MULTIPLE-SCLEROSIS-PowerPoint Presentation

Powerpoint presentation about Multiple Sclerosis

1. MULTIPLE SCLEROSIS Multiple Sclerosis is an immune mediated, progressive demyelinating disease of the CNS. Demyelination refers to the destruction of the myelin-the fatty and protein material that surrounds certain nerve fibers in the brain and spinal cord. MS may occur at any age but the age of peak of onset is between 20 and 50 years. It affects women three times more than men.

2. MULTIPLE SCLEROSIS MS is considered to have many risks including genetic factors. It has not been found to be genetically transmitted but there have been 200 genetic variations. The cause of MS is unknown. There are several acute and subacute forms of MS. Less forms include includes radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS) RIS consists of MS like lesions that are identifies on MRI in the absence of clinical signs and symptoms.

3. MULTIPLE SCLEROSIS CIS is the presence of acute and subacute clinical findings for at least 24 hours. The 4 main clinical forms: RRMS – Remitting-relapsing Secondary progressive PPMS- Primary progressive Progressive relapsing

4. MULTIPLE SCLEROSIS PATHOPHYSIOLOGY In MS, sensitized T cells remain in the CNS and promote the infiltration of other agents that damage the immune system. The immune system attack leads to inflammation that destroys mostly the white matter of the CNS myelin (which insulates the axon and speeds the conduction of impulses along the axon) and the oligodendroglial cells that produce myelin in the CNS. Demyelination interrupts the flow of nerve impulses and results in a variety of manifestations, depending on the nerves affected.

5. MULTIPLE SCLEROSIS Plaques appear on demyelinated axons, further interrupting the transmission of impulses. Demyelinated axons are scattered irregularly throughout the CNS. The areas most frequently affected are the opric nerves, chiasm and tracts, the cerebrum, the brainstem and the cerebellum and the spinal cord. The axons themselves begin to degenerate, resulting in permanent and irreversible damage.

6. MULTIPLE SCLEROSIS CLINICAL MANIFESTATIONS The course of MS assumes many different patterns. Some patients follows a benign course and symptoms are mild that the patient does not seek treatment. Patient with RIS have no symptoms while CIS includes unilateral opric neuritis, focal symptoms or partial myelopathy. 85% of patients have RRMS, with each relapse recovery is usually complete however residual deficits may occur and accumulate overtime, contributing to functional decline.

7. MULTIPLE SCLEROSIS 15% have PPMS in which disabling symptoms steadily increase, with rare plateaus and temporary minor improvement. PPMS may result in quadriparesis, cognitive dysfynction , visual loss and brainstem syndromes. The least common presentation is progressive relapsing which is characterized by relapses with continuous disabling progression between exacerbations. The signs and symptoms of MS are varied and multiple, reflecting the location of the lesion or combination of lesions.

8. MULTIPLE SCLEROSIS Physical, emotional and cognitive symptoms impact the quality of life. Fatigue, depression, weakness, and pain are common. Visual disturbances due to lesions in the optic nerves or their connections may include blurring of vision, diplopia (double vision), scotoma (patchy blindless) and total blindness. Fatigue affects most people with MS and is often the most disabling symptom. Heat, depression, anemia, medication may contribute to fatigue.

9. MULTIPLE SCLEROSI Pain is another common symptom with additional sensory manifestations such as paresthesias , dysesthesias, and proprioception loss due to lesions on the sensory pathways. Spasticity is characterized by muscle hypertonicity associated with weakness, increased deep tendon reflexes and diminished superficial reflexes. Involvement of the cerebellum or basal ganglia can produce ataxia and tremor. Bladder, bowel and sexual dysfunction are common.

10. MULTIPLE SCLEROSIS Urinary tract infections, constipation, pressure injury, contracture deformities, dependent pedal edema, pneumonia and osteoporosis. Emotional, social, marital, economic and vocational problems. Exacerbations and remissions are characteristic of MS. Relapses may be associated with emotional and physical stress. The life expectancy for patients with MS is 7 to 14 years shorter than patients without MS.

11. MULTIPLE SCLEROSIS ASSESSMENT AND DIAGNOSTIC FINDINGS The diagnosis of MS is based on clinical, imaging and laboratory findings. The presence of plaques in the CNS disseminated in space and over time observed in MRI scans. Electrophoresis of CSF identifies the presence of oligoclonal banding (several bands of immunoglobulin G bonded together, indicating the immune system abnormality. Evoked potential studies can help define the extent of the disease process and monitor changes.

12. MULTIPLE SCLEROSIS Underlying bladder dysfunction is diagnosed by urodynamic studies. Neuropsychological testing may be indicated to assess cognitive impairment. A sexual history helps identify changes in sexual function. MEDICAL MANAGEMENT There is no cure for MS An individual treatment program is indicated to relieve symptoms and provide continuing support, particularly for patients with cognitive changes.

