disease condition , its causes, sign and symptoms and management

1. MULTIPLE SCLEROSIS

2. MULTIPLE SCLEROSIS
• A slowly progressive neurological disease
characterized by patches of demyelination in
brain and spinal cord and affects only
oligodendrocytes not Schwann cells.
• MS is an immune mediated, progressive
demyelinating disease of CNS. Demyelination
refers to the destruction of myelin, the fatty
and protein material that surrounds the
certain nerve fibers in the brain and spinal
cord, it results in impaired transmission of

3. MULTIPLE SCLEROSIS: INCIDENCE
• Onset usually between the ages of 20
and 40 years
• Women affected more often than men
• Prominent regional clusters found
throughout the world, suggesting
environmental influences
• > 0.03 to 0.13% incidence in northern
tier

4. PATHOPHYSIOLOGY
• Sensitized T cells that typically cross the
blood brain barrier, their function is to
check the CNS for antigens and then
leave
• In MS, the sensitized T cells remain in the
CNS and promote the infiltration of other
agents that damage the immune system

5. PATHOPHYSIOLOGY
The immune system attack leads to
inflammation and destroys myelin and
oligodendroglial cells ( that produce myelin
in the CNS)
Demyelination interrupts the flow of nerve
impulses

6. PATHOPHYSIOLOGY
Plaques appear on demyelinated axons
further interrupts the transmission of impulses

7. PATHOPHYSIOLOGY
Demyelinated axons are scattered irregularly
throughout the CNS
The most frequently affected areas are the
optic nerves, cerebrum, brain stem, cerebellum
and spinal cord
Eventually, the axons themselves begin to
degenerate resulting in permanent and

8. CAUSES
Despite extensive research, we still don't
know what causes MS (O'Connor 8).
However they have found associations and
links between many factors including genetic
and environmental.
Genetic Environmental
• Sex Latitude
• Racial Group Socio
economic

9. GENETIC FACTORS
• Sex: Women are more likely to have MS
than men by a 2:1 ratio.
• Racial Group: Whites are more than twice
as likely as other races to develop Ms.
• Family History:
• In a normal population the chance of
someone to exhibit the symptoms of MS is
only 0.1%.

10. GENETIC FACTORS
• Family History: ……..
• Now if someone in family has MS, the risk
increases.
• If parent, brothers, or sisters ( first-degree
relatives) have MS chance increases to 3%.
• If a second-degree relative has it, only
have a 1% chance of having MS.
• If both of your parents have the disease
you have a risk of 20%.

11. ENVIRONMENTAL FACTORS
• Latitude: As you increase latitude, mainly
above and below 40° latitude, MS is more
common. These are temperate and cooler
climates. It is five times more likely in
these regions.
• Socioeconomic status: It is least
common in the lower class and in rural
residence.
• Migration

12. MULTIPLE SCLEROSIS: SYMPTOMS
• Early symptoms may include
• Fatigue , numbness, weakness in an arm or
leg
• Visual disturbances due to lesions in optic
nerve
• Blurring of vision, diplopia, patchy blindness
and total blindness
• Difficulty in coordination and loss of
balance

13. MULTIPLE SCLEROSIS: SYMPTOMS
• Spasticity (muscle hypertonicity) of
extremities.
• Disruption of sensory axons may produce
sensory dysfunction such as parasthesias,
pain
• Cognitive and psychological problems may
reflect frontal or parietal lobe involvement
• Some degree of cognitive changes such as
memory loss , decreased concentration
occurs in half of the patients

14. MULTIPLE SCLEROSIS: SYMPTOMS
• Loss of connection between the cortex
and and basal ganglia may occur and
cause euphoria.
• Bowel , bladder and sexual dysfunction
are common.
• Secondary complications includes UTI,
constipation, pressure ulcers, contracture
deformities, dependent pedal edema,
pneumonia etc..

