Motor neuron lesions and Homoeopathy medical science

Motor Neuron Lesions

(Upper motor and Lower motor Neuron)

With Homoeopathic TherapeuticsCompiled by: Dr.Shuchita Chattree

VermaB.H.M.S.Email: [email protected]

04/15/23 Dr.Shuchita chattree verma email: [email protected] 1

Introduction:Nervous system controls all the activities of the body. It is quicker than outer control system in the body namely the endocrine system.It is divided into two parts:•Central nervous system •Peripheral nervous system04/15/23 Dr.Shuchita chattree verma email:

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Central nervous systemThe Central nervous system includes the Brain and the spinal cord. It is formed by the neurons and the supporting cells called neuroglia.Brain is situated in the skull. It is continuous as spinal cord in the vertebral column the foremen magnum.Brain has 3 major divisions:•Prosencephalon- two cerebral hemispheres, thalamus, hypothalamus•Mesencephalon- mid brain•Rhombencehalon- pons, cerebellum, medulla oblongata.(Mid brain, pons, medulla together are called Brain stem)04/15/23 Dr.Shuchita chattree verma email:

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Neuron is defined as the structural and the functional unit of central nervous system.Neurons can be classified upon the basis of their functions as Sensory neuronsMotor neuronsMotor neurons: also known as efferent nerve cells. These neurons carry the motor impulses from the central nervous system to the peripheral effector organs like muscles, glands, blood vessels, etc. the motor neurons have long axon and short dendrites.Sensory neurons: also called as afferent nerve cells. These carry the sensory impulses from the periphery to the central nervous system. The sensory neurons have short axon and long dendrite.


Tracts of spinal cordThe different collections of the nerve fibers passing through the spinal cord are known as Tracts of the spinal cord. The spinal tracts are devided into two main groups; the short tracts and the long tracts.Short tracts : connects the different parts of the spinal cord itself.Long tracts: are also called as projection tracts, connects spinal cord with other parts of the central nervous system. The long tracts are of two types: Ascending tracts which carry sensory impulses from the spinal cord to the brain. Descending tracts which carry motor impulses from the brain to the spinal cord04/15/23 Dr.Shuchita chattree verma email:

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Descending tracts of spinal cord

The descending tracts of the spinal cord are formed by the motor nerve fibers arising from the brain and descending into the spinal cord. These tracts are concerned with the various motor activities of the body.Again the descending tracts are of two types:•Pyramidal tracts•Extrapyramidal tracts(this classification of the motor pathway is on the basis of the situation of their fibers in the medulla oblongata )•The neurons giving origin to the fibers of the pyramidal tract and their axons are together called the upper motor neurons.•The anterior motor neurons in the spinal cord and their axons are called the lower motor neurons.


Pyramidal tracts:These are concerned with the voluntary motor activity of the body. They are also know as CORTICOSPINAL TRACTS. There are two corticospinal tracts the anterior corticospinal tract and the lateral corticospinal tracts.(While running from the cerebral cortex towards spinal cord the fibres of these two tracts give the appearance of the pyramid hence called as pyramidal tracts.) Functions:Control voluntary movementsForm upper motor neurons04/15/23 Dr.Shuchita chattree verma email:

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Extrapyramidal tracts:The descending tracts of the spinal cord other then the coticospinal tract are know as extrapyramidal tractsThey are:•Medial longitudinal fasciculus•Anterior vestibulospinal tract•Lateral vestibulospinal tract•Reticulospinal tract•Tectospinal tract•Rubrospinal tract•Olivospinal tract04/15/23 Dr.Shuchita chattree verma email:

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Medial longitudinal fasciculus:•Coordination of reflex ocular movements•Integration of movements of eyes and neck

Anterior/ lateral vestibulospinal tract:•Maintenance of muscle tone and posture•Maintenance of position of head and body during acceleration.

