BB2 Revision13 Flashcards
DBS has NICE approval (NHS funded) for which three diseases? [3]
- Parkinson’s disease (Hypokinetic movement disorder)
- Essential Tremor (Hyperkinetic movement disorder)
- Dystonia (Hyperkinetic movement disorder)
What frequency is typically used for DBS? [1]
exam q
100 Hz
Whats the difference between essential tremor and dystonia? [2]
Essential tremor: A brain disorder causing part of your body (esp. head and forearms) to tremor uncontrollably.
Dystonia: A brain disorder with sustained or repetitive muscle contractions resulting is twisting and repetitive movements or abnormal fixed postures.
Criteria in DBS for Parkinson’s disease
What type of PD makes you elligible for DBS? [1]
What are the 4 classic symptoms for this? [4]
Idiopathic PD: with 4 classical symptoms: tremor, bradykinesia, rigidity, postural instability.
Criteria in DBS for Parkinson’s disease
Which treatment does Ptx need to have been treated withand still responsive to? [1]
Levodopa
A man sits down with his hands resting still in his lap. When he tries to grab a glass of water he begins to tremor. What is his diagnosis? [1]
Intentional tremor
DBS for PD
DBS directly impacts which two symptoms? [2]
DBS improves which symptom due to less drug being required? [1]
Directly decreases bradykinesia and rigidity
Improves dyskinesia as less L-DOPA required.
Reduced but not totally eliminated
Brain regions for DBS
Which areas of the brain targeted for tremor? [3]
Which areas of the brain targeted for Dystonia? [1]
Tremor:
* Zona incerta
* Subthalamic nucleus
* GPin
Dystonia:
* GPin
Which type of tremor indicates Parkinsons Disease unless proven otherwise?
Reemergent tremor
Resting tremor
Intentional tremor
Postural tremor
Which type of tremor indicates Parkinsons Disease unless proven otherwise?
Reemergent tremor
Resting tremor
Intentional tremor
Postural tremor
Which structures are the arrows pointing to? [5]
Label A-C
A: PAG
B: substantia nigra
C: red nucleus
FYI Method of DBS
Using MRI scan to work out the target site.
Connect a stereotaxic frame on patient’s head.
Drill a 4 cm hole into the skull, then insert the microelectrode tip to the presumptive target site.
Once target site has been located, microelectrode is removed and the stimulating electrode is inserted.
Cap hole, close wound, MRI scan to check electrode at correct site, then general anaesthesia for neuro-stimulator implant.
Return home next day, then 1 month later return to clinic to
programme DBS and adjust drug dosage.
State the effect (% of patients is effective for) of DBS on:
- Epilepsy [1]
- Chronic neuropathic pain [1]
Epilepsy:
* Reduce NOT eliminate seizures frequency
* Benefit for 50-60% patients (exam Q)
Chronic neuropathic pain
* Benefit 15-50% pain patients.
* Only reduce NOT eliminate pain experience.
Name 3 risks of DBS
- 2-3% risk of brain haemorrhage
- small risk of cerebrospinal fluid leakage
- 15% risk of temporary problems with transplantation (e.g. infection, allergy to implant).
Mechanisms of DBS
Explain the inhibition hypothesis [2]
Theory: PD due to overactive basal ganglia neurons in the STN and/or GPi.
DBS can block this and remove spontaneous discharge from GPi neurones
Mechanisms of DBS
Explain the excitation hypothesis [2]
DBS can excite afferent axons antidromically resulting in ‘jamming’ the spontaneous activity
DBS inhibits the local neuronal firing removing the spontaneous discharge from subthalamic nucleus
Mechanisms of DBS
Explain the excitation hypothesis [2]
DBS can excite afferent axons antidromically resulting in ‘jamming’ the spontaneous activity
DBS inhibits the local neuronal firing removing the spontaneous discharge from subthalamic nucleus
Mechanisms of DBS
Explain the disruption hypothesis
DBS in GPi can activate axon terminals causing extensive release of NTs (i.e. GABA & glutamate)
DBS dissociates inputs and outputs in the stimulated nucleus, thus disrupting/blocking the abnormal information flow through the GPi.
