degenerative brain disease Flashcards by Emma Ross

what lesion causes muscle spasticity?

damage to upper motor neuron

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what function is affected by MS?

any where nerves are involved - cognitive, motor, sensory, autonomic

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what causes multiple sclerosis?

changes to myelin sheath around nerve axons connecting different parts of brain
DEMYELINATION OF AXONS

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what is the most common CNS disorder of the young?

multiple sclerosis

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How does multiple sclerosis distribute?

Patchy distribution of CNS lesions - areas of body affected change from time to time - CT scan will show different areas of inflammation

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Describe the aetiology of multiple sclerosis

Background genetic/immune factors
Susceptibility acquired during childhood
More common in identical twins and among immediate family members

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What are the symptoms of MS?

Muscle weakness
Visual disturbance
Paraesthesia
Autonomic dysfunction
Dysarthria
Pain
Balance/hearing loss

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What are the signs of MS?

Muscle weakness
Spasticity
Altered reflexes
Tremor
Optic atrophy
Proprioceptive loss
Loss of touch

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how does MS affect IgG protein levels?

increased IgG in MS patients

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how does MS affect lymphocyte?

reduced lymphocytes

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what will an MRI of an MS patient show?

shows areas of plaques within the brain where there has been previous damage

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How do you investigate MS?

History and examination
CSF analysis – reduced lymphocytes and increased IgG production
MRI
Visual evoked potentials – always reduced after optic neuritis

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What are the two types of MS?

Relapsing and remitting type
Primary progressive type

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Describe the features of relapsing and remitting MS

Damage builds up with each episode - episodes of active disease and periods of stability
Acute exacerbations
Many develop progressive form

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How do you treat relapsing and remitting MS?

Disease modifying therapies e.g. cladribine

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How do you treat MS?

Physio and occupational therapy
Stem cell transplant
Disease modifying therapies e.g. cladribine

Describe the features of primary progressive MS

Slow and steady progressive deterioration
Cumulative neurological damage

How do you manage the symptoms of MS?

Antibiotics, antispasmodics, analgesia, steroids
Physiotherapy and occupational therapy

What are the dental aspects of MS?

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

what is the effect of optic neuritis on visual evoked potentials?

always reduced after optic neuritis

What is motor neurone disease?

Degeneration in the spinal cord causing progressive loss of motor function
Limbs, inter costal muscles, diaphragm and motor cranial nerves VII and XII

Where in the spinal cord does MND affect?

Corticospinal tracts/anterior horns
Bulbar motor nuclei - in brain stem

Who are mostly affected by MNS and what is the life expectancy after diagnosis?

30-60yr
Males 2.5:1
Death within 3 years

Ultimately MND causes death due to what?

Ventilation failure
Aspiration pneumonia - unable to use protective reflexes

What might a patient suffering from MND notice?

Weakness in ankle or leg - tripping Slurred speech – may develop to difficulty swallowing A weak grip – dropping things, difficulty opening things Muscle cramps and twitches Weight loss Emotional liability – crying and laughing inappropriately

How do you treat MND?

No treatment is effective Physio and occupational therapy Riluzole Aspiration prevention – PEG tube feed and reduce salivation to prevent aspiration of bacteria

What is a person’s lifetime risk of developing MND?

1 in 300

What are the dental aspects of MND?

Difficulty in acceptance due to muscle weakness in head and neck and OH Realistic treatment planning Drooling and swallowing difficulties, can't control neck

What is Parkinson’s disease?

A disabling, progressive condition due to degeneration of dopaminergic neurones in the basal ganglia of the brain (substantia nigra)

What causes Parkinson’s disease?

degeneration of dopaminergic neurones in the basal ganglia of the brain shortage of dopamine results in difficulty of passing messages from cortex (thinking part) of brain to cerebellum and brainstem (doing part)

where in the brain is affected by Parkinson’s?

basal ganglia – substantia nigra

what are the clinical signs of Parkinson’s disease?

Bradykinesia – slow movement and slow initiation of movement Rigidity - increased muscle tone Tremor – slow amplitude at REST - key feature

What are the effects of Parkinson’s disease that can be observed?

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

How is Parkinson’s treated in terms of support?

Physio and occupational therapy Maintain function at as high a level for as long as possible

what do MS MND and Parkinson's have in common?

slowly progressive diseases which stop proper neurological function

how is Parkinson's treated medically?

dopamine - levadopa dopamine analogues

how is Parkinson's treated surgically?

stereotactic stimulation - deep brain stimulation

what is the dental impact of Parkinson's?

unable to accept care due to access unable to cooperate - delay dry mouth - anticholinergic effect of drugs - suggest water drug interactions