Lecture 3 & 4: Movement Disorders (MS, MND, MD & CP)

Question 1

What is MS?

Answer 1

• Autoimmune disease where immune system attacks and degrades the myelin sheaths (which usually insulate and protect nerves)
• Immune system mistakes yourself as an enemy and begins to attack (like it would an infection)

Question 2

What does MS cause in terms of cell signalling

Answer 2

• If myelin sheath (which increases signalling) decreases, it slows down signalling
• Scarring prevents movement (signalling)

Question 3

Symptoms of MS

Answer 3

• Depression
• Pain
• Spasticity
• Fatigue
• Tremor
• Ataxia

Question 4

Types of MS

Answer 4

• Relapsing-Remitting
• Secondary-Progressive
• Primary-Progressive
• Progressive-Relapsing

Question 5

What is Relapsing-Remitting MS?

Answer 5

• Short duration

- May remain symptom-free for a long time

Question 6

What is Secondary-Progressive MS?

Answer 6

• Slow, steady progression (with or without relapse)

- Relapses do not fully remit

Question 7

What is Primary-Progressive MS?

Answer 7

• Slowly worsening symptoms with no relapses or remissions

Question 8

What is Progressive-Relapsing MS?

Answer 8

• Steadily worsen from the onset

- Flare-ups - with or without remissions

Question 9

How is MS treated and managed?

Answer 9

• Treat inflammation: corticosteroids
• Slow or prevent disease prevention
• Treat chronic symptoms
• Physical/psychological support

Question 10

What is the most common form of MS?

Answer 10

• Relapsing-Remitting

Question 11

What is motor neuron disease (MND)?

Answer 11

Group of conditions in which motor neurons die

Question 12

Symptoms of MND

Answer 12

• Muscle wasting
• Weakness
• Respiratory failure

Question 13

What happens to the neurons in MDN?

Answer 13

LMN: muscles gradually weaken, waste away and develop uncontrollable twitching
UMN: similar + stiffness & spasticity

Question 14

What are the 2 types of muscle atrophy?

Answer 14

• Disuse atrophy

- Neurogenic atrophy

Question 15

Which type of atrophy can be reversed?

Answer 15

DISUSE

Question 16

Why can’t neurogenic atrophy be reversed?

Answer 16

There is damage to the nerve innervating the muscle

Question 17

What is cell damage induced by in MND?

Answer 17

Reactive oxygen species (free radicals)

Question 18

What causes oxidative stress?

Answer 18

Persistent imbalance of oxidants & antioxidants (O>A)

Question 19

Riluzole MOA

Answer 19

Subtly blocks Na+ channels to slow down APs -> decreases glutamate that is released

Question 20

What drug can control spasticity?

Answer 20

Baclofen

Question 21

How does baclofen work?

Answer 21

• Injected into the spinal cord where it can bind to GABAb receptors and inhibit aspects of movement

Question 22

Respiratory care in MND

Answer 22

• Mask ventilator system overnight

Question 23

Other treatments for MND

Answer 23

• Assisted eating (muscle weakness in arms & hands)

- Gastrostomy insertion (feeding tube)

Question 24

What is Muscular Dystrophy (MD)?

Answer 24

Group of disorders which involve progressive loss of muscle mass and strength

Question 25

What causes MD?

Answer 25

Genetic mutations which interfere with the production of muscle proteins required to build and maintain muscle tissue

Question 26

Why are the vast majority of MD patients boys?

Answer 26

- It is an X linked recessive condition - female only has one carrier gene, therefore, female child will only likely be a carrier (as they have 2 x chromosomes) - if male gets the carrier X gene, then he will have MD as he only has one X chromosome

Question 27

Symptoms of MD

Answer 27

- Pain & stiffness - Difficulty with running and jumping - Walking on toes - Waddling gait

Question 28

How can you diagnose MD?

Answer 28

- Genetic testing - Heart monitoring - EMG - Biopsy

Question 29

Is there a cure of MD?

Answer 29

NO

Question 30

What can medications do in MD treatment?

Answer 30

Slow the progression and keep the patient mobile for as long as possible

Question 31

What are the 2 most commonly prescribed drugs for MD?

Answer 31

``` Corticosteroids Heart medications (e.g. beta blockers, ACE inhibitors) ```

Question 32

What are some other forms of treatment for MD?

Answer 32

- General exercise - Breathing assistance - Mobility aids - Braces

Question 33

What is CP?

Answer 33

A condition that is developed when there is brain injury or malformation while the child's brain is under development

Question 34

Symptoms of CP in babies

Answer 34

- Low muscle tone (floppy) - Unable to hold up their head - Muscle spasms - Poor muscle control - Delayed development

Question 35

Symptoms of CP in toddlers/children

Answer 35

- Not walking by 12-18 months - Not speaking simple sentences by 24 months (DEPENDING ON SEVERITY)

Question 36

How is CP diagnosed?

Answer 36

- Look at movement - Are their muscles floppy or stiff? - Do they have unusual posture or favour one side?

Question 37

What treatment is available/

Answer 37

- Medication for movement issues (diazepam & baclofen)