The Gale Encyclopedia of Neurological Disorders vol 1 - part 1 pps

The GALE

ENCYCLOPEDIA of

NEurological
Disorders


The GALE

ENCYCLOPEDIA of

NEurological
Disorders
VO L U M E

1
A-L

S TAC E Y L . C H A M B E R L I N , B R I G H A M N A R I N S , E D I TO R S


The Gale Encyclopedia of Neurological Disorders

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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
The Gale encyclopedia of neurological disorders / Stacey L. Chamberlin, Brigham Narins,
editors.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7876-9150-X (set hardcover : alk. paper) — ISBN
0-7876-9151-8 (v. 1) — ISBN
0-7876-9152-6 (v. 2)

1. Neurology—Encyclopedias.
[DNLM: 1. Nervous System Diseases—Encyclopedias—English. 2. Nervous System
Diseases—Popular Works. WL 13 G151 2005] I. Title: Encyclopedia of neurological
disorders. II. Chamberlin, Stacey L. III. Narins, Brigham, 1962– IV. Gale Group.
RC334.G34 2005
616.8'003—dc22

2004021644

This title is also available as an e-book.
ISBN 0-7876-9160-7 (set)
Contact your Gale sales representative for ordering information.
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1


CONTENTS

List of Entries ................................................vii
Introduction ..................................................xiii
Advisory Board..............................................xv
Contributors .................................................xvii
Entries
Volume 1: A–L........................................................1
Volume 2: M–Z...................................................511

Glossary .......................................................941
General Index...............................................973

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

v


LIST OF ENTRIES

SA

Abulia
Acetazolamide
Acupuncture
Acute disseminated encephalomyelitis
Adrenoleukodystrophy
Affective disorders
Agenesis of the corpus callosum
Agnosia
AIDS
Alcohol-related neurological disease
Alexander disease
Alpers’ disease
Alternating hemiplegia
Alzheimer disease
Amantadine
Amnestic disorders
Amyotrophic lateral sclerosis
Anatomical nomenclature
Anencephaly
Aneurysms
Angelman syndrome
Angiography

Anosmia
Anticholinergics
Anticonvulsants
Antiepileptic drugs
Antimigraine medications
Antiparkinson drugs
Antiviral drugs
Anxiolytics
Aphasia
Apraxia
Arachnoid cysts
Arachnoiditis
Arnold-Chiari malformation
Arteriovenous malformations
Aspartame
Asperger’s disorder
Assistive mobile devices
Ataxia-telangiectasia
Ataxia
Atomoxetine
Attention deficit hyperactivity
disorder
Autism
Autonomic dysfunction

SB

Back pain
Bassen-Kornzweig syndrome
Batten disease

Behỗet disease
Bells palsy
Benign positional vertigo
Benzodiazepines
Beriberi
Binswanger disease
Biopsy
Blepharospasm
Bodywork therapies
Botulinum toxin
Botulism
Brachial plexus injuries
Brain anatomy
Brain and spinal tumors
Brown-Séquard syndrome

SC

Canavan disease
Carbamazepine
Carotid endarterectomy
Carotid stenosis
Carpal tunnel syndrome
Catechol-O-methyltransferase
inhibitors
Central cord syndrome
Central nervous system
Central nervous system stimulants
Central pain syndrome
Cerebellum

Cerebral angiitis
Cerebral cavernous malformation
Cerebral circulation
Cerebral dominance
Cerebral hematoma
Cerebral palsy
Channelopathies
Charcot-Marie-Tooth disorder
Cholinergic stimulants
Cholinesterase inhibitors
Chorea

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Chronic inflammatory demyelinating
polyneuropathy
Clinical trials
Congenital myasthenia
Congenital myopathies
Corpus callosotomy
Corticobasal degeneration
Craniosynostosis
Craniotomy
Creutzfeldt-Jakob disease
CT scan
Cushing syndrome
Cytomegalic inclusion body disease

SD

Dandy-Walker syndrome
Deep brain stimulation
Delirium
Dementia
Depression
Dermatomyositis
Devic syndrome
Diabetic neuropathy disease
Diadochokinetic rate
Diazepam
Dichloralphenazone
Dichloralphenazone, Isometheptene,
and Acetaminophen
Diencephalon
Diet and nutrition
Disc herniation
Dizziness
Dopamine receptor agonists
Dysarthria
Dysesthesias
Dysgeusia
Dyskinesia
Dyslexia
Dyspraxia
Dystonia

SE

Electric personal assistive mobility
devices

vii


List of Entries

Electroencephalography
Electromyography
Empty sella syndrome
Encephalitis and Meningitis
Encephalitis lethargica
Encephaloceles
Encephalopathy
Endovascular embolization
Epidural hematoma
Epilepsy
Exercise

SF

Fabry disease
Facial synkinesis
Fainting
Fatigue
Febrile seizures
Felbamate
Fisher syndrome
Foot drop
Fourth nerve palsy
Friedreich ataxia

SG

Gabapentin
Gaucher disease
Gene therapy
Gerstmann-Straussler-Scheinker disease
Gerstmann syndrome
Glossopharyngeal neuralgia
Glucocorticoids
Guillain-Barré syndrome

SH

Hallucination
Headache
Hearing disorders
Hemianopsia
Hemifacial spasm
Hereditary spastic paraplegia
Holoprosencephaly
HTLV-1 Associated Myelopathy
Huntington disease
Hydantoins
Hydranencephaly
Hydrocephalus
Hydromyelia
Hypersomnia
Hypotonia
Hypoxia

SI

Idiopathic neuropathy
viii

Inclusion body myositis
Incontinentia pigmenti
Infantile spasms
Inflammatory myopathy
Interferons

SJ

Joubert syndrome

SK

Kennedy’s disease
Klippel Feil syndrome
Krabbe disease
Kuru

SL

Lambert-Eaton myasthenic syndrome
Laminectomy
Lamotrigine
Learning disorders
Lee Silverman voice treatment

Leigh disease
Lennox-Gastaut syndrome
Lesch-Nyhan syndrome
Leukodystrophy
Levetiracetam
Lewy body dementia
Lidocaine patch
Lissencephaly
Locked-in syndrome
Lupus
Lyme disease

SM

Machado-Joseph disease
Magnetic resonance imaging (MRI)
Megalencephaly
Melodic intonation therapy
Ménière’s disease
Meninges
Mental retardation
Meralgia paresthetica
Metachromatic leukodystrophy
Microcephaly
Mitochondrial myopathies
Modafinil
Moebius syndrome
Monomelic amyotrophy
Motor neuron diseases
Movement disorders

Moyamoya disease
Mucopolysaccharidoses
Multi-infarct dementia
Multifocal motor neuropathy

Multiple sclerosis
Multiple system atrophy
Muscular dystrophy
Myasthenia, congenital
Myasthenia gravis
Myoclonus
Myofibrillar myopathy
Myopathy
Myotonic dystrophy

SN

Narcolepsy
Nerve compression
Nerve conduction study
Neurofibromatosis
Neuroleptic malignant syndrome
Neurologist
Neuromuscular blockers
Neuronal migration disorders
Neuropathologist
Neuropsychological testing
Neuropsychologist
Neurosarcoidosis
Neurotransmitters

