MULTIPLE SCLEROSIS

HARSHITA

II ND YEAR

A.B.C.O.N

HUMAN NERVOUS SYSTEM

INTRODUCTION Multiple sclerosis (MS) is a disease

affecting nerves in the brain and spinal cord, causing problems with muscle movement, balance and vision.

Multiple sclerosis (MS), also known as disseminated sclerosis or encephalomyelitis disseminate, is an inflammatory disease in which the insulating cover of nerve cell in the brain and spinal cord are damaged

CONTINUE This damage disrupts the ability of parts

of the nervous system to communicate, resulting in a wide range of sometimes psychiatric problem.

CAUSES Multiple sclerosis (MS) occurs

because of damage to the nerve fibres of the central nervous system. Central nervous system consists of the brain and spinal cord and is responsible for controlling every action, conscious and unconscious, of our body.

Myelin

When you perform an action, your brain sends messages to the appropriate part of your body through the nerve fibres in your spinal cord. These nerve fibres are covered by a substance called myelin. Myelin insulates the nerve fibres and helps carry messages to and from your brain quickly and smoothly. In MS, the myelin around your nerve fibres becomes damaged. This disturbs the messages coming to and from your brain.

CAUSES OF MULTIPLE SCLEROSIS

Autoimmune condition

MS is an autoimmune condition.  This means your immune system mistakes the myelin for a foreign substance and attacks it. The myelin becomes inflamed in small patches (called plaques or lesions), which can be seen on an MRI scan. This process is called demyelination.

PATHO-PHYSIOLOGY The three main characteristics of MS are the

formation of lesions in the central nervous system (also called plaques), inflammation, and the destruction of myelin sheath of neurons.

These features interact in a complex and not yet fully understood manner to produce the breakdown of nerve tissue and in turn the signs and symptoms of the disease.

Additionally MS is believed to be an immune mediates disorder that develops from an interaction of the individual's genetics and as yet unidentified environmental causes.

Damage is believed to be caused, at least in part, by the person's own immune system attacking the nervous system.[1]

PATHO PHYSIOLOGY

lesions The name multiple sclerosis refers to the

scars that form in the nervous system. These lesions most commonly affect the white matter in the optic nerve, brain stem, basal ganglia and spinal cord, or white matter tracts close to the lateral ventricles.

The function of white matter cells is to carry signals between grey matter areas, where the processing is done, and the rest of the body. The peripheral nervous system is rarely involved.[2]

PATHO PHYSIOLOGY

INFLAMMATION

Apart from demyelination, the other sign of the disease is inflammation. Fitting with an immunological explanation, the inflammatory process is caused by T cells, a kind of lymphocyte that plays an important role in the body's defenses. T cells gain entry into the brain via disruptions in the blood–brain barrier. The T cells recognize myelin as foreign and attack it, explaining why these cells are also called "autoreactive lymphocytes".

PATHO PHYSIOLOGY

Blood–brain barrier

The blood–brain barrier is a part of the capillary system that prevents the entry of T cells into the central nervous system. It may become permeable to these types of cells secondary to an infection by a virus or bacteria. After it repairs itself, typically once the infection has cleared, T cells may remain trapped inside the brain. Gadolinium cannot cross a normal BBB and therefore Gadolinium-enhanced MRI is used to show BBB breakdowns.

SIGN AND SYMPTOMS The central nervous system (brain and

spinal cord) controls all of your body's actions. When MS damages the nerve fibres that carry messages to and from your brain, symptoms can occur in any part of your body.

There are many different symptoms of MS and they affect each person differently. Some of the most common symptoms include:

numbness and tingling blurring of vision problems with mobility and balance muscle weakness and tightness

TYPES OF MS RELAPSING REMITTING MSIt is characterized by periods of worsening symptoms followed by periods of improvement.It affects 90% of patients with MS. PROGRESSIVE MSthe disease keeps on getting worse without any improvement. About half the patients with the first type end up having the progressive MS within 15 years if they are not treated.

DIAGNOSIS

Animation showing dissemination of brain lesions in time and space as demonstrated by monthly MRI studies along a year.

Multiple sclerosis is typically diagnosed based on the presenting signs and symptoms, in combination with supporting medical imaging and laboratory testing.

 It can be difficult to confirm, especially early on, since the signs and symptoms may be similar to other medical problems.

CONTINUE The criteria which focus on clinical,

laboratory and radiologic evidence of lesions at different times and in different areas is the most commonly used method of diagnosis with the Schumacher and Poser criteria being of mostly historical significance. While the above criteria allow for a non-invasive diagnosis, some state that the only definitive proof is an autopsy or biopsy where lesions typical of MS are detected.

