Multiple Sclerosis

Multiple Sclerosis

Multiple Sclerosis • Chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve fibers of the brain and spinal cord

Multiple Sclerosis • Usually affects young to middle- aged adults, with onset between 15 and 50 years of age • Women affected more than men

Multiple SclerosisEtiology • Unknown cause • Related to infectious, immunologic, and genetic factors

Multiple SclerosisEtiology • Possible precipitating factors include • Infection • Physical injury • Emotional stress • Excessive fatigue • Pregnancy • Poor state of health

Multiple SclerosisPathophysiology • Mylelin sheath • Segmented lamination that wraps axons of many nerve cells • Increases velocity of nerve impulse conduction in the axons • Composed of myelin, a substance with high lipid content

Multiple SclerosisPathophysiology • Characterized by chronic inflammation, demyelination, and gliosis (scarring) in the CNS • Initially triggered by a virus in genetically susceptible individuals • Subsequent antigen-antibody reaction leads to demyelination of axons

Pathogenesis of MS Fig. 57-1

Multiple SclerosisPathophysiology • Disease process consists of loss of myelin, disappearance of oligodendrocytes, and proliferation of astrocytes • Changes result in plaque formation with plaques scattered throughout the CNS

Multiple SclerosisPathophysiology • Initially the myelin sheaths of the neurons in the brain and spinal cord are attacked, but the nerve fiber is not affected • Patient may complain of noticeable impairment of function • Myelin can regenerate, and symptoms disappear, resulting in a remission

Multiple SclerosisEtiology and Pathophysiology • Myelin can be replaced by glial scar tissue • Without myelin, nerve impulses slow down • With destruction of axons, impulses are totally blocked • Results in permanent loss of nerve function

Multiple SclerosisClinical Manifestations • Vague symptoms occur intermittently over months and years • MS may not be diagnosed until long after the onset of the first symptom

Multiple SclerosisClinical Manifestations • Characterized by • Chronic, progressive deterioration in some • Remissions and exacerbations in others

Multiple SclerosisClinical Manifestations • Common signs and symptoms include motor, sensory, cerebellar, and emotional problems

Multiple SclerosisClinical Manifestations • Motor manifestations • Weakness or paralysis of limbs, trunk, and head • Diplopia (double vision) • Scanning speech • Spasticity of muscles

Multiple SclerosisClinical Manifestations • Sensory manifestations • Numbness and tingling • Blurred vision • Vertigo and tinnitus • Decreased hearing • Chronic neuropathic pain

Multiple SclerosisClinical Manifestations • Cerebellar manifestations • Nystagmus • Involuntary eye movements • Ataxia • Dysarthria • Lack of coordination in articulating speech • Dysphagia • Difficulty swallowing

Multiple SclerosisClinical Manifestations • Emotional manifestations • Anger • Depression • Euphoria

Multiple SclerosisOther Clinical Manifestations • Bowel and bladder functions • Constipation • Spastic bladder: small capacity for urine results in incontinenceFlaccid bladder: large capacity for urine and no sensation to urinate

Multiple SclerosisOther Clinical Manifestations • Sexual dysfunction • Erectile dysfunction • Decreased libido • Difficulty with orgasmic response • Painful intercourse • Decreased lubrication

Multiple SclerosisDiagnostic Studies • Based primarily on history, clinical manifestations, and presence of multiple lesions over time measured by MRI • Certain laboratory tests are used as adjuncts to clinical exam

Multiple SclerosisDiagnostic Studies • Diagnosis based primarily on: • history and clinical manifestations • ruling out other causes of symptoms • No definitive diagnostic test • MRI – demonstrates presence of plaques

Multiple SclerosisCollaborative Care Drug Therapy • Corticosteroids • Treat acute exacerbations by reducing edema and inflammation at the site of demyelination • Do not affect the ultimate outcome or degree of residual neurologic impairment from exacerbation

Multiple SclerosisCollaborative Care • Immunosuppressive Therapy • Because MS is considered an autoimmune disease • Potential benefits counterbalanced against potentially serious side effects

Multiple SclerosisCollaborative Care • Antispasmotics (muscle relaxants)

Multiple SclerosisCollaborative Care • Physical therapy helps • Relieve spasticity • Increase coordination • Train the patient to substitute unaffected muscles for impaired ones

Multiple SclerosisCollaborative Care • Nutritional therapy includes megavitamins and diets consisting of low- fat, gluten-free food, and raw vegetables • High-protein diet with supplementary vitamins is often prescribed

Multiple SclerosisNursing Assessment • Health History • Risk factors • Precipitation factors • Clinical manifestations

Multiple SclerosisNursing Diagnoses • Impaired physical mobility • Dressing/grooming self-care deficit • Risk for impaired skin integrity • Impaired urinary elimination pattern • Sexual dysfunction • Interrupted family processes

Multiple SclerosisNursing Planning • Maximize neuromuscular function • Maintain independence in activities of daily living for as long as possible • Optimize psychosocial well-being • Adjust to the illness • Reduce factors that precipitate exacerbations

Multiple SclerosisNursing Implementation • Help identify triggers and develop ways to avoid them or minimize their effects • Reassure patient during diagnostic phase • Assist in dealing with anxiety caused by diagnosis • Prevent major complications of immobility

Multiple SclerosisNursing Implementation • Focus teaching on building general resistance to illness • Avoiding fatigue, extremes of hot and cold, exposure to infection • Teach good balance of exercise and rest, nutrition, avoidance of hazards of immobility

Multiple SclerosisNursing Implementation • Teach self-catheterization if necessary • Teach adequate intake of fiber to aid in regular bowel habits

Multiple Sclerosis