Multiple Sclerosis

Concept Map: Selected Topics in Neurological Nursing PATHOPHYSIOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation ICP Monitoring “Neuro Checks” Lab Monitoring PHARMACOLOGY --Decrease ICP --Disease / Condition Specific Meds Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_P_I_E Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary

Multiple Sclerosis Progressive Degenerative No Cure Affects nerve fibers in the brain and spinal cord Most common neurological cause of debilitation in young people (ages20 - 40)

Pathology Probably autoimmune disease Antibodies and white blood cells attack the proteins in the neuron’s myelin sheath

Inflammation and injury to the sheath and ultimately to the nerves that it surrounds

What’s in a Name? Multiple areas of scarring… + Hardening (Sclerosis) of nerve fibers...usually in spinal cord, brain stem and optic nerves

Risk Factors… More women than men More common in Caucasians Children of parents with MS have a higher rate of incidence (15 – 50% depending on data source) Geographic location --- Cold climate…?

Northern Europe and the northern United States have the highest prevalence, with more than 30 cases per 100,000 people

Diagnosis Based on the presence of CNS lesions that are disseminated in time and space (neurologic dysfunction in more than 2 sites at least one month apart), with no better explanation for the disease process Because no single test is totally reliable in identifying MS, and a variety of conditions can mimic the disease, diagnosis depends on clinical features supplemented by the findings of certain studies such as: - MRI (visualize plaques) - CSF analysis (increases protein and slight increase WBCs) - Evoked potentials (define extent of disease and monitors)

"Turbo FLAIR" MRI

Disease Progression – Erratic ! Because different nerves are affected at different times, MS symptoms often worsen (exacerbate), improve, and develop in different areas of the body This disease is unpredictable and varies in severity

Hallmark Characteristics… Intermittent damage to myelin…intermittent severity Scarring and sclerosis of nerve fibers usually in the spinal cord, brain stem, and optic nerves…

Common S & S’s Fatigue - Muscle Weakness Muscle Spasticity - Dysarthria Ataxia = Balance + Coordination difficulty (dizziness / vertigo / spasticity of extremities) Lhermitte's sign (Electrical sensation down the spine on neck flexion) Dysphagia - Tinnitis Uhthoff’s Sign (Exertion or Heat causes sudden exacerbation of S&S) Numbness, tingling (Paresthesia) - Pain Bowel, bladder and sexual dysfunction Vision Disturbances (Blurring, blindness, diplopia, patchy blindness)

“Dysarthria” "Slurred" speech Speaking softly or barely able to whisper Slow rate of speech Rapid rate of speech with a "mumbling" quality Limited tongue, lip, and jaw movement Abnormal intonation (rhythm) when speaking Changes in vocal quality ("nasal" speech or sounding "stuffy") Hoarseness Breathiness Drooling or poor control of saliva Chewing and swallowing difficulty

Common S & S’s Emotionally labile Depression (suicide increased 7.5%, usually in first 5 years)

Course of Disease MS can progress steadily… or cause acute attacks (exacerbation) followed by partial or complete reduction in symptoms (remission)

85% 10-20% Increasing severity … maybe minor plateaus or remissions Returns to baseline + recovery 85% 10-20%

Collaborative Tx Goals Control symptoms Prevent complications Provide adaptive devices to increase mobility and self-care

Meds specific for MS disease Avonex IM Weekly (interferon beta – 1a) Betaseron SQ Daily (interferon beta 1b) Copaxone SQ Daily Rebif SQ given 3 x week

Symptom Management Meds Baclofen / Dantrium (for spasms) NSAIDS (for flu-like side effects and pain) Analgesics Corticosteroids (limit severity by modulating immune response which decreases inflammation) Antidepressants (like Prozac) Beta blockers for tremors (like Inderal) Anticonvulsants for parethesia (like Tegretol) Anticholinergics for bladder dysfunction (Pro-Banthine)

Complications Bacterial infections (lung, bladder) Disturbed thought processes Impaired bladder & bowel function Contractures Seizures Impaired mobility / speech / swallowing Sensory & visual impairment

Most patients have a normal lifespan Prognosis In some people, MS is a mild illness, but, for others, it results in permanent disability Most patients have a normal lifespan