Multiple sclerosis

Multiple sclerosis A chronic, progressive, degenerative disorder of the central nervous system, characterised by isolated patchy demyelination of the neurones of the CNS. It is usually associated with progressive impaired motor nerve conduction and muscle weakness. The name multiple sclerosis refers to scars or lesions in the white matter of the brain and spinal cord, which is mainly composed of myelin.

incidence It is common in people within the ages of 18- 40 years and more common in females.

aetiology The specific cause is unknown It is associated with climatic influence; that is, low in the tropics and high in the temperate regions Familial Autoimmunity Viral infections e.g. measles Aggravated by pregnancy and infections

pathophysiology Multiple sclerosis affects the ability of nerve cells in the brain and spinal cord to communicate with each other. Nerve cells communicate by sending actions potentials down axons which are wrapped in myelin. In Multiple sclerosis, the body's own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals. Leading to progressively impaired motor nerve conduction and muscle weakness.

Clinical features Weakness in the limbs of one side of the body that often results in dragging of the feet. Paraesthesia e.g. numbness, tingling of the feet, needles and pin pricks in the limb Lhemetti’s Sign: Blurred vision, double vision [diplopia], amaurosis fugax and nystalgmus, Paralysis, Speech difficulty, Euphoria, Diminished position sense.

Diagnostic investigations Lumber puncture [to obtain CSF for analysis] CT scan EEG

management Medications: Corticosteroids: e.g. prednisone Immunosuppressants: e.g. cyclophosphamide ATBs: Diet: high calorie diet, high protein, high vitamin, low fat, gluten free

Sexual dysfunction related to neuromuscular deficits NURSING MANAGEMENT Impaired physical mobility related to muscle weakness, paralysis and muscle spasticity Sexual dysfunction related to neuromuscular deficits Altered urinary elimination pattern (retention) related to sensorimotor deficits Interrupted family processes related to changing family roles, fluctuating physical condition