Degenerative Brain Disease

Question 1

What is multiple sclerosis?

Answer 1

CNS lesions causing demyelination of axons
Has a patchy distribution
Causes functional loss

Question 2

Who does MS affect?

Answer 2

Most common CNS disorder of the young
80:100,000
More common in identical twins
More common amongst immediate family members

Question 3

Give some symptoms of MS

Answer 3

Muscle weakness
Visual disturbance
Paraesthesia

Question 4

Give some signs of MS?

Answer 4

Muscle weakness
Spasticity
Altered reflexes
Tremor

Question 5

What investigations are carried out for MS?

Answer 5

History and exam
Magnetic resonance imaging
CSF analysis
Visual evoked potentials

Question 6

What are the outcomes of MS?

Answer 6

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

Question 7

How can therapy treat MS?

Answer 7

Physiotherapy and occupational therapy help in function loss
Disease modifying drugs - cladribine, siponomod
Stem cell transplant - reboot the immune system

Question 8

What are the dental aspects of MS?

Answer 8

Limited mobility and psychological disorders
Treat under LA
Orofacial motor and sensory disturbance
Chronic orofacial pain possible
Enhanced trigeminal neuralgia risk

Question 9

What is motor neurone disease?

Answer 9

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

Question 10

Who does MND affect?

Answer 10

Patients aged 30-60 years - death within 3 years of diagnosis
Male 2.5:1
No relation to family history

Question 11

What are the signs and symptoms of MND?

Answer 11

Weakness in the ankle or leg
Slurred speech, may develop into difficulty swallowing
A weak grip
Muscle cramps and twitches
Weight loss
Emotional lability

Question 12

How is MND treated?

Answer 12

None effective
Physiotherapy and occupational therapy
Riluzole can give 6-9 months life extension
Aspiration prevention - PEG tube feed, reduces salivation

Question 13

How can MND cause death?

Answer 13

Ventilation failure
Aspiration pneumonia (swallowing/cough)

Question 14

What are the dental aspects of MND?

Answer 14

Difficult in acceptance of dental care - muscle weakness of head and neck
Realistic treatment planning
Drooling and swallowing difficulties

Question 15

What is Parkinson’s disease?

Answer 15

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

Question 16

What are the clinical signs of Parkinson’s?

Answer 16

Bradykinesia - slow movement and slow initiation of movement
Rigidity - increased muscle tone
Tremor - slow amplitude

Question 17

What are the clinical observations of Parkinson’s?

Answer 17

Impaired gait and falls
Impaired use of upper limbs
Mask-like face
Swallowing problems

Question 18

How is Parkinson’s treated?

Answer 18

Physiotherapy and occupational therapy
Dopamine analogues - tablets, injection or infusion
Stereotactic surgery
Stem cell transplant

Question 19

What are the dental aspects of Parkinson’s?

Answer 19

Difficulty accepting treatment - tremor at rest, often facial tremor reduces on mouth opening
Dry mouth
Drug interactions