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Motor neuron lesions and Homoeopathy medical science

Motor neuron lesions and Homoeopathy medical science

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Motor neuron lesions and Homoeopathy medical science

  1. 1. Motor Neuron Lesions (Upper motor and Lower motor Neuron) With Homoeopathic Therapeutics Compiled by: Dr.Shuchita Chattree Verma B.H.M.S. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 1
  2. 2. Introduction: Nervoussystem controlsall theactivitiesof thebody. It isquicker than outer control system in thebody namely theendocrine system. It isdivided into two parts: •Central nervoussystem •Peripheral nervoussystem07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 2
  3. 3. Central nervoussystem TheCentral nervoussystem includestheBrain and the spinal cord. It isformed by theneuronsand the supporting cellscalled neuroglia. Brain issituated in theskull. It iscontinuousasspinal cord in thevertebral column theforemen magnum. Brain has3 major divisions: •Prosencephalon- two cerebral hemispheres, thalamus, hypothalamus •Mesencephalon- mid brain •Rhombencehalon- pons, cerebellum, medulla oblongata.07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 3
  4. 4. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 4
  5. 5. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 5
  6. 6. Neuron isdefined asthestructural and thefunctional unit of central nervoussystem. Neuronscan beclassified upon thebasisof their functionsas Sensory neurons Motor neurons Motorneurons: also known asefferent nervecells. These neuronscarry themotor impulsesfrom thecentral nervous system to theperipheral effector organslikemuscles, glands, blood vessels, etc. themotor neuronshavelong axon and short dendrites. Sensory neurons: also called asafferent nervecells. These carry thesensory impulsesfrom theperiphery to thecentral nervoussystem. Thesensory neuronshaveshort axon and long07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 6
  7. 7. Tractsof spinal cord Thedifferent collectionsof thenervefiberspassing through thespinal cord areknown asTractsof thespinal cord. Thespinal tractsaredevided into two main groups; theshort tractsand thelong tracts. Short tracts : connectsthedifferent partsof thespinal cord itself. Long tracts: arealso called asprojection tracts, connects spinal cord with other partsof thecentral nervoussystem. Thelong tractsareof two types: Ascending tracts which carry sensory impulsesfrom07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 7
  8. 8. Descending tractsof spinal cord Thedescending tractsof thespinal cord areformed by the motor nervefibersarising from thebrain and descending into thespinal cord. Thesetractsareconcerned with thevarious motor activitiesof thebody. Again thedescending tractsareof two types: •Pyramidal tracts •Extrapyramidal tracts (thisclassification of themotor pathway ison thebasisof thesituation of their fibersin themedullaoblongata) •Theneuronsgiving origin to thefibersof thepyramidal tract and their axons aretogether called theupper motor neurons. •Theanterior motor neuronsin thespinal cord and their axonsarecalled the 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 8
  9. 9. Pyramidal tracts: Theseareconcerned with thevoluntary motor activity of thebody. They arealso know as CORTICOSPINAL TRACTS. Therearetwo corticospinal tractstheanterior corticospinal tract and thelateral corticospinal tracts. (Whilerunning from thecerebral cortex towardsspinal cord thefibresof thesetwo tractsgivetheappearanceof thepyramid hencecalled as pyramidal tracts.) Functions: Control voluntary movements07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 9
  10. 10. Extrapyramidal tracts: Thedescending tractsof thespinal cord other then the coticospinal tract areknow asextrapyramidal tracts They are: •Medial longitudinal fasciculus •Anterior vestibulospinal tract •Lateral vestibulospinal tract •Reticulospinal tract •Tectospinal tract •Rubrospinal tract •Olivospinal tract 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 10
  11. 11. Medial longitudinal fasciculus: •Coordination of reflex ocular movements •Integration of movementsof eyesand neck Anterior/ lateral vestibulospinal tract: •Maintenanceof muscletoneand posture •Maintenanceof position of head and body during acceleration. Reticulospinal tract: •Coordination of voluntary and reflex movements •Control of muscletone •Control of respiration and blood vessels 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 11
  12. 12. Tectospinal tract: •Control movementsof head in responseto visual and auditory impulses Rubrospinal tract: •Facilitory influenceon flexor muscletone Olivospinal tract: •Control movementsdueto proprioception 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 12