15. MULTIPLE SCLEROSIS: SYMPTOMS
• Advanced symptoms can include
• pronounced difficulty moving
• Severe visual impairment or even
blindness
• Severe neuropathic pain
• Pronounced cognitive and emotional
disturbances

16. MULTIPLE SCLEROSIS: DIAGNOSIS
• Neurological examination
• presenting symptoms
• exclusion of other disorders
• MRI may reveal plaques or
lesions around demyelinated
neurons
• Visual evoked potentials (VEP)
may be especially valuable for
early diagnosis
• delayed VEPs are indicative

17. MULTIPLE SCLEROSIS: DIAGNOSIS
• The terms visually evoked potential (VEP),
visually evoked response (VER) and visually
evoked cortical potential (VECP) are
equivalent.
• They refer to electrical potentials, initiated by
brief visual stimuli, which are recorded from the
scalp overlying visual cortex, VEP waveforms
are extracted from the electro-encephalogram
(EEG) by signal averaging.

18. MULTIPLE SCLEROSIS: DIAGNOSIS
• VEPs are used primarily to
measure the functional
integrity of the visual
pathways from retina via the
optic nerves to the visual
cortex of the brain.
• VEPs better quantify
functional integrity of the
optic pathways than scanning
techniques such as magnetic
resonance imaging (MRI).

19. MULTIPLE SCLEROSIS: DIAGNOSIS
• Any abnormality that affects the visual pathways
or visual cortex in the brain can affect the
VEP. Examples are cortical blindness due to
meningitis or anoxia, optic neuritis as a
consequence of demyelination, optic atrophy,
stroke, and compression of the optic pathways by
tumors.
• In general, myelin plaques common in multiple
sclerosis slow the speed of VEP wave peaks.

20. MEDICATIONS USED IN MS
• Spasticity- Baclofen, Tizanidine,
Diazepam, Dantrolene
• Optic Neuritis- Methlyprednisolone, Oral
steroids
• Fatigue- Antidepressant, Amantadine
• Pain- Codeine, Aspirin
• Sexual Dysfunction- Viagra, Pravatine
• Tremor- Isoniazid, Primidone, Propranolol
• Disease-Modifying Drugs- Interferon beta
1a and 1b, and Glatiramer acetate

21. DISEASE MODIFYING DRUGS
Interferon Beta 1a (Avonex and Rebif):
• is a protein that is a replica of human
interferon.
• It suppress the immune system and helps
to maintain the blood-brain barrier.
• Inject Avonex into the muscle once a week
and Rebif is injected subcutaneously three
times a week.
• One side effect of the drug is a flu like

22. DISEASE MODIFYING DRUGS
• Interferon Beta 1b (Betaseron): is slightly
different from our own interferon. This
medication does the same thing as beta 1a,
but is injected subcutaneously every two
days.
• Acetate ( Copaxone): “is a small fragment
of a protein that resembles a protein in
myelin. It decrease the reoccurrence of
relapse. It is injected subcutaneously daily.

23. DISEASE MODIFYING DRUGS
• Intravenous methylprednisolone, the agent
in treating acute relapse. It exerts anti
inflammatory effects by acting on T cells
and cytokines.
• One gram is administered IV daily for 3
days followed by oral taper of
prednisolone
• Mitoxantrone (Novantrone) is administered
via IV infusion every 3 months.

24. ALTERNATIVE TREATMENTS
• Acupuncture
• Aromatherapy
• Cannabis (Marijuana)
• Cold Immersion
• Dietary Supplements
• Herbal Medication
• Homeotherapy
• Injection of
Venom such as
snake and bee
• Massage
• Meditation
• Yoga

25. NURSING MANAGEMENT
Assessment
• Addresses the actual and potential
problems associated with the disease
including neurologic deficits, secondary
complications and impact of disease o the
patient and family
• Observe patients mobility and balance to
determine whether there is danger of
falling
• Assess for weakness, spasticity, visual
impairment, incontinence, disorders of

26. NURSING MANAGEMENT
Nursing diagnosis
• Impaired physical mobility related to
weakness, muscle paresis, spasticity
• Risk for injury related to sensory and visual
impairment
• Impaired urinary and bowel elimination
related to nervous system dysfunction
• Impaired verbal communication and risk for
aspiration related to cranial nerve involvement
• Disturbed thought process related to cerebral