Chronic Neuro diseases (Parkinson's, Seizure Disorder, MS, MG) Flashcards
Parkinson’s: Description
Progressive, degenerative disorder of the dopamine secreting neurons that control muscle movement.
There is no cure; not fatal but death may result from complications.
Acetylcholine and Dopamine
Acetylcholine is excitatory/ Dopamine is inhibitory.
Parkinson’s is the depletion of dopamine,
therefore the depletion of inhibitory inputs.
Forms of Parkinson’s
Primary: idiopathic
Secondary: caused by trauma, infection, tumor, atherosclerosis, toxins
–some block dopamine receptors
Parkinson’s: Diagnosis
15% under 50, most 60s-70s.
No lab test for it- diagnosis is clinical.
CT and MRI needed to rule out other causes
Parkinson’s: Patho
(Normal: dopamine and acetylcholine secretion from basal ganglia are balanced)
1) Extrapyramidal brain nuclei deep in basal ganglia affected - this influences initiation, modulation, completion of movement
2) Degeneration of dopaminergic neurons => deficiency of dopamine (and excess of ACh) - leads to rigidity, tremors, bradykinesia
3) Dopamine deficiency prevents affected brain cells from performing their normal inhibitory fxn in the CNS
Parkinson’s: Classic Manifestations
1) Resting tremor: asymmetric, rhythmic, low amplitude
- unilateral (usually hands and feet)
- “pill rolling”
- Disappears during sleep; worse with stress/anxiety
- intermittent but progressively worsens
2) Bradykinesia: slowness of voluntary mvmt
- failure of antagonistic muscles to relax
- loss of walking, blinking, swallowing saliva
3) Rigidity: contraction of striated muscle
- stiffness of limbs, resistance to ROM
- uniform: lead pipe or cogwheel
4) postural dysfunction: shuffling gait, balance issues
- loss of reflexes mean easy falls
- Stooped posture, lean to one side when seated
- Festinating gait: short, accelerating steps
Parkinson’s: Other Manifestations
- fine motor deficits
- microphagia (small handwriting)
- hypomimia (mask-like faces)
- dysarthria/ monotone, high-pitch, low-vol voice
- freezing/stuck when initiating movement
- foot drag on affected side (?)
- lack of arm swing on affected side (?)
- hesitant/ ‘en bloc’ turns
- increase in dandruff, ,seborrhea
- less blinking => conjunctivitis, blepharospasm
- drooling and dysphagia
- autonomic dysfunciton
- depression and anxiety
- intelligence NOT affected, but some late stage dementia
Parkinson’s: Complication
- various degrees of disability or difficulty performing ADLs
- injury from falls
- aspiration d/t difficulty swallowing/eating
- UTIs
- pressure ulcers
- Dementia
- Side effects of meds
Parkinson’s: Treatment (general)
- Goal is to relieve symptoms and maintain function. Through Rx, surgery, PT (PROM, walking, baths, massage).
Parkinson’s: pharmacological treatment
Dopaminergic (Levodopa-Carbidopa)
- needs to be given inactively so it can cross BBB
Anticholinergics (Artane, Cogentin)
Other drugs (Eldpryl, Tasmar, Symmetrel)
Parkinson’s: surgical treatment
- Pallidotomy by stereotactic neurosurgery: obliteration of ventrolateral nucleus of thalamus & globus pallidus (to prevent involuntary movement)
- Fetal tissue transplants: transplanting cells from the basal ganglia or adrenal medulla of fetuses into caudate
- Deep brain stimulation: pacemaker-like brain implants to decrease tremors
Parkinson’s: nursing care
- education
- refer to support groups
- exercise to maintain mobility and safety
- assess chewing, swallowing, nutrition, depression
- speech therapy for dysarthria
- home safety
- clothing choices
Epilepsy: Description
Condition of the brain characterized by susceptibility to recurrent seizures
- paroxysmal events associated w/ abnormal electrical discharges of the brain
Seizure Disorder: Causes
-primary = idiopathic (50%) secondary = structural changes or metabolic alteration increase automaticity - birth trauma - perinatal infection - anoxia - infection - toxins - brain tumors - PKU or TB - head injury/trauma - metabolic disorders - CVA
Seizure Disorder: Diagnostics
Dx based on occurrence of 1+ seizures
- CT or MRI to reveal sructural abnormalities
- EEG: high fast voltage in tonic clonic
- Skull XR to assess bony structures
- Serum chemistries to eval metabolic conditions
Seizure Disorder: Patho
- Epileptogenic focus: Neurons in the brain depolarize/ become hyperexcitable, fire more readily
- RMP is less negative or inhibitory connections are missing d/t GABA activity or electrolyte shifts (lower threshold)
- Epileptogenic focus fires, spreads electrical current to surrounding cells (fire with greater amplitude)
- Impulse cascades to 1 side of the brain (partial seizure) or both sides (generalized seizure) OR in the cortical, subcortical, and brain stem areas
- Incr. met demand for O2 & nutrients (200%): if not met, brain damage
- Firing of inhibitory neurons causes the excitatory neurons to slow firing & eventually stop
- If action doesn’t occur, status epilepticus without Tx anoxia is fatal
Seizure Disorder: Manifestations
- Recurrent seizures
- Aura/ Prodrome - a sensory sign that a seizure is imminent
- After generalized seizure (postictal state):
- slow return to consciousness
- combative or lethargic
- confusion, headache, fatigue
- loss of bladder/ bowel fxn
Simple Partial seizure (Jacksonian)
Begins locally, doesn’t cause change in consciousness
- sensory Sx: flashing lights, smells, auditory hallucinations
- autonomic sx: sweating, flushing, pupil dilation
- psychic sc: dream states, anger, fear
