Chronic Neurological Dysfunctions

Front 1

List the THREE MAJOR neurological dysfunctions that will be covered:

Back 1

Parkinson's Disease, Multiple Sclerosis, & Myasthenia Gravis

Front 2

Parkinson's Disease= a _____ progressive neurodegenerative disease of the ____, involving a deficiency in the production of ______, (a neurotransmitter), which acts to balance the effects of _____ which is responsible for _____ ________

Back 2

CHRONIC, CNS, DOPAMINE, ACH (acetylcholine), MUSCLE CONTRACTION

Front 3

Prevalence of Parkinson's. Greater in men or women?

Back 3

Men

Front 4

What is the mean age of Parkinson's Disease?

Back 4

40-70

Front 5

Risk Factors associated with Parkinson's? (5)

Back 5

Increases with Age, brain tumor (mess you up), your genetics, environmental exposures (CO, Mercury), & ILLEGAL DRUG USE (amphetamine & methamphetamine)

Hypoxia (oxygen deficiency) can cause PD

Hydrocephalus (Fluid accumulating in brain)

Infections

Tumors & Strokes

Trauma, Huntingtons

Front 6

PD involves degeneration of the dopamine-producing neurons in the substantia ___ of the midbrain

Back 6

nigra, disrupting the balance between dopamine and Ach in the basal ganglia

Front 7

What is essential for NORMAL functioning of the extrapyramidal motor system, including control of support, posture, and voluntary motion.

Back 7

Dopamine a neurotransmitter

Front 8

What are the 3 Classic Hallmark symptoms of Parkinson's? The first one we will talk about is often the first sign. The fourth?

Back 8

TREMOR at rest (can affect handwriting), more prominent at rest, RIGIDITY (increased muscle tone), SLOW MOVEMENTS/BRADYKINESIA OR LACK OF MOTOR MOVEMENT or 4th= Postural Instability

Front 9

What aggravates the tremors? The hand tremor is described as?

Back 9

Emotional stress or increased concentration "pill rolling"

Tremors= 1st sign

Front 10

What is usually the second sign, after tremors?

Back 10

Rigidity = Increased resistance to passive motion when the limbs are moved through their range of motion (Jerky quality) by sustained muscle contraction.

Front 11

Early symptoms of Parkinsons

Back 11

Fatigue, Hand writing change

Front 12

Other symptoms include:

Back 12

Mask-like face- noted by family, autonomic symptoms: orthostatic hypotension, diaphoresis (sweating), flushing, dysphagia (difficulty swallowing), mood swings, dementia, progressive inability to do ADL's, gait changes, urinary changes

Gradual & Insidious - Maybe slight change in speech patterns

Front 13

PD id a significant cause of ____ and ____ (2 D's)

Back 13

Disability and Dementia

Front 14

PD= Inability to control ________

Back 14

Movements

Front 15

In a patient with PD, patients do not execute the autonomic activities that we do (Ex: Blinking, swinging arms when walking, swallowing saliva, self-expression with facial and hand movements, and minor movement of postural adjustment). There is a lack of _____ activity

Back 15

Spontaneous

Front 16

Many nonmotor symptoms (psychological symptoms) are present including?

Back 16

Depression, anxiety, apathy (lack of interest/enthusiasm), fatigue, pain, constipation, impotence (can't get or stay hard/sexual limits), short-term memory impairment.

Front 17

As the disease progresses, complications ____

Back 17

Increase

Front 18

Unfortunately, sometimes people with benign tumors have accidently been diagnosed with?

Back 18

PD

Front 19

What is responsible for the rigidity in PD?

Back 19

Sustained muscle contraction, which causes soreness, being tired. Slowness of movement results because it inhibits the alternating of contraction and relaxation in opposing muscle groups.

Front 20

What is evident in the loss of automatic movements?

Back 20

Bradykinesia-Pt. does not exhibit the autonomic movements & there is a LACK of SPONTANEOUS ACTIVITY. NOT SPONTANEOUCS (Why they have stooped head, masked face, drool, shuffle, legs fixed)

Front 21

Define Dyskinesias or Akinesia=

Back 21

Involuntary Movements vs. Complete immobility

Neuropsychiatric problems (depression, hallucinations, and psychosis can happen)

Front 22

As swallowing becomes more difficult, what consequences follow?

