Degenerative brain disease Flashcards
1
Q
What is multiple sclerosis?
A
- Chronic, typically progressive disease involving damage to sheaths of nerve cells in brain and spinal cord
- Demyelination of axons only occurs in CNS
- Has a patchy distribution
- Leads to progressive functional loss
2
Q
What is the most common CNS disorder of the Young?
A
- Multiple sclerosis
- Women with 4th decade onset most severe
3
Q
What is the cause of Multiple sclerosis?
A
- Not entirely sure
- Susceptibility is acquired during childhood
- Altered host reaction to an infective agent?
- Background genetic/ immune factors
- More common in identical twins
- More common amongst immediate family members
4
Q
What are the symptoms of multiple sclerosis?
A
- Varies in individual
- Muscle weakness
- Visual disturbance
- Paraesthesia (look for this in face in dental practice)
- Autonomic dysfunction
- Dysarthria
- Pain
- Balance/hearing loss
5
Q
What are the Signs of multiple sclerosis?
A
- Muscle weakness
- Spasticity
- Altered reflexes
- Tremor (intention)
- Optic atrophy (light shown in eye takes time to reach occipital lobe in brain - this is delayed with MS)
- Proprioceptive loss
- Loss of touch
6
Q
What are the MS investigations performed?
A
- History and examination
- Magnetic Resonance Imaging
- CSF analysis
- Visual Evoked potentials
7
Q
What does CSF analysis show with someone with MS?
A
- Reduced lymphocytes
- Increased IgG proteins
8
Q
What are the results of a Visual Evoked Potentials test if patient has MS?
A
- Always reduces after optic neuritis
9
Q
What are the outcomes of Relapsing and remitting type of MS?
A
- This type is acute exacerbations followed by periods of respite
- Damage to CNS builds up with each episode
- Eventually become disabled as they develop progressive form of MS (called secondary progressive)
10
Q
What are the outcomes of Primary progressive type of MS?
A
- This type is a slow steady progressive deterioration of neurological condition
- Leads to cumulative neurological damage
11
Q
What is the management of symptomatic MS?
A
- Antibiotics
- Antispasmodics
- Analgesia
- Steroids
- Physiotherapy and occupational therapy (for function loss)
12
Q
What drugs can be used to slow down relapsing and remitting type of MS?
A
- Cladribine
- Siponomod
- Ocrelizumab
13
Q
How can stem cells be used to help MS?
A
- If it is due to infection
- Can use stem cell transplant to ‘reboot’ immune system
- Any existing disability not reversed and stem cell transplant has issues of it’s own and need to be considered whether worth it
14
Q
What are the dental aspects of MS?
A
- Limited mobility and psychological disorders to access dental care and OH care and measure
- Need to be treated under LA not GA
- If patient reports Orofacial motor and sensory disturbance then should be sent for MRI
- They have enhanced risk of Trigeminal neuralgia
15
Q
What is motor neurone disease?
A
- Rare condition affecting brain and nerves
- Degeneration of corticospinal tracts and anterior horns in the spinal cord
- Affects bulbar motor nuclei in cranial nerves
16
Q
When do patients develop motor neurone disease?
A
- 30-60years
- Most dead within 3 years diagnosis
- Males more likely to get it
17
Q
What can the patient expect after diagnosis of motor neurone disease?
A
- Progressive loss of motor function affecting;
- Limbs
- Intercostal muscles
- Diaphragm
- Motor cranial nerves VII-XII
Death due to;
- Ventilation failure
- Aspiration pneumonia (can’t swallow or cough)
18
Q
What are the signs of MND?
A
- Weakness in ankle or leg leading to tripping and harder to climb stairs
- Slurred speech which may develop to difficulty swallowing foods
- Weak grip so tend to drop things or can’t open jars
- Muscle cramps and twitches
- Weight loss
- Emotional liability where crying or laughing in appropriate situations
19
Q
What is the treatment of MND?
A
- No effective treatment
- Physiotherapy and occupational therapy for loss of function
- Riluzole (some say get 6-9month life extension)
- Use PEG tube feeder to reduce chance of aspiration
20
Q
What are the dental aspects of MND?
A
- Difficulty in accepting dental care
- Hard to keep oral hygiene
- Muscle weakness of head and neck
- Realistic treatment planning to improve self image and consider life expectancy and restorations needed
- Drooling and swallowing difficulties
- Can be asked to give medication or botox in salivary glands to reduce saliva
21
Q
What is Parkinson’s disease?
A
- Quite common neurological condition
- Is a progressive disabling disease most often affecting people aged 50years old
- Lack of neurotransmitter dopamine in substantia nigra in brain
22
Q
What is the cause of Parkinson’s disease?
A
- Degeneration of dopaminergic neurones in the basal ganglia of brain (Substantia nigra)
- Underlying reason for this is unclear
- Shortage of dopamine = difficulty of message passing from ‘thinking’ to ‘doing’ brain
23
Q
What are the clinical signs of Parkinson’s disease?
A
- Bradykinesia
- Rigidity of arms and legs due to increased muscle tone
- Tremor at rest of slow amplitude and goes away with forced movement of that limb (can occur in mandible)
- Impaired gait and falls
- Impaired use of upper limbs
- Mask-like face
- Swallowing problems
24
Q
What is Bradykinesia?
A
- Slow movement
- Slow initiation of movement
25
What are some of the effects of Parkinson's disease?
- Tremor
- Pain
- Dysphagia
- Frequent falls
- Mild cognitive impairment
- Drooling
- Visuospatial dysfunction
- Executive functioning deficits
26
What is the physical treatment of Parkinson's?
- Physiotherapy and occupational therapy to maintain function as long as poss
27
What is the medical treatment of Parkinson's?
- Dopamine (Levadopa) is effective at the beginning but dose needs to be continually increased to continue being effective - this causes more side effects
Dopamine analogues like;
- Tables (Promipexole, Selegiline)
- Injection (Apomorphine - subcutaneous)
- Infusion (duodopa - directly into gut)
*Patient needs to try different things to see if it is effective for them - side effects can lead to gambling*
28
What is the surgical treatment of Parkinson's?
- Stereotactic surgery for deep brain stimulation
- Research of stem cell transplant into basal ganglia being done
29
What are the dental aspects of Parkinson's disease?
- Difficulty in accepting treatment (go slow and at their pace)
- Concerns of tremor at rest (this goes away when purposeful movement like mouth opening occur)
- Dry mouth (is an anticholinergic side effects of drugs) - saliva substitutes and water
- Careful of drug interactions with their current meds
