Motor neuron lesions and Homoeopathy medical science

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

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
2

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
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07/11/15
4

07/11/15
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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
6

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
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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
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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
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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
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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
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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
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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
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• 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
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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
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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
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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
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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
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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
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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
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Common presenting features are:
• Ageof onset.
Usually after age50 years.
Very uncommon before30 years.
• Malesarecommon than females.
07/11/15
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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
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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
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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
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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
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• 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
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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
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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
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•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
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• 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
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•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
31

• 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
32

• 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
33

• 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
34

• 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
35

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