A to Z of Medical Conditions

Posted on September 25, 2018September 25, 2018 A to Z of Medical Conditions

Trigeminal neuralgia – what are the signs and symptoms of Trigeminal neuralgia?

Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.It usually occurs in short, unpredictable attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they start.

In most cases trigeminal neuralgia affects part or all of one side of the face, with the pain usually felt in the lower part of the face. Very occasionally it can affect both sides of the face, although not usually at the same time.

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may occur hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice

See your GP if you experience frequent or persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, don’t help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?

Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases trigeminal neuralgia can be caused by damage to the trigeminal nerve as a result of an underlying condition, such as multiple sclerosis (MS) or a tumour.

Typically the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can occur without any trigger at all.

Read more about the causes of trigeminal neuralgia.

Who’s affected

It’s not clear how many people are affected by trigeminal neuralgia, but it’s thought to be rare, with around 10 people in 100,000 in the UK developing it each year.

Women tend to be affected by trigeminal neuralgia more than men, and it usually starts between the ages of 50 and 60. It’s rare in adults younger than 40.

Treating trigeminal neuralgia

Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled with treatment to at least some degree.

An anticonvulsant medication called carbamazepine, which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia.

Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as necessary, sometimes for many years.

If you’re entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you’re advised otherwise by a doctor.

Carbamazepine wasn’t originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve.

Research suggests this operation offers the best results in terms of long-term pain relief, but it’s a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia.

Posted on September 20, 2018September 20, 2018 A to Z of Medical Conditions

The Infections That Cause Guillain-Barré Syndrome

person washing hands over sink

Guillain-Barré Syndrome (GBS) is a rare, but serious condition where the person’s immune system mistakenly attacks the peripheral nervous system. Up to half of people experience severe nerve pain and triggers have been linked mainly to infections. GBS is characterised by a rapid-onset change in sensation or pain and muscle weakness, usually starting in the hands and feet, which can lead to paralysis. The reason why the immune system attacks the peripheral nervous system is unclear, but links between certain viruses triggering GBS have been found.

Campylobacter Infection

Campylobacter is the most common cause of food poisoning in the UK and many other developed countries. Since laboratories were able to isolate campylobacter in stool specimens 20 years ago a link between it and GBS became apparent as people reported its onset after infection. More recently, stronger evidence has been able to support the association. Based on a study by McCarthy and Giesecke it’s estimated that 14% of people will develop GBS following a campylobacter infection.

The Link Between Zika Virus And GBS

The link between the Zika virus and GBS was first reported in 2014, and in 2016 the World Health Organisation concluded that it is a trigger. A 2016 study by Cao-Lormeau et al. found that 88% of patients with GBS had a history of viral infection 6 days before the onset. The results were compared against control patients and other infections and the Zika virus showed a stronger correlation as a trigger for GBS. Many countries with the Aedes mosquitoes, which carry the Zika virus, have also reported an unusual increase in GBS, adding to the strength of the theory that the two are linked.

Long-Term Treatment For GBS

Unfortunately, up to 20% of people left severely disabled after having GBS and others have persistent symptoms, such as poor balance, coordination and muscle weakness. Long-term treatment often involves physical therapy to strengthen muscles or re-learn movements, such as walking. An occupational therapist can help find ways to do daily tasks that you’ve always done but now find difficult. The Speech And Language Therapy (SALT) team may also be involved if you have problems with speech or swallowing and can help to strengthen these muscles or find alternatives that suit you, such as puréed foods. Counselling is helpful when GBS is life-changing, which can be overwhelming and difficult to deal with, so having a professional to talk to is beneficial.

To reduce your chance of developing GBS you should take precautions to avoid the infections that can trigger it. When it comes to food poisoning, make sure meat, especially poultry, is stored and cooked correctly to kill off campylobacter. If you’re in a country where Aedes mosquitoes are prominent, be sure to use insect repellent and wear clothes that fully cover your skin. Treatment can be a long battle, but it is possible. Using the affected muscles is the best way to get them working correctly again.

Posted on August 17, 2018August 18, 2018 A to Z of Medical Conditions

Aspergillosis – what is Aspergillosis?

