This chapter discusses the case of an 18-year-old woman, who had dystonia. She was sent to a psychiatric facility. She received low doses of haloperidol and a tricyclic antidepressant and after 2 weeks developed drooling, twisting of the neck to the right, and trouble walking. At that point, the psychiatrist consulted the movement disorders neurologist. She had drooling and cervical dystonia with laterocollis to the right with a mild rotational component. She presented an interesting diagnostic and treatment challenge. At the outset, the differential diagnosis consisted of primary psychiatric disorder and a possibility of drug-induced movement disorder versus a spontaneous movement disorder with psychiatric manifestations as seen in Wilson’s disease (WD). Her tests confirmed the diagnosis of WD, and she was treated with Penicillamine with the knowledge that it can cause further drop in platelets. Over the next several months, her eye movement became normal and the cervical dystonia disappeared.

This chapter discusses the case of a 38-year-old woman with diffuse, occasionally throbbing, headaches associated with nausea, which was worse while waking, together with intense pain accompanied by episodes of vomiting, diplopia, drowsiness, and torpor. Since symptoms’ onset, she reported being slower and having bilateral hand tremor. Analysis of cerebrospinal fluid (CSF) demonstrated a mild inflammatory reaction and neurocysticercosis (NCC) as detected by positive reactions to cysticercus antigens. She was assessed in the neurology service and diagnosed with intracranial hypertension after a brain MRI that showed the presence of supratentorial hydrocephalus with evidence of intraventricular cysts, as well as edema in the midbrain periaqueductal region. Methylprednisolone pulse therapy was then started, together with half a tablet of levodopa/carbidopa, with progressive improvement in the symptoms of parkinsonism. Eight months later, she was progressively taken off entacapone and then levodopa. She remained asymptomatic and returned to normal activities of daily life.

This chapter discusses the case of a 28-year-old man, who had progressive gait ataxia since the age of 16 years. Within a year, he developed dysarthria, followed by difficulties with fine finger movements. On examination, he had bilateral pes cavus and moderate scoliosis. He had gait and truncal ataxia with intention tremor, head tremor, dysmetria, dysdiadochokinesia, areflexia at lower limbs, bilateral Babinski sign, absent position and vibration senses in the feet, and positive Romberg’s sign. Neuropsychological examination revealed signs of minimal executive dysfunction. Supplementation with vitamin E in patients with ataxia with vitamin E deficiency (AVED) may improve neurologic symptoms and favorably influence prognosis. Therefore, screening for vitamin E deficiency is important in patients with ataxia of unknown etiology. Genetic analysis and early recognition of AVED may allow early introduction of effective treatment and appropriate genetic counseling.

Radiation oncologists have long understood the potential benefit of radiation therapy (RT) in palliating the distressing symptoms of advanced abdominal and pelvic cancers. Often, the role of external beam radiation therapy (EBRT) or brachytherapy in controlling bleeding or obstructive symptoms finds only a passing reference and most palliative medicine texts are silent on this important topic. Palliative RT achieves hemostasis in patients with unresectable gastric carcinoma not fit for systemic chemotherapy and is associated with a statistically significant rise in their hemoglobin levels. RT has been used for symptom relief in gynecological malignancies for many years. For abdominal malignancies, bony landmarks are less reliable for treatment planning, as compared to pelvic malignancies. This chapter discusses some case scenarios which illustrate the role of palliative radiation therapy in the treatment of bladder cancer, vaginal bleeding, rectal cancer, vulvar cancer, and liver metastasis.

Interictal epileptiform discharges (IEDs) represent a distinct group of waveforms that are characteristically seen in people with epilepsy. Scalp detection of IEDs is based upon dipole localization and the surrounding field. The interictal electroencephalogram (EEG) plays a pivotal role in providing ancillary support for a clinical diagnosis of epilepsy. Abnormal focal IEDs on EEG represent a heightened predisposition for the expression of focal seizures. Epileptiform discharges appear in different morphologies. Both spikes and sharp waves are referred to as IEDs and are defined by their duration. Mid-temporal IEDs occur in patients with temporal lobe epilepsy. Benign childhood epilepsy with centrotemporal spikes is a common childhood genetic localization related epilepsy syndrome. Frontal spikes are often found in patients with frontal lobe epilepsy, although they may be absent in up to one-third of patients. Central IEDs can occur with symptomatic focal epilepsies at any age.

Interictal electroencephalogram (EEG) provides useful information about the presence of nonepileptiform neurophysiological dysfunction. When abnormalities are encountered, they are not specific for an underlying etiology, and as such represent abnormalities without further differentiation of the pathological process. This chapter discusses and focuses on generalized and focal nonepileptiform abnormalities. Diffuse slowing on the EEG may have various morphologies, and occur intermittently or continuously, to reflect abnormal cerebral function. Low-voltage EEG is typically associated with diffuse slowing of the background rhythm. Focal abnormalities on the EEG provide electrographic evidence of a localized abnormal cerebral function. Intermittent irregular slowing has a low correlation with an underlying lesion compared to focal slowing that is continuous. EEG can reveal many types of nonepileptiform abnormalities corresponding to varied cerebral dysfunctions occurring at any age. Reactivity of nonepileptiform abnormalities is an important feature that helps assess the cause and prognosis of the clinical condition.

This chapter discusses case of a 19-year-old fine arts college student who was a very good athlete. A psychiatrist diagnosed her psychogenic gait and prescribed Clonazepam and later Seritonine reuptake inhibitors (IRSS), but no improvements were noted. She presented with dysthymia according to the DSM-III, and the movement disorder persisted unmodified. She underwent intravenous placebo therapy, but it never worked. An electromyography (EMG) was performed that did not reveal any cocontraction. The patient’s mother and sister came to the clinic and evident clinical ataxia was confirmed in both individuals with severe dysarthria and difficulties in walking without aid. She developed an increase in basal sustentation and alterations in her postural reflexes, therefore developing difficulties with walking as the disease progressed. She has almost completely recovered from the movement interpreted as “task-specific dystonia” because it has been predominantly replaced by pancerebellar ataxia with few extracerebellar signs.

The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.

The Absorption Technique for Children is a protocol that was derived from the work of Arne Hofmann who based his work on an adaptation of “The Wedging Technique”. The absorption technique for children is a resource technique that supports children in creating resources for present issues and future challenges such as dealing with a difficult teacher or handling a disagreement with a classmate and so forth. This chapter uses resource installation for stressful situations. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. The absorption technique, and the constant installation of present orientation and safety (CIPOS) technique, are excellent ways to encourage children to work with eye movement desensitization and reprocessing (EMDR) step-by-step even if they are not prepared to work with the worst issue in the beginning.