Neurological Diseases: Multiple Sclerosis

Neurological Diseases

• Batterjee Medical College, For Science and Technology, Internal Medicine Department
• Topics covered for Neurological Diseases include Multiple Sclerosis and Alzheimer's Disease, covering epidemiology & etiology, clinical manifestations, diagnosis & treatment, and oral health considerations.

Multiple Sclerosis

• Epidemiology & Etiology:

  • Multiple sclerosis (MS) involves inflammation, demyelination, and gliosis in the central nervous system (CNS) white matter.
  • Myelin damage slows or blocks nerve impulse propagation resulting in neuromuscular and neurologic abnormalities.
  • Age of onset is typically between 20 and 45 years old.
  • More common in women than men (2:1 ratio).
  • Cause unknown, but genetic susceptibility exists, and autoimmune mechanisms are implicated.

• Clinical Manifestations:

  • Manifestations depend on affected CNS areas, often including the optic chiasm, brainstem, cerebellum, and spinal cord.
  • Common symptoms include visual changes, limb weakness, spasticity, ataxia, bladder and bowel dysfunction, and sensory impairment.

• Diagnosis:

  • No definitive diagnostic test exists.
  • Diagnosis relies on evaluating evidence of dissemination in space through:
    • MRI scans
    • Cerebrospinal fluid (CSF) analysis
    • Evoked potentials

• Management:

  • Therapy targets acute attacks, disease-modifying therapies, and symptomatic treatment.
  • Treatment types include steroids, interferons, monoclonal antibodies.
  • Symptomatic treatment includes anticonvulsants, benzodiazepines, tricyclic antidepressants, smooth muscle relaxants, anticholinergics, and pain medications.

• Oral Health Considerations:

  • Patients may present with symptoms such as trigeminal neuralgia (TGN).
  • Facial weakness and paralysis may be present.
  • Avoid elective dental treatments during acute exacerbations due to limited mobility and possible airway compromise.

Alzheimer's Disease

• Epidemiology & Etiology:

  • Alzheimer's disease (AD) is the most common type of dementia.
  • It's a progressive disease, starting with mild memory loss, potentially leading to inability to converse or respond to the environment.
  • The disease affects brain regions vital for thought, memory, and language.
  • The disease significantly impacts daily activities.
  • Estimated global dementia prevalence is 24 million, projected to quadruple by 2050.
  • In Western countries, AD accounts for up to 65% of new dementia cases.
  • In Saudi Arabia, estimated to affect approximately 130,000 individuals.
  • Major pathological hallmarks are amyloid plaques and neurofibrillary tangles (absent in healthy brains).
  • Massive apoptosis (programmed cell death) happens in later development stages in the brain.

• Clinical Manifestations:

  • Common symptoms include memory loss that disrupts daily life, trouble handling finances, difficulty completing familiar tasks, decreased/poor judgment, misplacing things, changes in mood, personality, or behavior.

• Diagnosis:

  • Mini-Mental State Examination (MMSE) to assess cognitive abilities
  • Positron emission tomography (PET) scans
  • Magnetic resonance imaging (MRI)
  • Cerebrospinal fluid (CSF) analysis

• Management:

  • No cure for AD, therapy aims to slow disease progression.
  • Approved cholinesterase inhibitors treat mild to moderate cases.
  • Common side effects include nausea, vomiting, diarrhea, weight loss, bradycardia, and syncope.
  • New monoclonal antibody drug recently approved by USFDA.

• Oral Health Considerations:

  • AD patients are at higher risk of coronal and root caries, periodontal disease, temporomandibular joint problems, and orofacial pain than healthy individuals.
  • Patients might exhibit frustration, irritability, and aggression when confronted with unfamiliar situations or instructions.
  • Caregiver presence can be helpful to verify information, understand patient behavior, and reduce anxiety.
  • Local anesthetics containing vasoconstrictors should be used cautiously if the AD patient is also taking tricyclic antidepressants to avoid cardiovascular risks.
  • Cholinesterase inhibitors can cause excessive saliva production (sialorrhoea).