neurological conditions

Question 1

what is parkinsons disease

Answer 1

• Loss of dopaminergic neurons from basal ganglia (substantia nigra)
• The basal ganglia is involved in initiating, stopping and regulating the intensity of the skeletal muscle movements. The basal ganglia send neurons to the premotor cortex and they plan the movement together. The premotor cortex sends neurons to the basal ganglia to start and stop movement. Losing the dopamine neurons means that there is a decrease in skeletal muscle movement
  Neurons die and they can not be replaced

Signs and symptoms
- Tremors (resting)
- Muscle rigidity
- Bradykinesia (slowed movement)
- Akinesia (no movement)

Other effects
- Decreased facial expression and movement
- Posture and gait effects- not proper control
- Speech and swallowing difficulties
- Eventually cognitive decline

Management (symptom management)
- Levodopa: dopamine precursor (converted into dopamine)
- Dopamine agonists
- Anticholinergics
- Deep brain stimulation
- Supportive care e.g OT, physio

Question 2

what is multiple sclerosis

Answer 2

• Ones own immune system identifies something normal as foregin and attacks it
• Autoimmune
• Oligodendrocytes (only in central nervous system) are targeted leading to demylenation and therefore lose myelin around CNS system and the neurons of the optic nerve neurons
• Losing myelin decreases action potential conduction
• In the neuron there is a loss of change insulation so full charge change does not reach next node= no further depolarization
• Myelin is destroyed which leads to an inflammatory reaction and the action potential is disrupted which leads to some functional loss depending what neurons it has happened to. Potential repair and regain of function is dependent on the type of multiple sclerosis

Signs and symptoms are highly variable
- Depends on what neurons are affected- sensory, autonomic, skeletal

Types of multiple sclerosis
1. Relapse remitting- myelin disruption and loss of some function for a period of time and then repair and recovery and often regaining full function. Then there may be some time before another relapse. Progressively overtime there is an upward climb of progressively decreasing function.
2. Secondary progressive- starts like relapse remitting with periods of disease and progression but moves more quicker to decreasing function before steady progression of functional loss
3. Primary progressive- from the beginning it is continuous functional loss

Management: for symptoms and try to delay progression
- Various disease modifying drugs: reduce attacks

Question 3

what is epilepsy

Answer 3

• Recurrent and unprovoked seizure (uncontrolled movement of the body from hyperactive and synchronous action potential discharge in particular groups of neurons in the brain)

Seizures:
1. Partial (Focal) seizures- localized groups of neurons affected (a particular area of the brain affected)
- Simple: remain conscious + sensory and motor experience
- Complex: altered or loss of consciousness + sensory and motor experience
2. Generalized seizures- most of the brain is involved and some alteration or loss of consciousness
- Tonic: muscle stiffness in whole body
- Atonic: muscle relaxation in whole body
- Clonic: muscle convulsion in whole body
- Myoclonic: localized muscle convulsions/ twitches
- Absence: spaced out- not consciously aware of surroundings
- Tonic-clonic: most common and risky. A tonic phase followed by a clonic phase

• Prodrome: feelings/ perception preceding seizure
• Aura: feelings, thoughts, sensations etc associated with seizure
• Postictal: time after seizure- may still exhibit alterations in consciousness
  !! status epilepticus: medical emergency because it is when you have a seizure last more than 5 minutes or multiple seizures without any recovery inbetween. Significant disruption to ventilation (decreased) and an increase in oxygen demands to neurons so their oxygen demands are not met and they start to die which can lead to respiratory failure