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

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

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

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

Pathogenesis of MS

Fig. 57-1

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

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

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

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

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

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

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

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

Multiple Sclerosis
Clinical Manifestations
Cerebellar manifestations
Nystagmus
Involuntary eye movements

Ataxia
Dysarthria
Lack of coordination in articulating
speech

Dysphagia
Difficulty swallowing

Multiple Sclerosis
Clinical Manifestations

Emotional manifestations
Anger
Depression
Euphoria

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

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

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

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

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

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

Multiple Sclerosis
Collaborative Care
Antispasmotics (muscle relaxants)

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

Multiple Sclerosis
Collaborative Care
Nutritional therapy includes
megavitamins and diets consisting of lowfat, gluten-free food, and raw vegetables
High-protein diet with supplementary
vitamins is often prescribed

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

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

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

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

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

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

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