Multiple sclerosis (MS) is an immune-mediated progressive demyelinating disease of the central nervous system that results in destruction of myelin and oligodendrocytes. Genetic and environmental factors contribute to MS, which most commonly affects women aged 15-50. There are four clinical forms - relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing. Symptoms vary depending on location of lesions but may include fatigue, weakness, sensory disturbances, vision problems, and impaired coordination. Diagnosis involves MRI and lumbar puncture. While there is no cure, treatments aim to reduce relapses and slow progression through immunomodulators, corticosteroids, and rehabilitation. Nursing focuses on

1. MULTIPLE
SCLEROSIS (MS)
Compiled By-
Mr.Ashish Roy
(Nursing Tutor)

2. Multiple Sclerosis (MS)
• Multiple sclerosis (MS) is an immune-
mediated progressive demyelinating disease
of the CNS.
• Demyelination refers to the destruction of
myelin, the fatty and protein material that
surrounds certain nerve fibers in the brain and
spinal cord; it results in impaired transmission
of nerve impulses

4. Pathophysiology
In MS, the sensitized T cells remain in the CNS and promote the
infiltration of other agents that damage the immune system( or due to
autoimmune dysfunction, genetic susceptibility, or an infectious
process).
Leads to inflammation that destroys myelin (which normally insulates
the axon and speeds the conduction of impulses along the axon) and
oligodendroglial cells that produce myelin in the CNS.
Plaques of sclerotic tissue appear on demyelinated axons
Interrupting the transmission of impulses
Progressive muscle weakness.

5. Etiology Factors / Causes
• Genetic predisposition is indicated by the
presence of a specific cluster (haplotype) of
human leukocyte antigens (HLA) on the cell
wall.
• Viruses

6. Incidence
• 15 to 50 yrs of age
• women>men
• 30 per 100,000 occurs in northern European,
northern UN, southern Canada and southern
Australia and New Zealand and very low cases
seen in india.

7. Classification
The National Multiple Sclerosis Advisory Committee recognizes four
clinical forms of MS:
• Relapsing remitting (RR): clearly defined acute attacks evolve over
days to weeks. Partial recovery of function occurs over weeks to
months. Average frequency of attacks is once every 2 years and
neurologic stability remains between attacks without disease
progression. (At the time of onset, 90% of cases of MS are diagnosed
as RR.)
• Secondary progressive (SP): always begins as RR but clinical course
changes with declining attack rate, with a steady deterioration in
neurologic function unrelated to the original attack. (Fifty percent of
those with RR will progress to SP within 10 years; 90% will progress
within 25 years.)
• Primary progressive (PP): characterized by steady progression of
disability from onset without exacerbations and remissions. More
prevalent among males and older individuals. Worst prognosis for
neurologic disability. (Ten percent of cases of MS are diagnosed as PP.)
• Progressive relapsing (PR): the same as PP except that patients
experience acute exacerbations along with a steadily progressive
course. (Rarest form)

9. Clinical Manifestations
• Fatigue and weakness.
• Abnormal reflexes: absent or exaggerated.
• Vision disturbances: impaired and double vision,
nystagmus.
• Motor dysfunction:weakness, tremor,
incoordination.
• Sensory disturbances: paresthesias, impaired
deep sensation, impaired vibratory and position
sense.
• Impaired speech:slurring, scanning (dysarthria).
• Urinary dysfunction:hesitancy, frequency, urgency,
retention, incontinence; upper UTI
• Neurobehavioral syndromes:depression, cognitive
impairment, emotional distrubances.

10. Diagnostic Evaluation
• Serial brain MRI studies have proved to be
useful for diagnosing and monitoring patients
with MS show small plaques scattered
throughout white matter of CNS.
• Electrophoresis study of CSF shows abnormal
IgG antibody.

11. Management
• No cure exists for MS.

12. PHARMACOLOGIC THERAPY
• Three medications, referred to as the “ABC
drugs” are
• currently the main pharmacologic therapy for
MS. It inclides interferons beta-1a (Avonex)
and beta-1b (Betaseron) and Glatiramer
acetate (Copaxone) also reduces the number
of lesions on MRI and the relapse rate.