Back 22

Malnutrition or aspiration (breathing material into the airways)

Front 23

Debilitation may lead to? (3)

Back 23

Pneumonia, UTI's, and Skin breakdown

Front 24

What other random symptom can happen?

Back 24

Sleep disturbances

Front 25

Common reasons for hospitalization. Examples:

Back 25

Complication r/t aspiration, which can lead to PNEUMONIA and MALNUTRUTION

Front 26

Other complications:

Back 26

Complications r/t immobility-> pneumonia, UTI, Skin breakdown, & constipation

Front 27

Is there a specific diagnostic test for PD?

Back 27

NO

Front 28

What is the diagnosis based on?

Back 28

History & Clinical Features

Front 29

A diagnosis can be made when at least 2 of the three characteristics are present=

Back 29

Tremor, rigidity, and Bradykinesia

Front 30

What is the ultimate confirmation?

Back 30

Positive response to antiparkinson drugs

Front 31

Specific diagnostic tests in relation to PD?

Back 31

History and Physical exam (H&P), MRI, CT, EEG, (cat, mouse, elephant) and therapeutic response to Levodopa (increases dopamine in the brain) or Carvidopa

Front 32

Is there a cure for PD?

Back 32

NO

Front 33

What is drug therapy aimed at?

Back 33

Correcting the imbalance of neurotransmitters with the CNS>

Front 34

Interventions. We need to monitor response to meds. What is important, most of all, regarding medications?

Back 34

TIMING OF THE MEDS

Front 35

We need to monitor

Back 35

Side Effects, especially if using a high dose

Front 36

What is another medications for Parkinsons?

Back 36

Sinemet, Eldepryl

Front 37

Sinement=

Back 37

A combination of Carbidopa & Levodopa, which helps to decrease Rigidity/Akinetic symptoms! (THINK SUM)

Front 38

Eldepryl helps to?

Back 38

Enhance the sinemet effect (E FOR ENHANCE)

Front 39

Within 3-5 years of treatment with standard Parkinson's drug treatments, many patients experience episodes of?

Back 39

Hypo mobility (Inability to rise from a chair, to speak, walk)

Front 40

These episodes of hypo mobility can occur toward the end of a dosing interval with standard medications, known as?

Back 40

"wearing off syndrome" -dose wearing off

Front 41

The medications work best when they are taken on?

Back 41

An empty stomach

Front 42

What type of patches are available?

Back 42

Transdermal patches

Front 43

Due to the fact that the effectiveness of Sinemet wears off after a few years, they like to initiate therapy first with?

Back 43

Dopamine (DA) receptor agonists

Front 44

Examples of these drugs:

Back 44

Parlodel & Requip, which DIRECTLY stimulate the dopamine receptors. When more severe symptoms come into play, they will need to add the sinemet

Front 45

What are the last classification of drugs that are used to manage PD? What do they help control?

Back 45

ANTIcholinergics: Help control rigidity and TREMORS

Front 46

How do they work?

Back 46

Decrease the activity of Ach, providing balance between dopaminergic and cholinergic actions

Front 47

Examples of these anticholinergics

Back 47

Cogentin & Artane

Front 48

If an individual has failed to respond to drug therapy, OR if you have someone with SEVERE motor symptoms, what might be considered?

Back 48

Surgery

Front 49

Surgical procedures fall into 3 categories. Name them.

Back 49

Destruction, DBS (deep brain stimulation), and transplantation

Front 50

Stereotactic Pallidotomy

Back 50

A burr (drill) hole to target the area (located by previous CT or MRI of brain)

Front 51

Deep Brain stimulation

Back 51

Electrodes placed in THALAMUS and a CURRENT is delivered through an implanted pacemaker generator (current delivered to brain location) (can be adjusted to control symptoms better and is reversible, unlike ablation

Front 52

What do these surgical procedures aim to do?

Back 52

Decrease the increased neuronal activity produced by DA depletion

DBS can improve motor function and reduce dyskinesia+medication usage

Front 53

Why is nutrition so important for someone with PD?

Back 53

They have side effects of malnutrition (dysphagia) and constipation

Front 54

What kinds of foods do we want?

Back 54

Ones that are easily chewed and swallowed

Front 55

6 small meals are less tiring than?