TREATMENT Although there is still no cure for MS,

effective strategies are available to modify the disease course, treat exacerbations (also called attacks, relapses, or flare-ups),manage symptoms, improve function and safety, and provide emotional support. In combination, these treatments enhance the quality of life for people living with MS.

MEDICATIONS USED FOR MS

Spasticity- Baclofen, Tizanidine, Diazepam, Dantrolene

Optic Neuritis- Methlyprednisolone, Oral steroids

Fatigue- Antidepressant, Amantadine

Pain- Codeine, Aspirin

Sexual Dysfunction- Viagra, Pravatine

Tremor- Isoniazid, Primidone, Propranolol

Disease-Modifying Drugs- Interferon beta 1a and 1b, and Glatiramer acetate

DISEASE-MODIFYING DRUGS

Interferon Beta 1a (Avonex and Rebif): is a protein that is a replica of human interferon. It suppress the immune system and helps to maintain the blood-brain barrier. You inject Avonex into the muscle once a week and Rebif is injected under the skin three times a week. This drug is useful to people who have definite progressive MS. One side effect of the drug is a flu like symptom.

Interferon Beta 1b (Betaseron): is slightly different from our own interferon. This medication does the same thing as beta 1a, but is injected just under the skin every two days. Side effects include irritation, bruising, and redness at the site of injection and the flu like symptoms. This is also given to people who have definite progressive MS.

DISEASE-MODIFYING DRUGS (CON’T)

Glatiramer Acetate ( Copaxone): “is a small fragment of a

protein that resembles a protein in myelin” ( O’Connor 106). It decrease the reoccurrence

of relapse. It is injected just under the skin every day. There is no flu like symptoms but occasional redness may occur at the injection site. A few amount of people do experience

brief shortness of breathe.

In summary all three of these drugs decrease relapses by 33%, have manageable side effect, are injected, stabilize the disease, and tend to

be costly.

SIDE EFFECTS Beta interferons:Interferons can

cause many side effects, including reactions in the injection area and liver damage. However, it's rare to have serious, permanent side effects. You'll likely need blood tests to monitor your liver function and blood count.

Glatiramer acetate (Copaxone):Side effects are uncommon, but may include flushing, chest pain or heart palpitations after injection and reactions at the injection sites.

ALTERNATIVE TREATMENTS Acupuncture Aromatherapy Cannabis (Marijuana) Chiropractic Cold Immersion Dietary Supplements Herbal Medication

Homeotherapy Injection of Venom

such as snake and bee

Massage Meditation Reflexology Tai Chi Yoga

NURSING MANAGEMENT

NURSING MANAGEMENT OF PATIENT WITH MULTIPLE SCLEROSIS

Assessment Assess actual and potential problems. Observe the patient’s movements and walking to

determine if there is danger of falling. Assess the patient for weakness, spasticity, visual

impairment, incontinence, and disorders of swallowing and speech.

Assess the effect of MS on the patient’s lifestyle.

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Nursing diagnoses Risk for injury related to sensory and visual impairment Impaired speech and swallowing related to cranial nerve

involvement Planning and goals

Avoidance of injury. Promotion of speech and swallowing mechanisms.

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Nursing Interventions (Preventing injury) If the patient is at risk for falling, he is taught to walk with feet

wide apart to widen the base of support. If there is loss of position sense, the patient is taught to watch

the feet while walking. Gait training may require assistive devices (walker, crutches)

and instruction about their use by a physical therapist. If the gait remains inefficient, a wheelchair or motorized scooter may be the solution.

The patient is trained in transfer and activities of daily living. Because sensory loss may occur in addition to motor loss,

pressure ulcers are a continuing threat to skin integrity. Confinement to a wheelchair increases the risk.

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Managing speech and swallowing difficulties A speech therapist evaluates speech and swallowing and

instructs the patient, family, and health team members about strategies to compensate for speech and swallowing problems.

The nurse reinforces this instruction and encourages the patient and family to adhere to the plan.

Impaired swallowing increases the patient’s risk for aspiration; therefore, strategies (eg, having suction apparatus available, careful feeding, proper positioning for eating) are needed to reduce that risk.

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Evaluation (Expected patient outcomes) The patient is free of injury

Uses visual cues to compensate for decreased sense of touch or position

Asks for assistance when necessary The patient participates in strategies to improve speech and

swallowing Practices exercises recommended by speech therapist Maintains adequate nutritional intake without aspiration

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