Card Set Information
what is MS characterised by?
plaques of demyelination in the CNS and axon loss
what is the presentation of MS?
unilateral optic neuritis
: pain on eye movement and deteriorated central vision
numbness or tingling in limbs
UMN lesion signs
which investigations need to be done for MS and what would they show?
: plaques of demyelination
: oligoclonal bands of IgG
: DELAYED visual, auditory, somatosensory
what is an acute episode of MS?
limitation of activity
how are acute relapses of MS treated?
: methylprednisolone 1g/24h iv or po for 3d
NB sparingly as SE
which drugs are used to alter disease progression?
: mitoxantrone (doxorubicin analogue) for rapidly progressing pts
: natalizumab=adhesion molecule inhibitor to stop WBC entering CNS. only for rapidly evolving, severe relapsing remitting MS
what is parkinson's disease characterised by?
degneration of dopaminergic neurones in substantial nigra that project to striatum
what are the cardinal features of PD?
resting tremor - pill rolling
shuffling, festinant gait, no arm swing, hard to start and stop
what is the differential diagnosis of parkinsons? clue vodka
vascular events elsewhere
: (stroke, MI) = vascular parkinsons
orthostatic hypotension and atonic bladder
: multi system atrophy (Shy-Drager)
dementia + vertical gaze paralysis
: supranuclear palsy
: wilsons disease
: communicating hydrocephalus
what are the features and causes of drug induced parkinsons?
more likely to be symmetrical
any drug that blocks action of dopamine
neuroleptics (rx schizo)
: clozapine, risperidone
meds for N&V
: metocloperamide, prochlorperazine
what is tardive dyskinesia a side effect of?
what are the principles of treatment in PD?
restore DA activity
reduce cholinergic activity
what is the first line treatment for LATER PD? and what do you give it with?
: precursor for DA synthesis, crosses BBB
combo with benserazide/carbidopa
: peripheral DOPA-decarboxylase inhibitor (so cant turn Ldopa into dopamine in periphery)
What is the treatment for EARLY PD?
delay L-DOPA for as long as posse
what are the disadvantages of L-dopa?
honeymoon period for 5-6 years
: early phase of treatment, DA neurones still present and L-dopa can be stored in nerve terminals so it make a physiological concentration
chronic use of L-dopa
: motor complications - on and off as nerve endings lost
: psychiatric hallucinations, ortho hypotension, nausea
give an example of a dopamine agonist and its MOA and use and an advantage
apomorphine, cabergoline, bromocriptine
: direct action on DA receptors, mimic endog DA
: long duration of action esp. cabergoline so less fluctuation in symptom control
: L-DOPA sparing
: reduce motor fluctuations as an adjunct to L-DOPA
what is the side effect of DA agonist?
: but treated by peripheral DA antag domperidone
what must apomorphine be given with and why?
apomorphine is very emetogenic
what are the 2 categories of drugs that inhibit DA metabolism?
: tolcapone, entacapone
which is the rationale for using anti-cholinergics in PD? give some e.g. and SE
: depletion of DA leads to over activity of ACh
: improve tremor, stiffness, sialorrhoea, urinary urgency
eg benzhexol, procyclidine
: dry mouth, blurred vision, urinary retention, constipation, confusion in elderly
what is dementia?
memory, thought, mood changes
dependence on state and carer
what are the 4 common causes of dementia?
Lewy body dementia
what are the 3 pathological features in Alzheimer's?
beta amyloid plaques
: due to accum of B amyloid peptide, a degradation product of amyloid precursor protein - resulting in progressive neuronal damage
loss of ACh
what is the treatment of Alzheimer's?
: donezepil, rivastigmine, galantamine
: memantine (not NICE approved)
what are the RF for vascular dementia?
what are the features of vascular dementia?
impaired exécutive fonction (choc cake)
pseudo bulbar palsy (UMNL to corticobulbar path)
but preservation of personality
what does MRI show in vascular dementia?
diffuse white matter disease
what does MRI show in alzheimer's?
atrophy, typically in medial temporal lobes
what are the features of fronto-temporal dementia?
loss of social awareness
what are the MRI signs of fronto-temporal dementia?
in vCJD dementia what are the MRI signs?
high signal in posterior thalami
in sCJD what are the EEG signs?
periodic spike and wave