Chronic Neurological Dysfunctions Flashcards
Parkinson’s Disease: Definition and RFs
- progressive disease of the CNS involving a deficiency in the production of dopamine
- dopamine = NT that acts to balance the effects of Ach which is responsible for muscle contraction
- Lewy bodies are unusual clumps of proteins found in pts with PD
- exact cause is unknown
- more common in men (40-70 YO)
- some family hx
RF:
- increased age
- brain tumor
- genetics
- environmental exposures (CO, mercury)
- illegal drug use
PD: Sx
Beginning stages: mild tremor, slight limp, decreased arm swing
Later stages: shuffling, propulsive gait with arms flexed, loss of postural reflexes
(may experience hypokinetic dysarthria - speech abnormalities)
Early sx are gradual and insidious (ex. handwriting change, slight gait changes w/ decreased arm swing)
Hallmark Sx: TRAP
Tremor at rest (pill rolling motion with fingers)
Rigidity (slow motor movements)
Akinesia (absence or loss of control of voluntary muscle movements)
Postural instability
Autonomic Sx: orthostatic hypotension
Characteristics of PD
dysphagia mood swings dementia progressive inability to do ADLs gait changes urinary changes inability to control involuntary movements
Tremors (TRAP)
often first sign of PD
pill rolling type movement
Rigidity (TRAP)
cogwheel rigidity intermittently catches in PROM
causes pt to become more fatigued from sustained muscle contraction
Akinesia (TRAP)
- absence or loss of control of voluntary muscle movements
- bradykinesia: slowing of movements
- autonomic movements such as blinking eyelids, swallowing, swing of the arms (these movements are slowed)
- deadpan expression: mask-like face
- festination: shuffling gait
Postural Instability (TRAP)
- propulsion: inability to stop themselves from moving forward
- retropulsion: inability to stop themselves from moving backward
at risk for falls
PD: Non-motor Sx
depression, anxiety, apathy fatigue pain urinary retention and constipation ED memory changes
PD: Common reasons for hospitalization
aspiration>pneumonia>malnutrition
immobility>pneumonia>UTI, skin breakdown, constipation
PD: Dx
H&P exam
r/o other conditions w/ MRI, CT, EEG
then see if there is a positive response to levodopa
PD: Meds
- Sinemet (combo of carbidopa and levodopa): decreases muscle rigidity
- drug of choice for symptomatic pt
- may become ineffective over time and dopamine receptor agonist may be added to med regiment
- dyskinesias are significant SE of meds
-Selegiline (Eldepryl): enhances Sinemet effect by prolonging half-life of it
Entacapone (Comtan): also improves peripheral circulation, extends Sinement’s effects
Rotigotine (Neupro): once a day transdermal patch, better for adherence to tx
*timing of meds is important, monitor SE if using higher dosage, meds more effective on empty stomach, “wearing off syndrome”
PD: Interventions and Tx
- dopamine receptor agonist
- Ropinirole (Requip): better to try this before Sinemet b/c of the wearing off effect
- anticholinergics (Cogentin): controls tremors and rigidity
- Deep Brain Stimulation: electrode placed in thalamus and current delivered through an implanted pacemaker generator
- most common surgical tx, reversible and programmable, decreases the increased neuronal activity produced by DA depletion (improves motor fx, reduces dyskinesia and medication use)
-Marijuana
PD: Nutrition and Services
- high protein diet decreases effectiveness of Sinemet so limit protein to evening meals
- 6 small meals are less tiring than 3 larger meals
- PT: develop an exercise plan to prevent muscle contractions and atrophy. Will help w/ constipation prevention
- OT: can help with energy conservation
- Speech therapy: speaking issues and swallowing
- social work: will help with other services needed (meals on wheels)
Multiple Sclerosis: Definition
- demyelination impairs the transmission of nerve impulses. The destruction of myelin may be caused by an autoimmune reaction
- characterized by the relapses or exacerbation and remissions
- chronic, progressive, degenerative, CNS disease that is characterized by intermittent damage of the myelin sheath that covers nerve cell axons
MS: RFs
- women, 20-50YO
- evidence of genetic component
- d/t infection, virus, immunogenic, or precipitating factors of onset of disease and periods of exacerbations (infections, stresses, excessive fatigue, trauma, pregnancy)
- pregnancy- usually ok during pregnancy but during post-partum period may begin to demonstrate initial sx of disease
MS: S/Sx
insidious and gradual w/ vague sx
- fatigue, BLE weakness
- early: paresthesia’s, visual problems
- Lhermitte’s Sign: electric shock radiating down the spine into legs w/ flexion of neck
- later: bowel and bladder problems (constipation, spastic bladder [frequency, incontinence] OR flaccid bladder [urinary retention] or BOTH)
- Uhthoff’s Sign: temporary worsening of vision and neuro fxn following increased exertion or heat exposure
- emotional lability
- cognitive changes will develop in 5-10% of patients
- may interfere w/ ADLs
MS: Dx
- MRI of brain and spine will show plaques
- CSF analysis: may show increase in immunoglobulin G
- evoke potentials of optic and auditory pathways- are delayed in pts w/ MS d/t decreased nerve conduction
MS: Interventions
- prevent exacerbations
- identify triggers
- avoid people w/infections esp URI
- avoid very warm or hot climates
- reduce stress, develop relaxation techniques
- avoid pregnancy or plan carefully
- prevent UTI
MS: Meds
Disease modifying drugs: slow progression and prevent relapses
- Interferon Beta1a (Avonex)
- Interferon Beta1b (Betaseron)
- glatiramer acetate (Capaxone),
- given SQ, SE = flu like, protect from sun exposure, assess for depression
Tx acute exacerbation:
-corticosteroids (prednisone)
Tx symptoms:
- urinary retention: cholinergics (bethanechol)
- urinary frequency and urgency: anticholinergics (oxybutynin)
- muscle spasticity: muscle relaxant (diazepam)
- constipation: stool softener (colace)
Plasmapheresis and IVIG may be considered but it’s expensive
Tx of fatigue:
-CNS stimulant (ritalin & provigil)
MS: Management
PT: to help with assistive device training and balance therapy (aquatic therapy can be very helpful)
OT: for help w/ ADLs
Spasticity and tremors may be difficult to treat
DBS or dorsal column stimulator for tremors that cannot be managed with meds.
Diet: increase protein, Vit B12, Vit C, fiber
Bowel/Bladder schedule
SW fo services
Counseling if needed
Myasthenia Gravis: Def and RFs
chronic autoimmune disorder
fluctuating weakness of certain skeletal muscle groups
failure of nerve transmissions at the neuromuscular junction d/t inadequate release of ach or inadequate response of muscle fibers to ach.
periods of exacerbation and remissions
more common in women, age 28
RF: tumor of thymus gland, another autoimmune disease
MG: Characteristics
Sx: fatigue
problems with eyes (ptosis, problems with closing eyelids)
dysphagia
neck weakness (head bobbing)
chest wall muscle weakness -> respiratory complications
bowel and bladder problems
avoid exacerbations by avoiding stress, pregnancy, menses, trauma, temp extremes, hypokalemia
Myasthenic Crisis
acute exacerbation of muscle weakness (respiratory distress, increased muscle weakness, difficulty talking, dysphagia, excessive salivation, constricted pupils)
major complication of this is respiratory issues
corticosteroids can cause this
MG: Dx
H&P
Tensilon test
EMG
