1. A&P Signs & Symptoms Management of condition
Multiple Sclerosis Carol Forde-Johnston, Lecturer Practitioner Oxford, UK.
A&P
Signs & Symptoms
Management of condition

2. What is Multiple Sclerosis?
MS is a common demyelinating disease characterised by focal disturbance of function & relapsing & remitting course
MS usually occurs in young adults with a peak age of incidence of years.
Slightly more females affected than males
There is a 3 % risk of the disease if a sibling or parent is affected

3. Pathology
Scattered lesions with a greyish colour, 1mm-several cm in siz34e are present in the white matter of the brain & spine & are referred to as plaques
the lesions lie in close relationship to veins

4. Causes
Immune deficiency has been suggested. This might explain the possible persistence of a latent virus & could be the basis of ‘relapses & remissions’
Hereditary / genetic factors appear significant with an increased familial incidence of MS. Affected women transmit MS to offspring more frequently than affected men

5. Other Causes??
Viruses may be important in the development of MS, infection perhaps occurring in a genetically/immunologically acceptable host
In summary, the causation is probably multi factorial e.g. genetic predisposition, disordered immune response, environmental exposure

6. Clinical Features
Usually characterised by S&S of white matter disease with a relapsing & remitting course
Initially may have vague symptoms such as lack of energy, headache, depression and aching limbs
These may lead to more precise symptoms

7. Precise Symptoms Sensory disturbance (40%)
Retrobulbar neuritis (optic neuritis) (17%)
Limb weakness (12%)
Diplopia (11%)
Vertigo, Ataxia & Sphincter disturbance (20%)

8. Investigations
Neurophysiology / Visual Evoked potentials : positive wave may be delayed
CSF examination via Lumbar Puncture may detect oligoclonal bands in 95% patients with MS
MRI: abnormal plaques/lesions may be found on MRI scan

9. Treatments Steroid therapy such as prednisolone or methylprednisolone
Anti-spasmodics / cannabis trials to relieve leg spasms
Much of the treatment aims to reduce / relieve symptoms

10. Nursing care Aim: To control/relieve/prevent symptoms
Aid comfort & mobility
Elimination needs e.g. constipation, self catheterisation
Nutritional requirements eg poor swallow
Issues with sexuality, social/occupational issues

11. Psycho/social Care MDT Community services: Continence advisors
Voluntary services: MS Society / Relate
MS Specialist Nurses
Respite Care
Rehabilitation services

12. Research Immune Disease? Viruses? Gene therapy?
Cannabis to control spasms/pain
Betainterferon effects progression
Chemotherapy drugs