Degenerative Brain Disease

Question 1

What happens in multiple sclerosis? (to the nerves)

Answer 1

Demyelination of the axons in CNS only

Question 2

The demyelination happens due to what?

Answer 2

Inflammatory changes

Question 3

Describe the distribution of MS lesions.

Answer 3

there is patchy distribution - areas of the body affected change from time to time

Question 4

What is the aetiology of MS?

Answer 4

Its unknown but there are some genetic factors

Question 5

What are the symptoms of MS?

Answer 5

• Muscle weakness
• Visual disturbance
• Paraesthesia
• Autonomic dysfunction
• Dysarthria (change with speech)
• Pain
• Balance/hearing loss

Question 6

What are some signs of MS?

Answer 6

• Muscle weakness
• Spasticity (muscle spasticity happens when there is an upper motor neuron lesion)
• Altered reflexes
• Tremor (intention - happens when trying to complete a task)
• Optic Atrophy (testing optic nerve speed of conduction is a common test when assessing MS)
• Proprioceptive loss
• Loss of touch

Question 7

What investigations can be done for MS?

Answer 7

History & examination

Magnetic Resonance Imaging

CSF analysis (reduced lymphocytes and increased IgG protein)

Visual Evoked Potentials (ALWAYS reduced after optic neuritis)

Question 8

What are the 2 main types of MS?

Answer 8

• relapsing and remitting MS
• primary progressive MS

Question 9

Describe relapsing and remitting MS.

Answer 9

• Acute exacerbations and periods of respite (episodes of active diseases and loss of function but will settle after a few weeks and patient enters a stage of stability).
• Damage builds up with each episode o Eventually become disabled
• Many will eventually develop progressive form (“secondary progressive”)

Question 10

Describe primary progressive MS.

Answer 10

• Is a slow steady progressive deterioration
• Cumulative neurological damage

Question 11

If there is a symptomatic attack of MS, how is it treated?

Answer 11

o antibiotics, antispasmodics, analgesia, steroids

o physiotherapy & occupational therapy

Question 12

What treatment is there to help with function loss?

Answer 12

physiotherapy and occupational therapy

Question 13

How are the relapsing and remitting types of MS managed/treated?

Answer 13

o Disease modifying therapies – may also slow some progressive forms (slow damage but won’t reverse)

o Cladribine

o Siponomod

o Ocrelizumab

Question 14

What are the dental aspects of MS?

Answer 14

• limited mobility & psychological disorders
  
  • As disease progresses gets harder for them to manage their OH by themselves
  • More difficult for them to get to the dentist themselves
• treat under LA
  
  • As it is thought a GA increases the onset of damage within the brain
• orofacial motor & sensory disturbance
  
  • suspect in younger patients?
  • If a patient has a sudden loss of sensory or motor function in face they should get an MRI
• Chronic orofacial pain possible
• Enhanced TRIGEMINAL NEURALGIA risk
  
  • suspect in younger patients!

Question 15

What is motor neuron disease?

Answer 15

When there is degeneration of the nerves in the anterior horns of the corticospinal tracts in the spinal cord and it can also affect the bulbar motor nuclei in the brainstem

(degeneration in the spinal cord and bulabar motor neuclei)

Question 16

What is the life span like for this disease?

Answer 16

Most patients die within 3 years

Question 17

What is the aetiology of MND?

Answer 17

Unknown - no genetic link (cases tend to be sporadic)

Question 18

There is progressive loss of motor function in what in patients with MND?

Answer 18

Progressive loss of motor function in:

• The limbs
• Intercostal muscles
• The diaphragm
• Motor cranial nerves VII – XII

Question 19

Death of people with MND is normally due to what?

Answer 19

Ventilation failure or aspiration pneumonia

Question 20

What are some symptoms of motor neuron disease?

Answer 20

• Weakness in the ankle or leg – leading to tripping, or find it harder to climb stairs
• Slurred speech, which may develop into difficulty swallowing some foods
• A weak grip – dropping things, or finding it hard to open jars or do up buttons
• Muscle cramps and twitches
• Weight loss – arms or leg muscles may become thinner over time (muscle bulk loss)
• Emotional lability - crying or laughing in inappropriate situations

Question 21

What are the treatments for MND?

Answer 21

• NONE effective
• Physiotherapy & occupational therapy
  
  • Aim is to maintain function for as long as possible
• Riluzole
  
  • some get 6-9 months life extension
• Aspiration prevention
  
  • PEG tube feed
  • reduce salivation – dentists sometimes asked to help reduce salivation so they don’t inhale oral bacteria into the lungs

Question 22

What are the dental aspects of MND?

Answer 22

• Poor acceptance of dental care
  
  • Often significant mobility problems
  • Muscle weakness of head & neck
  • Head often tipped forward and drooling
• Realistic treatment planning
• Drooling & swallowing difficulties
  
  • Drooling can be associated with idiocy and patients feel like this makes them inferior and look bad to peers
  • Can prescribe Anticholinergics and place botox into salivary glands to help with drooling

Question 23

What is Parkinson’s disease?

Answer 23

A progressive, disabling disease that normally affects older people

Involves the degeneration of dopaminergic neurons in the basal ganglia leading to a lack of dopamine

Question 24

The lack of dopamine in Parkingson’s disease results in what?

Answer 24

results in difficulty of messages passaging from ‘thinking’ to ‘doing’ brain

Question 25

What are some clinical signs of Parkingson's disease?

Answer 25

* BRADYKINESIA * Slow movement, and slow initiation of movement * Can seem like someone is ignoring you at first * RIGIDITY * Increased muscle tone – jerks * TREMOR * Slow amplitude * Can happen in the mandible * When make and intentional movement the tremor will go away * Can progress to on/off movement disorder – often after treatment

Question 26

Loss of cognitive function can also occur in Parkingson'. What are some examples of this?

Answer 26

* Impaired gait and falls * Unsteady walking and unusual falls * Impaired use of upper limbs * E.g. arms don’t swing when they walk * Mask-like face * Flat looking appearance of face * Swallowing problems * Due to affect on voluntary muscles in the pharynx

Question 27

What are the 3 groups of treatments for parkingson's?

Answer 27

- Physical support - Medical treatments - Surgical treatments

Question 28

What physical support is there for parkingson's?

Answer 28

* Physiotherapy and Occupational therapy * These work to maintain function at as high a level for as long as possible

Question 29

What medical treatments are there for Parkingson's ?

Answer 29

* Dopamine * Levadopa * Is effective in the beginning * Dopamine analogues * Tablets – Promipexole, Selegiline * Injection – apomorphine - subcutaneous * Infusion – duodopa – directly into the gut

Question 30

What surgical treatments are there for Parkingson's?

Answer 30

* Stereotactic surgery * Deep brain stimulation * Helps some patients return to more normal function * Stem cell transplant? * Suggested as a way to get dopamine back in

Question 31

What are the dental aspects of Parkingson's disease?

Answer 31

* Difficulty accepting treatment * Tremor at rest of body * Often facial tremor reduces on purposeful movements e.g. mouth opening * Dry mouth * Anticholinergic effects of the drugs * Drug interactions?