Central and Peripheral Nervous System (Lecture 1, 2024) PDF

CENTRAL AND PERIPHERAL NERVOUS SYSTEM (LECTURE 1, 2024) BY Dr.TEHSEEN QUDS  LEARNING OBJECTIVES At the end of this lecture students will be able to: Differentiate between Psychiatric and Neurological disorders. Describe in detail about Migraine. Explain in detail about the herbs used in...

CENTRAL AND PERIPHERAL NERVOUS SYSTEM (LECTURE 1, 2024) BY Dr.TEHSEEN QUDS  LEARNING OBJECTIVES At the end of this lecture students will be able to: Differentiate between Psychiatric and Neurological disorders. Describe in detail about Migraine. Explain in detail about the herbs used in the treatment of Migraine. Describe about Parkinson’s disease and its treatment.  CNS DISORDERS Migraine Parkinson’s Disease Depression Anxiety  DISTINCTION B/W PSYCHIATRIC AND NEUROLOGICAL DISORDERS Psychiatric disorders: Disorders of mood, thought and perception. e.g. Anxiety, Depression etc. Neurological disorders: Disorders of movement, intellect and sensation. e.g. Epilepsy, Migraine, Parkinson’s Disease.  PSYCHIATRIC DISORDERS Psychiatric disorders are abnormalities in behavioral and emotional symptoms resulting from chemical imbalances in the brain, developmental challenges, or life experiences. 1. Depression 2. Anxiety 3. Schizophrenia  NEUROLOGICAL DISORDERS Neurological disorders depicts physical dysfunctions in the brain and involuntary bodily functions related to the nervous system. Parkinson’s Disease Migraine MIGRAINE Repeated attacks of headache. Moderately or severely painful. Frequent or infrequent. Last a few hours to a couple of days. Often only one side of the head hurts. Often experience loss of appetite, nausea, vomiting, and sensitivity to light. THROBBING PAIN ON ONE SIDE OF HEAD  HYPERSENSITIVITY TO LIGHT (PHOTOPHOBIA) According to the National Headache Foundation, between 80 and 90 per cent of migraine sufferers will experience hypersensitivity to light during an attack. Migraine sufferers have also been found to be more sensitive to light between attacks than people who don't get migraines. PHONOPHOBIA  CLASSIC MIGRAINE PHASES Types of Migraine (Migraine with aura, migraine without aura etc.) Classic Migraine Phases migraine_clinical_features TRIGGERS: CHANGES IN DAILY CYCLES TRIGGERS: ENVIRONMENT OR DIET TRIGGERS: MENTAL Stress  MIGRAINE AURA Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following: A temporary blind spot Blurred vision Eye pain Seeing stars or zigzag lines Tunnel vision MAJOR TYPICAL MIGRAINE SYMPTOMS Nausea/vomiting Photophobia and Phonophobia Unilateral pain Throbbing pain Aggravation by movement Moderate or severe intensity HERBS USED FOR THE TREATMENT OF MIGRAINE Feverfew Ginger FEVERFEW  FEVERFEW Tanacetum parthenium Parts Used: Aerial Parts Sesquiterpenes Lactones most important is Parthenolide. The most important herb for the long term treatment and prevention of migraine is feverfew.  FEVERFEW USE IN BRITAIN Feverfew has been used as a pain reliever for centuries. Its feathery aromatic leaves are used to prevent migraine headaches. In 80’s it was popular in Britain and a survey of 270 people with migraines in Great Britain showed that more than 70% of them felt much better after taking an average of 2 to 3 fresh feverfew leaves daily.  MECHANISM OF ACTION Feverfew inhibits hyperaggregation of platelets and the release of serotonin and some inflammatory mediators. Studies have shown that continuous use of feverfew leads to a reduction in severity, duration and frequency of migraine headaches. Much research into the plant anti-inflammatory properties and a compound called Parthenolide appears to be its main active ingredient. DOSAGE To prevent and treat migraine. Capsules (380mg pure leaf) Take 3 Capsules a day with food. Capsules (100mg leaf extract) Take 1 Capsule a day with food. PRECAUTION No serious side effects have been reported. Can cause stomach upset. To prevent allergic reactions do not use for more than four months at a time.  