Multiple sclerosis

Multiple sclerosis content for B.Sc Nursing third year

1. MULTIPLE SCLEROSIS Ms. Towar Shilshi

2. INTRODUCTION The autoimmune disorders of nervous system can attack the CNS which include brain and spinal cord . Autoimmune nervous system disorders include Multiple sclerosis , Myasthenia gravis, and Guillain- barre syndrome.

3. DEFINITION It is a progressive degenerative disease that affects the myelin sheath of neurons in CNS. It is characterized by small patches of demyelination in the brain and spinal cord. OR Multiple sclerosis (MS) is a chronic demyelinating disease that affects the myelin sheath of neurons in the central nervous system.

4. INCIDENCE Onset occurs between 20-40 years of age. W ome n a r e mo r e a f f e c t ed than men. Whites are more affected than blacks or Asians . Most prevalent in colder climates of North America & Europe.

5. ETIOLOGY & RISK FACTORS Exact cause is not known yet. Risk factors are: Age ( most of the time between 20-40 yrs). Sex (women have more chance). Family history (genetic susceptibility). Certain infections ( like Epsteinbarr virus).

6. Continued risk factors… Climate (more in cold climate areas). Certain auto-immune diseases (higher risks with thyroid disease Smoking. Stress, fatigue. Physical injury. Pregnancy (may relating to stress to labour, or puerperium).

7. PATHOPHYSIOLOGY Due to etiological factors or risk factor, Production of inflammatory cytokines Inflammation Then activated T-cells & B-cells cause demyelination and destruction of oligodendrocytes Formation of plaque Causes scarring & destruction of sheath Compensatory system starts causing subsidation of edema & inflammation After that some remyelination process occurs which is often incomplete Multiple sclerosis.

8. CLINICAL MANAGEMENT Fatigue and weakness Vision loss. Impaired speech. Urinary dysfunction. Paraesthesia (Tingling sensation) Bowel and bladder dysfunction. Abnormal reflexes. Incoordination cause by cerebral involvement.

9. Lhermitte signs : electric shock sensation that occurs with certain neck movement, especially bending the neck forward. Charcot’s neurological traid : Nystagmus Dysarthria Intention tremors

10. DIAGNOSTIC EVALUATION There is no definitive test for MS. De t ailed h i s t o r y of epi s odes of neurologic. De t ailed h i s t o r y of epi s odes dysfunction Physical examination.

11. Continued… Other tests include:- CSF evaluation (for presence of IgG antibody or oligoclonal bonding) MRI of brain and spinal cord (to determine the presence of MS plaques) CT scan ( to detect areas of demyelination , but with less detail as by MRI).

12. MEDICAL MANAGEMENT No exact cure. Aim is to prevent or postpone the long term disability (often evolves slowly over many years). The treatment falls into 3 categories:- Treatment of acute relapses. Treatment aimed at disease management. Symptomatic treatment.

13. CONTD… Corticosteroid therapy. Methyl-prednisolone , (given I.V. or orally) A z a th i o p rine Alkylating agents, e,g : Cyclophosphamide. ( in s e v e r e cases)

14. 2. Treat exacerbations :- ( Immunomodulators ) (treatment aimed at disease management) Interferon Beta 1a Avonex Interferon-Beta 1b Betaseron For reducing rate and size of multiple sclerosis plaque in CNS also decrease severity.

15. 3. Symptomatic treatment:- For bladder dysfunction: (muscle relaxants) oxybutynin, propantheline. For constipation: (laxatives) psyllium hydrophilic mucilloid, suppositories. For spasticity: baclofen, diazefen, dantrolene. For Tremor : Beta blockers and anticonvulsants -Propranolol & phenobarbital

16. Nutritional therapy:- - megavitamin therapy ( cobalamin/vit. B12 and vit. C ) low fat diet. high roughage diet (to relieve constipation) Other therapies:- (to improve neurological functioning) Physical and speech therapies . Exercise . Water exercise .

17. SURGICAL MANAGEMENT Deep brain stimulation :- I f other options have failed then a device is implanted that stimulates an area of brain. (in case of severe tremor in limbs). Implantation of a drug catheter or pump : A catheter is placed in lower spinal area to deliver a constant flow of drug like baclofen. (in case of severe pain or spasticity).

18. OTHER THERAPY Physical therapy Speech therapy

19. NURSING MANAGEMENT 1. Nursing diagnosis: Impaired urinary elimination pattern related to bladder dysfunction as evidenced by low output and acute pain. Intervention: As s ess t h e ski n f o r i n c o n tina n ce Maintain fluid intake of 2000ml /day. Toilet every 2 hour . Scan bladder for post void residual volume. If PVR is more than 100ml , then catheterize.

20. 2 . Nursing diagnosis: Impaired physical mobility related to weakness, contractures, spasticity and ataxia as evidenced by pain in muscles and verbal experience. Intervention : Assess the degree of muscle spasticity. Stretch muscles & perform ROM exercise. Administer anti-spasmotics as ordered. Consult with doctor for splints.

21. 3 . Nursing diagnosis: Impaired elimination pattern related to immobility & demyelination as evidenced by disturbed bowel movement. Intervention : Assess for normal bowel movement . Administer supposi t o r y as advice by physician. Teach client t o c onsume high fib r e di e t a nd 2000 ml of fluid.

22. 4 . Nursing diagnosis: F a tigue r el a t ed t o inc r eas e d ene r gy need s as evidenced by facial expression of client. Intervention : Keep the environment cool. Provide mental support. Plan for rest periods during the day. F acil i t a t e s l eep b y r e ducin g nig h t t i me interruption, noise, and light.

23. 5. Nursing diagnosis: Situational self esteeem, related to loss of independence and fear of disability as evidenced by irritativeness and facial expressions. Intervention : Assess for depression and any related treatment. Assess for client’s problem solving strategies. Evaluate client’s support system. P r ov i d e e xp e r i ence th a t i n c r ease the cl i e n t ’ autonomy.

24. THANK Y OU