Niemann-Pick Disease

SO

Occipital neuralgia
Olivopontocerebellar atrophy
Opsoclonus myoclonus
Organic voice tremor
Orthostatic hypotension
Oxazolindinediones

SP

Pain
Pallidotomy
Pantothenate kinase-associated
neurodegeneration
Paramyotonia congenita
Paraneoplastic syndromes
Parkinson’s disease
Paroxysmal hemicrania
Parsonage-Turner syndrome
Perineural cysts
Periodic paralysis
Peripheral nervous system
Peripheral neuropathy
Periventricular leukomalacia
Phantom limb
Pharmacotherapy
Phenobarbital

Pick disease
Pinched nerve
Piriformis syndrome
Plexopathies
Poliomyelitis

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS


SR

Radiation
Radiculopathy
Ramsay-Hunt syndrome type II
Rasmussen’s encephalitis
Reflex sympathetic dystrophy
Refsum disease
Repetitive motion disorders
Respite
Restless legs syndrome
Rett syndrome
Reye syndrome

SS

Sandhoff disease
Schilder’s disease
Schizencephaly
Schizophrenia
Sciatic neuropathy

Sciatica
Seizures
Septo-optic dysplasia
Shaken baby syndrome
Shingles
Single Proton Emission Computed
Tomography

Sixth nerve palsy
Sjogren-Larsson Syndrome
Sleep apnea
Social workers
Sodium oxybate
Sotos syndrome
Spasticity
Speech synthesizer
Spina bifida
Spinal cord infarction
Spinal cord injury
Spinal muscular atrophy
Spinocerebellar ataxia
Status epilepticus
Stiff person syndrome
Striatonigral degeneration
Stroke
Sturge-Weber syndrome
Stuttering
Subacute sclerosing panencephalitis
Subdural hematoma
Succinamides

Swallowing disorders
Sydenham’s chorea
Syringomyelia

ST

Tabes dorsalis
Tay-Sachs disease
Temporal arteritis
Temporal lobe epilepsy
Tethered spinal cord syndrome
Third nerve palsy
Thoracic outlet syndrome
Thyrotoxic myopathy
Tiagabine
Todd’s paralysis
Topiramate
Tourette syndrome
Transient global amnesia
Transient ischemic attack
Transverse myelitis
Traumatic brain injury

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Tremors
Trigeminal neuralgia
Tropical spastic paraparesis
Tuberous sclerosis

List of Entries

Polymyositis
Pompe disease
Porencephaly
Positron emission tomography (PET)
Post-polio Syndrome
Primary lateral sclerosis
Primidone
Prion diseases
Progressive multifocal
leukoencephalopathy
Progressive supranuclear palsy
Pseudobulbar palsy
Pseudotumor cerebri

SU

Ulnar neuropathy
Ultrasonography

SV

Valproic acid and divalproex
sodium
Vasculitic neuropathy
Vasculitis
Ventilatory assistance devices
Ventricular shunt
Ventricular system

Vertebrobasilar disease
Vestibular schwannoma
Visual disturbances
Vitamin/nutritional deficiency
Von Hippel-Lindau disease

SW

Wallenberg syndrome
West Nile virus infection
Whiplash
Whipple’s Disease
Williams syndrome
Wilson disease

SZ

Zellweger syndrome
Zonisamide

ix


PLEASE READ—IMPORTANT INFORMATION

The Gale Encyclopedia of Neurological Disorders is
a medical reference product designed to inform and educate readers about a wide variety of diseases, syndromes,
drugs, treatments, therapies, and diagnostic equipment.
Thomson Gale believes the product to be comprehensive,
but not necessarily definitive. It is intended to supplement,

not replace, consultation with a physician or other healthcare practitioner. While Thomson Gale has made substantial efforts to provide information that is accurate,

comprehensive, and up-to-date, Thomson Gale makes no
representations or warranties of any kind, including without limitation, warranties of merchantability or fitness for
a particular purpose, nor does it guarantee the accuracy,
comprehensiveness, or timeliness of the information contained in this product. Readers are advised to seek professional diagnosis and treatment for any medical condition,
and to discuss information obtained from this book with
their healthcare providers.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

xi


INTRODUCTION

The Gale Encyclopedia of Neurological Disorders
(GEND) is a one-stop source for medical information that
covers diseases, syndromes, drugs, treatments, therapies,
and diagnostic equipment. It keeps medical jargon to a
minimum, making it easier for the layperson to use. The
Gale Encyclopedia of Neurological Disorders presents authoritative and balanced information and is more comprehensive than single-volume family medical guides.

• Precautions
• Side effects
• Interactions
• Resources
• Key terms
Treatments
• Definition

SCOPE

Almost 400 full-length articles are included in The
Gale Encyclopedia of Neurological Disorders. Articles
follow a standardized format that provides information at
a glance. Rubrics include:
Diseases
• Definition
• Description
• Demographics
• Causes and symptoms
• Diagnosis
• Treatment team
• Treatment
• Recovery and rehabilitation
• Clinical trials
• Prognosis
• Special concerns
• Resources

• Purpose
• Precautions
• Description
• Preparation
• Aftercare
• Risks
• Normal results
• Resources
• Key terms

INCLUSION CRITERIA

A preliminary topic list was compiled from a wide variety of sources, including professional medical guides,
consumer guides, and textbooks and encyclopedias. The
advisory board, made up of seven medical and healthcare
experts, evaluated the topics and made suggestions for inclusion. Final selection of topics to include was made by
the medical advisors in conjunction with Gale editors.

• Key terms
Drugs
• Definition
• Purpose
• Description
• Recommended dosage

ABOUT THE CONTRIBUTORS

The essays were compiled by experienced medical
writers, physicians, nurses, and pharmacists. GEND medical advisors reviewed most of the completed essays to insure that they are appropriate, up-to-date, and medically
accurate.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

xiii


Introduction

HOW TO USE THIS BOOK

The Gale Encyclopedia of Neurological Disorders
has been designed with ready reference in mind:
• Straight alphabetical arrangement allows users to locate information quickly.
• Bold faced terms function as print hyperlinks that point
the reader to full-length entries in the encyclopedia.
• A list of key terms is provided where appropriate to define unfamiliar words or concepts used within the context of the essay.
• Cross-references placed throughout the encyclopedia direct readers to where information on subjects without their
own entries can be found. Cross-references are also used to
assist readers looking for information on diseases that are
now known by other names; for example, there is a cross-

xiv

reference for the rare childhood disease commonly known
as Hallervorden-Spatz disease that points to the entry entitled Pantothenate kinase-associated neurodegeneration.
• A Resources section directs users to sources of further
information, which include books, periodicals, websites,
and organizations.
• A glossary is included to help readers understand unfamiliar terms.
• A comprehensive general index allows users to easily
target detailed aspects of any topic.
GRAPHICS

The Gale Encyclopedia of Neurological Disorders is
enhanced with over 100 images, including photos, tables,
and customized line drawings.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

