Multiple sclerosis Flashcards
Define MS in one sentence
A chronic, progressive, degenerative disorder of the CNS characterised by disseminated demyelination of the nerve fibres of the brain and spinal cord
What is the etiology and pathophysiology of MS (briefly)
Infections, immunological and genetic factors. Chronic inflammation, demyelination and gliosis (scaring) in the CNS characterise MS. Activated T cells disrupt blood/brain barrier causing antigen-antibody reactions
What are the clinical manifestations?
Onset often insidious and gradual-vague symptoms occurring over months or years that often dissuade the patient from seeking medical attention. Chronic, progressive deterioration. Motor, sensory, cerebellar, emotional problems
What are the aims of collaborative care for MS?
Treating the disease process and providing symptomatic relief. Disease is treated with drugs and symptoms also treated.
Immunomodulator drugs may be used to modify the disease progression and prevent relapses. These drugs include interferon B-1b and glatiramer acetate, which are given IM three times/week.
Corticosteroids: ACTH, prednisone etc for exacerbations.
Immunosuppresants- mitoxantrone
Cholinergics- nethanechol, neostgmine for urinary retention
Anticholinergics- propantheline and oxybutyin for urinary retention
Muscle relaxants- diazepam, baclofen etc for spasticity
CNS stimulants- methylphenidate for fatigue
Antiviral= amatadine fatigue
What are the main aims of nursing management for a patient with MS?
Maximise neuromuscular function Maintain independence for ADLs for as long as possible Manage disabling fatigue Optimise psychosocial wellbeing Adjust to illness
What are types of MS?
Relapsing- remitting: Clearly defined relapses with full recovery or sequelae and residual deficit on recovery
85% of MS
Primary-progressive: Slowly worsening neurological function from the beginning with no distinct relapses or admissions.
Secondary-progressive: A relapsing-remitting initial course, followed by progression with or without occasional relapses, minor remissions and plateaus.
Progressive-relapsing: Progressive disease from onset, with clear acute relapses, with or without full recovery. Periods between relapses are characterised by continuing progression.
What causes an MS exacerbation?
Trauma, immunisation, childbirth, stress and change in climate
What are the signs and symptoms of MS?
Motor- weakness/paralysis of the limbs, trunk or head, diplopia, scanning speech, spasticity of muscles
Sensory: numbness and tingling, vertigo, tinnitus, chronic neuropathic pain, Lhernitte’s sign- electric shock down spine
Cerebellar- Nystagmus (involuntary eye movements); ataxia, dysarthria (speech unclear), dsyphagia
Emotional: Loss of sexuality, self-esteem, anger, depression
