Neurology - Degenerative Flashcards
How does MS occur
it is a CNS lesion only
due to demyelination of axons
What is the distribution of MS
patchy
there is progressive functional los
What is the etiology of MS
susceptibility acquired during childhood
possible altered hist reaction an infective agnet
background genetic/immune factors
What are signs of MS
muscle weakness spasticity altered reflexes tremor (intention) optic atrophy proprioceptive loss loss of touch
What are symptoms of MS
muscle weakness visual disturbance paraesthesia autonomic dysfunction dysarthria pain balancing/hearing loss
What are MS investigations
history and exam
MRI
CSF analysis
visual evoked potentials
What is looked for in the CSF analysis in MS investigation
reduced lymphocytes
increase IgG protein
What is the outcome of relapsing and remitting type of MS
acute exacerbations and periods of respite
What is the outcome of primary and progressive type of MS
slowly steady progressive deterioration
What happens in the relapsing and remitting type of MS
damage builds up with each episode
many will eventually develop progressive form ‘secondary progressive’
What happens in the primary progressive type of MS
cumulative neurological damage
What is the symptomatic management of MS
antibiotics, antispasmodics, analgesia, steroids
physiotherapy and occupational therapy
What is MS therapy consist of
physiological and occupational have a role with functional loss
for relapsing and remitting type there is also disease modifying therapies
can use stem cell transplant to reboot the immune system
What are the dental aspects of MS
limited mobility and psychological disorders
treat under LA
orofacial motor and sensory disturbance - suspect in young patients
chronic orofacial pain possible
enhanced trigeminal neuralgia risk - suspect in younger patients
What is MND due to
degeneration in the spinal cord in the corticospinal tracts and anterior horns
What is the presentation of MND
progressive loss of motor function limbs intercostal diaphragm motor cranial nerves VII-XII
What is MND death due to
ventilation failure aspiration pneumonia (swallowing/cough)
What may an MND patient notice
weakness in ankle or leg slurred speech weak grip muscle cramps and twitches weight loss emotional lability
What is the treatment for MND
none effective
physiotherapy and occupational therapy
riluzole - some get 6-9 months life extension
aspiration prevention (PEG tube feed and reduce salivation)
What are dental aspects of MND
difficulty in acceptance of dental care due to muscle weakness of head and neck
realistic treatment planning
drooling and swallowing difficulties
What is Parkinson’s disease due to
degeneration of dopaminergic neurons in the basal ganglia of the brain (substantial nigra)
shortage of dopamine results in difficulty of message passing from thinking to doing part of brain
What are clinical signs of Parkinson’s
bradykinesia
rigidity
tremor
What is the bradykinesia (PD)
slow movement slow imitation of movement
What is rigidity due to in PD
increased muscle tone
What is the tremor due to in PD
slow amplitude
can progress to on/off movement disorder - often after tx
What are the manifestations of PD than can be seen in clinical observations
impaired gait and falls
impaired use of upper limbs
mask like face
swallowing problems
What is the tx of parkinsons
physiotherapy and occupational therapy
these work to maintain function as high a level for as long as possible
What is the medical treatment for parkinsons disease
dopamine
dopamine analogues
What are the different forms of dopamine analogues
tablets
injection
infusion
What is the dopamine drug
levodopa
What is the surgical tx for PD
sterostatic surely - deep brain stimulation
stem cell transplant
What are the dental aspects of pD
difficulty accepting tx
temor at rest of body
often facial tremor reduces on purposeful movements e.g mouth opening
dry mouth - anticholinergic effect of drugs
drug interactions
