NR 507NP Week 7 CNS; Sensory and Motor Disorders

1. History and Family Hx 2. Physical exam 3. Med challenge a. Levodopa  improvement 4. Exclude other conditions a. Stroke, tumor, med-induced Parkinson’s 5. Specialist referral ix. Treatment 1. Meds a. Levodopa is converted to dopamine in brain and supplements reduced levels. Often combined with Carbidopa to reduce side effects. b. Dopamine agonists (Ropinerole) can mimic dopamine effects in brain. c. MAOI (selegiline) can help reduce breakdown of dopamine. d. Anticholinergics can help reduce tremor, but have side effects. 2. Deep Brain Stim  reduces tremors 3. PT/ST 4. Alternative  toga, tai-chi, meditation to COMPLIMENT treatment. b. Amyotrophic Lateral Sclerosis (ALS): Targets motor neurons in spinal cord and brain. i. Muscle weakness and atrophy c. Huntington’s: Degeneration of nerve cells in basal ganglia i. Uncontrolled movements and emotional disturbances. d. Multiple Sclerosis: Autoimmune disorder that damages the myelin sheath in CNS. i. Wide range of symptoms e. Myasthenia Gravis: Autoimmune disorder that impacts communication between nerves and muscles. i. Muscle weakness and fatigue 2. Neurodegenerative Disorders Affecting Cognitive Function (types of dementia) a. Alzheimer’s: Most common form that is marked by accumulation of amyloid plaques and tau tangles in brain  neuronal death. i. Progressive memory loss ii. Confusion iii. Changes in behaviors/personality iv. Pathophys of Alzheimer’s: accumulation of amyloid-beta plaques and tau protein tangles in brain, particularly in hippocampus and cortex. 2. Cholinesterase inhibitors (Donepezil) for mild/moderate cases. 3. N-methyl-D-aspartate (NMDA) receptor antagonists BLOCK glutamate. b. Vascular Dementia: From conditions that block or reduce blood flow to brain. Often follows strokes. i. Impaired judgement ii. Inability to plan iii. Loss of motivation c. Lewy Body Dementia: Commonly seen in Parkinson’s patients. There is a presence of Lewy bodies. i. Cognitive decline ii. Fluctuating alertness iii. Visual hallucinations iv. Parkinson’s motor symptoms. d. Frontotemporal Dementia: Degeneration of nerve cells in frontal and temporal lobe. Affects behavior, personality, and language VS memory. i. Socially inappropriate behavior ii. Impulsive iii. Language difficulties. DEMYELINATING DISORDERS 1. Normal Physiology of Nerve Function a. Myelin is produced by oligodendrocytes in CNS and Schwann cell in PNS b. Gaps b/w myeline sheaths = Nodes of Ranvier INCREASE speed of signal = Saltatory conduction c. 2. Multiple Sclerosis: chronic autoimmune disorder primarily affecting the central nervous system (CNS) a. Pathophys (4 key elements) i. Inflammation: From T and B cells and macrophages that cause scarring. ii. Demyelination iii. Gliosis (scarring): Scerosis can be seen as plaques or lesions in white matter of CNS via MRI. distinguish between old and active lesions, as gadolinium is taken up by active, inflamed lesions. 2. CSF: elevated levels of immunoglobulins (IgG) and the presence of oligoclonal bands, which indicate an immune response within the central nervous system (CNS). 3. Evoked Potential: measure the electrical activity of the brain in response to stimulation of specific sensory pathways. e. Treatment i. Limit inflammation ii. Alleviate symptoms iii. Flares = Corticosteroids, immunosuppressants, immune system modulators. iv. Spasticity = Muscle relaxants v. Neuropathic pain = anticonvulsants/antidepressants vi. Fatigue = rest and sleep hygiene