Multiple Sclerosis

• Chronic autoimmune disease affecting the myelin

sheath and conduction pathway of the CNS

• Inflammatory response resulting in random or

patchy areas of plaque in the white matter of the
CNS

• Usually characterized by periods of remission and

exacerbation (flares)

• Affects vision, speech, walking, writing, and

memory.
MS Affects:

• Women affect more than men 3:1

• Onset usually 15-50 years of age
• Primarily Caucasians
• European descent
• Increased risk if 1st degree
relatives
MS: Diagnosis of Exclusion
Difficult to diagnose because:

 More than 50 symptoms are linked to MS

 each person develops symptoms differently
 Many of the symptoms mimic problems that occur with other
diseases
 No diagnostic blood test
 Symptoms usually come and go over months or years
 Many symptoms are vague, hard to quantify and may be attributed to
stress by GPs therefore no neurologist referral
(ie: fatigue, sexual dysfunction, depression and cognitive difficulties)
 4

MS Etiology
• Unknown
• Autoimmune disorder
• Genetic component
• Immunologic
• Viral
• Environmental
Major Types of Multiple Sclerosis
• Relapsing-remitting
• Progressive-relapsing
• Primary progressive
• Secondary progressive

Elsevier items and derived items

© 2006 by Elsevier Inc.
Types of MS
Relapsing-Remitting MS
• Acute episodes

• recovery and stable course between relapses

• 85% of cases
Secondary-Progressive MS
• Begins with a relapsing-remitting course

• later becomes steadily progressive

• relapses and partial recoveries may occur

Types of MS
Primary-Progressive MS
• steady and gradual neurologic deterioration

• no remission of symptoms

• progressive disability with no acute attacks

• 10% of cases

Progressive Relapsing MS
• follows a progressive course from onset

• punctuated by relapses

• significant recovery immediately following relapse

• between relapses there is gradual worsening of symptoms

 9

Signs and symptoms

Primary: direct result of
damage
• weakness, tremors,
tingling, numbness,
paralysis and bladder/bowel
problems
Secondary: result from
primary
• Paralysis leads to
bedsores and
bladder/urinary incontinence
problems
Tertiary: Social,
psychological, & vocational
complications
• Depression very common
 Elsevier items and derived items © 2006 by Elsevier Inc.

Common Assessment Findings

• Muscle weakness • Decreased visual &
• Spasticity auditory acuity
• Intention tremors • Blurred vision
• Dysmetria • Scotomas
• Numbness or tingling • Nystagmus
• Hypalgesia • Tinitius
• Ataxia • Vertigo
• Dysarthria • Bowel and bladder
• Dysphagia
dysfunction
• Alteration in sexual
• Diplopia
function
• Cognitive changes
Diagnosis
Neurological Assessment: you would do on
anyone with a neurological disorder
Review history and ask about any changes to vision, mobility or
senses
S & S intermittent? Progressive?
OLDCARTS or PQRSTU
Assess:
 Cranial nerves
 Coordination
 Strength
 Reflexes
 Sensation
Diagnostic Tests
• MRI

• Evoked potentials

• Lumbar Puncture (to assess CSF for proteins)

Possible” vs. “Definite” MS
• General Physical

History of all complaints of patient’s

general health
• MRI
• Detects patchy areas of change in the CNS
Three Categories of Treatment
• Underlying Course of the Disease

• Treatment of Exacerbations

• Specific MS symptom treatment

Drug Therapy
• Therapies include:
• Biological response modifiers
• Immunosuppressives
• Steroids
• Antispasmodic drugs
• Adjuvent therapy
 Nursing diagnoses
• Fatigue related to disease state
• Activity Intolerance related to generalized weakness
• Disturbed Sensory Perception (Visual) related to altered sensory
reception
• Impaired Physical Mobility related to neuromuscular impairment
• Impaired Urinary Elimination related to sensory-motor impairment
• Chronic Pain related to chronic physical disability
• Self-Care Deficit related to neuromuscular impairment
• Disturbed Thought Processes related to disease state
• Imbalanced Nutrition: Less Than Body Requirements related to
difficulty swallowing
• Sexual Dysfunction related to altered body function
Management
• Promote mobility and self-care

• Manage cognitive problems

• Adapt to changes in sexual functioning

• Manage bladder & bowel problems

• Treat visual disturbances

• Complementary & alternative therapies

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Interventions
• Identify appropriate interventions for patients experiencing
the following problems
• Managing Fatigue
• Managing Activity Intolerance
• Coping with Cognitive Deficits
• Developing an exercise program
• Managing Pain
• Bladder and Bowel Dysfunction
2018-10-14 mmcg 19

Bladder & bowel dysfunction

• Approximately 80% of patients with MS experience

bladder dysfunction and approximately 68% experience
bowel problems

• Most common bowel complains from a person with MS

are constipation, involuntary bowel and diarrhea.
Health Teaching
• What health teaching would be important for a
newly diagnosed patient with MS?
Lifestyle considerations
Which lifestyle habits can help manage MS?
 Interprofessional Team and Community
Resources
Who can help and with what?