  13. 13. Upper motor neurons Upper motor neuronsaretheneuronsin thehigher centresof the brain, which control thelower motor neurons. Therearethreetypeof theupper motor neurons. •Motorneuron in the cerebral cortex. Thefibersof these neuronsform thecorticospinal and thecorticobulbar tracts. The cortical areasconcerned with theorigin of motor signalsarethe primary motor area, premotor area, and supplementary motor areas in frontal lobesand sensory areain parietal lobe. Themotor neuronsin thecerebral cortex , which giveorigin to pyramidal tractsbelong to thepyramidal. system and theremaining motor neuronsbelong to extrapyramidal system.07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 13
  14. 14. • Neurons in the cerebellum. Cerebellum playsan important rolein planning programming and integration of skilled voluntary movements. It isconcerned with muscletone, postureand equilibrium. • Neurons in the basal ganglia and nuclei in the brain stem. It playsimportant rolein thecoordination of the skilled movements, regulation of automatic associated movementsand regulation of muscletoneby sending output signalsto motor cortex. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 14
  15. 15. Lower motor neurons • Lower motor neuronsaretheanterior gray horn cellsin the spinal cord and themotor neuronsof thecranial nerve nuclei situated in thebrain stem., which innervatesthe musclesdirectly. • Thelower motor neuron areunder theinfluenceof the upper motor neurons. • Theactivitiesof theparticular musclesdepend upon the excitation of thealphamotor neuronsin thespinal cord or cranial nervenuclei. (lower motor neuron) • Thisistheonly path way through which the signalsof the other partsof nervoussystem reach themuscles, therefore07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 15
  16. 16. Aetiology: About 5 % of casesarefamilial, showing autosomal dominant inheritance. In many such familiesgenetic defectslieson chromosome21, theenzyme involved being asuperoxidedismutase(SOD1). Forthe remaining 95 %, probable causes includes: 1. Chronic Aluminium toxicity 2. Slow virusinfection 3. Auto immunity 4. Trauma 5. Electrical shock Another suggestivehypothesisisthat glutamatewhich isaprimary excitatory neurotransmitter in theCNS, accumulatesat synapsesand causestheneuronsto die, probably through acalcium dependent mechanism. Prevalenceof thisdiseaseis about 5/100000. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 16
  17. 17. Pathology: Themotor neuronsin thecerebral cortex, brainstem and spinal cord show atrophy and their axonsshow degenerativechanges. Musclesshow groupsof atrophic fibresamidst thegroupsof normal fibres. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 17
  18. 18. Classification: • A. Classical type: 1. Predominant LMN involvement a) Bulbar form: Progressivebulbar palsy. b) Spinal form: Progressive muscular atrophy. 2. Predominant UMN involvement • B. Non classical type: 1. Werding – Hoffmann disease 2. Kugelberg – Welander disease 3. Spinal muscularatrophy described from south India(Madras) 4. Motorneuron disease – dementia– parkinsonian complex described from Guam Island 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 18
  19. 19. Types of MotorNeurone Disease: Progressive BulbarPalsy (PBP) 20% of cases(onset) •involvesUMNsand LMNs • dysarthria • dysphagia • emotional lability • progressiveweaknessin upper limbs/neck/ shoulder girdle Amyotrophic Lateral Sclerosis (ALS) 65 - 66% of cases(onset) • involvesUMNsand LMNs • muscleweakness– often developsin handsand feet first, spasticity, • hyperactivereflexes 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 19
  20. 20. Types of MotorNeurone Disease: Progressive MuscularAtrophy (PMA) 7.5% - 10% of cases • predominantly LMNs • affected (may start in • small musclesof hand) • musclewasting, • weakness • fasciculation (may in time develo p UMN invo lvement and may eventually develo p so me speech pro blems) Primary Lateral Sclerosis (PLS) 2% of cases • rare • UMNsonly • muscleweakness • stiffness • balance • dysarthria • doesnot shorten • survival 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 20
  21. 21. Common presenting features are: • Ageof onset. Usually after age50 years. Very uncommon before30 years. • Malesarecommon than females. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 21
  22. 22. Effectsof upper motor and lower motor neuron lesion Effects Upper motor neuron lesion Lower motor neuron lesion 1. Muscle tone Hypertonia Hypotonia 2. Paralysis Spastic type Flaccid type 3. Wastage of muscle No wastage Wastage of muscles occurs 4. Superficial reflexes Lost Lost 5. Plantar reflex Babinski’s sign (abnormal plantar reflex) Plantar reflex absent 6. Deep reflexes Exaggerated Lost 7. Clonus Present Lost 8. Electrical activity Normal Absent 9. Muscles affected Groups of muscles are affected Individual muscles are affected 10. Fascicular twitch in EMG Absent Present 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 22
