Adult Medical-Surgical Adult Medical-Surgical NursingNursing

Neurology Module: Neurology Module:

Multiple SclerosisMultiple Sclerosis

Multiple Sclerosis: DescriptionMultiple Sclerosis: Description

A chronic degenerative progressive A chronic degenerative progressive disease of the central nervous system disease of the central nervous system affecting persons of all agesaffecting persons of all ages

Involves small patches of demyelination in Involves small patches of demyelination in the brain and spinal cord → impaired the brain and spinal cord → impaired transmission of impulsestransmission of impulses

Multiple Sclerosis: Multiple Sclerosis: Aetiology and IncidenceAetiology and Incidence

Unknown causeUnknown causePossible viral damage in early life → later Possible viral damage in early life → later auto-immune response (defective immune auto-immune response (defective immune response)response)Genetic component (chromosome 6)Genetic component (chromosome 6)Occurs in northern temperate zones more Occurs in northern temperate zones more than hot climatesthan hot climatesOften occurs in young adultsOften occurs in young adultsOccurrence in female twice that in maleOccurrence in female twice that in male

Multiple Sclerosis: PathophysiologyMultiple Sclerosis: Pathophysiology

Demyelination in patches irregularly Demyelination in patches irregularly throughout central nervous systemthroughout central nervous system

Replaced with sclerosed patches Replaced with sclerosed patches interrupting the flow of impulsesinterrupting the flow of impulses

Areas most affected: Optic nerves/ tractsAreas most affected: Optic nerves/ tracts

CerebrumCerebrum

Brain stem and cerebellumBrain stem and cerebellum

Spinal cordSpinal cord

Multiple Sclerosis: Multiple Sclerosis: Disease HistoryDisease History

MS is a progressive neurological disease MS is a progressive neurological disease but has periods of:but has periods of:

Remission (no symptoms, no progress)Remission (no symptoms, no progress)

Relapse: new symptoms and progression Relapse: new symptoms and progression (may be related to stressful times)(may be related to stressful times)

Remyelinisation may occurRemyelinisation may occur

Multiple Sclerosis: Multiple Sclerosis: Clinical ManifestationsClinical Manifestations

Fatigue, weakness; dysphasia, dysphagia Fatigue, weakness; dysphasia, dysphagia Numbness and paraesthesia (pain)Numbness and paraesthesia (pain)Poor coordination (proprioception)Poor coordination (proprioception)Loss of balance, ataxiaLoss of balance, ataxiaBlurred vision, diploplia → blindnessBlurred vision, diploplia → blindnessSpasticity of extremitiesSpasticity of extremitiesDepression, cognitive problemsDepression, cognitive problemsBladder, bowel, sexual dysfunctionBladder, bowel, sexual dysfunction

Multiple Sclerosis: ComplicationsMultiple Sclerosis: Complications

Urinary tract infectionUrinary tract infection

ConstipationConstipation

Pressure ulcers (paraesthesia/ spasticity)Pressure ulcers (paraesthesia/ spasticity)

Contractures, deformities, spasticityContractures, deformities, spasticity

Oedema of feet, legsOedema of feet, legs

PneumoniaPneumonia

DepressionDepression

Multiple Sclerosis: DiagnosisMultiple Sclerosis: Diagnosis

Patient history and clinical picturePatient history and clinical pictureNeurological examinationNeurological examinationMRI: shows small focal sclerotic plaques MRI: shows small focal sclerotic plaques (will also evaluate disease progression)(will also evaluate disease progression)Lumbar puncture: CSF shows “oligoclonal Lumbar puncture: CSF shows “oligoclonal bonding” in 95% patients (bands of bonding” in 95% patients (bands of abnormal IgG)abnormal IgG)Bladder function tests (neurogenic Bladder function tests (neurogenic bladder) bladder)

Multiple Sclerosis: Multiple Sclerosis: Medical ManagementMedical Management

Multiple Sclerosis is a progressive chronic Multiple Sclerosis is a progressive chronic disease: no cure existsdisease: no cure existsAn individualised care planAn individualised care plan is required to: is required to:Delay progressionDelay progressionMinimise complicationsMinimise complicationsMaintain functionMaintain functionRelieve symptomsRelieve symptomsSupport the patientSupport the patient

Multiple Sclerosis: MedicationsMultiple Sclerosis: Medications

Corticosteroids: anti-inflammatory (may Corticosteroids: anti-inflammatory (may improve nerve function)improve nerve function)Immunosuppressants (as abnormal Immunosuppressants (as abnormal immune response):immune response):Imuran, Cyclophosphamide, CyclosporinImuran, Cyclophosphamide, Cyclosporinββ-Interferon to reduce exacerbations-Interferon to reduce exacerbationsAnti-spasmodic for spasticity, BaclofenAnti-spasmodic for spasticity, BaclofenAnticholinergics: improve bladder tone; Anticholinergics: improve bladder tone; Antibiotics for UTI controlAntibiotics for UTI control

Multiple Sclerosis: Multiple Sclerosis: Nursing ConsiderationsNursing Considerations

Psychological/ emotional supportPsychological/ emotional supportAssist self-care and patient education to Assist self-care and patient education to avoid complications:avoid complications:Self-catheterisation, bowel care, use of Self-catheterisation, bowel care, use of walking aids, wheelchair may be requiredwalking aids, wheelchair may be requiredPrevent UTI: vitamin C, juices to acidify Prevent UTI: vitamin C, juices to acidify urineurineAdvise on side-effects of steroids, regular Advise on side-effects of steroids, regular health screening, not to omit medicationhealth screening, not to omit medication