Aspergillosis is a condition caused by aspergillus

Aspergillosis is a condition caused by aspergillus mould. There are several different types of aspergillosis – most affect the lungs and cause breathing difficulties.

How you get aspergillosis

Aspergillosis is usually caused by inhaling tiny bits of mould. The mould is found in lots of places, including:

soil, compost and rotting leaves

plants, trees and crops

dust

damp buildings

air conditioning systems

You can’t catch aspergillosis from someone else or from animals.

Most people who breathe in the mould don’t get ill.

Aspergillosis is rare in healthy people

You’re usually only at risk of aspergillosis if you have:

a lung condition – such as asthma, cystic fibrosis or chronic obstructive pulmonary disease (COPD)

a weakened immune system – for example, if you’ve had an organ transplant or are having chemotherapy

had tuberculosis (TB) in the past

Symptoms of aspergillosis

Symptoms of aspergillosis include:

shortness of breath

a cough – you may cough up blood or lumps of mucus

wheezing (a whistling sound when breathing)

a high temperature of 38C or above

weight loss

If you already have a lung condition, your existing symptoms may get worse.

See a GP if you have:

a cough for more than 3 weeks

a lung condition that’s getting worse or harder to control with your usual treatment

a weakened immune system and symptoms of aspergillosis

Get an urgent GP appointment if you cough up blood. Call 111 if you can’t see your GP.

What happens at your appointment

Your GP will check for an obvious cause of your symptoms, like a chest infection or asthma.

If they’re not sure what the problem is, they may refer you to a specialist for tests such as:

X-rays and scans

blood tests or tests on a sample of mucus

allergy tests

a bronchoscopy – where a thin, flexible tube with a camera at the end is used to look in your lungs

Treatment for aspergillosis depends on the type

Treatment usually helps control the symptoms. If it isn’t treated or well controlled, there’s a risk it could damage your lungs.

Common types	Treatment
Allergic bronchopulmonary aspergillosis (ABPA) – an allergy to aspergillus mould	steroid tablets and antifungal tablets for a few months (possibly longer)
Chronic pulmonary aspergillosis (CPA) – a long-term lung infection	long-term (possibly lifelong) treatment with antifungal tablets
Aspergilloma – a ball of mould in the lungs, often linked to CPA	surgery to remove the ball if it’s causing symptoms
Invasive pulmonary aspergillus (IPA) – a life-threatening infection in people with a weakened immune system	antifungal medicine given directly into a vein in hospital

You can’t always prevent aspergillosis

It’s almost impossible to completely avoid aspergillus mould.

But there are things you can do to reduce your risk of aspergillosis if you have a lung condition or weakened immune system.

try to avoid places where aspergillus mould is often found, such as compost heaps and piles of dead leaves

close your windows if there’s construction work or digging outside

wear a face mask in dusty places

consider using an air purifier at home – devices with HEPA filters are best

Posted on August 16, 2018August 11, 2018 A to Z of Medical Conditions

Living with arthritis

Living with arthritis isn’t easy and carrying out simple, everyday tasks can often be painful and difficult.

However, there are many things you can do to make sure you live a healthy lifestyle. A range of services and benefits are also available.

Work

Many people with arthritis want to continue working for many reasons, including better financial security and higher self-esteem.

Improved treatment approaches have helped ensure that many people who are diagnosed with arthritis can return to work. This is particularly the case if arthritis is diagnosed and treated at an early stage.

You may find work challenging, but your employer should help you with the training and support you need.

Help is also available if your arthritis is so severe that you’re unable to work. Find out more about the Personal Independence Payment(formerly known as the Disability Living Allowance).

Arthritis Care has more useful information about working with arthritis.

Healthy eating

It’s very important to eat a healthy, balanced diet if you have arthritis. Eating healthily will give you all the nutrients you need and help you maintain a healthy weight.

Your diet should consist of a variety of foods from all five food groups. These are:

fruit and vegetables

starchy foods – such as bread, rice, potatoes and pasta

meat, fish, eggs and beans

milk and dairy foods

foods containing fat and sugar

Read more about how to have a healthy, balanced diet.

If you’re overweight, losing weight can really help you cope with arthritis. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems.

