Long Term Effects of Chronic Neurological Conditions Flashcards
How many people in the UK live with neurological condition impacting on their lives ? How many are disabled by their condition ?
10Million 1 Million (2% of population)
How many in the UK are diagnosed with neurological condition each year ?
600,000 (1%) newly diagnosed each year with neurological condition
What proportion of hospital admissions are for neurological problem requiring treatment from a neurologist or neurosurgeon ?
19% of hospital admissions are for neurological problem requiring treatment from a neurologist or neurosurgeon
What is spina bifida ?
Describes a group of congenital conditions where there is an incomplete development or covering of the brain and/or spinal cord, caused by a failure of the foetal spine to close normally in the first month of pregnancy. Often linked with Hydrocephalus.
Identify proposed aetiologies of spina bifida.
- Multi-factorial inheritance.
- Potato blight.
- Vitamin deficiencies/folate.
- Maternal fever.
- Zinc deficiency.
- High sound intensity.
- Viral infection.
- Alcohol.
- Mineral deficiency.
- Medication – Phenytoin, Epilim, etc.
What determines the severity of spina bifida ?
Mild disability when the cord remains in the neural canal (sac contains the meninges and CSF but not the spinal cord)
Serious disability if the cord is displaced from the neural canal or has not developed
What are the neurological consequences of severe spina bifida ?
Paralysis, loss of sensation and reflexes distal to the abnormality
How is spina bifida treated ?
Surgery to close the defect (reduce exposure, and risk of meningitis)
Identify neonatal consequences of severe spina bifida.
- High risk of meningitis in open lesions in the neonate
- Hydrocephalus in 70-90% because of the interruption of the circulation of CSF
How is a hydrocephalus treated ? What is the main issue with hydrocephalus ?
Shunting, in order to drain the hydrocephalus from ventricular system
Shunts can become infected or blocked.
How is antenatal diagnosis of spina bifida performed ?
• Ultrasound
spinal anomalies identifiable at 16-18 weeks
• α fetoprotein raised in neural tube defects maternal serum at 16-20 weeks amniocentesis
Identify conditions associated with spina bifida.
- Renal anomalies
- Sphincter function
- Intellectual impairments
- Musculoskeletal
What can be done if a spina bifida is found antenatally ? What is the problem with this ?
• Antenatal counselling and possible termination of pregnancy
BUT not everyone attends for antenatal care, and some mothers may first attend after the legal gestational age for termination
Identify examples of musculoskeletal conditions associated with spina bifida.
Paralytic deformities of the feet
- Difficulties with shoe wear
- Plantar ulceration
Scoliosis
-Due to combo of congenital abnormalities of the spine and spinal muscle weakness
Abnormalities of gait/mobility (depending where lesion is)
When is surgery performed for scoliosis ?
If surgical correction is required, this is usually done after the age of 10 years to allow sufficient spinal
growth beforehand
Describe prognosis for independent walking as a adult, for a child diagnosed with spina bifida.
Assumes no significant intellectual or psychological impairment to walking:
-Thoracic and upper lumbar lesions – no walking ability
-Lower lumbar and sacral– can walk but will need
orthotics (splints) to compensate for paralysed/weak muscles
Describe gait, and mobility in a L4 lesion.
GAIT
-Flexed knee gait in a L4 lesion: patient relies on intact quadriceps
- Paralysed calf muscles result in excess ankle dorsiflexion
- Muscle fatigue
- Energy inefficient gait
- Knee pain
MOBILITY
- Increasing height and weight as child grows but muscle strength does not change
- Muscle fatigue and knee pain may worsen and adult becomes more reliant on a wheelchair
- An L4 lesion does not preclude driving
- If able to drive may need adapted vehicle
- Likely to use a self propelling or electric wheelchair for shorter distances
- Will require adapted housing if living independently
Define Charcot Joint.
Loss of protective sensation and proprioception in a joint, can result in joint destruction
Identify a lesion which can cause Urinary Tract consequences.
S2-4 lesion: urinary incontinence (neurogenic bladder), so incomplete bladder emptying leads to back pressure on ureters and eventual renal
parenchymal damage and failure, if left untreated
What are the treatment options for urinary incontinence at childhood ?
Urinary incontinence: aim to
achieve social continence in childhood
- Nappies (diapers) acceptable before primary school
- Permanent bladder catheterisation is not a satisfactory long term solution because of a high risk of UTIs
- Clean intermittent catheterisation often the best option - carer or patient self catherisation
What are the social consequences of urinary incontinence ?
Reduced quality of life - with social isolation and embarrassment
Urinary diversion may be necessary for physical or social reasons (urine drains continuously into a stoma bag)
Identify possible neurological causes of faecal incontinence.
- Paralysis of external anal sphincter and mechanism to indicate a full rectum
- Some patients will have weak abdominal and perineal muscles
What is the treatment for faecal incontinence ?
-Daily rectal enema
-Constipation may require laxatives or manual evacuation
-Surgical diversion may be
necessary for physical or social reasons
Identify a lesion which can cause fecal incontinence.
S2-S4 lesion
Describe the sexual potential after an S2-S4 lesion.
-Libido may be normal
-Sensation absent (S2-4)
-Erections may be possible due to spinal reflex
-Fertility females normal
males usually sterile
-Menstruation may cause further social difficulty
Describe the implications on education of a chronic neurological condition.
- Mainstream school
- Special needs school: learning and physical disability
- College to acquire life skills for those with learning difficulties
Describe the implications on employment of a chronic neurological condition.
- Ability’ rather than ‘disability’ i.e. what the young person or adult can do and not what they cannot do
- Extensive UK disability legislation
- Patients whose disabilities preclude employment may attend a day centre
Describe the implications on parents and caregivers of chronic neurological conditions.
- Emotional and physical support for child/young person
- Need to provide assistance with daily physical tasks e.g. bathing, dressing, mobility
- Also need not to forget siblings and partner
- Difficult for ageing parents
Identify the optimal outcome of independent living as an adult with a chronic neurological condition.
- Normal intellect
- Social continence stable
- Independently mobile, can drive an adapted vehicle and use walking aids
- Independent living - household adaptations, telecare and other technologies
- Employed
Identify challenges to independent living as an adult with a chronic neurological condition.
- Learning difficulties
- Behavioural difficulties
- Social continence not achieved
- Cannot transfer independently
- Ageing parents
- Some patients will live in a sheltered/residential facility and be looked after by a team of carers – options for community living are limited though in reality
Describe disability paradox.
Many people with serious and persistent disabilities report that they experience a good or excellent quality of life when to most external observers these individuals seem to live an undesirable daily existence
What is cerebral palsy ?
- Spectrum of motor disorders affecting posture, movement and co-ordination
- Caused by a brain lesion resulting in abnormal development of CNS
Identify risk factors for cerebral palsy.
Low birth weight or preterm birth
Multiple gestations
Infertility treatments
What proportion of live births in the UK are affected by cerebral palsy ?
0.2-0.3%
Do younger people with cerebral palsy have a different perception of their social integration compared to older people with cerebral palsy ?
Older people with CP feel less socially integrated than younger people with CP due to:
- Vocational Status
- Living Situation
- Musculoskeletal Pain
MS
- Underlying cause
- Most common sites
- Clinical features
- Investigations
MS
- Underlying cause: Multiple plaques of demyelination in the brain and spinal cord disseminated in time and space
- Most common sites: optic nerve, periventricular region, brain stem and cerebellar connections, cervical spine, posterior columns
- Clinical features: relapsing/remitting, chronic progressive
- Investigations: MRI brain and spinal cord, CSF for oligoclonal bands
