DISCUSS THE EPIDEMOLOGY OF ENCEPHALOPATHY


DISCUSS THE EPIDEMOLOGY OF ENCEPHALOPATHY
INTRODUCTION
Encephalopathy means disorder or disease of the brain. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of overall brain dysfunction; this syndrome can have many different organic and inorganic causes.
The following are some major types of encephalopathy, along with their causes:
Type Cause
chronic traumatic encephalopathy occurs when there are multiple traumas or injuries to the brain
glycine encephalopathy a genetic condition where there are abnormally high levels of glycine (an amino acid) in the brain
Hashimoto’s encephalopathy a rare effect of an autoimmune disease that attacks the thyroid gland
hepatic encephalopathy a result of liver disease
hypertensive encephalopathy a result of very high blood pressure
hypoxic encephalopathy when the brain does not get enough oxygen
Lyme encephalopathy a result of Lyme disease. Infected ticks transmit this bacterial disease
static encephalopathy permanent brain damage or dysfunction. A lack of oxygen to the brain, such as when a fetus is exposed to alcohol in the womb, is one of many causes of this type
toxic-metabolic encephalopathy a result of infections, toxins, or organ failure
transmissible spongiform encephalopathies a result of prion diseases. Prion proteins occur normally in the body. But they can also mutate, causing disease. Prion diseases include chronic wasting disease, fatal familial insomnia, kuru, and Creutzfeldt-Jakob disease
uremic encephalopath a result of kidney failure
Wernicke encephalopathy a result of a vitamin B1 deficiency. Long-term alcoholism and poor food absorption can cause a vitamin B1 deficiency

What Are the Symptoms of Encephalopathy?
Your symptoms will depend on the cause and severity of your encephalopathy.
Mental Changes
You may have difficulty focusing or suffer from memory loss. Also, you may have trouble with problem-solving skills.
Other people may notice symptoms in you before you do. A changing personality is one such symptom. For example, you may be more outgoing than you were before the encephalopathy. You may be more or less calm than you were before the disease.
You could also be lethargic and drowsy.
Neurological Changes
• Possible neurological symptoms include:muscle weakness in one area, poor decision-making or concentration
• involuntary twitching
• trembling
• difficulty speaking or swallowing
• seizures