ADVISORY BOARD
An advisory board made up of prominent individuals from the medical and healthcare communities provided invaluable assistance in the formulation of this encyclopedia. They defined the scope of coverage and reviewed individual entries for accuracy and accessibility; in some cases they contributed entries themselves. We would therefore like to express our great
appreciation to them:

Laurie Barclay, MD
Neurologist and Writer
Tampa, FL

Brenda Wilmoth Lerner, RN
Nurse, Writer, and Editor
London, UK

F. James Grogan, PharmD
Pharmacist, Clinician, Writer,
Editor, and Consultant
Swansea, IL

Yuen T. So, MD, PhD
Associate Professor
Clinical Neurosciences
Stanford University School of
Medicine
Stanford, CA

Joel C. Kahane, PhD
Professor, Director of the
Anatomical Sciences Laboratory
The School of Audiology and
Speech-Language Pathology
The University of Memphis

Memphis, TN

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Roy Sucholeiki, MD
Professor, Director of the
Comprehensive Epilepsy
Program
Department of Neurology
Loyola University Health System
Chicago, IL
Gil I. Wolfe, MD
Associate Professor
Department of Neurology
The University of Texas
Southwestern Medical Center
Dallas, TX

xv


CONTRIBUTORS

Lisa Maria Andres, MS, CGC
Certified Genetic Counselor and
Medical Writer
San Jose, CA
Paul Arthur
Science writer
London, England

Bruno Verbeno Azevedo
Espirito Santo University
Vitória, Brazil
Deepti Babu, MS, CGC
Genetic Counselor
Marshfield Clinic
Marshfield, WI
Laurie Barclay, MD
Neurologist and writer
Tampa, FL
Julia Barrett
Science Writer
Madison, WI

Robert G. Best, PhD
Director
Division of Genetics
University of South Carolina School
of Medicine
Columbia, SC
Michelle Lee Brandt
Medical Writer
San Francisco, CA
Dawn J. Cardeiro, MS, CGC
Genetic Counselor
Fairfield, PA
Francisco de Paula Careta
Espirito Santo University
Vitória, Brazil
Rosalyn Carson-DeWitt,

MD
Physician and Medical Writer
Durham, NC

James Paul Dworkin, PhD
Professor
Department of Otolaryngology,
Voice/Speech Pathology
Program and Laboratory
Wayne State University
Detroit, MI
L. Fleming Fallon, Jr., MD,
DrPH
Professor
Department of Public Health
Bowling Green State University
Bowling Green, OH
Antonio Farina, MD, PhD
Department of Embryology,
Obstetrics, and Gynecology
University of Bologna
Bologna, Italy
Kevin Fitzgerald
Science Writer and Journalist
South Windsor, CT

Stacey L. Chamberlin
Science Writer and Editor
Fairfax, VA

Paula Anne Ford-Martin
Medical Writer
Warwick, RI

Maria Basile, PhD
Medical Writer
Roselle, NJ

Bryan Richard Cobb, PhD
Institute for Molecular and Human
Genetics
Georgetown University
Washington, D.C.

Lisa A. Fratt
Medical Writer
Ashland, WI

Tanja Bekhuis, PhD
Science Writer and
Psychologist
TCB Research
Boalsburg, PA

Adam J. Cohen, MD
Craniofacial Surgery, Eyelid
and Facial Plastic Surgery,
Neuro-Ophthalmology
Downers Grove, IL

Juli M. Berwald, PhD
Geologist (Ocean Sciences)
Chicago, Illinois

Tish Davidson, AM
Medical Writer
Fremont, CA

Danielle Barry, MS
Graduate Assisstant
Center of Alcohol Studies
Rutgers University
Piscataway, NJ

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Rebecca J. Frey, PhD
Freelance Medical Writer
New Haven, CT
Sandra L. Friedrich, MA
Science Writer
Clinical Psychology
Chicago, IL
Sandra Galeotti, MS
Science Writer
Sao Paulo, Brazil
xvii


Contributors

Larry Gilman, PhD
Electrical Engineer and Science
Writer
Sharon, VT
Laith Farid Gulli, MD
Consulting Psychotherapist
Lathrup Village, MI
Stephen John Hage, AAAS,
RT(R), FAHRA
Medical Writer
Chatsworth, CA
Brook Ellen Hall, PhD
Science Writer
Loomis, CA
Dan Harvey
Medical Writer
Wilmington, DE
Hannah M. Hoag, MSc
Science and Medical Writer
Montreal, Canada
Brian Douglas Hoyle, PhD
Microbiologist
Nova Scotia, Canada
Cindy L. Hunter, CGC
Genetic Counselor
Medical Genetics Department
Indiana University School of
Medicine
Indianapolis, IN

Alexander I. Ioffe, PhD
Senior Scientist
Geological Institute of the Russian
Academy of Sciences
Moscow, Russia
Holly Ann Ishmael, MS, CGC
Genetic Counselor
The Children’s Mercy Hospital
Kansas City, MO
Joel C. Kahane, PhD
Professor, Director of the
Anatomical Sciences
Laboratory
The School of Audiology and
Speech-Language Pathology
The University of Memphis
Memphis, TN
xviii

Kelly Karpa, PhD, RPh
Assistant Professor
Department of Pharmacology
Pennsylvania State University
College of Medicine
Hershey, PA
Karen M. Krajewski, MS, CGC
Genetic Counselor, Assistant
Professor of Neurology
Wayne State University
Detroit, MI

Judy Leaver, MA
Behavioral Health Writer and
Consultant
Washington, D.C.
Adrienne Wilmoth Lerner
University of Tennessee College of
Law
Knoxville, TN
Brenda Wilmoth Lerner, RN
Nurse, Writer, and Editor
London, UK
K. Lee Lerner
Fellow (rt)
Science Policy Institute
London, UK
Agnieszka Maria Lichanska,
PhD
Department of Microbiology and
Parasitology
University of Queensland
Brisbane, Australia
Peter T. Lin, MD
Research Assistant
Member: American Academy of
Neurology, American
Association of Electrodiagnostic
Medicine
Department of Biomagnetic
Imaging
University of California, San

Francisco
Foster City, CA
Iuri Drumond Louro, MD,
PhD
Adjunct Professor
Human and Molecular Genetics
Espirito Santo University
Vitória, Brazil

Nicole Mallory, MS, PA-C
Medical Student
Wayne State University
Detroit, MI
Igor Medica, MD, PhD
Assistant Professor
School of Medicine
University of Rijeka
Pula, Croatia
Michael Mooney, MA, CAC
Consultant Psychotherapist
Warren, MI
Alfredo Mori, MD, FACEM,
FFAEM
Emergency Physician
The Alfred Hospital
Victoria, Australia
Oxford’s Program in EvidenceBased Health Care
University of Oxford
Oxford, England
Marcos do Carmo Oyama