13. MULTIPLE SCLEROSIS The goals of treatment are to delay the progression of the disease, manage chronic symptoms and treat acute exacerbations. Common symptoms requiring intervention include ataxia, bladder dysfunction, depression, fatigue, and spasticity. Management includes pharmacologic and nonpharmacologic strategies PHARMACOLOGIC THERAPY Interferon beta 1a and Interferon beta 1b are administered subcutaneously every other day.

14. MULTIPLE SCLEROSIS Another preparation of Interferon beta 1a is given intramuscularly once a week and pegylated interferon beta 1a can be given subcutaneously every 14 days. Side effects of all Interferon beta medications include flu like symptoms, increased liver function tests, leukopenia, headache depression and skin necrosis. For optimal control of disability, disease modifying medications should be started early in the course of the disease. Gratiramer acetate also reduces the rate of relapse in RRMS and is administered subcutaneously daily.

15. MULTIPLE SCLEROSIS Teriflunomide, fingolimod, and dimethyl fumarate are oral disease modifying therapies that are better tolerated by those with injection reactions. These medications have significantly reduced relapse rates in several types of MS. IV methylprednisolone used to treat acute exacerbations, shortens the duration of relapse but has not been found to have long term benefit. Mitoxantrone is given via IV infusion every 3 months. It can reduce the frequency of clinical relapses in patients with secondary progressive or worsening RRMS.

16. MULTIPLE SCLEROSIS Baclofe , a gamma aminobutyric acid agonist is the medication of choice for treating spasticity. Benzodiazepines (Diazepam) Tizanidine and Dantrolene may also be used to treat spasticity and improve motor function. Fatigue that interferes with activities of daily living may be treated with Amantadine, Pemoline or Dalfampridine. Ataxia is a chronic problem most resistant to treatment. Medications used to treat ataxia include beta adrenergic blockers, the anticonvulsant agent gabapentin and benzodiazines .

17. MULTIPLE SCLEROSIS POTENTIAL COMPLICATIONS Constipation or fecal incontinence Communication issues and potential for aspiration related to cranial nerve involvement Cognitive changes Managing therapies at home related to physical, psychological, and social limits imposed by MS.

18. MULTIPLE SCLEROSIS The majot goals for the patient may include promotion of physical mobility, avoidance of falls, decreasing fatigue, development of coping strategies and absence of complications. NURSING INTERVENTIONS PROMOTING PHYSICAL MOBILITY Relaxation and coordination exercises promote muscle efficiency Progressive resistive exercises are used to strengthen weak muscles, because diminishing muscle strength is often significant in MS. Walking improves the gait.

19. MULTIPLE SCLEROSIS Instruction on the use of assistive devices is needed to ensure their safe and correct use. MINIMIZING SPASTICITY AND CONTRACTURES Warm packs may be beneficial but hot baths should be avoided because of risk of burn injury secondary to sensory loss and increasing symptoms due to elevation of body temperature. Exposure to extreme cold is avoided as this may increase spasticity. Daily exercises for muscle stretching are prescribed to minimize joint contracture.

20. MULTIPLE SCLEROSIS Application of prescribed orthotics may help maintain a functional position and reduce contractures. Swimming and stationary bicycling are useful. ACTIVITY AND REST The patient is advised to take frequent short rest periods in every activity. Exposure to heat increases fatigue and muscle weakness, air conditioning is recommended.

21. MULTIPLE SCLEROSIS NUTRITION MS patients are overweight or have obesity due to the use of corticosteroids. Healthy eating should be given emphasis. Avoidance of alcohol and cigarette smoking must be emphasized. PREVENTING FALLS Patient is encouraged to walk with feet apart to widen the base of support and to increase walking stability. Gait training should require assistive devices.

22. MULTIPLE SCLEROSIS If gait remains inefficient a wheelchair or motorized scooter may be an option. If incoordination is a problem and tremors of the upper extremities occurs weighted wrist weights or neuromodulation devices may be used. The patient is trained in transfer and activities of daily living. MANAGING FATIGUE Fatigue is the most disabling symptom and the most common reason patients cease employment. Decreasing the use of electronic devices prior to sleep can improve sleep quality and lessen fatigue.

23. MULTIPLE SCLEROSIS STRENGTHENIGN COPING MECHANISMS No 2 patients with MS have identical symptoms or courses of illness. Some patients experience disability others have near normal lifespan with minimal disability. Family conflict, disintegration, separation and divorce are common. Young family members assume the responsibility of caring for a parent with MS. To strengthen the patient’s coping skills, the healthcare institution initiates home care and coordinates a network of services including social services, speech therapy, physical therapy and homemaker services.

24. MULTIPLE SCLEROSIS MONITORING AND MANAGING POTENTIAL COMPLICATIONS Complications are caused by damage to the myelin in the CNS. The nurse monitors for the present of cognitive changes, how the patient is able to manage at home or changes in sexuality. The patient is monitored for the risk of suicide as 50% of patients with MS experience major depression.