Neuropharmacology

Synthesis of Acetylcholine

-Acetylcholine synthesis is the rate limiting step

-Choline is the rate limiting factor in the synthesis of acetylcholine

-Inactivation occurs by degradation, then reuptake

Muscarinic ACh Receptors

-Antagonists: Atropine. Symptoms: Dry as a stone, red as a beat, mad as a hatter, Constipation, tachycardia, fever, mydriasis etc.

-Trihexiphenidyl is M1 blocker used in PD for tremor

    Ipratropium is M3 blockers used in asthma/COPD

-Agonists: Bethanecol, carbachol etc. Rarely used in ileus, atonic bladder.

Click here to Read More

Surgical Neuropathology

Click here to view Slideshow

Important questions

-Age

-Location

-Clinical presentation

-Imaging

-Is this a new or recurrent lesion?

-Systemic infection or illness?

-Prior surgery, chemotherapy, and radiation?

-Has the patient been treated by steroid?

Neuropathology-Metabolic disorders

Click here to view Slideshow

Leukodystrophy

--Definition: 

It can manifests as leukoencephalomyelopathy, leukoencephalopathy, and leukomyelopathy.

Defective formation and maintenance of myelin. The white matter but not the gray matter is affected.

Leukodystrophies usually occur as hereditary diseases in infants and children. 

Some milder forms can have initial presentation can occur in adults.

--Etiology:

Storage disorder: peroxisomal and lysosomal, e.g., X-linked adrenoleukodystrophy, Krabbe disease.

Myelin formation: e.g., Pelizaeus-Merzbacher disease.

Others: e.g., Alexander’s disease, ataxia with vitamin E deficiency, subacute combined degeneration.

AED--Guide lines

Click here to view Slideshow

What is a seizure?

John Hughlings Jackson (North Yorkshire 1835 – London 1911)

Studying his wife (who had ‘Jacksonian’ seizures), he stated: 

“I have for more than ten years, and before the experiments of Hitzig and Ferrier were made, held that convolutions of the brain contain nervous arrangements representing movements. It is in accordance with this belief that I have long considered chorea, and more lately convulsion, to be movements resulting from 'discharges' of the cerebral cortex.” This results in “an occasional, an excessive and a disorderly discharge of nerve tissue of muscle.”

What is epilepsy?

ILAE:

A chronic neurological condition characterized:

-By recurrent epileptic seizures1 or by an enduring predisposition to generate epileptic seizures2 

-And by the neurobiologic, cognitive, psychological, and social consequences of this condition2