Read more about how you can lose weight using the weight loss guide.

Exercise

If your arthritis is painful, you may not feel like exercising. However, being active can help reduce and prevent pain. Regular exercise can also:

improve your range of movement and joint mobility

increase muscle strength

reduce stiffness

boost your energy

As long as you do the right type and level of exercise for your condition, your arthritis won’t get any worse. Combined with a healthy, balanced diet (see above), regular exercise will help you lose weight and place less strain on your joints.

Your GP can advise about the type and level of exercise that’s right for you. You can also download useful free booklets from Arthritis Careand Arthritis Research UK, including:

Exercise and arthritis

Pain and arthritis

Joint care

If you have arthritis, it’s important to look after your joints so there’s no further damage. For example, try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting.

Some tips for protecting your joints, particularly if you have arthritis, include:

use larger, stronger joints as levers – for example, take the pressure of opening a heavy door on your shoulder rather than on your hand

use several joints to spread the weight of an object – for example, use both hands to carry your shopping or distribute the weight evenly in a shoulder bag or rucksack

don’t grip too tightly – grip as loosely as possible or use a padded handle to widen your grip

The Arthritis Care website has more information and advice about taking care of your joints.

It’s also important to avoid sitting in the same position for long periods of time and to take regular breaks so you can move around.

Read more about good posture and how to sit correctly.

At home

If you have arthritis, carrying out tasks around the home can be a challenge. However, making some practical changes to your home and changing the way you work should make things easier.

Practical tips that could help include:

keeping things in easy reach

using a hand rail to help you get up and down the stairs

using long-handled tools to pick things up or to clean

fitting levers to taps to make them easier to turn

using electric kitchen equipment, such as tin openers, when preparing food

You can find more useful information and advice about living independently at home on Arthritis Care.

Occupational therapy

An occupational therapist can help if you have severe arthritis that’s affecting your ability to move around your home and carry out everyday tasks, such as cooking and cleaning.

They can advise about equipment you may need to help you live independently.

Depending on the exact nature of your condition, your GP may be able to refer you to an NHS occupational therapist. However, you may need to access this type of therapy through your local council.

Find your local council on GOV.UK.

Does acupuncture help?

Some people with osteoarthritis say that acupuncture has helped relieve their symptoms.

However, if you wish to try it, bear in mind that any benefits of acupuncture are likely to be the result of expectation or the placebo effect.

Arthritis and driving

You only need to inform the DVLA if you have arthritis and use special controls for driving.

GOV.UK has more information and advice about telling the DVLA about a medical condition or disability.

Posted on August 14, 2018August 17, 2018 A to Z of Medical Conditions

Angelman syndrome – what is Angelman syndrome?

Angelman syndrome is a genetic disorder that affects the nervous system and causes severe physical and intellectual disability.

A person with Angelman syndrome will have a near-normal life expectancy, but needs looking after for the rest of their life.

Characteristics of Angelman syndrome

The typical characteristics of Angelman syndrome aren’t usually apparent at birth.

A child with Angelman syndrome will begin to show signs of delayed development at around 6-12 months, such as being unable to sit unsupported or make babbling noises.

Later, they may not speak at all or may only be able to say a few words. However, most children with Angelman syndrome will be able to communicate using gestures, signs or other systems.

The movement of a child with Angelman syndrome will also be affected. They may have difficulty walking because of problems with balance and co-ordination (ataxia). Their arms may tremble or move jerkily, and their legs may be stiffer than normal.

A number of distinctive behaviours are associated with Angelman syndrome. These include:

frequent laughter and smiling, often with little stimulus

being easily excitable, often flapping the hands

being restless (hyperactive)

having a short attention span

problems sleeping and needing less sleep than other children

a particular fascination with water

By around two years of age, an abnormally small head which is flat at the back (microbrachycephaly) will be noticeable in some children with Angelman syndrome. Children with Angelman syndrome may also start to have seizures (fits) around this age.

