Degenerative Brain Disease Flashcards
What is multiple sclerosis?
CNS lesions causing demyelination of axons
Has a patchy distribution
Causes functional loss
Who does MS affect?
Most common CNS disorder of the young
80:100,000
More common in identical twins
More common amongst immediate family members
Give some symptoms of MS
Muscle weakness
Visual disturbance
Paraesthesia
Give some signs of MS?
Muscle weakness
Spasticity
Altered reflexes
Tremor
What investigations are carried out for MS?
History and exam
Magnetic resonance imaging
CSF analysis
Visual evoked potentials
What are the outcomes of MS?
Relapsing and remitting type - acute exacerbations and periods of respite
Primary progressive type - slow steady progressive deterioration
Symptomatic management - analgesia, steroids, physiotherapy and occupational therapy
How can therapy treat MS?
Physiotherapy and occupational therapy help in function loss
Disease modifying drugs - cladribine, siponomod
Stem cell transplant - reboot the immune system
What are the dental aspects of MS?
Limited mobility and psychological disorders
Treat under LA
Orofacial motor and sensory disturbance
Chronic orofacial pain possible
Enhanced trigeminal neuralgia risk
What is motor neurone disease?
Degeneration in the anterior horn of the corticospinal tract of the spinal cord
Progressive loss of motor function of the limbs, intercostals, diaphragm and CN VII - XII
Who does MND affect?
Patients aged 30-60 years - death within 3 years of diagnosis
Male 2.5:1
No relation to family history
What are the signs and symptoms of MND?
Weakness in the ankle or leg
Slurred speech, may develop into difficulty swallowing
A weak grip
Muscle cramps and twitches
Weight loss
Emotional lability
How is MND treated?
None effective
Physiotherapy and occupational therapy
Riluzole can give 6-9 months life extension
Aspiration prevention - PEG tube feed, reduces salivation
How can MND cause death?
Ventilation failure
Aspiration pneumonia (swallowing/cough)
What are the dental aspects of MND?
Difficult in acceptance of dental care - muscle weakness of head and neck
Realistic treatment planning
Drooling and swallowing difficulties
What is Parkinson’s disease?
Degeneration of dopaminergic neurones in the basal ganglia of the brain
Shortage of dopamine results in difficulty of message passaging from thinking to doing
Disabling and progressive disease
Usually affects older people
What are the clinical signs of Parkinson’s?
Bradykinesia - slow movement and slow initiation of movement
Rigidity - increased muscle tone
Tremor - slow amplitude
What are the clinical observations of Parkinson’s?
Impaired gait and falls
Impaired use of upper limbs
Mask-like face
Swallowing problems
How is Parkinson’s treated?
Physiotherapy and occupational therapy
Dopamine analogues - tablets, injection or infusion
Stereotactic surgery
Stem cell transplant
What are the dental aspects of Parkinson’s?
Difficulty accepting treatment - tremor at rest, often facial tremor reduces on mouth opening
Dry mouth
Drug interactions
