field, the remainder of the Lobe is designated the Frontal Association Area.

In animals, damage in these areas causes hyperactivity and excessive emotional display, suggesting an inhibitory function of the region.

In humans, there is great diversity in symptoms displayed as a result of lesions in this area. Changes are most often seen in personality, emotional reactions, ability to accept life's responsibilities, and moral and social concepts.

Broca's Speech Area lies predominately in the Left Cerebral Hemisphere, regardless of handiness, and lies in close association with the motor areas concerned with the lips, jaws, and tongue - regions important in vocalization.

Lesions in these areas produce alterations in ability to vocalize, may cause speech arrest, and grossly interfere with ability to express oneself, even in the absence of vocal paralysis.

The Occipital Lobes (Visual Area) receive input from fibers originating in the Retina. Both eyes are represented in both Lobes, with Central Vision posteriorly and Peripheral Vision anteriorly.

On the lateral side of a Hemisphere and above it medially, are the visual association areas. Relating past to present Visual experiences, Binocular Vision, and depth perception are some of the vision related functions handled by these areas.

The Temporal Lobes house the Auditory Area, where the Cochleas of both ears are represented in one Temporal Lobe, contain the association areas, and probably are also major regions of memory storage generally.

The term Medullary Body, refers to all of the Myelinated fibers (White Matter) of the Cerebrum. The Basal Ganglia are large masses of Gray Matter buried within the Medullary Body.

Three types of Fibers compose the Medullary Body:
1 - Commissural fibers form the only means of connecting the two Cerebral Hemispheres to permit transfer of information between them.

The Corpus Callosum is the major bundle of Commissural Fibers, estimated to contain 300 million fibers. The Anterior, Posterior, and Habenular Commissures are much smaller bundles.

2 - Projection Fibers are bundles of fibers that enter the Cerebrum from outside or originate within the Cerebrum and leave it.

Ex. are the incoming Auditory and Visual projection fibers and the outgoing motor pathways to skeletal muscles.

3 - Association Fibers connect different parts of the same Hemisphere. These types of fibers enable one type of information to affect an entirely different part of the Cerebrum such as in motor responses to visual or thermal stimuli.

The major connection that the Basal Ganglia make are with Cerebral Cortex and Thalamus.

An internal circuit is formed from Cerebrum to Ganglia to Thalamus and back to Cerebral Motor Areas.

The Ganglia are thus postulated to influence the Motor Cortex. In general, it seems that the Ganglia are concerned with suppression of certain types of motor function that would destroy the purposeful nature of motor activity.

Parkinson's Disease is the most common disorder associated with lesions or damage to the Basal Ganglia.


>
>I also have spinal sclerotic tissue, "at" T9 was the one that produced
>the bilateral numbness from saddle area to tips of toes. The Neuro
>circled the area on the MRI film for me, then told me "Yes, it is
>Multiple Sclerosis". (My official dx in  5/92)
>
===================================

Anatomy & Physiology - 1992
Rod R. Steeley, PhD.; Trent D. Stephens, PHd.; Philip Tate, D.A.

The BrainStem: The Medulla Oblongata, Pons, and MidBrain constitute the BrainStem. It connects the Spinal Cord to the remainder of the Brain and is responsible for many essential functions.

Damage to small BrainStem areas often cause death, whereas relatively large areas of the Cerebrum or Cerebellum may be damaged without causing permanent symptoms.

All but two of the 12 Cranial Nerves enter or exit the Brain through the BrainStem.

The Medulla Oblongata is approx. 3 cm long, it is the most inferior (bottom) portion of the BrainStem and is continuous inferiorly with the Spinal Cord.

Superficially the Spinal Cord blends into the Medulla but internally there are several differences.

Discrete Nuclei (clusters of Gray Matter, composed mostly of Cell Bodies, surrounded by White Matter) with specific functions are found within the Medulla Oblongata but not within the Spinal Cord.

In addition, the Spinal Cord tracts that pass through the Medulla do NOT have the same organization as the tracts of the Spinal Cord.

The Pons is that portion of the BrainStem just superior (above) to the Medulla Oblongata.

It contains ascending and descending nerve tracts and several Nuclei. The Pontine Nuclei, located in the anterior (front) portion of the Pons, relay information from the Cerebrum to the Cerebellum.

The nuclei for Cranial Nerves
V (Trigeminal), VI (Abducens), VII (Facial), and VIII (VestBuloCochlear) are contained within the posterior (rear) Pons. Other Pontine areas include the Pontine Sleep Center and the Respiratory Centers, which along with the Medullary Respiratory Centers help control Respiratory movements.

The MidBrain or MesenCephalon, is the smallest region of the BrainStem. It is superior to the Pons and contains the Nuclei of Cranial Nerves III (OcculoMotor) and IV (Trochlear).

The Tectum (roof) of the MidBrain consists of four Nuclei that form mounds on the dorsal surface, collectively called Corpor (Bodies) Quadrigemina (four twins).

Each mound is called a Colliculus (hill); there are two Superior Colliculi and two Inferior Colliculi.

