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MS, Parkinson’s and Motor Neurone Disease |
Multiple Sclerosis
Patients with Multiple Sclerosis have a diverse condition comprising neurological signs and symptoms that are disseminated in both site and time. A viral aetiology has been postulated but the cause is not known. Onset is variable but optic neuritis can lead to visual disturbance or blindness, which may be a presenting feature. Weakness or paralysis of a limb can occur. Nystagmus (jerky, oscillating movement of the eyes - which can also be physiological) may occur, as may ataxia (uncoordinated movements) and dysphagia. Loss of sphincter control leading to urinary incontinence may occur. The diagnosis should be considered in a young patient presenting with trigeminal neuralgia or a facial palsy. Enquiry in such cases should be directed towards other areas to check for neurological signs or symptoms elsewhere.
Parkinson’s Disease
Parkinson's Disease results from degeneration of the pigmented cells of the substantia nigra leading to dopamine deficiency. The disease may also result from previous head injury or cerebrovascular disease. Clinically the patient may have tremor in the arms and hands (the latter being described as 'pill-rolling'). A so-called 'cog-wheel' type of rigidity may be seen on movement. Slow movements (bradykinesia) and restlessness (akathisia) may also be noted. The patient may have an expressionless face and a stooped posture. Impaired autonomic function may lead to a postural drop in blood pressure and hypersalivation resulting in drooling of saliva.
Motor Neurone Disease
Motor Neurone Disease comprises a group of disorders that affect motor neurones at various levels. There is no sensory loss and this helps differentiation from multiple sclerosis. The aetiology is unknown, but a viral agent is thought possible. Oral hygiene may be difficult in these patients and dysphagia and drooling may occur.
REF: British Dental Journal 12 July 2003; Volume 195, No. 1
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