DBS disrupts abnormal information flow through the GPi
Targeting which area of the brain may help Tourette Syndrome?
Brodmann area 25 (Subcallosal cingulate)
Hypothalamus
Thalamic centromedian/parafascicular complex
Nucleus Accumbens
Anterior of the fornix
Targeting which area of the brain may help Tourette Syndrome?
Brodmann area 25 (Subcallosal cingulate)
Hypothalamus
Thalamic centromedian/parafascicular complex
Nucleus Accumbens
Anterior of the fornix
Which potential mechansim for DBS is depicted by the figure?
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
3- Disruption hypothesis
DBS activates axon terminals in the stimulated nucleus, induces extensive release of neurotransmitters, such as GABA and glutamate (Glu), and dissociates inputs and outputs in the stimulated nucleus
‘Deep brain stimulation also excites afferent axons antidromically’
Which of the following best describes this theory of how DBS works
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
‘Deep brain stimulation also excites afferent axons antidromically’
Which of the following best describes this theory of how DBS works
1- Inhibition hypothesis
2- Excitation hypothesis
3- Disruption hypothesis
4- Neuro-network modulation hypothesis
What is the role of sleep? [6]
Maintenance of important cellular processes (e.g. biosynthesis of macromolecules and nuclear maintenance)
Waste clearance (e.g. elimination of brain metabolic products)
Neurodevelopment – consolidation of brain circuits
Regulation of the immune system and inflammation
Consolidation of memory processes
Which drug classes are current treatments for insomnia? [2]
Benzodiazepine - short acting
Z drugs
Name drugs & the drug class they belong to, to treat short term [2]& long term insomina [2]
Short-term use:
* lorazepam (benzo)
* temazepam (benzo)
Long-term use:
* eszopiclone (benzo)
* Zolpidem (Z-drug)
Name a drug that used for epilepsy that has recent use for insomnia [1]
Pregabalin
Which neuronal projections control wakefulness? [2]
Which neuronal projections control sleep? [2]
Wakefulness:
* cholinergic systems
* monoaminergic projections
Sleep:
* GABA
* Galanin neurons
GABA & Galanin neurons project from which nucleus?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
GABA & Galanin neurons project from which nucleus?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Ventrolateral Pre-optic nucleus
Supraoptic nucleus
Which sleep stage does this EEG show?
Beta
REM
Theta
Alpha
Delta
Which sleep stage does this EEG show?
Beta
REM
Theta
Alpha Alpha waves arise from the occipital lobe during wakeful relaxation with eyes closed.
Delta
Which stage of sleep normally lasts the longest?
Stage 1
Stage 2
Stage 3
Stage 4
REM
Which stage of sleep normally lasts the longest?
Stage 1
Stage 2
Stage 3
Stage 4
REM
What are 5 side effects of using benzodiazepines used as hypnotics? [5]
- Change in sleep patterns (suppress deep sleep and REM sleep - which is the period you become most rested in)
- Daytime sedation
- Rebound insomnia
- Tolerance
- Dependence
A deficiency in which pepitde causes narcolepsy? [1]
Orexins
Name an orexin antagonist that can treat insomnia [1]
Orexins bind to which receptors to promote wakefullness? [2]
Suvorexant: dual orexin receptor antagonist
Orexins bind to OX1 & OX2 receptors
(not in drug list)
A 51-year-old man is brought to the healthcare provider by his wife. She states that he has had significant trouble waking up in the mornings. The patient says he has to be shaken awake, after which he is drowsy, has reduced work performance, and keeps wanting to go back to sleep. He says, “It’s like my mind is all fogged up.” These symptoms last 30 minutes to an hour. The patient has most likely been woken up from which of the following stages of sleep?
A. Stage 1
B. Stage 2
C. Stage 3
D. REM sleep
A 51-year-old man is brought to the healthcare provider by his wife. She states that he has had significant trouble waking up in the mornings. The patient says he has to be shaken awake, after which he is drowsy, has reduced work performance, and keeps wanting to go back to sleep. He says, “It’s like my mind is all fogged up.” These symptoms last 30 minutes to an hour. The patient has most likely been woken up from which of the following stages of sleep?
A. Stage 1
B. Stage 2
C. Stage 3
D. REM sleep
A 22-year-old male presents to the clinic with the inability to stay awake. He falls asleep at inconvenient times and has even fallen asleep driving. An electroencephalogram (EEG) is ordered and shows a sudden transition into a stage of sleep, which resembles an awake individual, but muscle tone is lost. The patient has no other underlying conditions, and the physical examination is normal. Which of the following is another characteristic of this stage of sleep?
A. K complexes
B. Sleep spindles
C. Theta waves
D. Dreaming
A 22-year-old male presents to the clinic with the inability to stay awake. He falls asleep at inconvenient times and has even fallen asleep driving. An electroencephalogram (EEG) is ordered and shows a sudden transition into a stage of sleep, which resembles an awake individual, but muscle tone is lost. The patient has no other underlying conditions, and the physical examination is normal. Which of the following is another characteristic of this stage of sleep?
A. K complexes
B. Sleep spindles
C. Theta waves
D. Dreaming
Which NTs are involve in anxiety?
Monoamerinergic systems: Noradrenaline, 5-HT
Gabanergic systems
Describe the MoA of benzodiazepines? [2]
Increases the frequency of opening of GABA channels causing hyperpolarisation
Name a drug that acts as a benzo antagonist and can be used to treat overdose? [1]
What is administration like? [1]
Flumazenil
Has a short half-life so need continous adminsitration needed
Which nuclei controls circadian rhythm?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
Which nuclei controls circadian rhythm?
Paraventricular nucleus
Suprachiasmatic nucleus
Arcuate nucleus
Pre-optic nucleus
Supraoptic nucleus
Which of the following has the shortest half life
temazepam
zolpidem
eszopiclone
lorazepam
Which of the following has the shortest half life
temazepam
zolpidem
eszopiclone
lorazepam
A deficency in which of the following causes narcolepsy?
Orexins
Histamines
GABA
Melatonin
Setaonin
A deficency in which of the following causes narcolepsy?
Orexins
Histamines
GABA
Melatonin
Setaonin
Name an orexin antagonist that can treat insomnia [1]
Orexins bind to which receptors to promote wakefullness? [2]
Suvorexant
Orexins bind to OX1 & OX2 receptors
[]A common feature of anxiety disorders is the []activity of limbic structures such as the [] and the inability of higher cortical structures to control this hyperactivity
A common feature of anxiety disorders is the hyperactivity of limbic structures such as the amygdala and the inability of higher cortical structures to control this hyperactivity
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
These are indications that [] transmission is involved in the
genetic risk for anxiety disorders
Dopamine
Glutamate
GABA
5HT
Name 5 classes of drugs that can act as anxiolytics [5]
SSRIs
SNRIs
Benzodiazepines
5-HT1A agonists
β-adrenoceptor antagonists
Name 3 benzodiazepines used as anxiolytics
clonazepam, alprazolam, lorazepam
Name two SNRIs and three SSRIs used as anxiolytics [3]
SSRIs
* fluoxetine, escitalopram, paroxetine
* can be used to treat panic and social phobias
SNRIs:
* venlafaxine, duloxetine
Name two 5HT-1A agonists and one B-adrenoreceptor antagonists used as anxiolytics [3]
5-HT1A agonists: buspirone ipsapirone
β-adrenoceptor antagonists: propranolol
Describe the difference of action of barbiturates versus benzodiazepines on GABA receptors [2]
Barbiturates: increase the duration of how long GABA channels
Benzodiazepines: increase the frequency of the channels open
What type of drug is at A & B? [2]
A: Benzo
B: Barbiturate