Other possible features of the syndrome include:

tendency to stick the tongue out

crossed eyes (strabismus)

pale skin, and light-coloured hair and eyes in some children

a wide mouth with widely spaced teeth

a side-to-side curvature of the spine (scoliosis)

walking with arms in the air

Some young babies with Angelman syndrome may have problems feeding because they’re unable to co-ordinate sucking and swallowing. In such cases, a high-calorie formula may be recommended to help the baby gain weight. Babies with Angelman syndrome may need to be treated for reflux.

Causes of Angelman syndrome

In most cases of Angelman syndrome, the child’s parents don’t have the condition and the genetic difference responsible for the syndrome occurs by chance around the time of conception.

The typical characteristics of Angelman syndrome are caused when the Angelman gene, known as UBE3A, is either absent or malfunctions. A gene is a single unit of genetic material (DNA) which acts as an instruction for the way an individual is made and develops.

A child usually inherits one copy of the UBE3A gene from each parent. Both copies are switched on (active) in most of the body’s tissues. However, in certain areas of the brain, only the gene inherited from the mother is active.

In most cases of Angelman syndrome (about 70%), the child’s maternal copy of the UBE3A gene is missing (deleted), which means there’s no active copy of the UBE3A gene in the child’s brain.

In around 11% of cases, the maternal copy of the UBE3A gene is present but altered (mutated).

In a small number of cases, Angelman syndrome occurs when a child inherits two copies of chromosome 15 from the father, rather than inheriting one from each parent. This is known as uniparental disomy.

It can also occur when the copy of the UBE3A gene that comes from the mother behaves like it came from the father. This is known as an “imprinting defect”.

In about 5-10% of cases, the cause of Angelman syndrome is unknown. Most children in these unexplained cases have different conditions involving other genes or chromosomes.

Diagnosing Angelman syndrome

Angelman syndrome may be suspected if a child’s development is delayed and they have the syndrome’s distinctive characteristics (see above).

A blood sample can be taken to confirm the diagnosis. A number of genetic tests will be carried out on the sample. These may include:

chromosome analysis – to see if any parts of the chromosomes are missing (deletions)

fluorescence in situ hybridisation (FISH) – used to check specifically for chromosome 15 deletions when Angelman syndrome is suspected, or to check the mother’s chromosomes

DNA methylation – which shows whether the genetic material on both the mother’s and father’s chromosomes is active

UBE3A gene mutation analysis – used to see if the genetic code on the maternal copy of the UBE3A gene is altered

For each child with Angelman syndrome, it’s important to know the genetic change that caused the condition. This helps to determine whether there’s a risk of it occurring again in another child, or whether there are implications for other members of the family.

Most children with Angelman syndrome are diagnosed between the ages of 18 months and 6 years, when the typical physical and behavioural symptoms become apparent.

If your child is diagnosed with Angelman syndrome, you should be given the opportunity to discuss the genetic diagnosis and implications with a genetic doctor.

Managing Angelman syndrome

Some of the symptoms of Angelman syndrome can be difficult to manage, and you’re likely to need help from a wide range of different healthcare professionals.

Your child may benefit from some of the following treatments and aids:

anti-epileptic medicine to control the seizures – sodium valproate and clonazepam are some of the most commonly prescribed medicines and ketogenic diets have also been used

physiotherapy may help to improve posture, balance and walking ability; it’s also important to prevent permanent stiffening (contractures) of the joints as people with Angelman syndrome get older

a back brace or spinal surgery may be recommended to prevent the spine from becoming more curved (see treating scoliosis)

an ankle or foot orthosis (lower leg brace) may be recommended to help with walking independently

communication therapy may be needed to help them develop non-verbal language skills, such as sign language and using visual aids; using iPad applications and similar tablet devices may also help

behavioural therapy may be recommended to help overcome problem behaviours, hyperactivity and a short attention span

activities such as swimming, horseriding and music therapy have also been reported as being beneficial

Help and support

The Angelman Syndrome Support Education and Research Trust (ASSERT) is a UK based charity providing information and support for parents and carers of people with the syndrome.

As well as visiting the website, you can also call the charity’s helpline on 0300 999 0102 to speak with parents of people with Angelman syndrome, who can offer you help and advice.

Information about your child

If your child has Angelman syndrome, your clinical team will pass information about them on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.

Find out more about the register.

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