1. Multiple Sclerosis

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

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

4. Multiple Sclerosis Etiology
Unknown cause
Related to infectious, immunologic, and genetic factors

5. Multiple Sclerosis Etiology
Possible precipitating factors include
Infection
Physical injury
Emotional stress
Excessive fatigue
Pregnancy
Poor state of health

6. Multiple Sclerosis Pathophysiology
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

7. Multiple Sclerosis Pathophysiology
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

8. Pathogenesis of MS
Fig. 57-1

9. Multiple Sclerosis Pathophysiology
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

10. Multiple Sclerosis Pathophysiology
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

11. Multiple Sclerosis Etiology 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

12. Multiple Sclerosis Clinical Manifestations
Vague symptoms occur intermittently over months and years
MS may not be diagnosed until long after the onset of the first symptom

13. Multiple Sclerosis Clinical Manifestations
Characterized by
Chronic, progressive deterioration in some
Remissions and exacerbations in others

14. Multiple Sclerosis Clinical Manifestations
Common signs and symptoms include motor, sensory, cerebellar, and emotional problems

15. Multiple Sclerosis Clinical Manifestations
Motor manifestations
Weakness or paralysis of limbs, trunk, and head
Diplopia (double vision)
Scanning speech
Spasticity of muscles

16. Multiple Sclerosis Clinical Manifestations
Sensory manifestations
Numbness and tingling
Blurred vision
Vertigo and tinnitus
Decreased hearing
Chronic neuropathic pain

17. Multiple Sclerosis Clinical Manifestations
Cerebellar manifestations
Nystagmus
Involuntary eye movements
Ataxia
Dysarthria
Lack of coordination in articulating speech
Dysphagia
Difficulty swallowing

18. Multiple Sclerosis Clinical Manifestations
Emotional manifestations
Anger
Depression
Euphoria

19. Multiple Sclerosis Other 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

20. Multiple Sclerosis Other Clinical Manifestations
Sexual dysfunction
Erectile dysfunction
Decreased libido
Difficulty with orgasmic response
Painful intercourse
Decreased lubrication

21. Multiple Sclerosis Diagnostic 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

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

23. Multiple Sclerosis Collaborative 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

24. Multiple Sclerosis Collaborative Care
Immunosuppressive Therapy
Because MS is considered an autoimmune disease
Potential benefits counterbalanced against potentially serious side effects

25. Multiple Sclerosis Collaborative Care
Antispasmotics (muscle relaxants)

26. Multiple Sclerosis Collaborative Care
Physical therapy helps
Relieve spasticity
Increase coordination
Train the patient to substitute unaffected muscles for impaired ones

27. Multiple Sclerosis Collaborative 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

28. Multiple Sclerosis Nursing Assessment
Health History
Risk factors
Precipitation factors
Clinical manifestations

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

30. Multiple Sclerosis Nursing 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

31. Multiple Sclerosis Nursing 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

32. Multiple Sclerosis Nursing 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

33. Multiple Sclerosis Nursing Implementation
Teach self-catheterization if necessary
Teach adequate intake of fiber to aid in regular bowel habits