Degenerative syndromes

Metabolic disorders of muscle include those of glycogen storage, substrate transport and utilization, and electron transport chain and ATP metabolism. Some produce dynamic syndromes with symptoms occurring primarily during exertion, some cause degenerative syndromes, and some produce both. A few are discussed below. 

Sick sinus syndrome leading to sinus bradycardia may be caused by degenerative changes in the sinus node that occur with advancing age. However, there are other possible etiologies of sinus bradycardia, including drugs (Table 6-2).13... 

The cause of Alzheimer s disease is unknown, but genetic factors clearly play a role. One clue supporting this view is provided by the observation that individuals with Down syndrome, a common cause of mental retardation, frequently develop a dementia similar to Alzheimer s disease during early adulthood. Vascular dementia, which is also called multi-infarct dementia, results from the accumulation of tiny strokes. Individually, these strokes or infarcts are too small to cause any noticeable problem, but as they accumulate, they produce deficits similar to Alzheimer s disease. Other neurological diseases such as Parkinson s disease, Pick s disease, and Huntington s disease cause slow deterioration of the brain that ultimately leads to a degenerative dementia. 

The increasingly well-defined pathophysiology of the degenerative dementias adds a new domain to our understanding of the neural substrates of consciousness. The syndrome of dementia with Lewy bodies is distinguished by severe disturbances in consciousness. Patients with DLB suffer not only fluctuations... 

It is indicated in spasticity due to neurological disorders e.g., multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord, cerebrovascular accidents and cerebral palsy painful muscle spasm associated with static and functional disorders of the spine (cervical and lumbar syndromes) painful muscle spasm following surgery e.g., for herniated intervertebral disc or for osteoarthritis of the hip. 

Patients often undergo a protracted course [e.g., acquired immunodeficiency syndrome (AIDS), newly diagnosed cancer, primary degenerative dementia], whose ultimate outcome may be years away. This allows for numerous opportunities to intervene with a variety of therapeutic modalities including various psychotropics, depending on the particular phase or presenting symptoms. The eventual goal of all these therapeutic interventions is to provide the best circumstances possible to enhance the quality of life and ultimately for a peaceful death. 

Acquired immunodeficiency syndrome (AIDS), a degenerative disease of the immune and central nervous systems, is responsible for a rapidly growing fatality rate in the world population. Although no cure has been found, research worldwide is aimed at developing strategies for chemotherapy. The causative agent is the human immunodeficiency virus... 

Muscular dystrophy itself, however, is strictly defined as a genetically determined degenerative primary myopathy (W4). The condition is progressive, painless, almost always widespread, and frequently disastrous to the sufferer. The three main clinical forms are now described, together with the myotonic syndrome, but omitting those rare varieties mentioned elsewhere (W4). 

Orthopedists are trained in treating several degenerative diseases such as arthritis, osteoporosis, carpal tunnel syndrome, and so on. The treatment options may vary from making diet changes, medications, steroid injections, and incorporating exercise in the daily routine to surgical procedures and hormone replacement therapy. 

PejTonie s disease is a fibrotic condition of the penis that has been associated with beta-blockers, such as propranolol (283), metoprolol (284), and labetalol (284). However, 100 consecutive cases of Peyronie s disease included only five men who had taken a beta-blocker before the onset of the condition (285) the authors concluded that the syndrome was likely to be associated with chronic degenerative arterial disease and not with beta-adrenoceptor antagonists. 

Serious skin reactions (Stevens-Johnson syndrome and Lyell s syndrome) caused temporary withdrawal of isoxi-cam in several countries, even though an analysis of 1800 patients with rheumatoid arthritis or degenerative joint disease failed to confirm an increased risk (2). 

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