NT Final Exam Part 1 PDF

Multiple sclerosis, Parkinson & Alzheimer Diseases Lec.5, Neurological disorders Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Multiple Sclerosis is a chronic inflammatory disease caused by demyelination and widespread axonal injury in the central nervous system, leading to progressive motor and sens...

Multiple sclerosis, Parkinson & Alzheimer Diseases Lec.5, Neurological disorders Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Multiple Sclerosis is a chronic inflammatory disease caused by demyelination and widespread axonal injury in the central nervous system, leading to progressive motor and sensory dysfunction. Demographics • 20-40 years old • women>men Risk factors • genetic • not considered a hereditary disease • environment • stress • smoking • decreased sunlight/low vitamin D exposure Presentation clinically defined by two or more episodes of neurological dysfunction (brain, spinal cord or optic nerves) that are separated in time and space orthopaedic increased fracture risk osteoporosis gait abnormalities muscle and joint spasticity Imaging studies • MRI • Obtain MRI with gadolinium of brain and spinal cord • findings • multiple focal demyelination scattered in brain and spinal cord • asymmetric periventricular plaques Treatment • Immunomodulators • modalities • corticosteroids • prophylactic immunosuppresants (interferon beta) • Antispasticity agents • Physiotherapy • Osteoporosis management Parkinson Disease • is a neurodegenerative disorder. PD mostly presents in later life with generalized slowing of movements (bradykinesia) and at least one other symptom of resting tremor or rigidity. • It is the seconds most common neuro-degenerative condition in the world after Alzheimer’s. • PD usually occurs after the age of 50 affecting 1 to 2 people per 1000 at any time. Etiology • PD is a disorder of the basal ganglia, which is composed of many other nuclei. • The dopaminergic tract is predominantly affected in PD and it is characterised by neuronal loss of dopaminergic neurons in the substantia nigra pars compacta Diagnosis There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s. Usually diagnose the disease by taking a person’s medical history and performing a neurological examination. Treatment • Dopamine agonists to stimulate the production of dopamine in the brain • Enzyme inhibitors (e.g., MAO-B inhibitors, COMT inhibitors) to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain • Amantadine to help reduce involuntary movements • Anticholinergic drugs to reduce tremors and muscle rigidity • Deep brain stimulation, by implanting electrodes into part of the brain and connects them to a small electrical device implanted in the chest. Alzheimer’s disease Alzheimer's Disease (AD), a neurodegenerative disorder, is the most common cause of dementia worldwide AD results from the of accumulation and deposition of cerebral amyloid-β Accounting for 60-80% of all dementias. The prevalence is closely linked to age, >1% of 60-64-year-olds having the condition rising to 20-40%in the over 85-90 age bracket Risk factors • Advancing age, >85 y/o risk increases by nearly 50% • Direct family member with the disease (mother, father, brother or sister) • Apolipoprotein E-e4 (APOE4) carries • Traumatic brain injury • Cardiovascular risk factor Alzheimer's disease has also been described using four words that begin with A: Amnesia: Memory loss The Four As Aphasia: Impaired communication Apraxia: Physical functioning (motor skills) Agnosia: Difficulty understanding information from the senses, such as vision or smell Diagnosis Currently, the diagnosis of AD relies primarily on signs and symptoms of mental decline. Routine laboratory tests show no specific abnormality. CT brain reveal cerebral atrophy and widened third ventricles Next • Motor neuron disease Motor Neuron Diseases Lec.6, Neurological disorders Dr.Sarkawt S.Kakai KHCMS (Ortho. & Trauma) Introduction Motor neuron disease, or MND, is a group of neurological conditions that affect the body's motor neurons. These neurons control the movement of muscles throughout the body, including those responsible for breathing, speaking, and swallowing. When these neurons become damaged or die, the muscles they control weaken and eventually waste away, leading to paralysis. Understanding the Basics • MND affects the motor neurons in the brain and spinal cord, which are responsible for sending signals to the muscles throughout the body. • There are two types of motor neurons: upper motor neurons and lower motor neurons. • Upper motor neurons are responsible for sending signals from the brain to the spinal cord, • while lower motor neurons are responsible for sending signals from the spinal cord to the muscles. • In MND, both the upper and lower motor neurons can become damaged, leading to muscle weakness and wasting. • The symptoms of MND can vary depending on which motor neurons are affected and how quickly the disease progresses. Causes & Risk factors • The causes of MND are unknown, but worldwide research includes studies on: • exposure to viruses • exposure to certain toxins and chemicals • genetic factors • inflammation and damage to neurons caused by an immune system response • nerve growth factors • growth, repair and ageing of motor neurons. • Familial (hereditary) MND accounts for about 5-10 percent of cases. Types There are several different types of MND, each of which affects different motor neurons in the body. The most common type of MND is amyotrophic lateral sclerosis (ALS), which affects both upper and lower motor neurons and is the most severe form of include the disease. Other types of MND primary lateral sclerosis (PLS), which affects only the upper motor neurons, and progressive bulbar palsy (PBP), which affects the motor neurons responsible for speaking, swallowing, and breathing. • muscle aches, cramps, twitching • weakness or changes in hands, arms, legs and voice Symptom s • slurred speech, swallowing or chewing difficulty • fatigue • muscle wasting, weight loss • emotional lability – for example, where a slight upset can cause an exaggerated response, such as crying or laughing • cognitive change (changes in thought processes) • respiratory changes. Diagnosis 1. Blood Tests and Urine Tests • These can help rule out other conditions that can cause MND-like symptoms. They can also test for creatinine kinase, a substance produced when muscles are broken down. 2. MRI Brain Scan • MND can not be diagnosed with an MRI scan. MRIs can be used to rule out other conditions like stroke, unusual brain structures and tumours. 