===================================

>> The MidBrain contains the Thalamus, which is the
>> control center governing the Hormones and thereby ruling
>> the Emotions; it is some times called the
Limbic System
>>
(DienCephalon). All nerves travel from the Cerebrum
>> (top of the brain) to the Cerebellum (rear Bottom) to the
>> Thalamus, both incoming positional sense and the outgoing
>> orders. Any disruption in this loop will naturally cause
>> problems, some messages are not received, mis-sent, or only
>> partly received.


> >The NeuroPsychological Evaluation is done over a number
>> of sessions, generally taking from 2 - 4 weeks to complete. It
>> basically entails testing everything about you and comparing
>> your scores to the "norm" for your age & sex category. The tests
>> include: an IQ test; memory - both short & long term tests; strength
>> testing of limbs & grip; how socially adjusted you are; how you
>> present yourself & appear; how you react to emotional stress; tests
>> of spatial relationships and recall; they test how you recall things,
>> that is which methods of memorization you use - visualization,
>> association, grouping similar items vs. order of presentation, etc.
>
>Seems like a thorough exam. I wonder though, how can one's
>IQ be determined when there is cognitive dysfunction? Mine
>*was* in the 130's range; no genius, no schlock. Would there
>not be a mighty big decrease in the number, *because* of the
>disease? I guess it doesn't *really* matter, my days of dazzling
> the world with my brilliance [or baffling with bullsh*t] are long
>ago and far away.
>
>> I'm sure I left something out, but I hope this will give you
>>a fair idea.
>>
>Indeed it does.
>
>> They usually do try and gauge whether or not you are currently
>> depressed. Psychologist are trained in finding the physiological
>> causes of mental problems.
>>
>Is there such a thing as a "Neuropsychologist" discipline? Or is that
>implied with the title of "Psychologist"? I thought, until this response
>from you, that the only difference between and Psychologist and a
>Psychiatrist was that only the latter can write prescriptions for
>medications.
>
=======

Neuropsychologist are indeed another specialized branch of the ever
increasing number of "experts". If you can find and afford one, you are
really good!! Actually, whichever type of doctor performs the testing
doesn't really matter, as they are all medically qualified. The important
difference is whether the doc "knows" anything regarding MS!!!!

Before you decide which one to see, interview them by phone first. They may not say they don't know; but if you make them aware that you know MS does make you different - as MS involves the entire CNS - you can bet they will know more, when you actually do get tested. /:-)
>
==============
>> Psychiatrists treat mental problems which have no physiological
>> basis and are therefore considered to be of a "mental" or so called
>> maladjustment to social circumstances.
>
>I see.
>
>> Neurologist treat problems of the physical nerves themselves. To
>> them, a nerve conducts a message which is either normal or
>> abnormal. They can only "see" the physical parts of the nervous
>> system, it either is or isn't conducting.
>
> That's about the only medical discipline I *could* define!
>
>> Hmmmm.... about par for the course, I'd say. Today these
>> are each separate branches of medicine, having very little
>> to do with each other.

>
> How odd that, with a disease like MS, the Neurologists and the
> Psychologists don't work hand in hand, as a matter of course in the
> treatment of MS.
>>
>> Many of the new larger MS treatment centers now do incorporate
>> all the various disciplines: neuro, psych, rehab, pt, and if you're
>> lucky a nutritionist.

>>
>> One hundred and some odd number of years ago, when MS was first
>> discovered, this was not the case. Dr Freud's first patient was his

>> former Nanny, whom he treated for MS.
>
>I read that at your Website - found it very interesting.
>
>> For all too many years, MS was considered to be a part of the
>>"female syndrome" and therefore, not much real investigation was
>>done until recent times.
>
> *That* would explain why [perceived] I was treated like just another
> hysterical female when first I complained about fatigue and curling
> up *and* under of the toes.
>
This is a very common early sign of Spasticity in MS, as are Clonus
and a positive Babinski Sign.

For years I could never keep shoes on all day without my feet cramping, generally right in the arches. I found it helps to massage my feet, toes, and stretch the ankles, calves, and hamstrings.

If you stand on a step with only your toes on the step - hold the railing for balance - gently lower your body by relaxing the ankles and feet only.

You can alternate legs and progress to the point where you can incorporate a slight bend of the knee, and raise yourself up on your toes at the top of the movement.

Also if you recall the old hurtler's stretch - one leg up on a chair, sink, railing, wall, anything that will allow you to extend one leg at a 90 angle to the body and not fall will do. You bend from the waist, and gently try to bring your head to your knee.

This will not be as easy as it once was :-) so go slowly. The old way of during this on the floor, sitting with one leg stretched out in front and the other knee bent, is now considered too dangerous for the spine.
>
>> I'm glad you self-referred yourself, and hope you can make sense out of this "quick" post.
 >
> >

Happy Valentine's Day !!!

>
>Same to you, Tom. Thank you so much for your quick and informative
>response. I can't wait to read the other two you sent me!
>
>Karen
>IRC:wales
>
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


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