Multiple Sclerosis

Multiple SclerosisMultiple Sclerosis


• Chronic, progressive, degenerativeChronic, progressive, degenerative

disorder of the CNS characterized bydisorder of the CNS characterized by

disseminated demyelination of nerve disseminated demyelination of nerve

fibers of the brain and spinal cordfibers of the brain and spinal cord


• Usually affects young to middle- aged Usually affects young to middle- aged adults, with onset between 15 and 50 adults, with onset between 15 and 50 years of ageyears of age

• Women affected more than menWomen affected more than men

Multiple SclerosisMultiple Sclerosis EtiologyEtiology


• Unknown causeUnknown cause• Related to infectious, immunologic, and Related to infectious, immunologic, and

genetic factorsgenetic factors


• Possible precipitating factors include Possible precipitating factors include InfectionInfection Physical injuryPhysical injury Emotional stressEmotional stress Excessive fatigueExcessive fatigue PregnancyPregnancy Poor state of healthPoor state of health

Multiple SclerosisMultiple SclerosisPathophysiologyPathophysiology• Mylelin sheathMylelin sheath

• Segmented lamination that wraps Segmented lamination that wraps axons of many nerve cellsaxons of many nerve cells

• Increases velocity of nerve impulse Increases velocity of nerve impulse conduction in the axonsconduction in the axons

• Composed of myelin, a substance with Composed of myelin, a substance with high lipid contenthigh lipid content

Multiple SclerosisMultiple SclerosisPathophysiologyPathophysiology• Characterized by chronic inflammation, Characterized by chronic inflammation,

demyelination, and gliosis (scarring) in demyelination, and gliosis (scarring) in the CNSthe CNS

• Initially triggered by a virus in Initially triggered by a virus in genetically susceptible individualsgenetically susceptible individuals

• Subsequent antigen-antibody reaction Subsequent antigen-antibody reaction leads to demyelination of axonsleads to demyelination of axons

Pathogenesis of MSPathogenesis of MS

Fig. 57-1

Multiple SclerosisMultiple Sclerosis PathophysiologyPathophysiology

• Disease process consists of loss of myelin, Disease process consists of loss of myelin, disappearance of oligodendrocytes, and disappearance of oligodendrocytes, and proliferation of astrocytesproliferation of astrocytes

• Changes result in plaque formation with Changes result in plaque formation with plaques scattered throughout the CNSplaques scattered throughout the CNS

Multiple SclerosisMultiple Sclerosis PathophysiologyPathophysiology• Initially the myelin sheaths of the Initially the myelin sheaths of the

neurons in the brain and spinal cord are neurons in the brain and spinal cord are attacked, but the nerve fiber is not attacked, but the nerve fiber is not affectedaffected

• Patient may complain of noticeable Patient may complain of noticeable impairment of functionimpairment of function

• Myelin can regenerate, and symptoms Myelin can regenerate, and symptoms disappear, resulting in a remission disappear, resulting in a remission

Multiple SclerosisMultiple Sclerosis Etiology and PathophysiologyEtiology and Pathophysiology

• Myelin can be replaced by glial scar Myelin can be replaced by glial scar tissuetissue

• Without myelin, nerve impulses slow Without myelin, nerve impulses slow down down

• With destruction of axons, impulses are With destruction of axons, impulses are totally blockedtotally blocked

• Results in permanent loss of nerve Results in permanent loss of nerve functionfunction

Multiple SclerosisMultiple SclerosisClinical ManifestationsClinical Manifestations

• Vague symptoms occur intermittently Vague symptoms occur intermittently over months and yearsover months and years

• MS may not be diagnosed until long after MS may not be diagnosed until long after the onset of the first symptomthe onset of the first symptom

Multiple SclerosisMultiple Sclerosis Clinical ManifestationsClinical Manifestations

• Characterized by Characterized by • Chronic, progressive deterioration in Chronic, progressive deterioration in

somesome• Remissions and exacerbations in othersRemissions and exacerbations in others

Multiple SclerosisMultiple Sclerosis Clinical ManifestationsClinical Manifestations• Common signs and symptoms include Common signs and symptoms include

motor, sensory, cerebellar, and emotional motor, sensory, cerebellar, and emotional problemsproblems

Multiple SclerosisMultiple Sclerosis Clinical ManifestationsClinical Manifestations• Motor manifestationsMotor manifestations

• Weakness or paralysis of limbs, trunk, and head

• Diplopia (double vision)• Scanning speech• Spasticity of muscles

Multiple SclerosisMultiple Sclerosis Clinical ManifestationsClinical Manifestations• Sensory manifestationsSensory manifestations

• Numbness and tinglingNumbness and tingling• Blurred visionBlurred vision• Vertigo and tinnitusVertigo and tinnitus• Decreased hearingDecreased hearing• Chronic neuropathic painChronic neuropathic pain


• Cerebellar manifestationsCerebellar manifestations• Nystagmus Nystagmus

• Involuntary eye movements• AtaxiaAtaxia• DysarthriaDysarthria

• Lack of coordination in articulating speech

• DysphagiaDysphagia• Difficulty swallowing


• Emotional manifestationsEmotional manifestations• AngerAnger• DepressionDepression• EuphoriaEuphoria

