Week 8 - Neurodegenerative Disorders wrap up (cerebral palsy +) Flashcards
(32 cards)
What is Cerebral Palsy
Cerebral palsy is an umbrella terms for a group of non-progressive motor conditions. It results from damage to motor control centres during embryology
- Results from damage to motor control centres during embryonic development, pregnancy or childbirth
- Causes hypoxia, trauma, infection – genetic or biochemical factors possibly involved
What are the 4 main types of cerebral palsy
- Spastic (spasticity)
- Dyskinetic
- Ataxia
- mixed types - combination damage
what is spasticity
stiff or rigid muscles on one side of the body or in all four limbs
can include the mouth, tongue and pharynx
may have scissor gait or arms that are flexed and positioned against their bodies
What causes spasticity
Upper motor neuron lesion resulting in hypertonia (high muscle tone)
- motor cortex damage
What is dyskinesias
There are different types of dyskinesia
- dystonia
- athetosis
- chorea
What is dystonia
twisting and repetitive movements
What is athetosis
slow, writhing and continous worm like movement
a type of dyskinesia
what is chorea
Dance like irregular unpredictable movements
A type of dyskinesias
What causes dyskinesias
Injury to the basal ganglia
the different types of dyskinesia (dystonia, athetosis and chorea) is causes by injury to different structures within the basal ganglia
What is ataxia
- means without coordination
- loss of muscle control in arms and legs (lack of balance, coordination and trouble walking)
- may affect the fingers, hands, arms, legs, body, speech and even eye movement
- 3 main types: cerebellar (in CP), but also sensory or vestibular
What causes ataxia
damage to the cerebellum
What are associated disorders for cerebral palsy
- seizure disorders *(very common)
- vision and hearing impairments
- cognitive and behaviour issues (ADHD, depression, memory and learning)
- digestive issues (Dysphagia, constipation, incontinence)
- respiratory issues (asthma, bronchitis, pneumonia)
- Skin conditions (pressure ulcers)
- Oral health issues
Oral health issues
- May have increased periodontitis and dental caries due to poor oral hygiene
- Tongue thrusting and mouth breathing
- Decreased parotid flow rate
- Enamel hypoplasia
- Phenytoin-induced gingival hyperplasia
- Drooling
- Bruxism
- Hyperactive bite and gag reflexes
- May be dental trauma and fractured teeth
How do you treat someone with cerebel pasly as a dentist
- Consider decreased motor control and function
- May need to involve family member or carer in treatment plan – may or may not be able to provide consent
- Removable prostheses contraindicated with seizures
- May be in a wheelchair – if transferred to dental chair then do not lie flat (protect airway)
- May be necessary to use muscle relaxants or sedate patient
- Some cases may require hospitalisation and general anaesthesia
What is multiple sclerosis
An autoimmune disease of the CNS, causing demyelination that affects neural activity
Where the body’s immune system mistakenly attacks myelin disrupting the flow of information between the brain and periphery.
Multiple sclerosis means “scar tissue in multiple area”
What are the 4 main types of multiple sclerosis
names according to progression of symptoms over time
- relapsing - remitting MS (most common)*
- Secondary - progressive MS
- Primary progressive MS
- Progressive relapsing MS
(don’t need to remember or describe the 4 different types - just need to know the most common one)
What does relapsing remitting MS mean
short periods of symptoms followed by long stretches of relative inactivity or dormancy (quiescence) with partial or full recovery
What is the pathophysiology of MS
- CNS inflammation demyelination and lesions
- Results of immune system attacking myelin, nerve cell bodies and axons
- Hallmark: increased BBB permeability
- Dysregulated autoimmune T cell response associated with MS pathology
- Also involvement of mast cells, astrocytes, microglia and macrophages
- Symptoms depend on severity of inflammatory reaction
What is the hallmark component of MS
Increased blood brain barrier (BBB) permeability
What are some symptoms of multiple sclerosis
- Fatigue
- Cognitive impairment
- Depression
- Dysarthria
- Dysphagia
- Musculoskeletal weakness spasms, ataxia
- Pain
- Diarrhea or constipation
What is the treatment for MS
Aim to reduce number and severity of relapse and delay long term progression
- corticosteroid (high dose)
- Plasma exchange
also - disease modifying treatments to modulate or suppress inflammatory reactions
- medication (baclofen for spasticity) and alternative therapies (acupuncture) to manage symptoms
what is corticosteroids (high dose) as a treatment for MS
suppress immune system and reduce inflammation; hasten recovery from attacks but do not alter long term outcomes
What is plasma exchange (plasmapheresis) as a treatment to MS
treats severe flare ups in relapsing forms of MS who do not respond to corticosteroids - not effective for secondary progressive or chronic progressive MS
what are dental implications for MS
- higher rates of decay, periodontal disease, halitosis
- may have toothache due to nerve damage rather than an issue with tooth
- uncomfortable to sit in dental chair for long (plan breaks)
- muscle spasms - may make dentures difficult
