1. Adult Medical-Surgical Nursing Neurology Module: Multiple Sclerosis

2. Multiple Sclerosis: Description A chronic degenerative progressive disease of the central nervous system affecting persons of all ages Involves small patches of demyelination in the brain and spinal cord → impaired transmission of impulses

3. Multiple Sclerosis: Aetiology and Incidence Unknown cause Possible viral damage in early life → later auto-immune response (defective immune response) Genetic component (chromosome 6) Occurs in northern temperate zones more than hot climates Often occurs in young adults Occurrence in female twice that in male

4. Multiple Sclerosis: Pathophysiology Demyelination in patches irregularly throughout central nervous system Replaced with sclerosed patches interrupting the flow of impulses Areas most affected: Optic nerves/ tracts Cerebrum Brain stem and cerebellum Spinal cord

5. Multiple Sclerosis: Disease History MS is a progressive neurological disease but has periods of: Remission (no symptoms, no progress) Relapse: new symptoms and progression (may be related to stressful times) Remyelinisation may occur

6. Multiple Sclerosis: Clinical Manifestations Fatigue, weakness; dysphasia, dysphagia Numbness and paraesthesia (pain) Poor coordination (proprioception) Loss of balance, ataxia Blurred vision, diploplia → blindness Spasticity of extremities Depression, cognitive problems Bladder, bowel, sexual dysfunction

7. Multiple Sclerosis: Complications Urinary tract infection Constipation Pressure ulcers (paraesthesia/ spasticity) Contractures, deformities, spasticity Oedema of feet, legs PneumoniaDepression

8. Multiple Sclerosis: Diagnosis Patient history and clinical picture Neurological examination MRI: shows small focal sclerotic plaques (will also evaluate disease progression) Lumbar puncture: CSF shows “oligoclonal bonding” in 95% patients (bands of abnormal IgG) Bladder function tests (neurogenic bladder)

9. Multiple Sclerosis: Medical Management Multiple Sclerosis is a progressive chronic disease: no cure exists An individualised care plan is required to: Delay progression Minimise complications Maintain function Relieve symptoms Support the patient

10. Multiple Sclerosis: Medications Corticosteroids: anti-inflammatory (may improve nerve function) Immunosuppressants (as abnormal immune response): Imuran, Cyclophosphamide, Cyclosporin β-Interferon to reduce exacerbations Anti-spasmodic for spasticity, Baclofen Anticholinergics: improve bladder tone; Antibiotics for UTI control

11. Multiple Sclerosis: Nursing Considerations Psychological/ emotional support Assist self-care and patient education to avoid complications: Self-catheterisation, bowel care, use of walking aids, wheelchair may be required Prevent UTI: vitamin C, juices to acidify urine Advise on side-effects of steroids, regular health screening, not to omit medication