Revisiting Multiple Sclerosis And Parkinson’s Disease

Question 1

What is Multiple Sclerosis

Answer 1

Ms is a chronic demyelination disease of the CNS characterised by an inflammatory process and causing widespread degeneration of the CNS, gradually resulting in severe neurological deficit

Question 2

What is the pathology of multiple sclerosis?

Answer 2

Disruption of the blood-brain barrier
Leakage of inflammatory cells
Destruction of oligodendrocytes and myelin sheath
Disruption of nerve signals, rate of conduction of nerves is slowing down.

Plaques form throughout the CNS.
‘Sclerosis’ means ‘scarring’ and ‘multiple’ - occur in different places throughout the CNS

Question 3

What are the different types of MS?

Answer 3

Silent/Benign
Relapsing-Remitting
Secondary progressive
Primary progressive

Question 4

What are the initial symptoms of MS?

Answer 4

Limb weakness
Optic Neuritis
Parasthaesia
Diplopia
Vertigo
Micturition problems

Question 5

What are the signs and symptoms of MS?

Answer 5

Visual problems eg Diplopia - occipital lobe, optic nerve, thalamus
Weakness- motor cortex, descending pathways
Spasticity and hyper reflexic- cerebellum
Ataxia and poor coordination- sensory cortex or ascending pathways
Sensory loss eg parasthesia, tingling and burning
Dizziness and poor balance- Vestibular system or cerebellum
Sexual dysfunction- spinal cord
Sphincter disturbance- spinal cord
Psychiatric, psychological disturbances- limbic system, dopamine system and hypothalamus
Decreased intellectual function- frontal lobe

Question 6

What is ataxia?

Answer 6

Disorder/ confusion of movement

Types- cerebellar, sensory and vestibular

Question 7

What are some treatments for ataxia?

Answer 7

Cerebellar- core stability and coordination exercises
Vestibular- cooksey cawthorne exercises
Sensory- sensory stimulation ++

Question 8

What would some neuro rehab treatments for ataxia include?

Answer 8

Compensatory approach for everyday strategies eg- splints, orthoses, limiting degrees of freedom etc.
Treadmill training
Visually guided stepping
Light touch supplement
Cold therapy- transient effects
Memory guided movement where visual info is unhelpful closed may help feeding in people with strong intention training)

Question 9

What are some possible causes of fatigue?

Answer 9

Central
CNS
Endocrine dysfunction
Immunological
ANS
Neuromuscular
Hypothyroidism
Anaemia
Meds
Sleep
Diet
Anaemia

Question 10

How can fatigue be measured?

Answer 10

VAS-

Fatigue severity scale

Question 11

What are some outcome measures for MS?

Answer 11

Expanded disability status scale
MSIS-29
MSWS-12
Functional reach test

Question 12

What is Parkinson’s disease?

Answer 12

PD is a chronic, progressive, neuro degenerative disorder resulting from the degeneration of dopamine producing neurones in the substantia nigra of the basal ganglia. It comprises a group of disorders characterised by tremor and disturbance of voluntary movement, posture and balance.

Question 13

What is the pathophysiology of Parkinson’s disease?

Answer 13

Susbstantia nigra is the main source of dopamine. Dopamine is a neurotransmitter.
The basal ganglia is part of a series of parallel loops involving the thalamus and cerebral cortex
This classic model proposes two pathways-
Direct pathway- promotes movement
Indirect pathway- inhibits movement
DOPAMINE EXCITES THE DIRECT AND INHIBITS THE INDIRECT PATHWAY IE INHIBITS INHIBITION!

Question 14

So what happens in Parkinson’s disease in terms of dopamine

Answer 14

Neuro degeneration in the substantia nigra in the basal ganglia leads to a lack of dopamine.
Lack of dopamine leads to a lack of excitement of the direct pathway leading to lack of movement
Lack of inhibition of the indirect pathway leading to lack of movement

Question 15

What are the primary clinical features or cardinal signs of Parkinson’s disease?

Answer 15

Bradykinesia/Akinesia
Resting tremor
Rigidity

Question 16

What medication is given to Parkinson’s disease patients?

Answer 16

Madopar and sinemet

Anticholinergics (Arpicoline)

Question 17

What is the Hohn and Yale scale used for?

Answer 17

It is used to Show at which stage the patient currently presents at
0- no signs
1- unilateral involvement - minimal functional disability
1.5 unilateral involvement also involving the neck and spine
2- bilateral disease but no Impairment of balance
2.5- mild bilateral symptoms with recovery when the pull test is given

Question 18

What physiotherapy can be done for postural problems?

Answer 18

Assessment
Stretches
Strengthening exercises
Mobility exercises
Seating
Function 
Advice

Question 19

What type of cueing is there?

Answer 19

Kinesthetic
Visual
Auditory

Question 20

What are the principles of cueing?

Answer 20

Executing movement- primary motor cortex
Executing and planning movement- Premotor area (PMA) and supplementary motor area (SMA)
In PD, the SMA system is impaired, but the PMA system remains intact.

Question 21

What are the principles of treatment regarding the premotor ares and supplementary motor area in PD?

Answer 21

Premotor area (PMA) is involved in sensory guided movement
Supplementary motor area (SMA) is involved in internally generated movement (automatic)
Therefore the automatic subconscious basis of posture and movement is lost. (SMA) 
Abnormalities can often be overcome by voluntary effort (use of PMA)

Question 22

What does the different types of cueing entail?

Answer 22

Visual- lines on floor, lines on road crossing, steps and stairs
Kinaesthetic- dancing
Auditory- verbal prompts, metronome

Question 23

What is are the typical PD outcome measures?

Answer 23

Unified Parkinson’s disease rating scale

Get up and go test

Question 24

What upper motor neuron diseases are there

Answer 24

Spinal cord and brain injuries, CNS

Question 25

What lower motor neuron disease are there

Answer 25

Gillian barre syndrome