Neurodegenerative conditions (add more)

Question 1

What is parkinson’s disease?

Answer 1

A disease where the dopaminergic neurons in the substantia nigra are progressively lost.

– This leads to excessive filtering due to a weak direct pathway restricting voluntary movements.

– Can be drug-induced – gives motor symptoms rapid onset and bilateral with a faster onset

Question 2

Parkinson’s disease symptoms

Answer 2

– Clinical features have classical triad

1) Tremor –> worse at rest (pill rolling motion of thumb over fingers), improves with movement
2) Hypertonia –> cogwheel rigidity in the extremities
3) Bradykinesia –> slow initiation of voluntary movements and expressionless face (Mask face)

– Postural instability and festinant gait (shuffling, pitched forward gait)

– Also occurs with depression (most common mental symptom), dementia and psychosis

Question 3

Parkinson’s disease diagnosis

Answer 3

Diagnosed clinically by a specialist. Can use SPECT (DaT scan)

Question 4

Parkinson’s disease management

Answer 4

– If motor symptoms affect life 1st line is Levodopa combined with DDC inhibitor

– If motor symptoms do not affect life, then L-Dopa, or Da agonist or MAO-inhibitor

-2nd line = dual therapy with options above or COMT inhibitor

Question 5

What is multiple sclerosis?

Answer 5

This is an autoimmune disorder against the CNS oligodendrocytes with make myelin

– It is the commonest cause of chronic neurological disability in young adults (20-30)

-All sub-divisions except for Primary Progressive have a female predominance

– Developing the disease is associated with HLA-DR2 and further distance away from the equator

Question 6

Multiple Sclerosis risk factors

Answer 6

Smoking
Infectious mononucleosis
Osteomalacia

Question 7

Multiple Sclerosis types

Answer 7

i) Relapse-remitting:

Initial recovery between relapses, which leads to deterioration. With time the remission becomes incomplete, so disability gets worse and leads to secondary progressive.

ii) Primary Progressive MS:

Steadily progressive disability in absence of relapses

iii) Stable:

Some patients experience no progressive disablement at all

Question 8

Multiple Sclerosis symptoms

Answer 8

– Presents with relapsing neurological deficits with periods of remission

– Vision: Optic neuritis (1st sign) + Saccadic movements + Desaturation of red

– Sensory: Asymmetrical pins and needles + trigeminal neuralgia

– Motor: Spasticity + weakness of legs

– Cerebellar: Ataxia + tremor

– Incontinence, sexual dysfunction and fatigue

Question 9

Multiple sclerosis tests

Answer 9

– Refer to neurology. In order to be diagnosed there must be dissemination in time and space. This means that you must have more than one episode affecting more than one part of your body.

– MRI –> used to identify loss of white matter around neurones

– Lumbar puncture –> shows IgG (oligoclonal bands) + myelin basic protein in CSF