1. Multiple Sclerosis

2. 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

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

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

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

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

8. 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…?

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

10. 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)

11. "Turbo FLAIR" MRI

12. 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

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

14. 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)

15. “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

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

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

18. 85% 10-20% Increasing severity … maybe minor plateaus or remissions
Returns to baseline + recovery
85%
10-20%

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

20. 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

21. 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)

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

23. 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