Back 55

Eating 3 large meals for the patient with PD

Front 56

High protein can actually _____ the effectiveness of ____, so we need to limit protein to_____ meals

Back 56

Decrease, Sinemet

Front 57

Maximum goals for the patient with PD?

Back 57

Maximize neurological function, maintain independence and ADL's, optimize psychological well being

Front 58

Other interventions consist of:

Back 58

Physical Therapy (to strengthen and stretch muscles), Speech Therapy, & Social Work, Balanced Diets

Front 59

MS

Back 59

Again, a CHRONIC, DEGENERATIVE disease of the CNS

Front 60

MS characterized by?

Back 60

Demyelination of nerve fibers in the brain and spinal cord (intermittent damage of the sheaths that cover nerve cell AXONS)

Intermittent: occurring at irregular intervals

Front 61

Pathophysiology. Demyelination impairs the ____ of nerve impulses

Back 61

Transmission

Front 62

The destruction of myelin/cause of MS may be due to?

Back 62

Autoimmune reactions, genetics, infectious (viral), susceptibility appears to be inherited, or Trauma

Specific cause unknown

Front 63

MS characterized by?

Back 63

Relapses, Exacerbations, & Remissions

Front 64

Who is more likely to get MS men or women?

Back 64

Women

Front 65

Age range

Back 65

15-40 yoa

Front 66

MS is a major cause of ____ in young adults

Back 66

Disability

Front 67

There is a family history ____ of the time, so evidence of genetic component

Back 67

15%

Front 68

Precipitating factors that induce exacerbations/contribute to onset of disease:

Back 68

Infections, stress (emotional and physical), fatigue, & pregnancy

Front 69

Pregnancy: Usually okay during pregnancy, but during _____ period, may begin to demonstrate____?

Back 69

Postpartum; initial symptoms of diease

Front 70

Clinical symptoms vary according to the areas of the ____ involved

Back 70

CNS

Front 71

Symptoms of MS:

Back 71

BILATERAL LOWER EXTREMITY WEAKNESS (BLE weakeness), Fatigue

Front 72

Later, what kind of symptoms come?

Back 72

Bowel & Bladder problems. May have a spastic bladder(frequency, incontinence) OR Flaccid Bladder-Urinary retention, OR BOTH

Front 73

Another symptom=Uhthoff's sign:

Back 73

Temporary worsening of vision or neuro functions, following increased exertion/heat exposure

Front 74

Emotional lability:

Back 74

Involuntary crying or episodes of laughing

Front 75

Like Parkinson's, there is no diagnostic test, so diagnosis based on?

Back 75

H&P history, along with CLINICAL MANIFESTATIONS + presence of multiple lesions over time on an MRI

Front 76

List all diagnostic tests affiliated with MS on powerpoint:

Back 76

MRI of brain/spine (both affected plaques), CSF analysis (increase in immunoglobin G-GRUMPY, increased monocytes and lymphocytes), evoked potentials of optic and auditory pathways (delayed responses nerve conduction from ear to brain)

Front 77

Characteristic white-matter lesions are scattered through the brain and spinal cord, evident on a?

Back 77

Scan

Front 78

Patient Interventions:

Back 78

Avoid people with infections, live in WARM climate (not too hot or cold), stress reduction/relaxation techniques, need to avoid pregnancy or plan carefully, prevent UTI (bladder problems)

Front 79

Because there is no cure for MS, collaborative care is aimed at?

Back 79

Treating the disease process and providing symptomatic relief

Front 80

What drugs are helpful in treating acute exacerbations of the disease?

Back 80

Corticosteroids, (prednisone)

Think inflammatory, break out

Front 81

What drugs help to treat the slow progression aspect of MS and treat relapses (ABC)

Back 81

Immunosuppressant's (Avonex, Betaseron, Capaxone) THINK ABC :)

Front 82

What can help to treat urinary retention

Back 82

Cholinergics

Front 83

What can help to treat urinary frequency and urgency?

Back 83

ANTIcholinergics

Front 84

What other medications may be supplied (not specific ones), considering symptoms?

Back 84

muscle relaxants, and stool softeners

Front 85

What types of medications may help with fatigue?

Back 85

CNS STIMULANTS TO WAKE YOU UP (Example: RITALIN)

Front 86

Interventions for MS- Balance (with BLE weakness)

Back 86

PT, assistive devices

Front 87

With fatigue, we will also want to treat episodes of?

