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

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 20-40 years. Slightly more females affected than males There is a 3 % risk of the disease if a sibling or parent is affected

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

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

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

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

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

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

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

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

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

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