7 - Degernative brain disease Flashcards
1
Q
What is MS?
A
- multiple sclerosis
- affects CNS only
- demyelination of axons due to inflammatory changes
- progressive functional loss
2
Q
What are the causes of MS?
A
- aetiology is widely unknown
- susceptibility can be acquired during childhood
- genetic and immune factors play a role
3
Q
What are the symptoms of MS?
A
- muscle weakness
- visual disturbance
- paraesthesia
- autonomic dysfunction
- pain
- balance or hearing loss
4
Q
What are the signs of MS?
A
- muscle weakness
- spasticity (UMN)
- altered reflexes
- tremor
- optic atrophy
- proprioceptive loss
- loss of touch
5
Q
What investigations can be conducted for MS?
A
- history and exam
- MRI
- CSF analysis (reduced lymphocytes and increased IgG proteins)
- visual evoked potential (reduced after optic neuritis)
6
Q
What are the different types of MS?
A
- relapsing and remitting
- primary progressive
- secondary progressive
7
Q
Describe relapsing and remitting MS.
A
- acute exacerbation and periods of respite
- damage builds up with every episode
- most eventually develop secondary progressive MS and become disabled
8
Q
Describe primary progressive MS.
A
- slow and steady progressive deterioration
- no exacerbations
- cumulative neurological damage
9
Q
How is MS managed?
A
- antibiotics, antispasmodics, analgesia and steroids
- physiotherapy and OT
- relapsing and remitting can use disease modifying therapies to slow progression
- stem cell transplant (existing disability not reversed)
10
Q
What disease modifying drugs can be used to treat MS?
A
- cladribine
- siponomod
- ocrelizumab
11
Q
What are the dental aspect of MS?
A
- limited mobility for OH
- cannot be treated under GA
- orofacial motor and sensory disturbance can be sign
- chronic orofacial pain
- increased trigeminal neuralgia risk
12
Q
What is MND?
A
- motor neurone disease
- degeneration in spinal cord that affects corticospinal tracts, anterior horns and the bulbar motor nuclei
- more common in males
- patients aged 30-60
- usually die within 3 years
13
Q
Describe MND effects.
A
- progressive loss of motor function affecting the limbs, intercostal muscles, diaphragm and cranial nerves VII-XII
- death due to ventilation failure or aspiration pneumonia as protective reflex is lost
14
Q
What are symptoms of MND?
A
- weakness in ankle or leg
- slurred speech
- weak grip
- muscle cramps and twitches
- weight loss
- emotional lability (cry/laugh at wrong things)
15
Q
What is the treatment of MND?
A
- no treatment
- physiotherapy and OT to preserve function
- riluzole can extend life by 6-9 months
- aspiration prevention via PEG feed or reduced salivation
16
Q
What are the dental aspects of MND?
A
- difficult to accept care due to muscle weakness in head and neck
- OH difficult
- realistic treatment planning due to short life expectancy
- drooling and swallowing problems can be treated with botox into glands
17
Q
What is Parkinson’s disease?
A
- disabling and progressive disease of older people
- caused by lack of dopamine in substantia nigra
- shortage of dopamine results in difficulty of message passing atom thinking to doing
18
Q
What are clinical signs of Parkinson’s?
A
- bradykinesia (slow movement/initiation)
- rigidity due to increased muscle tone
- tremor with rest, intentional movement smooth
19
Q
How does Parkinson’s manifest?
A
- impaired gait and increased falls
- impaired use of upper limbs
- mask-like face
- swallowing problems
- cognitive function is lost
20
Q
What is the treatment for Parkinson’s?
A
- physiotherapy and OT
- dopamine replacement (levadopa)
- dopamine analogue (mimics) eg promipexole, selegiline
- stereotactic surgery for deep brain stimulation
- stem cell transplant (?)
21
Q
What are the risks with Parkinson’s medications?
A
Gambling problems
22
Q
What are the dental aspects of Parkinson’s?
A
- difficulty accepting treatment due to tremor or delayed compliance
- dry mouth due to anticholinergic effect of drugs
- drug interactions
- ability to conduct OH impaired
