SCI - Autonomic dysfunction

Autonomic dysfunction in SCI

Types
- autonomic dysreflexia
- OH
- thermoregulatory
- cardiac dysrhythmias
- bladder, bowel, and sexual dysfunction

Autonomic dysreflexia (AD)
- pts w/ lesions at ≥ T6 (sympathetic tone)
- triggered by noxious stimuli below the level of pts injury (unopposed sympathetic activation)
- fatal if not treated (AMI, stroke)
- usual presentation is throbbing headache, sweating, blurry vision, brad/tachy, spikes BPs

- causes
a. classical distention of hollow viscus (organs w/ air inside, like GUT)
- bladder scan and cath immediately is enough to stop
- bowel impaction and manual disimpaction, teach pts
- educate pts about avoiding AD
b. gentle stimuli due to tight clothes (shoes, belt, compression socks)
c. menstrual cramps
d. ulcers and wounds

- treatment
> remove stimuli
> nitro-paste 1 inch (above the pts level lesion)
> anti-HTN rapid-onset: nifedipine, captopril, prazosin

216. Accepted

215. Accepted

Neurotoxin - General

Neurotoxin General

History
- 1944: toxin purified
- 1970: clinical trials
- 1989: FDA approval of oculinum

Consideration
- advantages: focal & reversible
- natural product, no generics
- 1U = LD50 in mouse
- intraspecies difference in sensitivity

Pharmacology
- 7 serotypes that cleave SNAP, synaptobrevin, and syntaxin
- toxins A and B are usual targets

Types
A - Botox (OnabotulinumtoxinA); Dysport (AbobotulinumtoxinA); Xeomin (IncobotulinumtoxinA); Daxxify (DaxxibotulinumtoxinA-lanm)
B - Myobloc (RimabotulinumtoxinB)
Dilution
Vials type
- botox 50 (cosmetic only)/100/200U 
- xeomin 50/100U

Observations
- xeomin can be 1st line, depending on insurance; VA is xeomin instead of botox 

PD - Genetics and Environment

PD - Genetics and Environment

General
Conjugal PD
- envionment? luandromat, farmers

Genetics
- GBA is the MCC of genetic PD; especially in Ashkenazi

Foot drop

Foot drop

Devices


PSP

Progressive Supranuclear Palsy

Neuroimaging
- hummingbird sign 
> midbrain measurement of <9.35 mm and ratio (midbrain/pons) of 0.52 had 100% specificity for PSP


Essential tremor - management

Essential tremor - management

Essential tremor foundation
https://essentialtremor.org/ 

Medications
- Propranolol 
> propranolol IR 10 mg BID; inc 10 mg weak 
> when propranolol IR 30 mg BID, can be converted to propranolol ER 60 mg/daily 

Devices
- Weighted utensil, pen, gloves 
- Cala KiQ
> TAPS system, modulating sensory pathway of tremor 
> refractory tremor 
> 45 min 2x/d; not all the time; max 5 session/day 
> efficacy 50% 
> not covered by private; but, Medicare cover 
- Villim ball
> 10 min per hand, 3x/d




Ataxia-telangiectasia

Ataxia-telangiectasia

Management
- Amantadine for ataxic tremor

HD

Huntington's disease

General 
- predictable 15y of prognosis