neuromuscular conditions (gbs,mnd)

• types of NMD

  • neuropathies

    • GBS

    • chronic inflammatory demyelinating polyneuropathy

    • Charcot Marie tooth disease

  • motor neuron diseases

    • ALS

    • primary lateral sclerosis

    • spinal muscular atrophy

  • neuromuscular junction disorders

    • myasthenia gravis

  • myopathies

    • muscular dystrophies

• Guillain-barre syndrome

  • pathogenesis

    • acute polyneuropathy (immune mediated)

      • demyelination

      • axonal degeneration (in severe cases)

  • what causes it

    infections like campylobacter jejuni, causing gastro. also infection like HIV, influenzas and zika virus

  • clinical features of GBS

    • progressive bilateral weakness, initially in LL

    • paraesthesia: numbness and tingling

    • pain - diffuse

    • autonomic dysfunction: postural hypotension, arrhythmias

    • may involve swallowing issues and respiratory muscle issues

  • more likely in men or women

    men, 2:1

  • drug therapy

    • plasmaphoresis

    • immunoglobin infusion

  • physio role

    • prevent secondary impairments like

      • cardiorespiratory complication s

      • maintain muscle strength and length

      • prevent skin breakdown, DVT’s

  • exercise prescription

    • strength training

      • submax suggested

      • increase reps before load

      • do fast twitch training

    • aerobic exercise

      • may not improve fatigue or function

      • moderate intensity

• motor neuron disease

  • pathogenesis

    • progressive degeneration of motor neurons

      • sensory system is generally spared

  • diagnosis

    • clinical diagnosis

    • exclude other conditions

    • upper and lower motor neuron signs and progression of disease

  • clinical features

    • LMN: progressive bulbar palsy,

      • weakness

      • atrophy

      • cramps

      • fasciculations

      • hyporeflexia

      • hypotonicity

    • UPM

      • weakness

      • spasticity

      • hyperreflexia

      • pseudobulbar affect

    • upper and lower: ALS (amyotrophic lateral sclerosis)

      • dysarthria

      • dysphagia

      • fatigue

      • respiratory insufficiency

  • drug therapy

    no major effect on disease progression

    symptoms management

  • evidence on exercise

    • insufficient exercise on whether or not it is beneficial

    • some to show it helped improve ALS functional rating scale

functional nerurological disorder - its own thing 

• what is FND

  a disorder of motor and sensory symptoms (paralysis, tremor and seizures) that are genuinely experienced and related to a functional rather than a structural disorder

• diagnosis

  • exclude other structural disorders

  • made by neurologist and psychiatrist

  • usually triggered by an underlying psychological trigger