=====Degenerative & auto-immune Conditions====
====Parkinsons====

====Eaton Lambert syndrome====
  *a neuromuscular junction disorder which may present as a paraneoplastic phenomenon or a primary autoimmune disorder
  *antibodies against presynaptic voltage-gated calcium channels
    *~60% associated with underlying tumour, mostly **small cell lung cancer**, and may precede Dx of malignancy by >5years
  *muscle weakness is primary symptom esp of prox leg muscles and is usually of prox to distal, caudal to cranial distribution & symmetrical. Post-exercise facilitation is common (return of reflexes and muscle strength post exercise)
  *Cranial Nerve involvement in >75% with oculobulbar weakness prominent
  *autonomic involvement in >80%
  *similar to Myasthenia Gravis but distinguished by - areflexia, autonomic dysfunction and the phenomenon of post-exercise facilitation
==Management==
  *primarily of underlying malignancy - CT Ix 1st and PET scan if -ve
  *Acetylcholinesterase inhibitors for muscle weakness may help

[[https://www.ncbi.nlm.nih.gov/books/NBK507891/Eaton Lambert review 22]]

====PSP (Progressive Supra-Nuclear Palsy)====
**otherwise known as Steele-Richardson-Olszewski Syndrome condition**\\
  *progressive impairment of balance and walking
  *impaired eye movement, especially in the downward direction
  *abnormal muscle tone (rigidity)
  *speech difficulties (dysarthria)
  *problems related to swallowing and eating (dysphagia)
  *frequently experience personality changes and cognitive impairment.

====Spinocerebellar Ataxia====
[[https://www.ncbi.nlm.nih.gov/books/NBK557816/spinocerebellar ataxia review 2022]]\\ 
[[https://rarediseases.org/rare-diseases/autosomal-dominant-hereditary-ataxia/]]

==References include==
https://rarediseases.org/rare-diseases/progressive-supranuclear-palsy/\\ 
https://www.epda.eu.com/about-parkinsons/types/progressive-supranuclear-palsy-psp/\\