Degenerative Brain Disease Flashcards
What happens in multiple sclerosis? (to the nerves)
Demyelination of the axons in CNS only
The demyelination happens due to what?
Inflammatory changes
Describe the distribution of MS lesions.
there is patchy distribution - areas of the body affected change from time to time
What is the aetiology of MS?
Its unknown but there are some genetic factors
What are the symptoms of MS?
- Muscle weakness
- Visual disturbance
- Paraesthesia
- Autonomic dysfunction
- Dysarthria (change with speech)
- Pain
- Balance/hearing loss
What are some signs of MS?
- Muscle weakness
- Spasticity (muscle spasticity happens when there is an upper motor neuron lesion)
- Altered reflexes
- Tremor (intention - happens when trying to complete a task)
- Optic Atrophy (testing optic nerve speed of conduction is a common test when assessing MS)
- Proprioceptive loss
- Loss of touch
What investigations can be done for MS?
History & examination
Magnetic Resonance Imaging
CSF analysis (reduced lymphocytes and increased IgG protein)
Visual Evoked Potentials (ALWAYS reduced after optic neuritis)
What are the 2 main types of MS?
- relapsing and remitting MS
- primary progressive MS
Describe relapsing and remitting MS.
- Acute exacerbations and periods of respite (episodes of active diseases and loss of function but will settle after a few weeks and patient enters a stage of stability).
- Damage builds up with each episode o Eventually become disabled
- Many will eventually develop progressive form (“secondary progressive”)
Describe primary progressive MS.
- Is a slow steady progressive deterioration
- Cumulative neurological damage
If there is a symptomatic attack of MS, how is it treated?
o antibiotics, antispasmodics, analgesia, steroids
o physiotherapy & occupational therapy
What treatment is there to help with function loss?
physiotherapy and occupational therapy
How are the relapsing and remitting types of MS managed/treated?
o Disease modifying therapies – may also slow some progressive forms (slow damage but won’t reverse)
o Cladribine
o Siponomod
o Ocrelizumab
What are the dental aspects of MS?
- limited mobility & psychological disorders
- As disease progresses gets harder for them to manage their OH by themselves
- More difficult for them to get to the dentist themselves
- treat under LA
- As it is thought a GA increases the onset of damage within the brain
- orofacial motor & sensory disturbance
- suspect in younger patients?
- If a patient has a sudden loss of sensory or motor function in face they should get an MRI
- Chronic orofacial pain possible
- Enhanced TRIGEMINAL NEURALGIA risk
- suspect in younger patients!
What is motor neuron disease?
When there is degeneration of the nerves in the anterior horns of the corticospinal tracts in the spinal cord and it can also affect the bulbar motor nuclei in the brainstem
(degeneration in the spinal cord and bulabar motor neuclei)
What is the life span like for this disease?
Most patients die within 3 years
What is the aetiology of MND?
Unknown - no genetic link (cases tend to be sporadic)
There is progressive loss of motor function in what in patients with MND?
Progressive loss of motor function in:
- The limbs
- Intercostal muscles
- The diaphragm
- Motor cranial nerves VII – XII
Death of people with MND is normally due to what?
Ventilation failure or aspiration pneumonia
What are some symptoms of motor neuron disease?
- 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 (muscle bulk loss)
- Emotional lability - crying or laughing in inappropriate situations
What are the treatments for MND?
- NONE effective
- Physiotherapy & occupational therapy
- Aim is to maintain function for as long as possible
- Riluzole
- some get 6-9 months life extension
- Aspiration prevention
- PEG tube feed
- reduce salivation – dentists sometimes asked to help reduce salivation so they don’t inhale oral bacteria into the lungs
What are the dental aspects of MND?
- Poor acceptance of dental care
- Often significant mobility problems
- Muscle weakness of head & neck
- Head often tipped forward and drooling
- Realistic treatment planning
- Drooling & swallowing difficulties
- Drooling can be associated with idiocy and patients feel like this makes them inferior and look bad to peers
- Can prescribe Anticholinergics and place botox into salivary glands to help with drooling
What is Parkinson’s disease?
A progressive, disabling disease that normally affects older people
Involves the degeneration of dopaminergic neurons in the basal ganglia leading to a lack of dopamine
The lack of dopamine in Parkingson’s disease results in what?
results in difficulty of messages passaging from ‘thinking’ to ‘doing’ brain
What are some clinical signs of Parkingson’s disease?
- BRADYKINESIA
- Slow movement, and slow initiation of movement
- Can seem like someone is ignoring you at first
- RIGIDITY
- Increased muscle tone – jerks
- TREMOR
- Slow amplitude
- Can happen in the mandible
- When make and intentional movement the tremor will go away
- Can progress to on/off movement disorder – often after treatment
Loss of cognitive function can also occur in Parkingson’. What are some examples of this?
- Impaired gait and falls
- Unsteady walking and unusual falls
- Impaired use of upper limbs
- E.g. arms don’t swing when they walk
- Mask-like face
- Flat looking appearance of face
- Swallowing problems
- Due to affect on voluntary muscles in the pharynx
What are the 3 groups of treatments for parkingson’s?
- Physical support
- Medical treatments
- Surgical treatments
What physical support is there for parkingson’s?
- Physiotherapy and Occupational therapy
- These work to maintain function at as high a level for as long as possible
What medical treatments are there for Parkingson’s ?
- Dopamine
- Levadopa
- Is effective in the beginning
- Dopamine analogues
- Tablets – Promipexole, Selegiline
- Injection – apomorphine - subcutaneous
- Infusion – duodopa – directly into the gut
What surgical treatments are there for Parkingson’s?
- Stereotactic surgery
- Deep brain stimulation
- Helps some patients return to more normal function
- Stem cell transplant?
- Suggested as a way to get dopamine back in
What are the dental aspects of Parkingson’s disease?
- Difficulty accepting treatment
- Tremor at rest of body
- Often facial tremor reduces on purposeful movements e.g. mouth opening
- Dry mouth
- Anticholinergic effects of the drugs
- Drug interactions?