3. Nerve Conduction Study (NCS) • This test measures how fast electrical impulses are moving through your muscles. 4. Electromyography (EMG) • This test measures how much electrical activity is taking place in the muscles. 5. Spinal Tap or Lumbar Puncture • Testing of the cerebrospinal fluid to rule out other conditions. 6. Muscle Biopsy • Testing the muscle tissue can help to rule out muscular diseases. Treatment Options There is no known cure for MND, and treatment options are limited. However, there are ways to manage the symptoms and slow the progression of the disease. Several medications can be prescribed to help manage the symptoms of MND, including muscle relaxants, pain relievers, and medications to help with breathing. In some cases, medications that are used to treat other conditions, such as antidepressants and anti-anxiety medications, may also be prescribed to help with mood and emotional symptoms. Next • Polyneuropathies Polyneuropathies Prepared by: Zina Ibrahim Bavy Rebwar Bzhwen Dlawar Sipal Syamand Raz Sirwan Helin Hemin Supervised by: Dr. Sarkawt S.Kakai OUTLINE ❖ ❖ ❖ ❖ ❖ ❖ Polyneuropathy definition Types Symptoms Causes Diagnosis Treatments DEFINITION Polyneuropathy is a complex and often debilitating neurological disorder that affects the peripheral nerves throughout the body. In this presentation, we will explore the causes, symptoms, diagnosis, and treatment options for polyneuropathy, shedding light on the challenges and impact it has on those who suffer from it. TYPES 1. Chronic Symmetrical Peripheral Neuropathy: Gradual development, affects nerves throughout the body, often chronic. 2. Acute Symmetrical Peripheral Neuropathy: Rapid and severe, seen in Guillain-Barré syndrome, can be fatal. 3. Chronic Polyneuropathy: Long-lasting symptoms, often linked to underlying conditions like diabetes or kidney failure. Causes can vary and sometimes are unknown. CONT… 4. Acute Polyneuropathy: Sudden onset with severe symptoms, typically caused by autoimmune reactions or infections. Can be treated successfully in a short time. 5. Multiple Mononeuropathy: Damage to at least two nerve areas, may result from conditions like vasculitis, sarcoidosis, or cancer. 6. Peripheral Neuropathy: Nerve damage outside the brain and spinal cord, commonly leads to weakness, numbness, and pain, especially in hands and feet. Can affect various areas and bodily functions, including digestion and urination. SYMPTOMS Polyneuropathy can manifest with a wide range of symptoms, which may include: 1. Numbness and tingling in the extremities, such as the hands and feet. 2. Muscle weakness and difficulty with coordination. 3. Pain, which can be burning, shooting, or aching. 4. Sensory disturbances, like loss of temperature or pain sensation. 5. Muscle atrophy (shrinkage). 6. Difficulty with fine motor skills and grip strength. 7. Balance and gait problems. 8. Autonomic symptoms, such as changes in blood pressure, heart rate, or bowel and bladder function. DIAGNOSIS Neurological Examination Blood test MRI Scans Nerve Conduction Study electromyogram Skin Biopsy • Neurological Examination: A doctor evaluates mental and emotional state and ability to communicate, movement, muscle strength coordination, balance, vision and other senses. • blood test can detect conditions that may be causing peripheral neuropathy, such as diabetes, nutrient deficiencies, liver or kidney dysfunction, and abnormal immune system activity. CONT… • MRI Scans: Suspects an underlying medical condition is contributing to symptoms of poly neuropathic. • Nerve Conduction Study: Test measures how fast electrical impulses are moving through your muscles. • Electromyogram: electromyogram evaluates how the nerves and muscles work together by measuring electrical impulses along nerves, nerve roots, and muscles. • Skin Biopsy: This test can help a doctor identify whether the nerves are damaged, causing sensory loss. TREATMENT Treatment of polyneuropathy depends on the condition that caused it. It can also depend on where in your body you feel symptoms. In some cases, your doctor may give you pain medications to help manage the pain and discomfort from nerve damage. A comprehensive treatment plan often combines pharmacological and therapeutic interventions. It is important to note not all neuropathies are reversible. TREATMENT AND ROLE OF PHYSIOTHERAPY * medication: pain medications (painkillers), corticosteroids (anti-inflammatory drugs that can relieve severe pain associated with nerve irritation and inflammation.), Anti-seizure medications (Drugs that were originally developed to treat epilepsy are sometimes used to relieve nerve pain.) * Lifestyle changes: Making lifestyle changes may help treat your polyneuropathy. Drinking less alcohol or avoiding certain repetitive tasks can help relieve your symptoms. * Therapies: approaches such as physiotherapy or TENS.. What is the role of physiotherapy in polyneuropathy? Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. Your physical therapist may provide the following recommendations and care: * Nerve gliding activities * Moderate- intensity exercise * Balance and coordination activities * Bracing * Patient Education * Acupuncture * Devices Note: best exercise for polyneuropathy conditions is walking. ANY QUESTION THANK YOU