505. Parkinsons and MS and MND Flashcards
What is the triad of parkisonism?
Tremor- worst at rest pill rolling
Hypertonia- Rigidity and tremor gives cogwheel rigidity. Bets felt during pronation and supanation
Bradykinesia- Slow to intiate movement. Actions slow and decrease in amplitude with repitition
What causes parkinsons disease?
Loss of dopaminergic neurons in the substantia nigra
What might make you consider an alternative diagnosis to parkinsons?
Signs are symettrical
What is progressive supranuclear palsy?
Early postural instability
Vertical gaze palsy
Rigidity of trunk>limbs
Symmetrical
What is Cortico-basal degeneration
Akinetic rigidity involvign one limb
What is multi system atrophy?
Early autonomic features e.g. impotence, incontinence, postural reduced BP and cerebellar and pyrammidal signs
What are the various drugs used to treat parkinsons?
Levodopa- dopamine precurosor. sooner start, tolerance builds
Dopamine agonsits- helps delay levodopa starting
Apomorphine- injected subcut
Anticholinergics- Better for younger patients
MOA-B inhibitors- Alternative to dopamine agonsits. Post. Hypotension and a fib
COMT inhibitors- Hleps motor complications
Discuss Levodopa in more detail
Given combined with Co-careldopa
SE dyskinesea, painful dystonia, psychosis, N and V
What more can be said about dopamine agonists
e.g. Ropinirole. Can be given as a patch
SE- drowsiness, nausea, hallucinations
Amantadine can be used for drug induced dyskinaesia
COMT inhibitors. Discuss
Have an on time nad an off time
Monitor LFT’s
What anti-emetic is given in parkinsons
Dompiridone
What causes MS
Demylination of neurons casuing axonal loss
What are the sensory symtpoms of MS
Pins and needles
Decreased vibratin snese
Trigeminal neuralgia
Abnormal sensations
What are the motor symtpoms of MS
Spastic weakness
Myelitis
swallowing problems, constipation
What are the sexual/Genitourinary sypmtoms of MS?
Erectile dysfunciton
Anorgasmia
Urine retention
Incontinence
What tests can be done for MS
MRI- sensitive, not specific
CSF- oligoclonal IgG bands
What are some diferentials for MS?
Sarcoidosis
Vasculitis
What is the clinical diagnositc criteria for MS?
Attacks that are disseminated in time and space
This essentially means different attacks that happen on different occasion or there is proven degeneration over time.
This is difficult in primary progressive dimentia
What are poor prognostic signs in MS?
Older, male,
early relapses
MRI lesions ( a lot of)
What lifestyle advice is available to those with MS?
Exercise
Dont smoke
Avoid stress
What disease modifying drugs are available for those who have MS?
Dimethyl fumarate- Relapsing and remitting
Monoclomal antibodies- relapsing and remiting
Interferon beta and glatiramer- not NICE approved
How do you treat relapses in MS?
Methylpred, 3-5 day course. use sparingly
What medications are available to treat relapses in MS
Spasticity- baclofen or gabapentin
Tremor- botox
Urgency/frequency- Intermittent self cathetirsation
Fatigue- Amantadine
Discuss the follwing MS associated symtpoms:
Devics
Lhermittes
Uhthoff’s
Charles Bonnet’s
Pulfrich
Argyll robertson pupil
Devics- Neuromyeltis optica. Eye disease and tranverse myelitis
Lhermittes- Neck flexion causes electric shocks
Uhthoff’s- Worsenign of symptoms in heat
Charles Bonnet’s- Reduced acuity, temporary blindness, hallucinations
Pulfrich- Unequal eye latieces: straight things seemed curved
Argyll robertson pupil- pupil constrictive and unreactive to light. Reacts to accomidaiton
What are the different types of MND?
ALS- UMN and LMN signs
Progressive bulbar palsy- only cranial nerves IX-XII
Progressive muscular atrophy- LMN lesions
Primary lateral sclerosis- umn signs
What is meant by bulbar and corticobulbar palsy
Bulbar- diseases of CN IX and XII- tongue, muscles of talkign and swallowing, sack of worms
Corticobulbar- UMN lesions of swallowing. slow otngue, hyperreflexic jaw jerk
What are the presenting signs of MND?
Never affects the eyes- distinguishable from MG
How do you treat MND?
MDT
Riluzole- improves survival
Saliva- good positioning, oral care and suctioning
Alternative communication
End of life care