Espirito Santo University
Vitória, Brazil
Greiciane Gaburro Paneto
Espirito Santo University
Vitória, Brazil
Borut Peterlin, MD, PhD
Neurologist; Consultant Clinical
Geneticist; Director
Division of Medical Genetics
University Medical Center
Lubiana, Slovenia
Toni I. Pollin, MS, CGC
Research Analyst
Division of Endocrinology,
Diabetes, and Nutrition
University of Maryland School of
Medicine
Baltimore, MD
J. Ricker Polsdorfer, MD
Medical Writer
Phoenix, AZ
Scott J. Polzin, MS, CGC
Medical Writer
Buffalo Grove, IL
Jack Raber, PharmD
Principal
Clinipharm Services
Seal Beach, CA

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Amie Stanley, MS
Genetic Counselor
Medical Genetics
The Cleveland Clinic
Cleveland, OH

Richard Robinson
Medical Writer
Tucson, AZ

Constance K. Stein, PhD
Director of Cytogenetics, Assistant
Director of Molecular
Diagnostics
SUNY Upstate Medical University
Syracuse, NY

Jennifer Ann Roggenbuck, MS,
CGC
Genetic Counselor
Hennepin County Medical Center
Minneapolis, MN
Nancy Ross-Flanigan
Science Writer
Belleville, MI
Stephanie Dionne Sherk
Freelance Medical Writer
University of Michigan

Ann Arbor, MI
Lee Alan Shratter, MD
Consulting Radiologist
Kentfield, CA
Genevieve T. Slomski, PhD
Medical Writer
New Britain, CT

Roger E. Stevenson, MD
Senior Clinical Geneticist, Senior
Clinical Laboratory Geneticist
Greenwood Genetic Center
Greenwood, SC
Roy Sucholeiki, MD
Professor, Director of the
Comprehensive Epilepsy
Program
Department of Neurology
Loyola University Health System
Chicago, IL
Kevin M. Sweet, MS, CGC
Cancer Genetic Counselor
James Cancer Hospital, Ohio State
University
Columbus, OH

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

David Tulloch
Science Writer

Wellington, New Zealand

Contributors

Robert Ramirez, DO
Medical Student
University of Medicine and
Dentistry of New Jersey
Stratford, NJ

Carol A. Turkington
Medical Writer
Lancaster, PA
Samuel D. Uretsky, PharmD
Medical Writer
Wantagh, NY
Chitra Venkatasubramanian,
MBBS, MD (internal
medicine)
Resident in Neurology
Department of Neurology and
Neurosciences
Stanford University
Stanford, CA.
Bruno Marcos Verbeno
Espirito Santo University
Vitória, Brazil
Beatriz Alves Vianna
Espirito Santo University
Vitória, Brazil

xix


A
Abetalipoproteinemia see BassenKornzweig syndrome

Key Terms
Basal ganglia A group of brain structures that are
responsible for movement.

S Abulia
Definition
Abulia is a state in which an individual seems to have
lost will or motivation.

Dopamine A brain chemical (neurotransmitter)
responsible for carrying messages throughout the
nervous system, particularly messages regarding
movement.
Frontal lobe The area of the brain responsible for
higher thinking.

Description
Abulia is not a separate condition; rather, it is a symptom associated with various forms of brain injury. It may
occur in association with a variety of conditions, including
stroke, brain tumor, traumatic brain damage, bleeding into
the brain, and exposure to toxic substances.

Causes and symptoms

Some research suggests that abulia occurs due to malfunction of the brain’s dopamine-dependent circuitry. Injuries to the frontal lobe (the area of the brain responsible
for higher thinking) and/or the basal ganglia (the area of
the brain responsible for movement) can interfere with an
individual’s ability to initiate speech, movement, and social interaction. Abulia has been noted in patients who have
suffered brain injuries due to stroke, bleeding into the brain
from a ruptured aneurysm, trauma, brain tumor, neurological disease (such as Parkinson’s disease), psychiatric
condition (such as severe depression or schizophrenia),
and exposure to toxic substances (such as cyclosporin-A).
An individual with abulia may not appear to have
much will or motivation to pursue activities or initiate
conversation. Such an individual may appear apathetic,
disinterested, asocial, quiet or mute, physically slowed or
still (hypokinetic), and emotionally remote.

Diagnosis
Abulia is not an individual diagnosis; it is a symptom
that usually occurs as part of a constellation of symptoms
accompanying a specific disorder. Diagnosis of the underlying disorder depends on the kinds of symptoms that
co-exist with abulia. Psychiatric interview, magnetic resonance imaging (MRI), ultrasound, or computed tomography (CT) imaging of the brain, EEG, blood tests, and
neurological testing may all be used to diagnose an underlying condition.

Treatment team
Treatment of abulia is usually part of a program of
general rehabilitation for the symptoms accompanying the
underlying condition. A neurologist or psychiatrist may
lead a treatment team. Other professionals that may be involved include physical therapists, occupational therapists,
recreational therapists, and speech and language therapists.

Treatment
There are no specific treatments for abulia. The underlying condition should be treated such as administering

antidepressants or electroconvulsive therapy to depressed
patients or antipsychotic medications to schizophrenic patients. Patients who have suffered brain injury due to

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

1


Acetazolamide

stroke, bleeding, or trauma will benefit from rehabilitation
programs that provide stimulation and attempt to re-teach
skills.
Research has looked at the possibility of treating abulia with medications that boost the activity of dopamine
throughout the brain, but this is far from becoming a standard treatment.

Prognosis
The prognosis of abulia depends on the prognosis of
the underlying condition.
Resources

Purpose
Acetazolamide is used to treat a number of disorders,
including the control of epileptic seizures in those individuals who suffer epilepsy.
Acetazolamide is also used to treat non-neurological
disorders such as glaucoma (acetazolamide decreases
pressure in the eye), and to reduce the symptoms of edema
(an excess storage of water by the body that leads to localized swelling or puffiness) and altitude sickness.

Description

BOOKS

Friedman, Joseph H. “Mood, Emotion, and Thought.” In
Textbook of Clinical Neurology, edited by Christopher G.
Goetz. Philadelphia: W. B. Saunders Company, 2003.
PERIODICALS

Al-Adawi, Samir. “Abulia: The Pathology of ‘Will’ and
Dopaminergic Dysfunction in Brain-Injured Patients.”
Medical Sciences 1 (1999): 27–40.
Nishie, M. “Posterior Encephalopathy Subsequent to
Cyclosporin A Presenting as Irreversible Abulia.” Internal
Medicine 42, no. 8 (1 August 2003): 750–755.
Pantoni, L. “Abulia and Cognitive Impairment in Two Patients
with Capsular Genu Infarct.” Acta Neurologica
Scandinavia 104, no. 3 (1 September 2001): 185–190.
Vijayaraghavan. “Abulia: A Delphi Survey of British
Neurologists and Psychiatrists.” Movement Disorders 17,
no. 5 (September 2002): 1052–1057.

Rosalyn Carson-DeWitt, MD

Acanthocytosis see Bassen-Kornzweig
syndrome

Acetazolamide is prescription medication and is
available only with a licensed physician’s prescription. Acetazolamide is available in oral form in extended release
capsules and tablets. Acetazolamide can also be administered by injection.

