NUR 149 2nd SEMESTER
A.Y. 2022-2023 ms
MULTIPLE SCLEROSIS
MULTIPLE SCLEROSIS
- Multiple areas of scar and plaque formation in
the CNS (brain and spinal cord)
- SCLEROSIS or hardening
- RARE: 30 out of 100,000 - common among
WOMEN 20-40 years old; common in
CAUCASIAN
MULTIPLE SCLEROSIS
Types & Courses - RPSP
- First described in 1868 by Jean-Martin Charcot
- An immune-mediated, chronic, progressive, RELAPSING REMITTING MS
degenerative disease with periods of remission - is characterized by clearly acute attacks
and exacerbation characterized by randomly with full recovery or with sequelae &
scattered patches of demyelination in the residual deficit upon recovery.
brainstem, cerebrum, cerebellum and spinal
cord resulting to impaired transmission of nerve PRIMARY PROGRESSIVE MS
impulses - is characterized by disease showing
- Twice as many women are diagnosed with MS progression of disability from onset, without
as men plateaus & temporary minor improvements.
Cause: SECONDARY PROGRESSIVE MS
o remains unknown - begins with an initial RR course, followed
o INFECTIONS (viral) + autoimmunity EBV, by progression of variable rate, which may
Hepatitis and Herpes Zoster also include occasional relapses & minor
remissions
THEORIES: (Predisposing Factors)
o Genetics: indicates the presence of a PROGRESSIVE RELAPSING MS
specific cluster (haplotype- DNA variation) - shows progression from onset but with
o Infections clear acute relapses with or without
o Environmental factors - geographic recovery.
o Severe stress
o Smoking
o Intake of aspartame
MS LEC NEURO, TCGGUILLERMO
1
Clinical Manifestation
During EXACERBATIONS, new symptoms
appear & existing ones worsen
During REMISSIONS, symptoms decrease or
disappear
Signs & symptoms are varied & multiple,
reflecting the location of lesion or combination
of lesions
Primary symptoms
• Fatigue, weakness
• Depression
• Numbness
• Difficulty in coordination, loss of
balance & Pain
Visual disturbances (demyelination of CN 2)
• Blurring of vision
• Diplopia
• Patchy blindness- scotoma
• Total blindness
Heat, Depression
Anemia, Deconditioning (weakness)
Sensory manifestations
• Pain
• Paresthesias
• Dysesthesias
Spasticity of the extremities
BEHAVIORAL- emotional lability, euphoria,
depression
UHTHOFF – often the first sign of M.S. -
Worsening of vision caused by hot temperature
(increased temp: slowed/blocked nerve
TRANSMISSION
LHERMITTE’S SIGN – electric shock like
sensation radiating down the spine to the legs MEDICAL MANAGEMENT
and arms when neck is moved
Cognitive change • No known cure for MS
• Memory loss • Goal of the treatments
• Decreased concentration • Attempt to return function after an attack
Impaired cerebellar function (Charcot’s Triad) • Prevent new attacks
• Scanning speech • Prevent disability
• Intention tremors • Delay the progression of the disease
• Nystagmus
• Ataxia PHARMACOLOGIC THERAPY
• Dysarthria (poor speech articulation)
Bladder, bowel & sexual dysfunctions
• Disease-Modifying therapies
• Immunosuppressants
DIAGNOSTIC FINDINGS
• ❖ CORTICOSTEROIDS
• MRI- scattered patches of scar/plaque - Prednisone (Deltasone, Liquid Pred,
(>5mm) in the CNS Deltasone, Orasone, Prednicen-M);
• CSF Studies- protein electropheresis., Igs methylprednisolone (Medrol, Depo-
are separated from csf, results (+) Medrol)
oligoclonal bonds
• CT Scan ❖ INTERFERONS
• EEG - have the ability to regulate the immune
system & play an important role in
protecting against intruders including
viruses
MS LEC NEURO, TCGGUILLERMO
2
❖ Minimizing Spasticity and Contractures
o Beta interferons: found to be useful o Application of warm packs
in managing MS - Beta 1a: rebig; o Daily exercises
o Beta 1b: betasteron (SQ) o Stretch- hold- relax routine
o Swimming and stationary bicycling
GLATIRAMER ACETATE (COPAXONE) o Giving enough time to do activities
- increase suppresor T cells, Admin sq ❖ Activity and Rest
daily (P3000/shot) o Very strenuous exercise is not advisable
o Take frequent short rest periods
Symptom Management ❖ Preventing Injury
o Gait training – widen base of support
❖ Baclofen (Lioresal); o Teach patient how to walk with feet apart
o (GABA agonist)- for spasticity o Weighted bracelets or wrist cuffs – aids in
coordination
❖ Benzodiazepines (Valium),
o Tizanidine (Zanaflex)
o & Dantrolene (Dantrium)
❖ Fatigue:
o Amantadine (Symmetrel),
o Pemoline (Cylert),
o Fluoxetine (Prozac)
❖ Enhancing Bladder and Bowel Control
❖ Ataxia: o The sensation of the need to void must be
o Beta adrenergic blockers (Inderal); heeded immediately
antiseizure agents (Neurontin) o Voiding time schedule
o & Benzodiazepines (Klonopin) o Adequate fluids, dietary fiber and bowel
training program
BOWEL AND BLADDER PROB: ❖ Enhancing Communication and Managing
Swallowing Difficulties
❖ Anticholinergic (incontinence/frequency) o Speech therapy
o Probanthine; oxybutynin o Availability of suction apparatus, careful
feeding and proper positioning for eating
❖ Cholinergic (retention) ❖ Improving Sensory and Cognitive Function
o Bethanecol; Neostigmine o Vision: use of eye patch or a covered
eyeglass, prism glasses (for diplopia), free
❖ PAIN talking book
o Gabapentin o Cognition and emotional responses:
o Carbamazepine providing emotional support; assisting in
o amytriptyline setting meaningful and realistic goals;
provision of hobbies; and structured daily
Nursing Diagnoses routine
❖ Promoting Sexual Functioning
• Impaired physical mobility related to o Collaboration among the patient, family,
weakness, muscle paresis, spasticity and health care provider
o Sharing and communication of feelings,
• Risk for injury related to sensory & visual
planning for sexual activity and exploring
impairment
alternative methods of sexual expression
• Impaired urinary & bowel elimination
• Disturbed thought process related to
cerebral dysfunction
• Potential for sexual dysfunction related to Complications:
lesions or psychological reactions
• Complications of Immobility
Nursing Interventions • Blindness
❖ Promoting physical mobility Exercises:
o Walking
o Use of assistive device- cane. crutches,
walker
MS LEC NEURO, TCGGUILLERMO