EPIDEMOLOGY OF ENCEPHALOPATHY
Encephalopathy is a broad term used to describe abnormal brain function or brain structure. (Encephalo= brain + pathy= disorder). The abnormality may be transient, recurrent, or permanent. The loss of brain function may be reversible, static and stable, or progressive with increasing loss of brain activity over time.
Normal brain function
Brain cells are linked together with neurons, called axons and dendrites, covered in myelin sheaths. The electrical impulses work together with chemical receptors to allow brain activity to translate into thought and action. Different locations in the brain are associated with specialized function, for example, vision function is located in the occipital lobes, speech production in Broca’s area in the lower part of the frontal lobe, speech recognition is located in Wernicke’s area of the temporal lobe, and the motor strip in the parietal lobes of each hemisphere.
The brain also requires blood flow to provide oxygen and glucose to function. Other chemicals, nutrients, and vitamins are needed for normal function both immediately and in the long term.
Abnormalities and conditions that affect brain function
• The brain develops quickly in the fetus as it grows in a mother’s uterus; and any disruption in this growth and development may lead to encephalopathy.
• Abnormalities in anatomic structure, electrical, and chemical function may lead to altered mental function and encephalopathy.
• Poisoning of brain tissue and cells may also affect function. This poison may be produced within the body, for example from liver or kidney failure, or it may be ingested intentionally or unintentionally. Examples of intentional ingestion include alcohol intoxication or drug abuse. Examples of unintentional ingestion include carbon monoxide poisoning, medications, or toxic substances such as lead paint.
• Encephalopathy may be due to a birth defect (a genetic abnormality causing abnormal brain structure or chemical activity with symptoms being found at birth), or it may be evident towards the end of life due to disease, such as dementia or Alzheimer’s disease.
Terminology
In some contexts, it refers to permanent (or degenerative) brain injury, and in others it is reversible. It can be due to direct injury to the brain, or illness remote from the brain. In medical terms it can refer to a wide variety of brain disorders with very different etiologies, prognoses and implications. For example, prion diseases, all of which cause transmissible spongiform encephalopathies, are invariably fatal, but other encephalopathies are reversible and can have a number of causes including nutritional deficiencies and toxins.
Signs and symptoms
The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are loss of cognitive function, subtle personality changes, inability to concentrate, lethargy, and depressed consciousness. Other neurological signs may include myoclonus (involuntary twitching of a muscle or group of muscles), asterixis (abrupt loss of muscle tone, quickly restored), nystagmus (rapid, involuntary eye movement), tremor, seizures, jactitation (restless picking at things characteristic of severe infection), and respiratory abnormalities such as Cheyne-Stokes respiration (cyclic waxing and waning of tidal volume), apneustic respirations and post-hypercapnic apnea.
Diagnosis
Blood tests, cerebrospinal fluid examination by lumbar puncture (also known as spinal tap), brain imaging studies, electroencephalograms and similar diagnostic studies may be used to differentiate the various causes of encephalopathy.
Diagnosis is frequently clinical. That is, no set of tests give the diagnosis, but the entire presentation of the illness with nonspecific test results informs the experienced clinician of the diagnosis.
Treatment
Treatment varies according to the type and severity of the encephalopathy. Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed.
Prognosis
Treating the underlying cause of the disorder may improve or reverse symptoms. However, in some cases, the encephalopathy may cause permanent structural changes and irreversible damage to the brain. These permanent deficits can be considered a form of stable dementia. Some encephalopathies can be fatal.
How Is Encephalopathy Treated?
The treatment for encephalopathy varies according to the cause. Treatment may consist of medications to treat your symptoms and medications or surgery to treat the underlying cause. Your doctor may recommend nutritional supplements to slow the damage to your brain, and/or a special diet to treat underlying causes. In some cases of the disease, such as when the brain does not receive enough oxygen, you may slip into a coma. In severe cases like this, your doctor may put you on life support to keep you alive.
Is Encephalopathy Preventable?
Some types of encephalopathy—like hereditary types—are not preventable. However, some types are preventable.
In general, living a healthy lifestyle can reduce your risk factors for brain disease. Making the following changes can lessen the risk of many underlying causes of encephalopathy:
• avoiding excess alcohol
• reducing exposure to toxic substances like drugs
• eating a healthy diet
• seeing your doctor regularly

CONCLUSION
Encephalopathy is a general term describing a disease that affects the function or structure of your brain. There are many types of encephalopathy and brain disease. Some types are permanent and some are temporary. Some types are present from birth and never change, while others are acquired after birth and may get progressively worse. Depending upon the cause, encephalopathy may occur at any age. Symptoms may present as a form of altered mental status including confusion and loss of memory because the impairment affects the thought process locations in the brain, or symptoms may present with a physical impairment like weakness or numbness of a body part, or uncoordinated movements because it affects the motor or sensory parts of the brain. Global involvement may present as seizure, or any combination of thought, motor, or sensory symptoms. The symptoms depend on what part of the brain is being affected and how much or how little it continues to function.

REFERENCES
“eMedicine/Stedman Medical Dictionary Lookup!”. Retrieved 2008-11-30.
“encephalopathy” at Dorland’s Medical Dictionary

Müller M, Baumeier A, Ringelstein E, Husstedt I (2008). “Long-term tracking of neurological complications of encephalopathy and myopathy in a patient with nephropathic cystinosis: a case report and review of the literature”. J Med Case Reports 2: 235. doi:10.1186/1752-1947-2-235. PMC 2491650. PMID 18644104.

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