Multiple sclerosis presented by Ofosu Bempah Kingsley, ECG Hospital, Kpandai-Ghana

1. MULTIPLE SCLEROSIS
BY
OFOSU BEMPAH

2. LEARNING OBJECTIVES
• Anatomic and Physiologic Overview
• Definition
• Causes
• Pathophysiology
• Clinical Manifestations
• Diagnostic Investigations
• Management

3. Anatomic and Physiologic Overview
The nervous system consists of two major parts: the central
nervous system (CNS), including the brain and spinal cord, and
the peripheral nervous system, which includes the cranial
nerves, spinal nerves, and autonomic nervous system. The
function of the nervous system is to control motor, sensory,
autonomic, cognitive, and behavioral activities.

4. Anatomic and Physiologic Overview
• The brain itself contains more than 100 billion cells that link
the motor and sensory pathways, monitor the body’s
processes, respond to the internal and external environment,
maintain homeostasis, and direct all psychological, biologic,
and physical activity through complex chemical and electrical
messages (Klein & Stewart-Amidei, 2009).

5. Cells of the Nervous System
The basic functional unit of the brain is the neuron. It is composed of
dendrites, a cell body, and an axon. The dendrites are branch-type
structures for receiving electrochemical messages. The axon is a long
projection that carries electrical impulses away from the cell body.
Neurons have a myelinated sheath that increases speed of conduction.

6. Cells of the Nervous System
Nerve cell bodies occurring in clusters are called ganglia or
nuclei. A cluster of cell bodies with the same function is called
a center (eg, the respiratory center). (Hickey, 2009). Neurones
cannot divide, and for survival they need a continuous supply
of oxygen and glucose.

11. Neurotransmitters
Neurotransmitters communicate messages from one neuron to another or
from a neuron to a specific target tissue. Neurotransmitters are
manufactured and stored in synaptic vesicles. As an electrical action
potential propagated along the axon reaches the nerve terminal,
neurotransmitters are released into the synapse. The neurotransmitter
diffuses or is transported across the synapse, binding to receptors in the
postsynaptic cell membrane. A neurotransmitter potentiates, terminates, or
modulates a specific action, and it can either excite or inhibit activity of
the target cell.

12. MAJOR NEUROTRANSMITTERS
NEUROTRANSMITTERS SOURCES ACTION
Serotonin Brain stem, hypothalamus,
spinal cord
helps control mood and
sleep, inhibits pain pathways
Dopamine Substantia nigra and basal
ganglia
affects behavior (attention,
emotions) and fine movement
Norepinephrine Brain stem, hypothalamus,
Spinal cord, cerebellum
affects mood and overall
activity
Enkephalin, endorphin Nerve terminals in the spine, brain
stem, thalamus and hypothalamus,
pituitary gland
pleasurable sensation,
inhibits pain
transmission

13. Multiple sclerosis
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. MS may occur at any age but typically
manifests in young adults between the ages of 20 and 40 years; it affects
women more frequently than men (Porth & Matfin, 2009).

14. CAUSES
The cause of MS is an area of ongoing research (Costello & Sipe, 2008).
Autoimmune activity results in demyelination, but the sensitized antigen has
not been identified.
Precipitating factors
Geographic prevalence
Related to infectious, immunologic, and genetic factors
Physical injury
Emotional stress
Excessive fatigue
Pregnancy
Poor state of health

15. Pathophysiology
Sensitized T and B lymphocytes cross the blood–brain barrier; their
function is to check the CNS for antigens and then leave. In MS,
sensitized T cells remain in the CNS and promote the infiltration of
other agents that damage the immune system. The immune system
attack leads to inflammation that destroys myelin (which normally
insulates the axon and speeds the conduction of impulses along the
axon.

16. Pathophysiology cont...
Demyelination interrupts the flow of nerve impulses and results in a variety of
manifestations, depending on the nerves affected. Plaques appear on
demyelinated axons, further interrupting the transmission of impulses.
Demyelinated axons are scattered irregularly throughout the CNS. The areas
most frequently affected are the optic nerves, the cerebrum; the brain stem and
cerebellum; and the spinal cord. The axons themselves begin to degenerate,
resulting in permanent and irreversible damage (Costello & Sipe, 2008; Porth &
Matfin, 2009).

