Multiple Sclerosis (MS)

Introduction:

This is an autoimmune disease that results in demyelination of the white matter of
the nervous system. Nerve impulses travel along the myelin coating on the outside
of the nerve cells. With the disruption in the myelin on the outside of the nerve
cells, the transmission of information from cell to cell within the nervous system is
altered. The patient’s sensations, movements, or mental function may be affected.
A patient with relapsing-remitting disease will have episodes of exacerbation when
symptoms occur and then months or years of symptom-free episodes. A portion of
these patients will progress to enter a disease state that has a steady pattern of dete-
rioration without relation to the periodic exacerbations; this is referred to as a sec-
ondary progressive disease. Other patients have a primary progressive disease and
develop the steady deterioration from the onset of the disease.

PROGNOSIS

The actual cause of the disease is unknown, although it is thought to be autoim-
mune. The disease is progressive. Stress may be noted to aggravate symptoms.
When damage is done to the nerve cells, it is not repairable, even when symptoms
resolve in between periods of exacerbation. The pattern of symptoms will vary
from one patient to the next. The time frame between exacerbations will also vary.
As the disease progresses, the patient will lose more functional ability and will
ultimately need assistance with basic self-care needs.

SIGNS AND SYMPTOMS

Symptoms have periods of exacerbation and remission. Symptoms typically
resolve completely in between exacerbations early in the disease process.
• Double vision (diplopia)
• Blurred vision
• Fatigue
• Muscle weakness or unsteadiness
• Unsteady gait due to muscle weakness and general unsteadiness
• Intolerance of temperature changes
• Ataxia (decrease in motor coordination, gross motor movements)
• Increased deep tendon reflexes
• Slurred speech
• Burning tingling on the skin (paresthesia)
• Paralysis later in disease state
• Memory loss; loss of attention or mental focus
• Urinary urgency or hesitancy due to changes in sphincter control


TREATMENT

• Use one of the following Biologic Response Modifiers on a continuous
basis, not just during periods of exacerbation:
• interferon beta-1a
• interferon beta-1b
• glatiramer acetate
• Administer immunosuppressants—may be helpful for secondary progres-
sive MS:
• cyclophosphamide
• azathioprine
• methotrexate
• cladribine
• mitoxantrone
TREATMENT
• Use one of the following Biologic Response Modifiers on a continuous
basis, not just during periods of exacerbation:
• interferon beta-1a
• interferon beta-1b
• glatiramer acetate
• Administer immunosuppressants—may be helpful for secondary progres-
sive MS:
• cyclophosphamide
• azathioprine
• methotrexate
• cladribine
• mitoxantrone
thesia
• Administer medications to help with altered bladder function:
• oxybutynin
• hyoscyamine sulfate
• darifenacin
• solifenacin
• tolterodine
• Remove antibodies by removing plasma (plasmapheresis).

NURSING DIAGNOSES

• Impaired physical mobility
• Fatigue
• Self-care deficit

NURSING INTERVENTION

• Monitor motor movements for interference with ADLs.
• Encourage activity balanced with rest periods.
• Assess cognitive function for changes, or deterioration.
• Explain to the patient:
• Bladder training.
• Teach self-catheterization if necessary (for patients with flexic bladder).
• Increase fluid intake unless other medical problems contraindicate.
• Importance of positioning.
• Avoid temperature extremes.
• Medication compliance.