  23. 23. Theeffectsof theupper motor neuron lesion depend upon thetype of neuron involved. Thefollowing aretheeffectsof upper motor neuron lesion: 1.Thelesion in thepyramidal system causesincreasein themuscle tone– hypertoniaand spastic paralysis. Spsatic (toneof themuscle isincreased) paralysisinvolvesonly onegroup of muscles particularly theexstensors. (spasticity isdueto thefailureof inhibitory impulsesfrom cerebral cortex to reach thespinal cord.) 2.Lesion in basal gangliaproduceshypertoniaand rigidity involving both flexor and extensorsmuscles. 3.Lesion in cerebellum causesdecreasein muscletone– hypotonia , muscular weakness, and in coordination of movements. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 23
  24. 24. Rubrics in repertotries: I)Repertory of William Boerick: 1) Nervous system, Bulbarparalysis: Guaco, Plumb. met, Mang.oxydatum. 2) Nervous system, Degeneration(softening, sclerosis): 2+ – Aur.mur,Phos, Plumb.met. 1+- Alum, Alum.sil, Arg.nit. Aur, Bar.mur, Carb.sulph, Naja, Oxalic.acid, Phos, Physostigma, Picric acid. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 24
  25. 25. II. Kent’s repertory: 1)Throat, swallowing, impossible, paralysis from: 3+- Stram. 2+- Alum, Alumn, Apis, Cocc, Gelse, Nat. mur, Nux Vom,Tab 2)Mouth, speech, wanting paralysis of organs from: 3+- Caust. 2+- Anac, Crot.c, Gelse, Glon, Mur.acid, Staph. 3) Mouth, speech difficult: 3+- Bell, Crot.c, Gels, Lach, Nat.mur, Op, Stann. 4) Throat,liquids taken are forced in to nose: 3+- Arum.t, Lach, Lyc 2+- Bar. carb, Carb.ac, Cur,Nat.mur,Phyt,Plumb. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 25
  26. 26. • III. Rau’s special pathology: 1) Paralysis of bulbarmuscles: Caust, Hyos,Nux.vom,Cocc,Gels, Op,Plumb,Ruta 2) Paralysis of face: Bell,Caust,Cocc, Graph, Nux vom 3) Paralysis of tongue and organs of speech: Arn, Acon, Ars,Bar.carb, Bell, Caust, Cocc, Cupr, Dulc, Lach, Op, Mur.ac,   Plumb, Hyos,Stann. • IV. Boeninghausen’scharacteristicmateria medica and repertory: 1) Mouth, throat and gullet, paralysis of deglutition: 4+- Caust. 3+- Cocc, Gels, Laur, Lach 2) Voice and speech, paralysis of vocal cord: 4+- Cocc,Gels, 3+- Caust, Hyos,Laur,Nux vom, Rhust, Stram 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 26
  27. 27. Therapeutics: Causticum: Paralysisof singleparts- vocal organs, tongue, eyelids, face, bladder, extremities, generally of rt. sided. Paralysisfrom exposureto cold wind or draft. Paralysisafter typhoid, typhusor diphtheria; appearing. Drooping of eyelids, cannot keep them open. It isused in paralysiswhich isremote from apoplexy, theparalysisremaining after patient has recovered from apoplexy with inability to select proper words. Laryngeal musclesrefusetheir services, cannot speak aloud word. Aphonia. Sudden aphoniaafter taking cold. Paralysisof faceor tongueor hemiplegiawith giddiness, weaknessof sight, weeping mood, hopelessnessand fear of death.07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 27
  28. 28. Guaco:-Actson nervoussystem. Bulbar paralysis. Deafness. Tongueheavy and difficult to move. Spinal irritation. Spinal symptomsaremost marked. Beer drinkersthreatened with apoplexy. Larynx and tracheaareconstricted. Difficult deglutition. Paralysisof lower extremities. Plumbum metalicum: Paralysiswith atrophy. Muscular atrophy from sclerosisof spinal system. Excessiveand rapid emaciation. General or partial paralysiswith great weaknessand anaemia. Clonic ortonic spasm from cerebral sclerosisor tumor. Paralysisof plumbum isprominently of spinal origin. Paralysisof upper extremitiesismoremarked. Ptosis. Heavy tongue. Difficulty in articulation. Tremor of nasolabial muscles. Twitching of thesideof theface. Paralysisof gullet and inability to swallow. Paralysisof lower extremitieswith paralysisof single 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 28
  29. 29. •Plumbum iodatum: Hasbeen used empirically in various formsof paralysis. Sclerotic degeneration, especially of spinal cord. Atrophies. •Phosphorus: Paralysisfrom fatty degeneration of nerve cells. Progressivespinal paralysis. Ascending sensory and motor paralysisfrom endsof fingersand toes. Armsand handsbecomenumb. Fingersfeel likethumb.Can lieon right side. Post diphtheritic paralysis. Tottery gait Periodical contractionsof fingersasfrom cramps. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 29