Recommended dosage
For both adults and children the recommended
dosage for use in epilepsy cases is based upon actual body
weight. In all cases, the exact dosage is determined by an
experienced physician and/or pharmacist. In the most
common cases, the normal recommended dosage is 4.5
mg per pound of body weight (10 mg per kg of body
weight) and is administered in multiple (divided) doses delivered in the form of tablets or capsules.
Doses must be taken on a regular schedule but individuals should not double dose to make up for a missed
dose.
When used to control anticonvulsive seizures, acetazolamide doses should not be stopped all at once. In most
cases, physicians usually curtail (gradually lower) the dose
an individual takes over time.

Precautions

S Acetazolamide
Definition
Acetazolamide (a-set-a-ZOLE-a-mide) is a carbonic
anhydrase inhibitor. Carbonic anhydrase is an enzyme that
shifts the rate of reaction to favor the conversion of carbon
dioxide and water into carbonic acid, bicarbonate ions, and
free protons. Carbonic anhydrase activity is key to the regulation of pH and fluid balance in many different reactions
throughout the body.
Fluid buildup can alter the shape of the eye and cause
pressure on the optic nerve. Clinically, this condition is described as glaucoma. Inhibition of the enzymatic work of
carbonic anhydrase activity (e.g., through the action of a
2

carbonic anhydrase inhibitor) can lower fluid pressure in

the eye.

As with most prescription medicines, acetazolamide
should stored in a safe place—away from the reach of children. Acetazolamide should also be stored in a dry area
away from excessive heat or light. Outdated medicine
(medicines past their expiration date) should be discarded
in a container that is safe from the reach of children.
Women who are pregnant, plan to become pregnant,
or who are breast-feeding infants should inform their
physician of this fact before taking acetazolamide.

Side effects
Unwanted side effects while taking acetazolamide include drowsiness, fatigue, or a dizzy lightheaded feeling.
Individuals who experience these side effects should not

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS


Key Terms
Carbonic anhydrase An enzyme that shifts the
rate of reaction to favor the conversion of carbon
dioxide and water into carbonic acid, bicarbonate
ions, and free protons.

Medline Plus. U.S. National Library of Medicine and the
National Institutes of Health. < />medlineplus/druginfo/uspdi/202114.html> (May 9, 2004).
ORGANIZATIONS

National Eye Institute. 2020 Vision Place, Bethesda, MD
20892-3655. (301) 496-5248. < />

Optic nerve The bundle of nerve fibers that carry
visual messages from the retina to the brain.

Paul Arthur

S Acupuncture

operate machinery or drive while experiencing these
symptoms. Other common side effects include shortness
of breath.
Acetazolamide can also lead to excessive depletion
(loss) of potassium from the body. To counter this potential loss, many physicians recommend that patients eat
food or drink beverages such as orange juice to replace
lost potassium. The loss of potassium does not occur in
every case, however, and high levels of potassium can also
be dangerous. Individuals who show signs of potassium
loss—including, but not limited to, dryness of mouth, increased thirst, or muscle cramps—should alert their physician. Because diet can impact a number of health factors,
individuals should only alter their diet after consulting
their physician.
Individuals who are diabetic and who take acetazolamide may experience elevated sugar levels in their urine
and blood.
Individuals who experience changes in their vision
should also consult their physician.
In some rare cases, individuals may suffer depression, pains in the area of the kidneys, and bloody or black
tarry stools.

Interactions
Physicians and pharmacists are trained to evaluate the
potential for adverse interactions by prescription drugs with
other drugs. In the case of acetazolamide physicians evaluate potential adverse reactions with a range of drugs that

include—but are not limited to—amphetamines, over-thecounter aspirins, cyclosporine, mood altering drugs (e.g.,
lithium), drugs used to control mental depression, drugs
used to control irregular heartbeats, digoxin, diuretics (also
known as water pills), and vitamins.
Resources
PERIODICALS

Varadkar S., J. S. Duncan, and H. Cross. “Acetazolamide and
Autosomal Dominant Nocturnal Frontal Lobe Epilepsy.”
Epilepsia 44 (July 2003): 986.

Definition
Acupuncture, one of the main forms of therapy in traditional Chinese medicine (TCM), has been practiced for
at least 2,500 years. In acupuncture, certain points on the
body are stimulated by the insertion of fine needles. Unlike
the hollow hypodermic needles used in mainstream medicine to give injections or to draw blood, acupuncture needles are solid. The points can be needled between 15° and
90° relative to the skin’s surface, depending on treatment.
Acupuncture is thought to restore health by removing
energy imbalances and blockages in the body. Practitioners of TCM believe that there is a vital force or energy
called qi (pronounced “chee”) that flows through the body
and between the skin surface and the internal organs, along
channels or pathways called meridians. There are 12 major
and eight minor meridians. Qi regulates the spiritual, emotional, mental, and physical harmony of the body by keeping the forces of yin and yang in balance. Yang is a
principle of heat, activity, brightness, outwardness, while
yin represents coldness, passivity, darkness, interiority, etc.
TCM does not try to eliminate either yin or yang, but rather
keep them in harmonious balance. Acupuncture may be
used to raise or lower the level of yin or yang in a specific
part of the body in order to restore the energy balance.
Acupuncture was virtually unknown in the United

States prior to President Richard Nixon’s trip to China in
1972. A reporter for the New York Times named James Reston wrote a story for the newspaper about the doctors in
Beijing who used acupuncture to relieve his pain following abdominal surgery. By 1993, Americans were making
12 million visits per year to acupuncturists, and spending
$500 million annually on acupuncture treatments. By
1995, there were an estimated 10,000 certified acupuncturists practicing in the United States; as of 2000, there
were 20,000. About a third of the credentialed acupuncturists in the United States as of 2002 are MDs.
Acupuncture’s record of success has stimulated a
number of research projects investigating its mechanisms

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

3

Acupuncture

OTHER


Acupuncture

Key Terms
Cardiac tamponade A condition in which blood
leaking into the membrane surrounding the heart puts
pressure on the heart muscle, preventing complete
filling of the heart’s chambers and normal heartbeat.

dried wormwood leaves, close to the skin to relieve
pain. When used with acupuncture, the cone is
placed on top of the needle at an acupuncture point

and burned.

Electroacupuncture A variation of acupuncture in
which the practitioner stimulates the traditional
acupuncture points electronically.

Neurotransmitter A chemical in the brain that
transmits messages between neurons, or nerve cells.

Endorphins A group of peptide compounds released by the body in response to stress or traumatic
injury. Endorphins react with opiate receptors in the
brain to reduce or relieve pain.

Opioids Substances that reduce pain and may induce sleep. Some opioids are endogenous, which
means that they are produced within the human
body. Other opioids are produced by plants or formulated synthetically in the laboratory.

Hyperemesis gravidarum Uncontrollable nausea
and vomiting associated with pregnancy. Acupuncture appears to be an effective treatment for women
with this condition.

Pneumothorax A condition in which air or gas is
present in the chest cavity.

