degenerative brain disease Flashcards
name degenerative brain diseases
multiple sclerosis
motor neurone disease
Parkinson’s
slow progressive diseases!
multiple sclerosis
most common CNS disorder of the Young (80:100000)
CNS lesions only -> DEMYELINATION of Axons
inflammatory change seen on MRI as red patches
progressive functional loss
women with 4th decade onset most severe
aetiology multiple sclerosis
susceptibility acquired during childhood
? altered host reaction to a infective agent
background genetic/immune factors
more common in identical twins
-> would progress differently though
more common amongst immediate family members
possible lack of vitamin D and sunshine -> studies showed more prevalence in colder countries
ms signs and symptoms
symptoms -
Muscle weakness
Visual disturbance
Paraesthesia
Autonomic dysfunction
Dysarthria
Pain
Balance/hearing loss
signs -
Muscle weakness
Spasticity
Altered reflexes
Tremor (intention)
Optic Atrophy
Proprioceptive loss
Loss of touch
changes in optic nerve conduction -> measured
ms investigations
History & examination
Magnetic Resonance Imaging - can show plaques
CSF analysis -
reduced lymphocytes
increased IgG protein
Visual Evoked Potentials -> ALWAYS reduced after optic neuritis
ms outcome
Relapsing and remitting type =
acute exacerbations and periods of respite
Damage builds up with each episode
Many will eventually develop progressive form (“secondary progressive”)
Primary progressive type
= slow steady progressive deterioration
Culmulative neurological damage
Symptomatic management
antibiotics, antispasmodics, analgesia, steroids
physiotherapy & occupational therapy
ms therapy
Physiotherapy and Occupational therapy have role with function loss
Relapsing & Remitting type
Disease modifying therapies – may also slow some progressive forms
Cladribine
Siponomod
Ocrelizumab
= do not reverse damage but slow it down
Stem Cell Transplant – ‘reboot’ the immune system
ms dental aspects
imited mobility & psychological disorders
treat under LA -> GA is dangerous
orofacial motor & sensory disturbance
suspect in younger patients?
Chronic orofacial pain possible
Enhanced TRIGEMINAL NEURALGIA risk
suspect in younger patients!
what is motor neurone disease
degeneration in the spinal cord
corticospinal tracts/anterior horns
also can affect bulbar motor nuclei
patients aged 30-60yrs
death with 3 years of diagnosis
male 2.5:1 female
No good family history – most are sporadic
motor neurone disease where is loss of motor function
limbs
intercostal
diaphragm
motor cranial nerves VII – XII
Death due to:
ventilation failure
aspiration pneumonia (swallowing/cough)
what patients might notice with mnd
Weakness in the ankle or leg – leading to tripping, or find it harder to climb stairs
Slurred speech, which may develop into difficulty swallowing some foods
A weak grip – dropping things, or finding it hard to open jars or do up buttons
Muscle cramps and twitches
Weight loss – arms or leg muscles may become thinner over time
Emotional lability - crying or laughing in inappropriate situations
mnd treatment
NONE effective
Physiotherapy & occupational therapy
Riluzole
some get 6-9 months life extension
Aspiration prevention
PEG tube feed
reduce salivation
mnd dental aspects
difficulty in acceptance of dental care
muscle weakness of head & neck
realistic treatment planning
drooling & swallowing difficulties
parkinson’s disease
Quite common
Disabling
Progressive
Usually older people
Degeneration of dopaminergic neurones in the basal ganglia of the brain (substantia nigra)
Shortage of Dopamine results in difficulty of message passaging from ‘thinking’ to ‘doing’ brain
delayes in doing and understanding
Underlying reason for this is unclear
parkinson’s disease clinical signs
BRADYKINESIA - Slow movement, and slow initiation of movement
RIGIDITY - Increased muscle tone
TREMOR - slow amplitude , AT REST
Can progress to on/off movement disorder – often after treatment