  30. 30. • Gelsemium: Completemotor paralysis, rather functional than organic in nature. Paralysisof occular muscles. Ptosis. Paretic condition of thetonguecausesdifficulty to speak. Speak isthick. Paralysisfrom emotions. Post diphtheritic paralysis. Paralysisof larynx causesaphonia. Locomotor ataxia. Paraplegia. • Nux vomica: Incompleteparalysisof theface, arms, and legs with vertigo, weak memory, darknessbeforetheeyes, ringing in ears, lossof appetite, burning in stomach, flatulenceand vomiting after eating and drinking.Constipation especially in drunkards. Jaw contracted. Infraorbital neuralgia. Left angleof themouth drops. Twitching and spasmodic distortion of face. Articulation and speech difficult. Paralysisof arms. Automatic motion of hand towardsmouth. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 30
  31. 31. •Opium: Paralysisand insensibility after apoplexy, in drunkards, in old people, associated with retention of stool and urine. Spasmodic facial twitching, especially of cornersof mouth. Hanging down of lower jaw. Distorted face. Twitching of facial muscles. Facecovered with profuse sweat. Paralysed tonguewhich dry and black. Difficult articulation and swallowing. Tongueprotrudesto right side. Inability to swallow. On swallowing food goesthewrong way or returnsthrough nose. Painless paralysis. Twitching of limbs. Numbness. Jerksasif flexorsare overacting. Sensation asif lower limbsweresevered and belongsto someoneelse. Shifting and trembling gait. Oneor other arm moves convulsively to and fro. Coldnessof extremities. • Belladona: Apoplexy , congestion of thehead, paralysisof oneand spasm of other sideof thebody, paralysisof thefaceand locomotor ataxia. • Lachesis: Especially left side. Awkward. Stumbling gait. Paralysisafter07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 31
  32. 32. • Stramonium: Paralysisafter convulsion,. Paralysisof oneor spasm of other side. Stammering speech. Cannot swallow on account of spasm. • Graphitis: Rheumatic, peripheric paralysisof face. Distortion of muscles of faceand difficult speech. Sensation of cobweb over theface. • Arnica: Paralysis due to exudation within the brain or spine. Paralysis in consequence of apoplexy, of concussion, of weakening disease and of protracted intermittent fevers. Paralysis of face and lower lip hang down. Lower lip trembling whileeating. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 32
  33. 33. • Conium: Paralysisfrom periphery upwards, of old women. Speech difficult from paralysisof tongue. Distortion of tongueand mouth. Food goesdown thewrong way and stopswhileswallowing. Paralysisof lower limbsthan of upper limbs. Staggering < turning the head or looking sideways. • Arsenicum album: Paralysisassociated with great prostration and neuralgic pains. Spinal affection with gressusgallinaceus. Twitching of musclesof face. Paralysisand contraction of limbs. • Manganum oxydatum: Low monotonousvoice. Economical speech. Mask likefacies. Muscular twitching. Crampsin calvesStiff leg muscles. Occasional uncontrollablelaughter. Peculiar slapping gait. Workersof manganum binoxidearefrequently affected with07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 33
  34. 34. • Ruta graveolance: Facial paralysisafter catching cold. • Baryta carbonicum: Causes paralysis by producing degeneration of the coats of the blood vessels. Facial paralysis. Paralysis of old people. Paralysis after apoplexy. Facial paralysis of young people where the tongueisimplicated. • Natrum muriaticum: Paralysis from cold. Numbness. Tingling of tongue and lips. Loss of taste. Tongue striped along the edge. Numbness and stiffness ofone side of the tongue. Tongue heavy and difficult speech. Tongue feels dry but actually not dry. Uvula hangs to one side. Food goes down the wrong way. Post diphtheritic paralysis. Fluids can beswallowed. Paralytic condition of lower limbs. • Curare: It isagreat remedy for paralysisof variouskindsand of various partsof our body. General paralysisof motor system. Ptosis. Facial and 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 34
  35. 35. • Cocculus: Paralysisof facial nerveespecially of oneside. Or tonguepharynx. Paraplegiaand rheumatic lamnessin weakened or nervoussubjects, who areinclined fainting fitsand palpitation of theheart. Paralytic affection originatesin thesmall of the back after taking cold, with cold feeling of extremitiesand edemaof thefeet. Paralysisafter apoplexy. Paralysisof lower limbs. Paralytic immobility. Onesided paralysisof thefacewith cramp likepain in masseter < opening themouth. Prosopalgia. Tremor of lower jaw and chattering of teeth when attempting to speak. Linesof facearedeepened asif drawn. Paralysisof the tonguewith difficult speech. Painsat thebaseof thetongue when protruded. Paralysisof musclesof deglutition with difficulty to swallow. 07/11/15 Dr.Shuchita chattree verma email: shuchita.chattree99@gmail.com 35

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