GINGER Zingiber officinale Zingiberaceae Parts Used: Rhizome Constituents: Zingiberene, Gingerols  MECHANISM OF ACTION Gingerols increase the motility of the gastrointestinal tract and have analgesic, sedative, anti-inflammatory, and antibacterial properties. Studies have shown that it may reduce nausea caused by motion sickness or pregnancy and may relieve migraine. Gingerols responsible for its Antinauseatic effect. Sesquiterpenes (zingiberene) responsible for its antiinflammatory activity.  COMPARISON WITH METOCLOPRAMIDE Ginger has a sedative effect and also reduces nausea and vomiting including travel sickness. A study in 1990 at St Bartholomew’s hospital, London, found that ginger reduced the incidence of nausea for post-operative patients. Its efficacy was comparable with metoclopramide, a widely used antiemetic drug.  DOSAGE To treat nausea and vomiting. Powder: 0.5-1.5g a day in water or mixed with food. Tincture: 1: 5 in 60% alcohol, take up to 30 drops a day in a glass of water.  CONTRAINDICATIONS Do not take ginger if taking anticoagulants (blood thinning ) drugs. Overdose may cause stomach upsets. Do not take in high amount during pregnancy.  PARKINSON’S DISEASE Parkinson's disease is a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination. INCIDENCE OF PD DOPAMINE PATHWAYS IN HUMAN BRAIN  CAUSE Parkinson's disease occurs when the nerve cells in the brain (i.e. substantia nigra) that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.  SIGN AND SYMPTOMS Four Cardinal symptoms (TRAP): T remor R igidity A kinesia and bradykinesia P ostural instability GOAL  TREATMENT OF PARKINSON’S DISEASE The goal of treatment is to control symptoms. Medications control symptoms, mostly by increasing the levels of dopamine in the brain. Many medications can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. Monitoring and follow-up by the health care provider is important. HERBS USED FOR THE TREATMENT OF PARKINSON DISEASE Atropa belladonna Mucuna pruriens  BELLADONNA Atropa belladonna Solanaceae Deadly Nightshade Parts Used: Leaves Perennial Herb Atropine, Hyoscyamine, Scopolamine/Hyoscine  MECHANISM OF ACTION Atropine and Scopolamine are competitive with acetylcholine at the postganglionic synapse (muscarinic site) of the parasympathetic nervous system. Antisecretory effect used to reduce respiratory secretions and also used to decrease muscular rigidity.  DOSAGE Belladonna Tincture: 0.6-1 ml, 3 or 4 times a day. Atropine Sulfate : 300-600 µg, 3 or 4 times a day. Hyoscyamine Sulfate: 125-250 µg, 3 or 4 times a day. Scopolamine Hydrobromide: 320 µg -1.1mg.  MEDICINAL USES OF ATROPA BELLADONNA In Parkinson’s Disease used to reduce muscular rigidity and excessive salivary secretion.  INTERACTIONS Belladonna contains constituents that causes drying effect. It also affects the brain and heart. Taking belladonna with other anticholinergics, together might cause side effects including dry skin, dizziness, fast heartbeat and other serious side effects. MUCUNA PRURIENS (COWHAGE)  IS MUCUNA PRURIENS ITCHY TO THE SKIN? Mucuna pruriens or Velvet Bean, is a bean that grows from trees. It is very itchy to touch due to serotonin on its surface. It is a good source of L-DOPA, and contains some other molecules that may aid the benefits of L-DOPA.  REFERENCES Current medical diagnosis and Treatment American Migraine Foundation (https://americanmigrainefoundation.org/resource-library/migraine- prodrome-symptoms-prevention/) Feverfew for preventing Migraine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133498/) Forestalling the Epidemics of Parkinson's Disease Through Plant-Based Remedies (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218400/) Russell J Greeene, Pathology and Therapeutics for Pharmacist, Second Edition. Herbal Drug interactions and adverse effects by Richard B. Philip