pom-neuro disorders Flashcards
seizures- do they mean epilepsy? what else?
stress, sleep deprivation, drug/alcohol withdrawal, syncope
2 types of seizures?
partial (focal, local), generalized (convulsive or non-convulsive)
3 types of partial seisures
simple partial, complex partial, partial sizuresevolving to secondarili generalized seizures
5 types of generalized seizures
absence (petit mal), myoclonic, tonic clonic (grand mal), tonic, atonic
most common infection in kid?
acute otitis media
who is most likely to get seizure?
kid- due to fever (otitis media)
who else is likely to get seizures
elderly
why do old people get seizures
cerebrovascular dz
causes of seizurs- 6
head trauma, intracranial neoplasm, meningitis/encephalitis, metabolic disturbances, drug effects, ideopathic/epilepsy
does type of brain lesion determine what type of seizure you’ll have?
no
pathophysiology of seizure
excessive focal neuronal discharge that may spread to areas throughout the brain
first stage of gm seizure
aura
second stage of gm seizure
epileptic cry (air through diahram)
describe tonic phase of gm seizure
muslce rigidity, pupil dilation, eye movment, lose congiousness
describe clonic phase of gm seizure
uncoordinated movment
describe post-ictal phase (post neuronal firing ) of gm seizure
headache, confusion, sleepy
status epilepticus
emergency- seizure doesnt stop
describe absence seizure
seconds of lost conciousness, facial twitch, daydreaming, eyes flutter
ied-
interictal epileptiform discharges- neurologist looks for on eeg
tests to do on pt with seizure
diag, hx, blood test (cbc, electroylytes, glucose), eeg, ct, mri
draw what seizure looks like on eeg
ied- bigger squiggles than normal
who should take drugs for seizure
high risk pt? not sure who that would be
after how long of not having a seizure can you come off the drugs
2 yr
classic drugs for seizures
carbamazepin, phenytoin, valproic acid, phenobarbital
recent drugs for seizures
gabapentin, lamotrigine, oxcarbazepin, topirimate
valproic acid side effect?
bone marrow supression
what percent of pt are resistant to drugs?
20
what should we do for pt who are resistant to drug
surgery or vagus nerve stimultion (increases seizure threshold)
how do we do dental tx on pt with seizures?
gotta do v. thorough hx- lab eval if needed (if on phenobarb do lab bc narrow TI
if pt is on VNS (vagal nerve stimulator) what should you avoid?
diathermy or any other device that heats up-
should you use a mouth prop on a seizure pt?
only if you have a retrieval method
what could we use if pt is having seizure to stop it?
diazepam iv or im
drugs that cause gingival hypertropy?
rinses: chlorohexidine rinse, folic acid, dilantin
what other oral issue is related to seizures
dry mouth, candida
what is ms
demylination of neurons in cns, an most common autoimmune dz of nervous system
age for ms?
age 20-40
men or women get more ms?
women 3/2
what infectious agents can cause ms?
trigger by infectious agent (rabies, mumps, measles, clap, hsv1,2, ebv, hhv-6
what else can cause ms other than infections ?
geneic factors (20-49x greater chance child getting it if parent has), geographical factors- countries further from equiator get it worse
what cant the nerves do in ms
impulse cant travel down ason, no saltatory conductin
affected areas in ms are called
plaques
what are plaques made of
macs, b+t cells, plasma cells, cytokines, ig
most common demylinated regins
optic nerve, periventricular cerebral white, cervical spinal cord
uhthoff’s sign
symptoms are more hnoticable when there is a rise in body temp, so do some exercisoes to inc body temp to test this
lab findings for ms
inc ig in csf, mylin basic protein in csf (from breakdown of mylin), and mri sos hypodense demyelinated regions
meds for pt w ms?
anti inflamms, interferon b, chemotherapeutics
drug for spasticity
baclofen, bdz
drug for bladder control
anticholinergic
drug for fatigue
stimulant
symptoms dentist sould note when examining v1,2 3 if involved in ms
facial pain, can mimic trigemical neuralgia, facial paralysis, oral symptoms like skipping words, myokymia (muscle fasciculations)
ms relapse- should we treat?
only for emergency
when to tx?
during remission
cerebral palsy definition
disorders in the develpment of movemnt and posture, causing activity limitation, that are attributed to non progressive disurbances that occured in developing fetal or infant brain
motor probs of cp can be accompanied by these other things
disturbance in sensation, cognition, communicaiton, perception, behavior, and seizures
cuases of cp
anoxia, ischemia during labor, trauma, congenital infections, rubella, cmv, hsv, syphilis, influenza
spastic cp
70-80 percent of cases- inc muscle tone, results from upper motor neuron damage
types of spastic cp
diplegia, hemipleigia (one side of body) quadriplegia
oral problems seen in cp pt
malocc, injury, bruxism, sialorrhea, speach and swallowing difficulty, oral hygiene, venue for tx
parkinsons definition
dopamine deficiency causes degenerative cns disorder
primary parkinsons
degen of dopa neurons in substantia nigra
secondary parkinsons
loss or interference w action of dopaimine
factors cuasing parkinsons maybe
genetic mut, stroke, brain tumor, head injury, exporue to chemicals
signs of parkinsons-
resting rhythmic tumors, pill rolling, pain, bladder probsl, mood problems, dementia
meds for parkinsons
sinemet (carbidopa and levodopa)
glossodynia
burning mouth syndrome
oral issues in pt with parkinsons
oral and motor and sensory impariment, dysphagia, xero, candida, burning mouth suynrome
things to help parkinsons pt with oral health
electric brush, chlorohexidine rinse, topical fluoride, sialogogues (for xero)
alzheimers dz
neruodegenerative disorder characerized by dementia, gradual decline in cognitive processes, may lead to toal mental and physical disability
primary pathophysio of alz
beta amyloid depositon, neuritisplaques, neurofibrillary tangles
stage 1 alzheimers
memory loss, time disorientation, judgement erros, decline in appearance or hygiene
3 stages of alz progress over
8-10 yr
stage II alz
intellectual decline, cant recognize self, understand speech or recognize familar objects or people
stage 3 alz
terminal- disoriented, wasting, seizure, hyperorality, aggressive
death in alz is from?
malnutrition, infection, heart dz
drugs for alz
acetylcholinesterase inhibitors- tacrine, donepezil, rivastigmine, galantamine
what otc can help with alz
gingo biloba, nsaid, antioxidant
memantine
know- nmda receptor antagonist
nmda receptor antagonist action-
regulates glutamate activity, healp with learning and memory
if you put a restoration in a pt that has alz and it is high twhat can happen
it can trigger a behavioral change
myashthemia gravis
AI dz unknown cause
what happens in mg
autoab combine with ach at neuromusclar jxn, prevent transmission of nerve impulse
more men or women in mg?
women, but men more in the 60s and 70s yrs old
what abnomrality do mg pt frequently have?
thymic
what happens in itital phase of myasthenia gravis?
ptosis, diplopia, inability to blink continually
myasthenia crisis
resp involvment, in 20% of pt, 8% fatal
diag of mg?
serum level of ach receptor ab
tx of mg
acetylcholinesterase inhibitors
4 main tx modality in mg
anticholinesterase, thymectomy (dec quanity of ach receptor ab), ummunosupp therapy (high dose coritcostreoid), short term immunotherapy (plasmaphersis, iv ig)
dental considerations for mg
cranial nerve exam, faial and masticatory weakness, probs with prostethics, do short morning appt when they are stronger, can can’t give muscle relaxants or anxiolytics to help bc ineract with mg