Reticulospinal tract:•Coordination of voluntary and reflex movements•Control of muscle tone•Control of respiration and blood vessels


Tectospinal tract:•Control movements of head in response to visual and auditory impulses

Rubrospinal tract:•Facilitory influence on flexor muscle tone

Olivospinal tract:•Control movements due to proprioception


Upper motor neuronsUpper motor neurons are the neurons in the higher centres of the brain, which control the lower motor neurons.There are three type of the upper motor neurons.•Motor neuron in the cerebral cortex. The fibers of these neurons form the corticospinal and the corticobulbar tracts. The cortical areas concerned with the origin of motor signals are the primary motor area, pre motor area, and supplementary motor areas in frontal lobes and sensory area in parietal lobe.The motor neurons in the cerebral cortex , which give origin to pyramidal tracts belong to the pyramidal. system and the remaining motor neurons belong to extrapyramidal system.


•Neurons in the cerebellum. Cerebellum plays an important role in planning programming and integration of skilled voluntary movements. It is concerned with muscle tone, posture and equilibrium.•Neurons in the basal ganglia and nuclei in the brain stem. It plays important role in the coordination of the skilled movements, regulation of automatic associated movements and regulation of muscle tone by sending output signals to motor cortex.


Lower motor neurons• Lower motor neurons are the anterior gray horn cells in the spinal cord and the motor neurons of the cranial nerve nuclei situated in the brain stem., which innervates the muscles directly.• The lower motor neuron are under the influence of the upper motor neurons.• The activities of the particular muscles depend upon the excitation of the alpha motor neurons in the spinal cord or cranial nerve nuclei. (lower motor neuron)• This is the only path way through which the signals of the other parts of nervous system reach the muscles, therefore also called as final common pathway.


Aetiology:About 5 % of cases are familial, showing autosomal dominant inheritance. In many such families genetic defects lies on chromosome 21, the enzyme involved being a superoxide dismutase (SOD1).

For the remaining 95 %, probable causes includes:1. Chronic Aluminium toxicity2. Slow virus infection3. Auto immunity4. Trauma5. Electrical shock

Another suggestive hypothesis is that glutamate which is a primary excitatory neurotransmitter in the CNS, accumulates at synapses and causes the neurons to die, probably through a calcium dependent mechanism. Prevalence of this disease is about 5/100000.


Pathology:The motor neurons in the cerebral cortex, brainstem and spinal cord show atrophy and their axons show degenerative changes. Muscles show groups of atrophic fibres amidst the groups of normal fibres.


Classification:• A. Classical type:

1. Predominant LMN involvement

a) Bulbar form: Progressive bulbar palsy.

b) Spinal form: Progressive muscular

atrophy.

2. Predominant UMN involvement

a) Bulbar form: Pseudo bulbar palsy

(spastic bulbar palsy)

b) Spinal form: Primary lateral sclerosis.

3. Combination of upper and lower motor

involvement.

a) Amyotrophic lateral sclerosis.

• B. Non classical type:

1. Werding – Hoffmann disease

2. Kugelberg – Welander disease

3. Spinal muscular atrophy

described from south India

(Madras )

4. Motor neuron disease –

dementia – parkinsonian complex

described from Guam Island


Types of Motor Neurone Disease:Progressive Bulbar Palsy (PBP)20% of cases (onset)•involves UMNs and LMNs• dysarthria• dysphagia • emotional lability• progressive weakness in upper limbs/neck/ shoulder girdle

Amyotrophic Lateral Sclerosis (ALS)65 - 66% of cases (onset)• involves UMNs and LMNs• muscle weakness – often develops in hands and feet first, spasticity,• hyperactive reflexes


Types of Motor Neurone Disease:Progressive Muscular Atrophy (PMA)7.5% - 10% of cases

• predominantly LMNs • affected (may start in • small muscles of hand)• muscle wasting, • weakness• fasciculation(may in time develop UMN involvement and may eventually develop some speech problems)

Primary Lateral Sclerosis (PLS)2% of cases

• rare• UMNs only• muscle weakness• stiffness• balance• dysarthria• does not shorten• survival


Common presenting features are:

• Age of onset.