19. CLINICAL MANIFESTATION
• Common signs and symptoms include motor, sensory,
cerebellar, and emotional problems
Motor manifestations
Weakness or paralysis of limbs, trunk, and head
Diplopia (double vision)
Scanning speech
Spasticity of muscles

20. •Sensory manifestations
Numbness and tingling
Blurred vision
Vertigo and tinnitus
Decreased hearing
Chronic neuropathic pain
• Cerebellar manifestations
 Nystagmus- Involuntary eye
movements
Ataxia- impaired coordination of
movements
Dysarthria
Lack of coordination in articulating
speech
 Dysphagia-Difficulty swallowing

21. CLINICAL MANIFESTATION
• Emotional manifestations
Anger
Depression
Euphoria
• Bowel and bladder functions
 Constipation
Spastic bladder: small capacity for
urine results in incontinence
Flaccid bladder: large capacity for
urine and no sensation to urinate

22. CLINICAL MANIFESTATION
• Sexual dysfunction
 Erectile dysfunction
 Decreased libido
 Difficulty with orgasmic response
 Painful intercourse
 Decreased lubrication

23. Diagnostic Studies
• Based primarily on history,
clinical manifestations, and
presence of multiple lesions over
time measured by MRI
• Computed Tomography
• Magnetic Resonance Imaging

25. MANAGEMENT
• No cure exists for MS. An individual treatment program is indicated to relieve
the patient’s symptoms and provide continuing support, particularly for
patients with cognitive changes, who may need more structure and support.
The goals of treatment are to delay the progression of the disease.Medications
prescribed for MS include those for disease modification and those for
symptom management. The disease-modifying therapies available to treat MS
include immunomodulating therapies and immunosuppressive agents
• (Ross, Hackbarth, Rohl, et al., 2008).

26. • (Betaseron) are administered subcutaneously.
• Copaxone is administered subcutaneously daily
• IV methylprednisolone
• (Novantrone) is administered via IV infusion every 3 months.
• NB
Ataxia is a chronic problem most resistant to treatment. Medications used to
treat ataxia include betaadrenergic blockers (Inderal), antiseizure agents
(Neurontin), and benzodiazepines (Klonopin).

27. Management cont...
• Physical therapy helps
Relieve spasticity
Increase coordination
Train the patient to substitute
unaffected muscles for impaired
ones
• Nutritional therapy includes
megavitamins and diets
consisting of low_x0002_fat,
gluten-free food, and raw
vegetables
High-protein diet with
supplementary vitamins is often
prescribed

28. Nursing Diagnoses
• Impaired physical mobility
• Dressing/grooming self-care
deficit
• Risk for impaired skin integrity
• Impaired urinary elimination
pattern
• Sexual dysfunction
• Interrupted family processes

29. Nursing Planning
• Maximize neuromuscular function
• Maintain independence in activities of daily living for as long as
possible
• Optimize psychosocial well-being
• Adjust to the illness
• Reduce factors that precipitate exacerbations

30. Nursing Implementation
• Help identify triggers and develop ways to avoid them or
minimize their effects
• Reassure patient during diagnostic phase
• Assist in dealing with anxiety caused by diagnosis
• Prevent major complications of immobility
• Focus teaching on building general resistance to illness
Avoiding fatigue, extremes of hot and cold, exposure to infection
• Teach good balance of exercise and rest, nutrition, avoidance of
hazards of immobility
• Teach adequate intake of fiber to aid in regular bowel habits

31. REFERENCES
• Hinkle and Cheever (2010), Brunner and Suddarth’s Textbook of
Medical-Surgical Nursing, Twelve edition
• Ross and Wilson Anatomy and Physiology in health and illness,
Twelve edition

32. THANK YOU FOR YOUR
ATTENTION