Neurology Flashcards
What is the aetiology of epilepsy?
Reduction of GABA levels in brain leading to abnormal cell message propagation
What is a febrile seizure and how is this managed?
Occurs in children
Fever >38 degrees (risk of seizure)
Cool child down- remove layers of clothes, cool sponge, cool bath
Paracetamol and ibuprofen
What are the 2 types of epilepsy?
Generalised (tonic/ clonic and absence)
Partial (simple, complex, simple sensory)
What is tonic clonic seizures?
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
What is absence epilepsy?
Common in children
No obvious changes - vacant look, flutter eyelids, loss of activity
What is a partial seizure?
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)
What is the treatment for epilepsy?
Anticonvulsants - carbamazepine, phenytoin, valproate
Emergency- airway and oxygen, benzodiazepines
Surgical removal of brain tumor
What are some dental implications of epilepsy?
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
What is multiple sclerosis?
CNS lesion causing demyelination of axons
Inflammatory changes leads to permanent damage/ loss of function which can be motor, sensory, autonomic or cognitive
How may MS present?
Muscle weakness, muscle spasiticity (altered reflexes)
Optic atrophy
Proprioceptive loss
Changes in pain perception
Dysarthria
What are the 2 types of MS?
Relapsing and remitting (acute exacerbations and periods of respite - damage builds up with each episode)
Primary progressive
What is the management of MS?
Symptomatic management - antibiotics, antispasmodics, analgesia, steroids
Physiotherapy and occupational therapy
Disease modifying therapies (for remitting- may slow progression of lesions)
Stem cell transplant
What are dental implications of MS?
Limited mobility
Chronic orofacial pain
Enhanced trigémina neuralgia risk
What is Motor neuron disease?
Degeneration in the spinal cord (anterior horn of corticospinal tract)
Unremitting and progressive with prognosis of 3 years
What may MND present as?
Progressive loss of motor function
Weakness in ankle/ leg
Weak grip
Slurred speech
Weight loss
Muscle cramps and spasms
What are the common causes of death for MND patients?
Aspiration pneumonia (so often PEG fed)
Ventilation failure
What is the management of MND?
No effective treatment - physiotherapy and occupational therapy
What are dental implications of MND?
Realistic treatment planning
Acceptance of care/ accessibility
Difficulties with swallowing/ drooling
What is Parkinson’s disease?
Degeneration of dopamine neurons in the basal ganglia of the brain - difficulty of message propagation from thinking to doing
What may Parkinson’s present as?
Slow movement and slow initialisation of movement
Rigidity (increased muscle tone)
Tremor (often at rest)
Difficulty swallowing due to voluntary muscle of pharynx
What is the treatment for Parkinson’s?
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)
What are the dental implications of Parkinson’s?
Difficulty in accepting treatment- often tremor stops when opening mouth (purposeful action)
Dry mouth (anticholinergic drugs)
Drug interactions
Difficulty swallowing
Access to care