Meridians In traditional Chinese medicine, a network
of pathways or channels that convey qi (also sometimes
spelled “ki”), or vital energy, through the body.
Moxibustion A technique in traditional Chinese
medicine that involves burning a “Moxa,” or cone of

as well as its efficacy. Research has been funded not only
by the National Center for Complementary and Alternative
Medicine (NCCAM), but also by the National Institute on
Alcohol Abuse and Alcoholism (NIAAA), the National
Institute of Dental Research, the National Institute of Neurological Disorders and Stroke (NINDS), and the National
Institute on Drug Abuse. In 1997, a consensus panel of the
National Institutes of Health (NIH) presented a report in
which it described acupuncture as a sufficiently promising
form of treatment to merit further study. In 2000, the
British Medical Association (BMA) recommended that
acupuncture should be made more readily available
through the National Health Service (NHS), and that family doctors should be trained in some of its techniques.

Yin and yang In traditional Chinese medicine and
philosophy, a pair of opposing forces whose harmonious balance in the body is necessary to good
health.

used to treat a variety of disorders such as asthma, infertility, depression, anxiety, HIV infection, and fibromyalgia, although its efficacy in relieving these disorders is
largely unproven. Acupuncture should not be used to treat
traumatic injuries and other emergency conditions requiring immediate surgery. Also, while it appears to have benefits in relieving symptoms such as pain under the proper
circumstances, it has not been shown to alter the underlying course of a disease.
The exact mechanism by which acupuncture works is
not known. Studies have demonstrated a variety of physiologic effects such as release in the brain of various chemicals and hormones, alteration of immune function, blood
pressure, and body temperature.

Precautions

Purpose
The purpose of acupuncture in TCM is the rebalancing of opposing energy forces in different parts of the
body. In Western terms, acupuncture is used most commonly as an adjunctive treatment for the relief of chronic

or acute pain. In the United States, acupuncture is most
widely used to treat pain associated with musculoskeletal
disorders, but it has also been used in the treatment of
headaches, other painful disorders, and nausea and vomiting. In addition to these disorders, acupuncture has been
4

Qi The Chinese term for energy, life force, or vital
force.

The risk of infection in acupuncture is minimal if the
acupuncturist uses sterile disposable needles. In the United
States, the Food and Drug Administration (FDA) mandates the use of sterilized needles made from nontoxic materials. The needles must be clearly labeled as having their
use restricted to qualified practitioners.
Patients should also inquire about the practitioner’s
credentials. People who would prefer to be treated by an
MD or an osteopath can obtain a list of licensed physicians

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS


Acupuncture

BL

ST
LI

GV
CV
SI

KI

LU

HE

PE

TW

BL

GB
SP

LV

Traditional Chinese medicine teachings state that channels of energy flow throughout the body, and that disease is caused
by too much or too little flow of energy along these channels. Points along the channels, called meridians, are manipulated
in acupuncture. In the illustration, points are shown on the bladder (BL), conception vessel (CV), gallbladder (GB), governing vessel (GV), heart (HE), kidney (KI), large intestine (LI), liver (LV), lung (LU), pericardium (PE), small intestine (SI), spleen
(SP), stomach (ST), and triple warmer (TW) meridians. (Illustration by Electronic Illustrators Group.)

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

5


Acupuncture

Governor vessel
Bladder meridian
Triple burner meridian
Conception vessel
Stomach meridian
Large intestine meridian
Small intestine meridian
Gallbladder meridian

Acupuncture sites and meridians on the face and neck. (Illustration by Hans & Cassady, Inc.)

who practice acupuncture in their area from the American
Academy of Medical Acupuncture. With regard to nonphysician acupuncturists, 31 states have established training standards that acupuncturists must meet in order to be
licensed in those states. In Great Britain, practitioners
must qualify by passing a course offered by the British
Acupuncture Accreditation Board.
People seeking acupuncture treatment should provide
the practitioner with the same information about their
health conditions and other forms of treatment that they
would give their primary care doctor.
As is true with other forms of medical treatment, a
minority of patients do not respond to acupuncture. The
reasons for nonresponsiveness are not known at the present stage of research.

Description
In traditional Chinese practice, the needles are twirled
or rotated as they are inserted. Many patients feel nothing
at all during this procedure, while others experience a
prickling or aching sensation, and still others a feeling of
warmth or heaviness.

6

The practitioner may combine acupuncture with moxibustion to increase the effectiveness of the treatment.
Moxibustion is a technique in which the acupuncturist
lights a small piece of wormwood, called a moxa, above
the acupuncture point above the skin. When the patient begins to feel the warmth from the burning herb, it is removed. Cupping is another technique that is a method of
stimulation of acupuncture points by applying suction
through a metal, wood, or glass jar, and in which a partial
vacuum has been created. Cupping produces blood congestion at the site, and the site is thus stimulated.
In addition to the traditional Chinese techniques of
acupuncture, the following are also used in the United
States:
• Electroacupuncture. In this form of acupuncture, the traditional acupuncture points are stimulated by an electronic device instead of a needle.
• Japanese meridian acupuncture. Japanese acupuncture
uses thinner, smaller needles, and focuses on the meridians rather than on specific points along their course.
• Korean hand acupuncture. Traditional Korean medicine
regards the hand as a “map” of the entire body, such that

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS


• Western medical acupuncture. Western physicians
trained in this style of acupuncture insert needles into socalled trigger points in sore muscles, as well as into the
traditional points used in Chinese medicine.
• Ear acupuncture. This technique regards the ear as having acupuncture points that correspond to other parts of
the body. Ear acupuncture is often used to treat substance
abuse and chronic pain syndromes.
A standard acupuncture treatment takes between 45
minutes to an hour and costs between $40 and $100, although initial appointments often cost more. Chronic conditions usually require 10 treatment sessions, but acute

conditions or minor illnesses may require only one or two
visits. Follow-up visits are often scheduled for patients
with chronic pain. As of 2000, about 70–80% of health insurers in the United States reimbursed patients for
acupuncture treatments.

Preparation
Apart from a medical history and physical examination, no specific preparation is required for an acupuncture
treatment. In addition to using sterile needles, licensed
acupuncturists will wipe the skin over each acupuncture
point with an antiseptic solution before inserting the needle.

Aftercare
No particular aftercare is required, as the needles
should not draw blood when properly inserted. Many patients experience a feeling of relaxation or even a pleasant
drowsiness after the treatment. Some patients report feeling energized.

Resources

Acupuncture

any part of the body can be treated by stimulating the
corresponding point on the hand.

BOOKS

Pelletier, Kenneth R., MD. “Acupuncture: From the
Yellow Emperor to Magnetic Resonance Imaging
(MRI).” Chapter 5 in The Best Alternative
Medicine. New York: Simon and Schuster,
2002.

