Diseases of Human Systems - Neurology: Degenerative Brain Disease

Question 1

What is MS?

Answer 1

Demyelination of axons due to inflammatory changes which lead to permanent loss of function.

Question 2

Who is affected by MS?

Answer 2

Disorder of the young

Question 3

What causes MS?

Answer 3

Genetic link

Environmental triggers - the further away from the equator the higher the incidence

Question 4

What are the signs of MS?

Answer 4

muscle weakness/spasticity 
visual disturbances 
Paraesthesia 
autonomic dysfunction 
dysarthria 
pain 
balance/hearing loss

Question 5

What are the types of MS?

Answer 5

Relapsing and remitting - patient will eventually become disabled from the accumulation of all the damage during acute episodes

Primary progressive - slow, steady degeneration

Question 6

What are the dental implications of MS?

Answer 6

Limited mobility

Orofacial motor and sensory disturbances

Chronic orofacial pain

Enhanced risk of trigeminal neuralgia

Question 7

What is motor neurone disease?

Answer 7

degeneration of motor nerves in the anterior horn of the corticospinal tracts in the spinal chord and the motor nuclei in the brain stem.

Question 8

What do most patients with MND die of?

Answer 8

Type 2 respiratory failure
or
aspiration pneumonia

Question 9

What are the effects of MND?

Answer 9

Progressive loss of motor function in the limbs, intercostal muscles, diaphragm and motor cranial nerves

= hypoxia

Question 10

What are the symptoms of MND?

Answer 10

Weakness in the legs - hard to climb stairs

slurred speech and trouble swallowing

weak grip

muscle cramps and twitches

Emotional liability

Question 11

What are the dental implications of MND?

Answer 11

Limited mobility - problems with access and tooth brushing

Difficulty in maintaining head posture

Drooling - dentist may be asked to prescribe anticholinergics and administer botox in order to reduce the saliva

Question 12

What patients are at risk of MDN? age + sex

Answer 12

Commonly males (females can develop too) from 30-60 y/o

Question 13

What age range of patients are more at risk of developing Parkinson’s disease?

Answer 13

> 50 y/o’s

However some forms can affect younger people

Question 14

What is Parkinson’s?

Answer 14

Progressive and disabling disorder cause by a lack of the neurotransmitter domaine in the substance nigra basal ganglia of the brain

Question 15

What are the signs of Parkinson’s? (5)

Answer 15

Bradykinesia - slow movement, slow initiation of movement

Rigidity - from increased muscle tone

Tremor at rest which disappears when making a conscious muscle movement

Unsteady/unusual walking

Mask like facial expression

Question 16

How is Parkinson’s treated (3 + named examples)?

Answer 16

Dopamine replacement - levodopa

Dopamine analogues - duodopa and apomorphine

Surgery - stereostatic surgery (deep brain stimulation)

Question 17

What are the limitations of dopamine replacements such as levodopa?

Answer 17

These medications will be effective initially and the dosage has to be continually increased to have an effect. Eventually the dose is too high and the side effects are intolerable and then the medication has to be stopped.

Can also give the patients weird compulsions such as gambling.

Question 18

What are the considerations in terms of dental treatment in those with Parkinson’s? (5)

Answer 18

difficult to comply with treatment as the patients capacity deteriorates.

Difficulty in communication

Dry mouth from anticholinergic drugs used to treat symptoms

Drug interactions

mask like appearance = unable to identify visual cues in terms of how patient is tolerating treatment/feeling