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BDS3 BAMS > Degenerative brain disease > Flashcards

Degenerative brain disease Flashcards

1
Q

What is multiple sclerosis?

A
  • Chronic, typically progressive disease involving damage to sheaths of nerve cells in brain and spinal cord
  • Demyelination of axons only occurs in CNS
  • Has a patchy distribution
  • Leads to progressive functional loss
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2
Q

What is the most common CNS disorder of the Young?

A
  • Multiple sclerosis
  • Women with 4th decade onset most severe
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3
Q

What is the cause of Multiple sclerosis?

A
  • Not entirely sure
  • Susceptibility is acquired during childhood
  • Altered host reaction to an infective agent?
  • Background genetic/ immune factors
  • More common in identical twins
  • More common amongst immediate family members
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4
Q

What are the symptoms of multiple sclerosis?

A
  • Varies in individual
  • Muscle weakness
  • Visual disturbance
  • Paraesthesia (look for this in face in dental practice)
  • Autonomic dysfunction
  • Dysarthria
  • Pain
  • Balance/hearing loss
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5
Q

What are the Signs of multiple sclerosis?

A
  • Muscle weakness
  • Spasticity
  • Altered reflexes
  • Tremor (intention)
  • Optic atrophy (light shown in eye takes time to reach occipital lobe in brain - this is delayed with MS)
  • Proprioceptive loss
  • Loss of touch
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6
Q

What are the MS investigations performed?

A
  • History and examination
  • Magnetic Resonance Imaging
  • CSF analysis
  • Visual Evoked potentials
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7
Q

What does CSF analysis show with someone with MS?

A
  • Reduced lymphocytes
  • Increased IgG proteins
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8
Q

What are the results of a Visual Evoked Potentials test if patient has MS?

A
  • Always reduces after optic neuritis
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9
Q

What are the outcomes of Relapsing and remitting type of MS?

A
  • This type is acute exacerbations followed by periods of respite
  • Damage to CNS builds up with each episode
  • Eventually become disabled as they develop progressive form of MS (called secondary progressive)
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10
Q

What are the outcomes of Primary progressive type of MS?

A
  • This type is a slow steady progressive deterioration of neurological condition
  • Leads to cumulative neurological damage
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11
Q

What is the management of symptomatic MS?

A
  • Antibiotics
  • Antispasmodics
  • Analgesia
  • Steroids
  • Physiotherapy and occupational therapy (for function loss)
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12
Q

What drugs can be used to slow down relapsing and remitting type of MS?

A
  • Cladribine
  • Siponomod
  • Ocrelizumab
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13
Q

How can stem cells be used to help MS?

A
  • If it is due to infection
  • Can use stem cell transplant to ‘reboot’ immune system
  • Any existing disability not reversed and stem cell transplant has issues of it’s own and need to be considered whether worth it
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14
Q

What are the dental aspects of MS?

A
  • Limited mobility and psychological disorders to access dental care and OH care and measure
  • Need to be treated under LA not GA
  • If patient reports Orofacial motor and sensory disturbance then should be sent for MRI
  • They have enhanced risk of Trigeminal neuralgia
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15
Q

What is motor neurone disease?

A
  • Rare condition affecting brain and nerves
  • Degeneration of corticospinal tracts and anterior horns in the spinal cord
  • Affects bulbar motor nuclei in cranial nerves
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16
Q

When do patients develop motor neurone disease?

A
  • 30-60years
  • Most dead within 3 years diagnosis
  • Males more likely to get it
17
Q

What can the patient expect after diagnosis of motor neurone disease?

A
  • Progressive loss of motor function affecting;
  • Limbs
  • Intercostal muscles
  • Diaphragm
  • Motor cranial nerves VII-XII

Death due to;
- Ventilation failure
- Aspiration pneumonia (can’t swallow or cough)

18
Q

What are the signs of MND?

A
  • Weakness in ankle or leg leading to tripping and harder to climb stairs
  • Slurred speech which may develop to difficulty swallowing foods
  • Weak grip so tend to drop things or can’t open jars
  • Muscle cramps and twitches
  • Weight loss
  • Emotional liability where crying or laughing in appropriate situations
19
Q

What is the treatment of MND?

A
  • No effective treatment
  • Physiotherapy and occupational therapy for loss of function
  • Riluzole (some say get 6-9month life extension)
  • Use PEG tube feeder to reduce chance of aspiration
20
Q

What are the dental aspects of MND?

A
  • Difficulty in accepting dental care
  • Hard to keep oral hygiene
  • Muscle weakness of head and neck
  • Realistic treatment planning to improve self image and consider life expectancy and restorations needed
  • Drooling and swallowing difficulties
  • Can be asked to give medication or botox in salivary glands to reduce saliva
21
Q

What is Parkinson’s disease?

A
  • Quite common neurological condition
  • Is a progressive disabling disease most often affecting people aged 50years old
  • Lack of neurotransmitter dopamine in substantia nigra in brain
22
Q

What is the cause of Parkinson’s disease?

A
  • Degeneration of dopaminergic neurones in the basal ganglia of brain (Substantia nigra)
  • Underlying reason for this is unclear
  • Shortage of dopamine = difficulty of message passing from ‘thinking’ to ‘doing’ brain
23
Q

What are the clinical signs of Parkinson’s disease?

A
  • Bradykinesia
  • Rigidity of arms and legs due to increased muscle tone
  • Tremor at rest of slow amplitude and goes away with forced movement of that limb (can occur in mandible)
  • Impaired gait and falls
  • Impaired use of upper limbs
  • Mask-like face
  • Swallowing problems
24
Q

What is Bradykinesia?

A
  • Slow movement
  • Slow initiation of movement
25
Q

What are some of the effects of Parkinson’s disease?

A
  • Tremor
  • Pain
  • Dysphagia
  • Frequent falls
  • Mild cognitive impairment
  • Drooling
  • Visuospatial dysfunction
  • Executive functioning deficits
26
Q

What is the physical treatment of Parkinson’s?

A
  • Physiotherapy and occupational therapy to maintain function as long as poss
27
Q

What is the medical treatment of Parkinson’s?

A
  • Dopamine (Levadopa) is effective at the beginning but dose needs to be continually increased to continue being effective - this causes more side effects

Dopamine analogues like;
- Tables (Promipexole, Selegiline)
- Injection (Apomorphine - subcutaneous)
- Infusion (duodopa - directly into gut)

Patient needs to try different things to see if it is effective for them - side effects can lead to gambling

28
Q

What is the surgical treatment of Parkinson’s?

A
  • Stereotactic surgery for deep brain stimulation
  • Research of stem cell transplant into basal ganglia being done
29
Q

What are the dental aspects of Parkinson’s disease?

A
  • Difficulty in accepting treatment (go slow and at their pace)
  • Concerns of tremor at rest (this goes away when purposeful movement like mouth opening occur)
  • Dry mouth (is an anticholinergic side effects of drugs) - saliva substitutes and water
  • Careful of drug interactions with their current meds

BDS3 BAMS (15 decks)

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