Multiple sclerosis is a neurological disorder that affects the myelin sheath of the neurons in the central nervous system. This video will discuss the pathophysiology of multiple sclerosis, signs and symptoms, nursing interventions, and medications used to treat MS.
Multiple sclerosis tends to affect women more than men and tends to occur between the ages of 20-40 years. It is an autoimmune condition where the immune system cells are actually attacking the myelin sheath on the axon of the neuron.
What is the function of the myelin sheath? To protect and insulate the axon so nerve transmission can occur. However, if the myelin sheath is damaged this causes inflammation and scarring of the neuron, which will lead to a decrease in nerve transmission. This is why sensory and motor symptoms can present in this condition.
Signs and symptoms of multiple sclerosis vary among patients because lesions (demyelination of the myelin sheath) can occur in various places. Therefore, typical signs and symptoms include: fatigue, tingling/numbness of the face and extremities, speech issues (dysarthria), coordination issues, dizziness, vertigo, vision issues (blurry vision, dark spots in visual field, nystagmus, pain when moving the eyes etc.), tremors, muscle spasms, bowel and bladder problems along with specific signs such as:
Lhermitte's Sign: this is where if the patient moves their head and neck in certain positions it will elicit an electrical shock sensation down the body. Uhthoff's Sign: experiencing extreme heat will make MS signs and symptoms worst. Romberg's Sign: the patient loses coordination when closing eyes in a standing position (their body becomes unaware of its position in space).
Multiple Sclerosis nursing intervention include: safety, educating about preventing worsening of symptoms (avoid heat, stress, infection, and overexertion), bladder and bowel education (self-cath, high fiber diet, 1-2 L of fluids, skin care), etc.
Medication used to treat multiple sclerosis are based on the patient's signs and symptoms (there is currently no cure for this disease). Medications include: Beta interferon (Avonex, Rebif), corticosteroids (for relapse of symptoms), Oxybutynin and Bethanechol (bladder issues), Bacolfen (spasms), Propranolol (tremors), etc.
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