Multiple Sclerosis

Multiple Sclerosis

• Chronic, progressive, autoimmune, degenerative disorder of the CNS. Autoimmune process driven by activated T cells (WBC)

• Characterized by disseminated demyelination of nerve fibers of brain and spinal cord

Multiple Sclerosis onset

• Onset usually ages 20 to 50 years

  • Symptoms first appear ages 30 to 35

  • Disease more progressive when diagnosed at age 50 or older 

Multiple Sclerosis cause

• Cause unknown, but more prevalent in temperate climates

  • Researchers suspect that exposure to some environmental agent before puberty may predispose a person to develop MS later in life

Multiple Sclerosis Etiology and Pathophysiology

• Nerve fiber is not affected

• Impulses still occur, but slowed

• Patient may have noticeable impairment of function…Exacerbation

• Myelin can still regenerate…Remission

• As inflammation continues, myelin loses ability to regenerate

  • Nerve impulse transmission is disrupted 

  • Nerve function lost permanently

  • Progressive deterioration in neurologic function

Multiple Sclerosis First symptoms may include

• Blurred or double vision

• Red-green color distortion

• Blindness in one eye

Multiple Sclerosis common manifestations

• Motor problems

• Sensory problems

• Cerebellar problems

• Emotional problems

MS motor manifestations

• Weakness or paralysis of limbs (legs, arms), trunk, and head

• Spasticity (spasms) of muscles

• Scanning speech (noticeable pause and spoken with varying force)

MS Sensory manifestations

• Numbness and tingling

• Pain

• Decreased hearing

• Vertigo and tinnitus

• Chronic neuropathic pain

MS Cerebellar manifestations

• Nystagmus

• Ataxia (lose muscle control in arms and legs. Lack of balance, coordination, and trouble walking)

• Dysarthria (muscle weakness. Hard to talk)

• Dysphagia

• Fatigue 

MS Bowel and bladder functions can be affected

• Constipation

• Variable urinary problems

  • Spastic (uninhibited) bladder

  • Flaccid (hypotonic) bladder

MS Cognitive manifestations

• Difficulty with (Cognitive manifestations problems)

  • Short-term memory attention

  • Attention

  • Information processing

  • Planning

  • Visual perception

  • Word finding

MS Emotional manifestations

• Anger

• Depression

• Euphoria

MS Diagnostic Studies

• MRI of brain and spinal cord may show plaques, inflammation, atrophy, and tissue breakdown and destruction

• Evidence of at least two inflammatory demyelinating lesions in at least  two different locations within CNS (MRI determination)

• Cerebral spinal fluid (CSF) analysis

Collaborative Care…Drug Therapy

There is no cure for MS, only symptomatic relief and to slow the progressions of the disease -Disease Modifying Drugs (DMDs):

Drug Therapy

• Immunomodulators…Ex. Β1a/b-interferon, alemtuzumab. Reduce the risk of relapses and new MS plaques in the central nervous system. 

• Immunosuppressives…Ex. methotrexate. Diminishes autoimmune responses

• Corticosteroids…Ex. prednisone

• Antispasmodics…Ex. baclofen. Muscle relax

• Anticholinergics…Ex. oxybutynin. Urinary frequency, nocturia, urgency, and urge incontinence 

• Antidepressants…Ex. duloxetine, venlafaxine

Collaborative Care

• Help patient identify triggers and develop ways to avoid them or decrease their effects…stress, trauma, childbirth, climate/weather change

• Assist patient in dealing with anxiety and grief caused by diagnosis

• During acute exacerbation, prevent complications of immobility

• Focus teaching on building general resistance to illness

  • Avoid fatigue, extremes of hot and cold, exposure to infection

Collaborative Care: exercise

• Decreases spasticity, increases coordination, retrains unaffected muscles to act for impaired ones

• Nutritious, well-balanced meals

• Rest

Priority Problems and Goals

• Problems

  • Impaired physical mobility 

  • Difficulty coping

  • Urinary retention

  • Lack of knowledge 

• Goals

  • Maximize neuromuscular function

  • Maintain independence in activities of daily living for as long as possible

  • Manage fatigue

  • Optimize psychosocial well-being

  • Adjust to the illness

  • Decrease factors that precipitate exacerbations

Which of the following would be most important for the nurse to teach a young adult with MS?

a. How to prevent sexually transmitted infections

b. That pregnancy will improve symptoms

c. What can be done to cure the disease

d. Why it is important to avoid extremes of heat and cold

When teaching care at home for a client with multiple sclerosis, what would be the highest priority to discuss?

a. Preventing overdose of the medications

b. Avoiding daily baths and showers

c. Preventing falls

d. Increasing the patient’s appetite