Motor Neurone Disease Flashcards
What are motor neurone diseases (MND’s)?
A group of neurodegenerative disorders that selectively affect motor neurons
What are motor neurons?
The cells that control voluntary movement of muscles of the body
What are some examples of MND’s?
- Amyotrophic lateral sclerosis (ALS)
- Progressive bulbar palsy (PBP)
- Pseudobulbar palsy
- Progressive muscular atrophy
- Primary lateral sclerosis
Which type of MND accounts for most cases?
ALS
What proportion of MND’s are PBP?
Around 2/10
What muscles are first affected in PBP?
Those involved in talking, chewing and swallowing
How common is progressive muscular atrophy?
Uncommon
What are the muscles first affected in progressive muscular atrophy?
Small muscles of hands and feet
What is often absent in progressive muscular atrophy?
Muscle spasticity
How common is primary lateral sclerosis?
Rare
Where does primary lateral sclerosis mostly cause weakness?
Leg muscles
What other problems may develop in primary lateral sclerosis?
- Clumsiness of hands
- Speech problems
What parts of the motor system are affected in MND?
Anterior horn cells of the spinal cord and motor cranial nuclei
Does MND affect UMN or LMN’s?
Mixture
What is the result of the mixed effect of MND on UMN and LMN’s?
A mixed picture of muscular paralysis with LMN signs predominating
What is the current focus of aetiological hypotheses of MND?
Abnormalities of mitochondrial function causing oxidative stress in motor neurones
What is the underlying cause of MND?
Unkown
What do 5% of people with MND have in terms of causes?
A familial form of the disease thought to be due to a mutation in the superoxide dismutase-1 gene
What are the risk factors for MND?
- Over 50
- Male
- Family history
- Frontotemporal dementia
What is the typical onset of the presentation of ALS?
Focal with a particular muscle group affected first
What are the three recognised focal patterns of onset in ALS?
- Limb onset
- Bulbar onset
- Respiratory onset
What is the most common pattern of onset in ALS?
Limb onset
Where does limb onset ALS typically affect first?
The upper limbs
What upper limb signs/symptoms may present in limb onset ALS?
- Dropping objects
- Difficulty manipulating objects
- Wrist drop or stiffness
- Cramping of hands
- Wasting of intrinsic hand muscles
- Fasciculations of muscles of limbs
Where may limb onset ALS occasionally first present?
The legs
What are the leg signs/symptoms that a patient may present with in limb onset ALS?
- Foot drop
- Gait disorder
- Sensation of heaviness in one or both legs
- Tendency to trip
- Excessive fatigue when walking
What are some diagnostic pointers of limb-onset ALS?
- Asymmetrical distal weakness
- Brisk reflexes occurring in wasted limb
- Absence of major sensory symptoms/pain
- Relentless progression of symptoms and signs
Bulbar onset accounts for what percentage of ALS?
20%
What is usually the first sign of bulbar onset ALS?
Slurring of speech
What causes the slurring of speech in bulbar onset ALS?
Impaired tongue movement