Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination of neurons. It typically occurs between ages 20-40 and involves periods of remission and exacerbation. The causes are unknown but may involve an autoimmune response or viral infection. Symptoms include fatigue, weakness, vision problems, numbness, tremors, and emotional changes. Diagnosis involves a medical history, physical exam, EEG, and lumbar puncture. Management focuses on conservation of energy during exacerbations, safety measures, exercise, assistive devices, therapy, a balanced diet, and medication administration.

1. JOHNY WILBERT, M.SC[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. Definition
 Multiple sclerosis is a chronic, progressive,
noncontagious, degenerative disease of the CNS
characterized by demyelinization of the neurons.
 It usually occurs between the ages of 20 and 40 years and
consists of periods of remissions and exacerbations.

3. Etiology
 The causes are unknown, but the disease is
thought to be the result of an autoimmune
 response or viral infection.
 Precipitating factors include pregnancy,
 fatigue,
 stress,
 infection,
 and trauma.

4. Clinical manifestation
1. Fatigue and weakness
2. Ataxia and vertigo
3. Tremors and spasticity of the lower extremities
4. Parasthesias
5. Blurred vision, diplopia, and transient blindness
6. Nystagmus
7. Dysphasia

5. 8. Decreased perception to pain, touch, andtemperature
9. Bladder and bowel disturbances, including
urgency, frequency, retention, and incontinence
10. Abnormal reflexes, including hyperreflexia,
absent reflexes, and a positive Babinski reflex
11. Emotional changes such as apathy, euphoria,
irritability, and depression
12. Memory changes and confusion

6. Diagnostic evaluation
 History collection
 Physical examination
 Electroencephalographic findings are abnormal.
 Assessment of a lumbar puncture indicates an
increased gamma globulin level, but the serum
globulin level is normal.

7. Managements
1. Provide energy conservation measures during
exacerbation.
2. Protect the client from injury by providing
safety measures.
3. Place an eye patch on the eye for diplopia.
4. Monitor for potential complications such as
urinary tract infections, calculi, pressure ulcers,
respiratory tract infections, and contractures.

8. 5. Promote regular elimination by bladder and
bowel training.
6. Encourage independence.
7. Assist the client to establish a regular exercise
and rest program.
8. Instruct the client to balance moderate activity with rest
periods.
9. Assess the need for and provide assistive
devices.

9. 10. Initiate physical and speech therapy.
11. Instruct the client to avoid fatigue, stress,
infection,overheating, and chilling.
12. Instruct the client to increase fluid intake
and eat a balanced diet, including low-fat,
high-fiber foods and foods high in potassium.
13. Instruct the client in safety measures related
to sensory loss, such as regulating the temperature
of bath water and avoiding heating
pads.

10. 14. Instruct the client in safety measures related to motor
loss, such as avoiding the use of scatter
rugs and using assistive devices.
15. Instruct the client in the self-administration ofprescribed
medications.
16. Provide information about the National Multiple
Sclerosis Society.