Usually after age 50 years.

Very uncommon before 30 years.

• Males are common than females.


Effects of 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


The effects of the upper motor neuron lesion depend upon the type of neuron involved. The following are the effects of upper motor neuron lesion:1.The lesion in the pyramidal system causes increase in the muscle tone – hypertonia and spastic paralysis. Spsatic (tone of the muscle is increased) paralysis involves only one group of muscles particularly the exstensors. (spasticity is due to the failure of inhibitory impulses from cerebral cortex to reach the spinal cord.)2.Lesion in basal ganglia produces hypertonia and rigidity involving both flexor and extensors muscles.3.Lesion in cerebellum causes decrease in muscle tone – hypotonia , muscular weakness, and in coordination of movements.


Rubrics in repertotries:

I)Repertory of William Boerick:1) Nervous system, Bulbar paralysis: 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.


II. Kent’s repertory:

1)Throat, swallowing, impossible, paralysis from:3+- Stram.2+- Alum, Alumn, Apis, Cocc, Gelse, Nat. mur, Nux Vom,Tab2)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, Lyc2+- Bar. carb, Carb.ac, Cur,Nat.mur,Phyt,Plumb.


• III. Rau’s special pathology:

1) Paralysis of bulbar muscles: Caust, Hyos,Nux.vom,Cocc,Gels, Op,Plumb,Ruta2) Paralysis of face: Bell,Caust,Cocc, Graph, Nux vom3) 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


Therapeutics:

Causticum: Paralysis of single parts- vocal organs, tongue, eyelids, face, bladder, extremities, generally of rt. sided. Paralysis from exposure to cold wind or draft. Paralysis after typhoid, typhus or diphtheria; appearing. Drooping of eye lids, cannot keep them open. It is used in paralysis which is remote from apoplexy, the paralysis remaining after patient has recovered from apoplexy with inability to select proper words. Laryngeal muscles refuse their services, cannot speak a loud word. Aphonia. Sudden aphonia after taking cold. Paralysis of face or tongue or hemiplegia with giddiness, weakness of sight, weeping mood, hopelessness and fear of death.04/15/23 Dr.Shuchita chattree verma email:


Guaco:-Acts on nervous system. Bulbar paralysis. Deafness. Tongue heavy and difficult to move. Spinal irritation. Spinal symptoms are most marked. Beer drinkers threatened with apoplexy. Larynx and trachea are constricted. Difficult deglutition. Paralysis of lower extremities.

Plumbum metalicum: Paralysis with atrophy. Muscular atrophy from sclerosis of spinal system. Excessive and rapid emaciation. General or partial paralysis with great weakness and anaemia. Clonic ortonic spasm from cerebral sclerosis or tumor. Paralysis of plumbum is prominently of spinal origin. Paralysis of upper extremities is more marked. Ptosis. Heavy tongue. Difficulty in articulation. Tremor of nasolabial muscles. Twitching of the side of the face. Paralysis of gullet and inability to swallow. Paralysis of lower extremities with paralysis of single muscle. Paralysis from over exertion.


•Plumbum iodatum: Has been used empirically in various forms of paralysis. Sclerotic degeneration, especially of spinal cord. Atrophies.•Phosphorus: Paralysis from fatty degeneration of nerve cells. Progressive spinal paralysis. Ascending sensory and motor paralysis from ends of fingers and toes. Arms and hands become numb. Fingers feel like thumb.Can lie on right side. Post diphtheritic paralysis. Tottery gait Periodical contractions of fingers as from cramps.


