Neurological Diseases: Multiple Sclerosis

Neurological Diseases

• Batterjee Medical College, For Science and Technology, Internal Medicine Department
• Covers topics like Multiple Sclerosis and Alzheimer's Disease

Multiple Sclerosis

• Epidemiology & Etiology: Multiple sclerosis (MS) involves inflammation, demyelination, and scarring (gliosis) in the central nervous system (CNS) white matter. Myelin is crucial for nerve impulse propagation; its destruction in MS leads to impaired nerve signals, causing muscular and neurological symptoms.
• Epidemiology & Etiology (cont.): Onset typically occurs between 20 and 45 years of age. Women are affected more frequently than men (2:1 ratio). The exact cause of MS is unknown, but genetic predisposition plays a role, and autoimmune mechanisms are implicated.
• Clinical Manifestations: Visual changes, limb weakness, spasticity, ataxia, bladder and bowel dysfunction, and sensory impairment are common symptoms, contingent on the affected CNS areas.
• Diagnosis: There's no definitive test for MS. Diagnosis relies on identifying evidence of disseminated lesions in the CNS using MRI, CSF analysis, and evoked potentials.
• Management: Treatment targets acute attacks, disease modification, and symptom management. Approaches include steroids, interferon, monoclonal antibodies, and symptomatic therapy (e.g., anticonvulsants, muscle relaxants, pain medications).
• Oral Health Considerations: Trigeminal neuralgia (TGN), characterized by electric shock-like facial pain, is an initial manifestation that can occur with MS. Avoid elective dental procedures during MS disease exacerbations due to potential airway compromise, mobility limitations, and other related complications from oral health.

Alzheimer's Disease

• Epidemiology & Etiology: Alzheimer's disease (AD) is the most common form of dementia, characterized by progressive memory loss, difficulty performing daily tasks, and issues in understanding conversations or responding adequately to external stimuli. Parts of the brain controlling thought, memory, and language are affected. AD involves amyloid plaques and neurofibrillary tangles, absent in healthy brain tissue; massive apoptosis occurs in advanced stages.
• Epidemiology & Etiology (cont.): Global prevalence of dementia is estimated at 24 million and projected to nearly quadruple by 2050. In western countries, AD accounts for up to 65% of new dementia cases. Prevalence estimates suggest approximately 130,000 individuals with AD are in Saudi Arabia.
• Clinical Manifestations: Symptoms include memory loss disrupting daily life; trouble managing money, completing tasks, or maintaining one's work or leisure routines; poor judgement, disorientation in familiar environments/repeated questioning; misplacing items/inability to retrace steps; changes in mood, personality, and behavior.
• Diagnosis: Mini-Mental State Examination (MMSE) is a tool used to assess global cognitive abilities. Other diagnostic approaches include PET scans, MRI, and CSF analysis.
• Management: There's no cure for AD. Treatment focuses on slowing disease progression, particularly in mild to moderate cases. Drugs approved by the FDA, such as cholinesterase inhibitors, target symptom management; side effects include nausea, vomiting, diarrhea, weight loss, and possibly bradycardia or syncope. New monoclonal antibody treatments have also been developed.
• Oral Health Considerations: Patients with AD may face a heightened risk of oral problems such as caries, periodontal issues, TMJ disorders, and orofacial pain. Their symptoms can make oral care challenging; irritability, combativeness, and misunderstanding of instructions should be considered. Caregiver input is often beneficial to verify information, interpret behavior, and alleviate anxiety for the patient. Cholinesterase inhibitors, while sometimes beneficial, can lead to significant side effects, such as excessive saliva production (sialorrhea) and/or xerostomia (dry mouth). Local anesthesia with vasoconstrictors should be used cautiously in patients taking tricyclic antidepressants to avoid potentially serious cardiovascular issues.