Reid, Daniel P. Chinese Herbal Medicine. Boston, MA:
Shambhala, 1993.
Svoboda, Robert, and Arnie Lade. Tao and Dharma: Chinese
Medicine and Ayurveda. Twin Lakes, WI: Lotus Press,
1995.
PERIODICALS

Cerrato, Paul L. “New Studies on Acupuncture and
Emesis (Acupuncture for Relief of Nausea
and Vomiting Caused by Chemotherapy).” Contemporary
OB/GYN 46 (April 2001):
749.
Kemper, Kathi J., et al. “On Pins and Needles—Pediatric Pain:
Patients’ Experience with Acupuncture.” Pediatrics 105
(April 2000): 620–633.
Kirchgatterer, Andreas. “Cardiac Tamponade Following
Acupuncture.” Chest 117 (May 2000):
1510–1511.
Nwabudike, Lawrence C., and Constantin IonescuTirgoviste. “Acupuncture in the Treatment of
Diabetic Peripheral Neuropathy.” Diabetes 49
(May 2000): 628.
Silvert, Mark. “Acupuncture Wins BMA Approval (British
Medical Association).” British Medical Journal 321 (July
1, 2000): 637–639.
Vickers, Andrew. “Acupuncture (ABC of Complementary
Medicine).” British Medical Journal 319 (October 9,
1999): 704–708.
ORGANIZATIONS

Risks

Most complications from acupuncture fall into one of
three categories: infections, most often from improperly
sterilized needles; bruising or minor soft tissue injury; and
injuries to muscle tissue. Rarely, serious side effects from
improper application of the needle may result in pneumothorax and cardiac tamponade.

Normal results
Normal results from acupuncture are relief of pain
and/or improvement of the condition being treated.

Abnormal results

American Academy of Medical Acupuncture/Medical
Acupuncture Research Organization. 5820 Wilshire
Boulevard, Suite 500, Los Angeles, CA 90036.
(800) 521-2262 or (323) 937-5514; Fax: (323)
937-0959. (May 9, 2004.) acupuncture.org>.
American Association of Oriental Medicine. 433 Front
Street, Catasaqua, PA 18032. (610) 266-1433;
Fax: (610) 264-2768. (May 9, 2004.) org>.
National Center for Complementary and Alternative Medicine
(NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg,
MD 20898. (888) 644-6226; TTY: (866) 464-3615; Fax:
(866) 464-3616. (May 9, 2004.) nih.gov>.

Abnormal results from acupuncture include infection,
a severe side effect, or worsening of the condition being

treated.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

Rebecca Frey, PhD
Rosalyn Carson-DeWitt, MD

7


Acute disseminated encephalomyelitis

S Acute disseminated

Key Terms

encephalomyelitis

Definition
Acute disseminated encephalomyelitis (ADE) is a
neurological disorder involving inflammation of the brain
and spinal cord. A hallmark of the disorder is damage to
the myelin sheath that surrounds the nerve fibers in the
brain, which results in the inflammation.

Description
Acute disseminating encephalomyelitis was first described in the mid-eighteenth century. The English physician who first described the disorder noted its association
with people who had recently recovered from smallpox.
Symptoms often develop without warning. As well, mental disorientation can occur. The disorder is also known as
postinfectious encephalomyelitis and immune-mediated

encephalomyelitis. The nerve demyelination that occurs in
ADE also occurs in multiple sclerosis. However, the two
maladies differ in that multiple sclerosis is long lasting and
can recur over time, while ADE has a monophasic course,
meaning that once it is over, further attacks rarely occur.

Encephalitis Inflammation of the brain, usually
caused by a virus. The inflammation may interfere
with normal brain function and cause seizures,
sleepiness, confusion, personality changes, weakness in one or more parts of the body, and even
coma.
Myelin A fatty sheath surrounding nerves throughout the body that helps them conduct impulses
more quickly.

of symptoms to coma and death in only a few days. Brain
damage is largely confined to the white matter. Microscopic examination will typically reveal invasion of white
blood cells into small veins. The nerve myelin damage occurs in the regions where the white blood cells accumulate. Examination of the brains of patients who have died
of the disorder has not yielded consistent results. Some
brains appear normal, while others display the nerve damage and white blood cell congestion.

Demographics
ADE can occur in both children and adults, although
it occurs more commonly in children. ADE is not rare, accounting for approximately 30% of all cases of encephalitis (brain inflammation).

Causes and symptoms
Acute disseminating encephalomyelitis can occur as a
consequence of a bacterial or viral infection (including
HIV), following recovery from infection with the malarial
protozoan, or as a side effect of vaccination or another inoculation. ADE is usually a consequence of a viral illness,
and occurs most often after measles, followed by rubella,

chicken pox, Epstein-Barr, mumps and pertussis (whooping cough). Typically, symptoms appear two to three weeks
after the precipitating infection or immunization. Alternatively, ADE may develop with no known associations.
Despite the different causes, the symptoms that develop are similar. A number of non-specific symptoms,
which vary from one person to another, include
headache, stiff neck, fever, vomiting, and weight loss.
These symptoms are quickly followed by lethargic behavior, seizures, hallucinations, sight difficulties, and
even coma. Paralysis can occur in an arm or leg (monoparesis) or along an entire side of the body (hemiplegia).
These symptoms can last a few weeks to a month. In
some people, symptoms can progress from the appearance

8

Diagnosis
Diagnosis is made based on the above symptoms and
the patient’s medical history (i.e., recent infection or vaccination). In the early stages of the disorder, diagnosis can
be confused with diseases including acute meningitis,
acute viral encephalitis, and multiple sclerosis. Often, the
latter can be ruled out using magnetic resonance imaging (MRI) and examination of the cerebrospinal fluid
(CSF). Typically, in acute disseminating encephalomyelitis, CSF contains abnormally elevated levels
of white blood cells and protein; and magnetic resonance
imaging can reveal brain alterations.

Treatment team
The treatment team typically consists of a primary
care physician and, when hospitalization is necessary,
nurses and specialized medical care personnel.

Treatment
Corticosteroid medication is often prescribed in
order to lessen the nerve inflammation. Use of high doses

of steroids can often produce a rapid diminishing of the
symptoms. Other kinds of treatment depend on the nature
of the symptoms that develop. Supportive care includes
keeping a patient comfortable and hydrated.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS


Persons recovering from acute disseminated encephalomyelitis need time to recover their normal consciousness and movements. Problems with memory,
especially short-term memory, may be present. The recovering person sometimes has trouble controlling their
emotions and is easily frustrated. Frequent periods of rest,
alternating with shorter periods of mental and physical exercise are prescribed during initial recovery. The maximum possible recovery of brain and motor function may
take a period of weeks or months.

Clinical trials
There are no clinical trials for the study of ADE recruiting patients or being planned in the United States, as
of January 2004. However, organizations such as the National Institute for Neurological Disorders and Stroke undertake and fund studies on disorders that involve damage
to the myelin sheath of nerve cells. By understanding the
nature of the disorders, it is hoped that detection can be
improved and strategies will evolve to prevent or reverse
the nerve damage.

Prognosis
Prognosis varies from person to person. Some patients
may recover fully, with no residual effects. Others may
have some residual damage. Seldomly, ADE is fatal. Early
detection and treatment improves a patient’s outlook.