Multiple SclerosisMultiple Sclerosis Other Clinical ManifestationsOther Clinical Manifestations

• Bowel and bladder functionsBowel and bladder functions• ConstipationConstipation• Spastic bladder: small capacity for Spastic bladder: small capacity for

urine results in incontinenceFlaccid urine results in incontinenceFlaccid bladder: large capacity for urine and bladder: large capacity for urine and no sensation to urinate no sensation to urinate

Multiple SclerosisMultiple Sclerosis Other Clinical ManifestationsOther Clinical Manifestations

• Sexual dysfunction Sexual dysfunction Erectile dysfunction Erectile dysfunction Decreased libidoDecreased libido Difficulty with orgasmic responseDifficulty with orgasmic response Painful intercoursePainful intercourse Decreased lubricationDecreased lubrication

Multiple SclerosisMultiple Sclerosis Diagnostic StudiesDiagnostic Studies

• Based primarily on history, clinical Based primarily on history, clinical manifestations, and presence of multiple manifestations, and presence of multiple lesions over time measured by MRIlesions over time measured by MRI

• Certain laboratory tests are used as Certain laboratory tests are used as adjuncts to clinical exam adjuncts to clinical exam

Multiple SclerosisMultiple SclerosisDiagnostic StudiesDiagnostic Studies• Diagnosis based primarily on:Diagnosis based primarily on:

• history and clinical manifestationshistory and clinical manifestations• ruling out other causes of symptomsruling out other causes of symptoms

• No definitive diagnostic testNo definitive diagnostic test• MRI – demonstrates presence of plaquesMRI – demonstrates presence of plaques

Multiple SclerosisMultiple Sclerosis Collaborative CareCollaborative Care

Drug TherapyDrug Therapy• CorticosteroidsCorticosteroids

• 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 SclerosisMultiple Sclerosis Collaborative CareCollaborative Care

• Immunosuppressive Therapy• Because MS is considered an autoimmune

disease• Potential benefits counterbalanced against

potentially serious side effects

Multiple SclerosisMultiple Sclerosis Collaborative CareCollaborative Care• Antispasmotics (muscle relaxants)

Multiple SclerosisMultiple Sclerosis Collaborative CareCollaborative Care• Physical therapy helpsPhysical therapy helps

Relieve spasticityRelieve spasticity Increase coordinationIncrease coordination Train the patient to substitute Train the patient to substitute

unaffected muscles for impaired onesunaffected muscles for impaired ones

Multiple SclerosisMultiple Sclerosis Collaborative CareCollaborative Care• Nutritional therapy includes Nutritional therapy includes

megavitamins and diets consisting of low- megavitamins and diets consisting of low- fat, gluten-free food, and raw vegetablesfat, gluten-free food, and raw vegetables

• High-protein diet with supplementary High-protein diet with supplementary vitamins is often prescribedvitamins is often prescribed

Multiple SclerosisMultiple Sclerosis Nursing AssessmentNursing Assessment

• Health History Health History Risk factorsRisk factors Precipitation factorsPrecipitation factors Clinical manifestationsClinical manifestations

Multiple SclerosisMultiple Sclerosis Nursing DiagnosesNursing Diagnoses

• Impaired physical mobility Impaired physical mobility • Dressing/grooming self-care deficitDressing/grooming self-care deficit• Risk for impaired skin integrityRisk for impaired skin integrity• Impaired urinary elimination patternImpaired urinary elimination pattern• Sexual dysfunctionSexual dysfunction• Interrupted family processesInterrupted family processes

Multiple SclerosisMultiple Sclerosis Nursing PlanningNursing Planning

• Maximize neuromuscular functionMaximize neuromuscular function• Maintain independence in activities of Maintain independence in activities of

daily living for as long as possibledaily living for as long as possible• Optimize psychosocial well-beingOptimize psychosocial well-being• Adjust to the illnessAdjust to the illness• Reduce factors that precipitate Reduce factors that precipitate

exacerbationsexacerbations

Multiple SclerosisMultiple Sclerosis Nursing ImplementationNursing Implementation• Help identify triggers and develop ways Help identify triggers and develop ways

to avoid them or minimize their effectsto avoid them or minimize their effects• Reassure patient during diagnostic phaseReassure patient during diagnostic phase• Assist in dealing with anxiety caused by Assist in dealing with anxiety caused by

diagnosisdiagnosis• Prevent major complications of Prevent major complications of

immobilityimmobility

Multiple SclerosisMultiple Sclerosis Nursing ImplementationNursing Implementation• Focus teaching on building general Focus teaching on building general

resistance to illnessresistance to illnessAvoiding fatigue, extremes of hot and

cold, exposure to infection• Teach good balance of exercise and rest, Teach good balance of exercise and rest,

nutrition, avoidance of hazards of nutrition, avoidance of hazards of immobilityimmobility

Multiple SclerosisMultiple Sclerosis Nursing ImplementationNursing Implementation

• Teach self-catheterization if necessaryTeach self-catheterization if necessary• Teach adequate intake of fiber to aid in Teach adequate intake of fiber to aid in

regular bowel habitsregular bowel habits

Documents

Multiple Sclerosis