13. • Corticosteroids(prednisolone) hormone are used to
decrease inflammation, shorten duration of relapse or
exacerbation.
• Immunosuppressive agents may stabilize the course.
• Treatment of spasticity with agents, such as baclofen,
dantrolene diazepam; physical therapy; nerve blocks and
surgical intervention
• Control of fatigue with amantadine (Symmetrel) and
lifestyle changes
• Treatment of depression with antidepressant drugs.
• Bladder management with anticholinergics, intermittent
catheterization for drainage, prophylactic antibiotics
• Bowel management with stool softeners, bulk laxative,
suppositories
• Rehabilitation management with physical therapy,
occupational therapy, speech therapy, cognitive therapy,
vocational rehabilitation, and complementary and
alternative medicine

14. Complications
• Respiratory dysfunction
• Infections: bladder, respiratory, sepsis
• Complications from immobility
• Speech, voice, and language disorders such as
dysarthria

15. Nursing Diagnoses
1. Impaired Physical Mobility related to muscle weakness, spasticity,
and incoordination.
• Promoting Motor Function
• Perform muscle stretching and strengthening exercises daily, or
teach patient or family to perform, using a stretch-hold-relax
routine to minimize spasticity and prevent contractures.
• Apply ice packs before stretching to reduce spasticity.
• Tell patient to avoid muscle fatigue by stopping activity just short of
fatigue and taking frequent rest periods.
• Encourage ambulation and activity, and teach patient how to use
such devices as braces, canes, and walkers when necessary.
• Inform the patient to avoid sudden changes in position, which may
cause falls due to loss of position sense, and to walk with a wide-
based gait.
• Encourage frequent change in position while immobilized to
prevent contractures; sleeping prone will minimize flexor spasm of
hips and knees

16. 2. Fatigue related to disease process and stress of
coping
• Minimizing Fatigue
• Help patient and family understand that fatigue is
an integral part of multiple sclerosis.
• Plan ahead, and prioritize activities. Take brief
rest periods throughout the day.
• Avoid overheating, overexertion, and infection.
• Encourage energy conservation techniques, such
as sitting to perform activity, limiting trips up and
down stairs, pulling, or pushing rather than
lifting.
• Help patient develop healthy lifestyle with
balanced diet, rest, exercise, and relaxation.

17. 3. Disturbed Sensory Perception (tactile, kinesthetic, visual)
related to disease process
• Optimizing Sensory Function
• Suggest use of an eye patch or frosted lens (alternate eyes)
for patients with double vision.
• Encourage ophthalmologic consultation to maximize vision.
• Provide a safe environment for patient with any sensory
alteration.
– Orient patient to the environment, and keep arrangement of
furniture and personal articles constant.
– Make sure floor is free from obstacles, loose rugs, or slippery
areas.
– Teach the use of all senses to maintain awareness of
environment

18. 4. Impaired Urinary Elimination related to the disease process
• Interrupted Family Processes related to inability to fulfill
expected roles
• Normalizing Family Processes
• Encourage verbalization of feelings of each family member.
• Encourage counseling and use of church or community
resources.
• Suggest dividing up household duties and child-care
responsibilities to prevent strain on one person.
• Explore adaptation of some roles so patient can still function
in family unit.
• Expand treatment efforts to include the whole family.
• Support mothers with MS who often face fatigue and episodic
exacerbations during their child-rearing years.

19. 5. Sexual Dysfunction related to disease process
• Suggest sexual activity when patient is most
rested.
• Promoting Sexual Functions by certain exercises
• Encourage open communication between
partners.
• Discuss birth control options, if appropriate.
• Suggest consultation with sexual therapist to help
obtain greater sexual satisfaction.

20. THANKYOU FOR YOUR KIND
ATTENTION &
ACTIVE LISTENING…
IF ANY QUERY REGARDING THE TOPIC
KINDLY ASK…
THE END.