This presentation provides an overview of multiple sclerosis (MS). It defines MS as an immune-mediated demyelinating disease of the central nervous system where myelin is destroyed. Symptoms can include sensory and mobility issues as well as cognitive and psychological problems. Diagnosis involves MRI, lumbar puncture, and evoked potential studies. Management focuses on symptomatic treatment and disease-modifying drugs. Nursing care aims to improve mobility and elimination while preventing injury through safety measures and assistive devices. Recent studies examine cognitive dysfunction in MS and its effects on daily living.

1. peer group
presentation
on
multiple sclerosis
Presented by:
Ms. Hari singh nagar
M. Sc Nursing 1st year

2. Multiple sclerosis
Introduction – it is an immune mediated
demyelinating disease of the CNS.
Demyelination refers to destruction of myelin,
the fatty and protein material that surround
the nerve fibres in the brain and spinal cord,
it result in impaired transmission of nerve
impulse.

3. Neurons
Cell bodies
Form the grey matter ( grey
matter found in periphery of
brain, centre of spinal cord )
Group of cell bodies called
Nuclei ( CNS )
Ganglia ( PNS )
Axon & dendrites
Form the white matter (
white matter found in
centre of brain, periphery
of spinal cord )
Group of axon called
Tract ( CNS )
Nerves ( PNS )

6. Incidence
It occurs between the age of 20-50 years.
It mostly affect to the female than male.
Definition
It is a chronic, progressive, non contagious,
degenerating disease of the CNS
characterized by the demyelination of the
neurons.

7. Etiology
• Unknown
• Immune system attack it own tissue so it is
considered an autoimmune disease.
• Factor
 Age – 20-50 years of age
 Gender – female
 Certain infection – Epstein barr virus
 Temperature climate
 Smoking
 Autoimmune disease - DM

9. Clinical manifestation
• Disruption of sensory axon may produce sensory
dysfunction such as pain, paresthesia (pricking
sensation).
• Spasticity (unusual "tightness", stiffness, or
"pull" of muscles) of the extremities results
from involvement of the main motor pathway of
the spinal cord.
• Cognitive and psychological problems involve
frontal lobe and parietal lobe.
• Euphoria – due to loss of connection between
cortex and basal ganglia.

10. • Bowel, bladder and sexual dysfunction.
• Advanced symptoms –
 Pronounced difficulty in moving
 Severe visual impairment

14. Diagnostic evaluation
• History and Physical examination
• MRI – reveal plaque or lesion around demyelinated
neuron.
• EEG
• CSF Electrophoresis– presence of immunoglobulin G
(normal protein is 15-45mg/dl) elevated 10 mg/dl then
normal
• Evoked potential studies – it measure electrical activity
in the brain in response to stimulation of sight, sound, or
touch. When the brain is stimulated by sight, sound, or
touch, signals travel along the nerves to the brain.
There, electrodes detect the signals and display them
for your doctor to interpret.

16. Management
1. Symptomatic treatment
• Spasticity – Dantrolene sodium
• Optic neuritis – oral steroids
• Fatigue – anti depressant (fluoxetine and
amitryptylin)
• Pain – codeine sulphate
• Sexual dysfunction – Viagra
• Tremors – Propranolol

17. 2. Disease modifying drugs
A. Interferon beta 1a – it suppress immune
system and helps to maintain blood brain
barriers.
E.g. - Avonex – I/M, once a week
Rebif – S/C three times a week
B. Interferon beta 1b – used to treat the
relapsing-remitting and secondary-progressive
forms of multiple sclerosis. It is given.
E.g. – Betaseron, S/C in every 2 days

18. C. Glatiramer Acetate – it decrease the
reoccurrence of relapse. S/C, daily.
D. Methylprednisolone – treat acute relapse. It
relieve inflammation act on T-Cells & cytokines.
1 gm IV daily for 3 days
3. Alternative complementary therapies
It include Acupuncture, Aromatherapy (oil), Cold
immersion, Dietary supplements, Herbal
medication, Massage, Meditation, Yoga and

19. Venom such as snake and bee-Bee venom
is a mixture of many substances. The pain and
swelling of the sting are caused by histamine,
dopamine, serotonin, and norephinephrine. Several
toxins are also present, including apamin, melittin,
monoamine, and mast-cell degranulating peptide.
Lastly, the substances responsible for the allergic
response include hyaluronidase and phospholipase-
A2, enzymes that work to activate immune cells and
produce immunoglobulin E (IgE). Bee venom is a
complex mixture, and it is not known how its
components affect the human body or interact with
autoimmune conditions such as MS.

20. Complication
• Paralysis
• Epilepsy
• Muscle spasm
• Depression
• Mental changes – mood swings or
forgetfulness
• Bladder, bowel and sexual dysfunction

21. Nursing management
1. Nursing diagnosis – Impaired physical mobility
related to weakness, spasticity as evidence by
fatigue, gait (unsteady) limited ROM.
Nursing goal – To improve physical mobility
Intervention – Assess the muscle strength,
weakness and coordination.

22. • Encourage ambulation
• Provide safety measures.
• Provide rest between the movement.
• Place personal belonging near to the patient.
• Observe vital sign.

23. 2. Nursing diagnosis – impaired urinary
elimination related to neurological impairment as
evidence by incontinence, UTI.
Nursing goal – To improve urinary elimination
Intervention - Institute bladder training
program.
• Encourage adequate fluid intake, avoid use of
caffeine.

24. • Provide continuity mobility decrease risk of
UTI.
• To teach about the catherization.
• Provide perineal care to prevent skin irritation.
• Monitor I/O ratio.
• Administer antibiotics medication.

25. 3. Nursing diagnosis – risk for injury related
to sensory and visual impairment as evidence by
pain, paresthesia and blindness.
Nursing goal – To prevent injury
Intervention
• Walk with feet apart to widen the base of
support and increasing walking stability.
• Provide assistive device (walker, cane and
crutches)

26. • Provide wheel chair to patient.
• Watch the feet while walking.
• The patient is trained in transfer and perform
the ADLs.

27. Recent studies regarding the MS
Cognitive dysfunction in multiple sclerosis: a
review of recent developments
Purpose of review: Nearly half of all patients
diagnosed with multiple sclerosis will develop
cognitive dysfunction, a symptom associated
with significant decline in activities of daily
living. The purpose of this review is to discuss
recent literature investigating issues related to
cognitive dysfunction in multiple sclerosis.

28. Cont....
Recent studies, examined in this review, have
provided increased understanding regarding
specific cognitive processes affected in multiple
sclerosis, as well as a characterization of its
natural history. Studies have also continued to
emphasize the extent to which cognitive deficits
in the condition are associated with decline in
daily living skills. Recent concerns regarding
driving performance have been documented
among cognitively impaired individuals.

29. Cont.....
Studies have also examined correlates of
cognitive dysfunction, with particular emphasis
on neuro-imaging techniques reflecting disease
activity or lesion burden. With increased
understanding of neurobiological correlates of
cognitive deficits, investigators have begun to
examine potential treatments for managing
cognitive dysfunction.

30. Summary

31. References
• “Burnner and Suddarth’s” text book of
medical surgical nursing, twelth
edition,Wolters publication, Page no. 1316-
1317
• “Saunders” comprehensive review for the
NCLEX RN examination, fifth edition,
elsevier publication, page no. 494-495
• www.authorstream.com
• www.slideshare.com