Special concerns
Although the incidence of ADE occurring after vaccination is rare, in recent years, public debate has led some

parents to choose that their children not receive the recommended childhood vaccinations. The American Academy of Pediatrics asserts that, despite concerns about
vaccine safety, vaccination is far safer than accepting the
risks for the diseases that the vaccines prevent.
Resources
BOOKS

Icon Health Publications. The Official Patient’s Sourcebook on
Acute Disseminated Encephalomyelitis: A Revised and
Updated Directory for the Internet Age. San Diego: Icon
Group International, 2002.
PERIODICALS

Anlar, B., C. Basaran, G. Kose, A. Guven, S. Haspolat,
A. Yakut, A. Serdaroglu, N. Senbil, H. Tan, E.
Karaagaoglu, and K. Oguz. “Acute disseminated
encephalomyelitis in children: outcome and prognosis.”
Neuropediatrics (August 2003): 194–199.
Brass, S. D., Z. Caramanos, C. Santos, M. E. Dilenge,
Y. Lapierre, and B. Rosenblatt. “Multiple sclerosis vs

acute disseminated encephalomyelitis in childhood.”
Pediatric Neurology (September 2003): 227–231.
Koibuchi, T., T. Nakamura, T. Miura, T. Endo, H. Nakamura,
T. Takahashi, H. S. Kim, Y. Wataya, K. Washizaki,
K. Yoshikawa, and A. Iwamoto. “Acute disseminated
encephalomyelitis following Plasmodium vivax malaria.”
Journal of Infection and Chemotherapy (September
2003): 254–256.
Narciso, P., S. Galgani, B. Del Grosso, M. De Marco, A.
De Santis, P. Balestra, V. Ciapparoni, and V. Tozzi. “Acute

disseminated encephalomyelitis as manifestation of primary HIV infection.” Neurology (November 2001):
1493–1496.
OTHER

“Acute Disseminated Encephalomyelitis Information Page.”
National Institute of Neurological Disorders and Stroke.
< />disorders/acute_encephalomyelitis_doc.htm> (January
26, 2004).
ORGANIZATIONS

National Institute for Neurological Diseases and Stroke
(NINDS). 6001 Executive Boulevard, Bethesda, MD
20892. (301) 496-5751 or (800) 352-9424.
<>.
National Organization for Rare Disorders. 55 Kenosia Avenue,
Danbury, CT 06813-1968. (203) 744-0100 or (800) 9996673; Fax: (203) 798-2291.
<>.

Brian Douglas Hoyle, PhD

ADHD see Attention deficit hyperactivity
disorder

S Adrenoleukodystrophy
Definition
Adrenoleukodystrophy (ALD) is a progressive condition that affects both the adrenal glands (located atop the
kidneys and responsible for the production of adrenalin)
and myelin (the substance that insulates the nerves in the
brain, spinal cord, and the limbs).

Description
First described in the early 1900s, adrenoleukodystrophy was originally called Schilder-Addision disease.
“Adreno” refers to the adrenal glands, “leuko” is the Greek
word for white (myelin is the main component of the
white matter in the brain and spinal cord), and “dystrophy”
means impaired growth. This disease affects the adrenal
glands and the growth of the myelin.

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS

9

Adrenoleukodystrophy

Recovery and rehabilitation


Adrenoleukodystrophy

Key Terms
Adrenal insufficiency Problems with the adrenal
glands that can be life threatening if not treated.
Symptoms include sluggishness, weakness, weight
loss, vomiting, darkening of the skin, and mental
changes.
Central nervous system (CNS) The CNS is composed of the brain, the cranial nerves, and the
spinal cord. It is responsible for the coordination
and control of all body activities.
Leukodystrophy A disease that affects the white
matter called myelin in the CNS.

Myelin A fatty sheath surrounding nerves in the
peripheral nervous system that helps them conduct
impulses more quickly.
Peroxisomes Tiny structures in the cells that
break down fats so that the body can use them.
Very long chain fatty acid (VLCFA) A type of fat
that is normally broken down by the peroxisomes
into other fats that can be used by the body.

Types of ALD
There are three types of ALD, each with a different
severity of symptoms and age of onset of ALD. All varying degrees of severity have been seen within the same
family. Therefore, a family who has many mildly affected
members could still have a more severely affected member. Some patients do not fall neatly into one of the three
categories, and instead fall somewhere in between. Each
type is given a different name, although all have mutations
(changes in the genetic code) in the same gene and the
same type of inheritance.
The most severe form of ALD is called childhood
ALD. About 35% of people with ALD have this type.
These children usually have normal development in the
first few years of life. Symptoms typically begin between
four and eight years of age. Very rarely is the onset before
the age of three or after the age of 15. In some boys, the
first symptom may be seizures. Other children become
hyperactive and have behavioral problems that may initially be diagnosed as attention deficit/hyperactivity
disorder (ADHD). Early signs may also include poor
school performance due to impaired vision that is not correctable by eyeglasses. Although these symptoms may last
for a few months, other more severe problems develop.
These include increasing problems with schoolwork and

deterioration in handwriting and speech. Affected children
usually develop clumsiness, difficulty in reading and comprehension of written material, aggressive or uninhibited
10

behavior, and various personality and behavioral changes.
Most affected boys have problems with their adrenal
glands by the time their first symptoms are noticed.
A milder form of ALD, called adrenomyeloneuropathy (AMN), usually has a symptom onset at the age of 20
or later. Approximately 40–45% of people with ALD have
AMN. The first symptoms are typically a progressive stiffness and weakness in the legs. Problems with urination
and sexual function may also develop. Symptoms slowly
progress over many years. Less than 20% of men with
AMN will develop significant brain involvement that leads
to cognitive and behavioral problems that are severe and
may cause a shortened lifespan. About 70% of men with
AMN will have problems with their adrenal glands when
other symptoms are initially noticed.
A third type of ALD is called Addison disease and affects about 10% of all of those with ALD. In this condition, people do not have the neurologic symptoms
associated with ALD and AMN, but they do have problems resulting from adrenal insufficiency. Symptoms typically begin between two years of age and adulthood. The
first symptoms are often vomiting, weakness, or coma.
People with Addision disease may or may not have darker
skin. Many who are initially diagnosed with Addison disease will later develop symptoms of AMN.
In female carriers of ADL, about 20% will develop
mild to moderate progressive stiffness and weakness in the
legs and sometimes problems with urination. Rarely do
they develop adrenal insufficiency. Symptoms in women
generally do not begin before middle age.

Demographics
ALD is found in all ethnic groups. About one in every

100,000 people suffers from ALD. Because the most severe form, called classic ALD, is X-linked, many more
males than females are affected. Women are carriers of this
X-linked form of the disease and may exhibit no or only
mild symptoms. Another form of the disease is called
neonatal ALD; this form of ALD is not X-linked and
therefore both male and female babies exhibit symptoms.
An adult-onset type of the disease is commonly called
adrenomyeloneuropathy.

Causes and symptoms
ALD causes problems in the peroxisomes, tiny cellular structures that are involved in breaking down large
molecules of fats into smaller ones that can be used by the
body. In ALD, the peroxisomes cannot break down a type
of fat called very long chain fatty acid (VLCFA). As a result, VLCFAs accumulate throughout the body, particularly in the brain and adrenal glands. This accumulation
interferes with the adrenal glands’ conversion of cholesterol into steroids, and prompts deterioration of the myelin

GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS