CCC - GP Neuro Flashcards
Who gets MS?
Females, 30yrs old, White
20% have affected relative
What is the pathophysiology of MS?
Demyelination of neurones
Affects movement and sensation
What are the patterns of MS?
Relapsing-remitting Secondary progressive (follows relapsing-remitting)
As disease gets more advanced remissions are less frequent and have less remyelination
How does MS present? (4)
Optic neuritis = vision loss progressing over few days
Transverse myelitis = tight band around level of inflammation or shock-like sensations travelling down spine induced by neck flexion
Cerebellar symptoms = balance issues, ataxia
Brainstem syndromes = ataxia, nystagmus, dysphagia etc
When would you diagnose MS?
After two isolated attacks
Dx is by neurologist
What tests may be helpful in MS?
MRI
LP
MOG and MBP antibodies
Why might an MRI be useful in MS?
Sensitive for plaque detection
Can exclude other causes
Why might an LP be useful?
Oligoclonal bands of IgG in CSF but not serum may suggest CBS infection
Why might MOG and MBP antibodies be useful?
In those with MS-like lesion, can predict conversion to definitive MS
What are the disease-modifying therapies available for MS?
INF-beta = reduces relapse by 30%
Monoclonal Ab eg. Natalizab = reduces relapses and lesions on MRI
What is the treatment of a relapse of MS?
Methylprednisolone 1g OD 3 days
Used max 2x per year
Does not affect progression
How many develop secondary progressive MS from R-R MS?
50% after 10yrs
What is Motor Neurone Disease?
Degeneration of anterior horn cells of the spinal cord and motor cranial nuclei
Which motor neurones does MND affect?
Upper and lower
What are the 3 types of MND?
Amyotrophic lateral sclerosis 50%
Progressive muscular atrophy 25%
Progressive bulbar palsy 25%
What is Amyotrophic lateral sclerosis?
Combined LMN wasting and UMN hyperreflexia
What is Progressive muscular atrophy?
Anterior horn cell lesions
Affect distal before proximal muscles
Better prognosis that ALS
What is Progressive bulbar palsy?
Loss of function of brainstem motor nuclei (LMN) -> tongue weakness, chewing/swallowing difficulties, facial weakness
How does NMD present?
Weakness
Stiffness
Cramping
Generally focal onset with mixed UMN/LMN features
What is different about Primary lateral sclerosis?
Has either pure UMN or pure LMN features
What does MND never affect?
Eye movements
What is the management of MND?
Riluzole - may prolong life by 2-4 months
Treats secretions with Buscopan and cramps with diazepam/baclofen
What is the prognosis of MND?
Death within 3-5yrs from ventilatory failure
What are the features of Parkinson’s? (6)
Pill-rolling tremor Lead-pipe or cog-wheel rigidity Difficulty initiating movement Slow movements Shuffling gait Micrographia
What is the mean onset of Parkinson’s?
65yrs
What is the pathophysiology of Parkinson’s?
Degeneration of dopaminergic neurons in substantia nigra -> decreased striatal dopamine
What is required for a Parkinson’s diagnosis?
Bradykinesia + 2+ of:
- Rigidity
- Resting tremor
- Postural instability
What investigations may be useful in Parkinson’s?
CT/MRI - to exclude other diagnoses
What is the first line management of Parkinson’s?
Levodopa
Effects diminish over time
What two ‘effects’ are relevant to Levodopa?
On-off effect
End-of-dose effect
What is the on-off effect of Levodopa?
Fluctuations between periods of exaggerated involuntary movements and periods of immobility
What is the end-of-dose effect of Levodopa?
Duration of benefit is reduced after each dose
What are other examples of potential Parkinson’s drugs?
MAOIs eg. selegiline
Amatadine
Tolcapone (inhibits dopamine breakdown)
