MS & MG

Multiple Sclerosis (MS)

  • Definition: Chronic, progressive, degenerative CNS disorder characterized by demyelination of nerve fibers.

  • Onset: Ages 20-40; more common in women (2-3x).

  • Progression: Remission and exacerbation pattern; highly variable pace; potentially disabling.

Pathophysiology of MS

  • Immune system activation → CNS inflammation → demyelination → slowed nerve impulses → gliosis and plaque formation → irreversible axon damage in late disease.

Clinical Manifestations of MS

  • Symptoms: Fatigue, weakness, numbness, pain, vision problems, speech/swallowing difficulty, bowel/bladder dysfunction.

  • Specific manifestations: Lhermitte’s sign, diplopia, nystagmus, tremors, spasticity.

Types of MS

  • Relapsing-remitting (85%)

  • Primary-progressive (10%)

  • Secondary-progressive

  • Progressive-relapsing (5%)

Diagnostic Studies for MS

  • Medical history & neurological exam: Gait, posture, coordination assessment.

  • MRI: Test of choice for revealing MS lesions.

  • Evoked Potential test: Measures nerve responses to stimuli.

  • Lumbar puncture: Evaluates WBCs or proteins.

Criteria for MS Diagnosis

  • Two or more episodes of exacerbation separated by 1 month.

  • Clear exacerbations and remissions with symptom progression.

Treatment of MS

  • Individualized care plan with three goals: modify disease process, treat exacerbations, manage symptoms.

Nonpharmacologic Interventions for MS

  • Physical/occupational therapy, counseling, self-care education, exercise, environmental control, and nutrition.

Myasthenia Gravis (MG)

  • Definition: Autoimmune disease affecting the neuromuscular junction, leading to skeletal muscle weakness.

  • Symptoms: Muscle weakness worsens with use, often starting in the face, neck, and jaw.

  • Types: Ocular and generalized; vision problems common in 50% of cases.

Clinical Manifestations of MG

  • Symptoms: Ptosis, diplopia, difficulty chewing/swallowing, proximal limb weakness (improves with rest).

Diagnosis of MG

  • Bedside tests: Tensilon test (AChE inhibitor) and Ice pack test (improves ptosis with cooling).

  • Serologic tests: Look for AChR and MuSK antibodies.

  • Electrophysiological studies: RNS study shows decline in response amplitude; single-fiber EMG is sensitive but not widely available.

Collaborative Care for MG

  • Short-term treatment: IVIG and plasmapheresis for symptom reduction.

  • Surgical management: Thymectomy may enhance symptom control.

Nursing Management for MG

  • Monitor respiratory status, medication timing, and provide small, frequent meals. Focus on energy conservation and patient education about flares and medications.