Neurology

Question 1

What is the aetiology of epilepsy?

Answer 1

Reduction of GABA levels in brain leading to abnormal cell message propagation

Question 2

What is a febrile seizure and how is this managed?

Answer 2

Occurs in children
Fever >38 degrees (risk of seizure)
Cool child down- remove layers of clothes, cool sponge, cool bath
Paracetamol and ibuprofen

Question 3

What are the 2 types of epilepsy?

Answer 3

Generalised (tonic/ clonic and absence)
Partial (simple, complex, simple sensory)

Question 4

What is tonic clonic seizures?

Answer 4

Usually have a prodromal aura
Loss of consciousness/ continence
Initial tonic (stiff) followed by clonic (muscle jerk/ spasm)
Usually stops after 1-3 mins

Remove sources of injury

Question 5

What is absence epilepsy?

Answer 5

Common in children
No obvious changes - vacant look, flutter eyelids, loss of activity

Question 6

What is a partial seizure?

Answer 6

Motor localised to one region of the brain (although may spread)
Sensory modality (may involve deja vu)
Complex partial- variety of muscles involved causing linked movements eg lip smacking (pt often unaware)

Question 7

What is the treatment for epilepsy?

Answer 7

Anticonvulsants - carbamazepine, phenytoin, valproate
Emergency- airway and oxygen, benzodiazepines
Surgical removal of brain tumor

Question 8

What are some dental implications of epilepsy?

Answer 8

Complication of fits- soft tissue injury
Complication of medications (anticonvulsants- gingival hyperplasia, bleeding tendency- valproate)

Assess risk of seizure- ask about last 3, how long they lasted, seizure management

Question 9

What is multiple sclerosis?

Answer 9

CNS lesion causing demyelination of axons
Inflammatory changes leads to permanent damage/ loss of function which can be motor, sensory, autonomic or cognitive

Question 10

How may MS present?

Answer 10

Muscle weakness, muscle spasiticity (altered reflexes)
Optic atrophy
Proprioceptive loss
Changes in pain perception
Dysarthria

Question 11

What are the 2 types of MS?

Answer 11

Relapsing and remitting (acute exacerbations and periods of respite - damage builds up with each episode)
Primary progressive

Question 12

What is the management of MS?

Answer 12

Symptomatic management - antibiotics, antispasmodics, analgesia, steroids
Physiotherapy and occupational therapy
Disease modifying therapies (for remitting- may slow progression of lesions)
Stem cell transplant

Question 13

What are dental implications of MS?

Answer 13

Limited mobility
Chronic orofacial pain
Enhanced trigémina neuralgia risk

Question 14

What is Motor neuron disease?

Answer 14

Degeneration in the spinal cord (anterior horn of corticospinal tract)
Unremitting and progressive with prognosis of 3 years

Question 15

What may MND present as?

Answer 15

Progressive loss of motor function
Weakness in ankle/ leg
Weak grip
Slurred speech
Weight loss
Muscle cramps and spasms

Question 16

What are the common causes of death for MND patients?

Answer 16

Aspiration pneumonia (so often PEG fed)
Ventilation failure

Question 17

What is the management of MND?

Answer 17

No effective treatment - physiotherapy and occupational therapy

Question 18

What are dental implications of MND?

Answer 18

Realistic treatment planning
Acceptance of care/ accessibility
Difficulties with swallowing/ drooling

Question 19

What is Parkinson’s disease?

Answer 19

Degeneration of dopamine neurons in the basal ganglia of the brain - difficulty of message propagation from thinking to doing

Question 20

What may Parkinson’s present as?

Answer 20

Slow movement and slow initialisation of movement
Rigidity (increased muscle tone)
Tremor (often at rest)
Difficulty swallowing due to voluntary muscle of pharynx

Question 21

What is the treatment for Parkinson’s?

Answer 21

Physiotherapy and occupational therapy
Dopamine -levadopa (effective at start but need to continually increase dose, eventually side effects outweigh benefit)
Dopamine analogues - tablets/ injects/ infusion (can cause abnormal compulsions eg gambling)

Question 22

What are the dental implications of Parkinson’s?

Answer 22

Difficulty in accepting treatment- often tremor stops when opening mouth (purposeful action)
Dry mouth (anticholinergic drugs)
Drug interactions
Difficulty swallowing
Access to care