Back 87

Vertigo, Syncope (temporary loss of consciousness)

Front 88

We want to treat BOWL AND BLADDER PROBLEMS T/F?

Back 88

True

Front 89

We want to monitor and treat (similar to parkinsons) How can we do this?

Back 89

Tremors and Spasms-evident with voluntary movement. By lifting weights to stretch muscle, we can increase the strength of them, thereby decreasing the tremors

Front 90

___ pain may also result, due to BLE weakness, fatigue, etc.

Back 90

Chronic

Front 91

Sensory problems include:

Back 91

Optic neuritis (inflammation of optic nerve)

Dipliopia (double vision)

Tinnitis (ringing)

SPEECH

Front 92

Diet precautions:

Back 92

Increase protein, V b12, and C, Cranberry juice to prevent UTIS

Front 93

Explain Myasthenia Gravis= ______ disease

Back 93

CHRONIC AUTOIMMUNE

Front 94

Characterized by disease of the _______ _________????

Back 94

Neuromuscular Junction, with fluctuating weakness of muscle groups

Front 95

_____ of nerve TRANSMISSIONS (not happening) at the neuromuscular junction. Due to inadequate release of?

Back 95

Failure; Ach, OR inadequate response of muscle fibers to ach (either ach not released, or the muscle fibers are not responding)

Front 96

Periods of _____ and ______

Back 96

Exacerbations and Remissions (like MS)

Front 97

Myasthenia Gravis greater in?

Back 97

Women (think of women being weaker with their muscles) age 20-40 actually > in men though, after 50

Front 98

Risks for Myasthenia Gravis (2)

Back 98

Tumor of Thymus gland, or it can just coexist with another autoimmune disease

Front 99

Symptoms of Myasthenia Gravis:

Back 99

Fatigue, problems with eyes (ptosis=drooping of upper eyelid), problems closing eyelids), neck weakness, head bobbing, chest wall muscle weakness, RESPIRATORY COMPLICATIONS and bowel/bladder problems (obviously if you have muscle weakness)

Front 100

Muscles most often involved include:

Back 100

Eyelids, those for chewing, swallowing, speaking, and breathing (why the resp issues)!

Front 101

Diagnostic Tests can be on?

Back 101

History and Physical Exam. Also EMG and TENSILON TEST

Front 102

What could an EMG show?

Back 102

Decreased response to repeated stimulation of hands, indicative of muscle fatigue

Front 103

Tension Test would show?

Back 103

Would show IMPROVED muscle contractility after IV injection of anticholinesterase, which blocks enzyme of acetylcholinesterase

inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine.

Front 104

Interventions: Monitor closely for ____ complications

Back 104

RESPIRATORY

Front 105

An extreme respiratory complication that can result frm Myasthenia Gravis=

Back 105

Myasthenia Crisis (Resp distress, which is brought on by increased muscle weakness making it more difficult to breathe, talk, or swallow (dysphagia)

Front 106

We also want to monitor for a _____ crisis:

Back 106

Cholinergic

Front 107

Cholinergic Crisis Symptoms and Cause

Back 107

Abdominal cramping, diaphoresis (sweating), muscle cramps

Side effects of too much medication

Front 108

If this happens, what can we give?

Back 108

Anticholinergic drug (atropine)

Front 109

Overall goals of someone with M.G

Back 109

Return to normal muscle endurance, manage fatigue, avoid complications, and maintain a quality of life appropriate to the disease course

Front 110

A patient admitted to the hospital usually has a ?

Back 110

Respiratory tract infection or is in acute myasthenic crisis

Front 111

Other treatments for Myasthenia Gravis:

Back 111

Thymectomy ( Test of culture With Thymic Tumor)

Plasmaohersis: Removing circulating antibodies

Front 112

Medications should be administered when?

Back 112

30 min before meals to promote swallowing and help with chewing

Front 113

Medications again:

Back 113

Cholinesterase Inhibitor (Pyridostigmine), first line treatment. Take at same time daily, Immunosuppresants (Immuran, Prednisone), and Igg (IV, acute management)

Front 114

Other tips for Myasthenia Gravis

Back 114

Aspiration precautions, avoid people with infections (on immunospressant drugs), avoid extreme temps, allow for rest periods, have high calorie meals (small+frequent), speech therapist to evaluate swallowing, WEAR MEDIC BRACELET