•Gelsemium: Complete motor paralysis, rather functional than organic in nature. Paralysis of occular muscles. Ptosis. Paretic condition of the tongue causes difficulty to speak. Speak is thick. Paralysis from emotions. Post diphtheritic paralysis. Paralysis of larynx causes aphonia. Locomotor ataxia. Paraplegia.•Nux vomica: Incomplete paralysis of the face, arms, and legs with vertigo, weak memory, darkness before the eyes, ringing in ears, loss of appetite, burning in stomach, flatulence and vomiting after eating and drinking.Constipation especially in drunkards. Jaw contracted. Infra orbital neuralgia. Left angle of the mouth drops. Twitching and spasmodic distortion of face. Articulation and speech difficult. Paralysis of arms. Automatic motion of hand towards mouth.


•Opium: Paralysis and insensibility after apoplexy, in drunkards, in old people, associated with retention of stool and urine. Spasmodic facial twitching, especially of corners of mouth. Hanging down of lower jaw. Distorted face. Twitching of facial muscles. Face covered with profuse sweat. Paralysed tongue which dry and black. Difficult articulation and swallowing. Tongue protrudes to right side. Inability to swallow. On swallowing food goes the wrong way or returns through nose. Painless paralysis. Twitching of limbs. Numbness. Jerks as if flexors are overacting. Sensation as if lower limbs were severed and belongs to someone else. Shifting and trembling gait. One or other arm moves convulsively to and fro. Coldness of extremities.• Belladona: Apoplexy , congestion of the head, paralysis of one

and spasm of other side of the body, paralysis of the face and locomotor ataxia.• Lachesis: Especially left side. Awkward. Stumbling gait. Paralysis

after apoplexy. Trifacial neuralgia. Spasm of glottis.04/15/23 Dr.Shuchita chattree verma email:


• Stramonium: Paralysis after convulsion,. Paralysis of one or spasm of other side. Stammering speech. Cannot swallow on account of spasm.

• Graphitis: Rheumatic, peripheric paralysis of face. Distortion of muscles of face and difficult speech. Sensation of cobweb over the face.

• 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 while eating.


• Conium: Paralysis from periphery upwards, of old women. Speech difficult from paralysis of tongue. Distortion of tongue and mouth. Food goes down the wrong way and stops while swallowing. Paralysis of lower limbs than of upper limbs. Staggering < turning the head or looking sideways.

• Arsenicum album: Paralysis associated with great prostration and neuralgic pains. Spinal affection with gressus gallinaceus. Twitching of muscles of face. Paralysis and contraction of limbs.

•Manganum oxydatum: Low monotonous voice. Economical speech. Mask like facies. Muscular twitching. Cramps in calves Stiff leg muscles. Occasional uncontrollable laughter. Peculiar slapping gait. Workers of manganum binoxide are frequently affected with bulbar paralysis. Pseudo sclerosis. Progressive lenticular degeneration. Similar symptoms to paralysis agitance.


• Ruta graveolance: Facial paralysis after 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 tongue is implicated.

• 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 be swallowed. Paralytic condition of lower limbs.

• Curare: It is a great remedy for paralysis of various kinds and of various parts of our body. General paralysis of motor system. Ptosis. Facial and buccal paralysis. Paralytic failure of power to swallow. Paralysis of deltoid muscles.


•Cocculus: Paralysis of facial nerve especially of one side. Or tongue pharynx. Paraplegia and rheumatic lamness in weakened or nervous subjects, who are inclined fainting fits and palpitation of the heart. Paralytic affection originates in the small of the back after taking cold, with cold feeling of extremities and edema of the feet. Paralysis after apoplexy. Paralysis of lower limbs. Paralytic immobility. One sided paralysis of the face with cramp like pain in masseter < opening the mouth. Prosopalgia. Tremor of lower jaw and chattering of teeth when attempting to speak. Lines of face are deepened as if drawn. Paralysis of the tongue with difficult speech. Pains at the base of the tongue when protruded. Paralysis of muscles of deglutition with difficulty to swallow.04/15/23 Dr.Shuchita chattree verma email:


Motor neuron lesions and Homoeopathy medical science

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Transcript of Motor neuron lesions and Homoeopathy medical science