Medicine Notes Neurology Notes
These notes helped me achieve a mark of 76% in my neurology exam, which is the equivalent of a 1st. The notes are based on a series of 49 lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the nervous system (e.g. physiology o...
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SYMPOSIUM ON MOVEMENT DISORDERS
Clinical Aspects of Parkinson’s Disease and Huntington’s Disease
Pathology
Usually, axons from substantia nigra stretch out to putamen and DA released at terminals (but not in PD)
Cells in substantia nigra die off
Unilateral symptoms at first
2 nigra striated pathways. One begins to die off faster than other. If left, see symptoms on right
Number of different genes that have been found to cause PD
Lark 2 gene
Autosomal dominant
40% of Arabians with PD have gene
But genes cannot explain all cases
Environmental causes
Cardinal signs
TREMOR
Rhythmic, involuntary movements; Asymmetric; At rest
1/3 never have tremor
May not respond to meds
RIGIDITY
‘Cogwheel’
Try to move limb but very stiff
BRADYKINESIA
Slowness of movement & fatigue over time
Degeneration of PD causes this
Reduced speed and amplitude
Absent facial expression
Postural instability
Loss of so-called reflexes
Sluggish, stooped gait
Medication
L-Dopa
Can’t just give dopamine, won’t cross BBB
Give this pro-form that crosses and is then converted to dopamine
Dopamine agonists
Can cause impulsive behaviours
Works on receptor of next (post synaptic) nerve
MAOI
Stop breakdown of transmitters= around for longer
NMDA antagonist
Glutamate receptors
Antagonise and may make symptoms better
Anticholinergic
Reduce dopamine
ACh may decrease & so these give
COMT inhibitor
Motor complication
End of dose tail off
Sudden switching off
Dyskinesias
Freezing
Postural instability
Falling
Unable to swallow
Non-motor complications
Dementia (70-80%)
Depression
Anxiety
REMSBD (Body=paralysis. Patients act out dreams in REM sleep)
Daytime drowsiness
Restless Leg Syndrome
Treatment of movement disorders:
Parkinson’s disease and Huntington’s disease
Parkinson’s disease
Treatment options
Preventative
None
Symptomatic
Pharmacological
Surgical- Deep brain stimulation
Non-motor management
Cognitive & speech therapy
Physiotherapy
Dietician
Psychologist
Restorative (experimental)
Transplantation of stem cells
Gene therapy
Neurotrophic factors- support surviving cells
Drug classes
DOPAMINERGIC AGENTS
L-Dopa
Most effective
Always given with decarboxylase inhibitor to limit peripheral...
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These notes helped me achieve a mark of 76% in my neurology exam, which is the equivalent of a 1st. The notes are based on a series of 49 lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the nervous system (e.g. physiology o...
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