MULTIPLE SCLEROSIS
VM
Definition
An immune mediated progressive
degenerative disorder of the CNS
characterized by demyelination of the
neurons.
MS is a chronic, autoimmune,
demyelinating disease of the CNS
The immune system attacks myelin
sheath (protective covering of nerve
fibers), leading to impaired nerve
conduction.
MULTIPLE SCLEROSIS
Common between the ages
of 20 and 50
Affects women more
frequently than men
Demyelination is the
destruction of myelin which
results in impaired
transmission of nerve
impulses.
Cause
The causes are unknown, but the disease
is thought to be the result of an
autoimmune response
Risk factors
Genetic predisposition
Viral infections (e.g., Epstein-Barr virus)
Female sex (more common in women 2–
3:1)
Young adults (20–40 years most affected)
Exacerbations and remissions
Exacerbations - new symptoms appear
and existing ones worsen
Remissions - symptoms decrease or
disappear.
Relapses - associated with periods of
emotional and physical stress.
Pathophysiology
Immune system (T-cells, B-cells,
macrophages) attacks myelin sheath.
Causes inflammation & demyelination of
nerve fibers.
Nerve conduction slows or stops resulting
in neurological symptoms.
Over time, axons are damaged causing
permanent disability.
Clinical Features
Motor: weakness, spasticity, tremors,
poor coordination, paralysis.
Sensory: numbness, tingling, pain, loss
of vibration sense.
Vision: optic neuritis (pain, blurred vision,
blindness in one eye).
Cerebellar signs: ataxia, balance
problems.
Cognitive/psychological: memory loss,
depression, fatigue.
Uhthoff’s phenomenon → worsening of
symptoms with heat/exercise.
Lhermitte’s sign → electric shock-like
sensation down spine when neck is
flexed.
Diagnosis
MRI → shows demyelinating plaques in
brain/spinal cord.
CSF analysis → oligoclonal bands
(antibodies).
Clinical history + neurological exam.
Management
No cure, but treatment controls symptoms
and progression:
Acute attacks: Corticosteroids (e.g.,
methylprednisolone)
Symptomatic treatment: Muscle relaxants
(baclofen) for spasticity
Antidepressants for depression
Physical therapy for mobility
Lifestyle: balanced diet, avoid overheating,
physiotherapy, rest.
Complications
Permanent disability (wheelchair-bound).
Bladder/bowel dysfunction.
Cognitive decline.
Depression/anxiety.
Nursing Diagnoses in MS
Impaired physical mobility related to muscle
weakness, spasticity, and fatigue.
Activity intolerance related to fatigue and
muscle weakness.
Impaired urinary elimination related to
neurogenic bladder (urgency, frequency,
incontinence, or retention).
Constipation related to decreased physical
activity and neurogenic bowel dysfunction.
Self-care deficit (bathing, dressing, feeding,
toileting) related to coordination problems.
Impaired verbal communication related to
dysarthria (difficulty speaking).
Risk for impaired skin integrity related to
immobility and incontinence.
Disturbed sensory perception (visual, tactile)
related to demyelination of optic nerve and
sensory pathways.
Chronic pain related to neuropathy or muscle
spasticity.
Ineffective coping related to chronic disease
progression and lifestyle changes.
Risk for infection related to urinary retention or
use of immunosuppressive therapy.
Disturbed thought processes / Impaired
memory related to CNS demyelination.
Powerlessness or Hopelessness related to
progressive, unpredictable disease course.
