Multiple sclerosis

Multiple sclerosis (MS) is a demyelinating disease of central nervous system which includes brain and spinal cord.
it affect the myelin and by damaging the the myelin producing cell -Oligodendrocytes, which leads to sensory, motor and cognitive problems.

1. Multiple sclerosis Mr.Sachin Dwivedi M.SC. Medical surgical Nursing K.G.M.U Institute of Nursing , Lucknow

2. Autoimmune Processes

3. INDRODUCTION Multiple sclerosis (MS) is a demyelinating disease of central nervous system which includes brain and spinal cord. This myelin is produced by oligodendrocytes which are a group of cells that support neurons. In multiple sclerosis , demyelination happens when the immune system inappropriately attacks and destroy the myelin , which make communication between neuron break down, ultimately leading sensory , motor and cognitive problem.

4. FACTS MS was first described in 1868 by Jean-Martin Charcot. The name multiple sclerosis refers to the numerous scars ( sclerae —better known as plaques or lesions) that develop on the white matter of the brain and spinal cord.

5. DEFINITION Multiple sclerosis (MS) OR Disseminated sclerosis. Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms,

6. INCIDENCE 2.5 million people are affected with MS worldwide. R eported mostly in women (approximately 3 times more often than in men)

7. ETILOGICAL factors Idiopathic. Genetic factor: Female Genes encode for HLA-DR2(Identify and bind foreign molecule) Environmental factor Infections such as measles, mumps and rubella, Epstein–Barr virus . Vitamin D deficiency

8. PATHOGENESIS OF MS

9. Blood Brain B arrier allow some specific molecules to get entry such as T-cells or B-Cells

10. T-cells cross the BBB and attached to specific type of protein present in myelin

11. T-cell Activated by myelin and changes to endothelial cells to express more receptors

12. It allow immune cells to easily bind to receptors

13. These myelin specific T-cells produce cytokines (IL-1,IL-2,INF-GAMMA) Which dilate blood vessels

14. Cytokines attract Macrophages & B-Cells as a part of inflammatory reaction

15. B-Cells Produce antibodies, which mark to myelin proteins

16. Macrophages targets the Antibodies markers and engulf the Oligodendrocytes

17. In process of remyelination these Regulatory T-cells suppress the immune cells

18. Types OF MS

19. Relapsing Remitting(RRMS ) Bouts of autoimmune attacks happening months or even years and causing an increasing in the level of disability . 80-85 % . Time(Life span) Severity Relapsing Remission

20. Secondary progressive (SPMS ) similar to RRMS but after some time immune attacks become constant which cause a steady progression of disability . 60-65%. Time(Life span) Severity Relapsing Remission

21. Primary Progressive (PPMS ) Constant attack on myelin which cause a steady progression of disability over a person’s lifetime . 10%. Time(Life span) Severity

22. Progressive Relapsing (PRMS ) Constant attack but bouts superimposed during which the disability increase even faster . 1-2%. Time(Life span) Severity Relapsing Remission Progression

23. CLINICAL MANIFESTATION Charcot’s neurologic triad of multiple sclerosis

24. Others cm Dysphagia Loss of vision (optic neuritis) Blurring of the vision

25. Cont … Muscles weakness & spasm Ataxia (Loss of balance or coordination ) Paresthesias ( Tingling,iching ) LHERMITTE’S SIGN (Electric shocks runs down back & radiate to limbs when bending neck forword )

26. DIAGNOSTIC MEASURES

27. Non-pharmacological management Physical therapy.  Cognitive Rehabilitation therapy

28. pharmacological management Corticosteroid, Cyclophosphamid (Cell cycle inhibitor) Intravenous immunoglobulin Plasmapheresis (Remove disease causing antibodies) Chronic MS Immunosuppressants like Recombinant beta-IFN Vitamine D

29. SURGICAL MANAGEMENT Deep brain stimulation a surgeon places an electrode in thalamus . The electrodes are connected to a pacemaker-like device by wires. “brain pacemaker,” deep brain stimulation works by blocking errant signals from damaged brain cells to “reset” the brain’s natural rhythm. This can help decrease or stop tremors entirely.

30. CONT…. Intrathecal baclofen pump therapy a Surgeon will implant a pump near the spinal cord. This pump is programmed to deliver the medication on a regular basis. For most people, the surgery is easily managed. Some people may experience soreness around the incision site. The pump will need to be refilled every few months.

31. NURSING management Impaired physical mobility Fatigue related to decrease energy production Self-Care Deficit Potential for Ineffective Family Coping Sleep Disturbance .

32. SUMMARY MULTIPLE SCLEROSIS is a Chronic & progressive Autoimmune disorder and the most common pattern is the relapsing-remitting type and slightly worsening their over all condition. T-cells cause inflammation and damage to oligodendrocytes in the CNS which leaves behind scarred areas of demyelinated neurons called plaques which cause variety of symptoms depending on the location.

33. MS Awareness Week 22-28 April

34. THANK YOU