Chapter 8 MultipleSclerosis Overview of Multiple Sclerosis•Inflammatory, demyelinating condition of the central nervous system. •Affects twice as many women as men. •Multifaceted and progressive disease. •Myriad of physical, psychological, social, vocational, and economic implications. •It is a lifelong condition. •Caused by complex set of factors includinggenetic predisposition and unknown environmental factors. The Role of Myelin •Myelin -Fatty, protective sheath that surrounds and insulates the axon in the brain and spinal cord; promotes rapid transmission of nerve impulses. •Term multiple sclerosis comes from: -Multiple areas of scarring (sclerosis) that occur when myelin surrounding nerve fibers in the brain and spinal cord destroyed. Types of Multiple Sclerosis •Relapsing-Remitting-Fluctuating course of relapses with associatedneurologic deficits, followed by periods of partial or total recovery after relapse. •Secondary Progressive -Cessation of fluctuations with slow deterioration and progression. •Primary Progressive -Deterioration from beginning. Initial Manifestationsof Multiple Sclerosis•Vary dramatically from individual to individual.-Fatigue -Slight muscle weakness -Difficulty with vision -Impaired balance or coordination Potential Manifestations of Multiple Sclerosis •Systemic Changes -Fatigue; sensitivity to heat. •Sensory Manifestations -Can vary from decreased sensation to pain. •Vision -Any portion of visual system may be affected. •Optic neuritis (blurring of vision) •Diplopia (double vision) •Nystagmus (back-and-forth movement of eye)
Potential Manifestationsof Multiple Sclerosis (Cont.)•Motor Manifestations -Muscle weakness, or partial or complete paralysis of any part of the body; individuals also experience ataxia, vertigo, and spasticity.•Speech and Swallowing -Difficulty swallowing (dysphagia) or difficulty with speech. -Unclear articulationof words (dysarthria)-Changes in voice quality (dysphonia) •Cognitive Changes -Difficulties with attention, conceptualization, memory, or new learning.Potential Manifestationsof Multiple Sclerosis (Cont.)•Depression -Both depression and euphoria may be direct result of neural damage. •Bowel or Bladder Control-May affect bladder and bowel function. •Sexual Function and Fertility -May be direct result of nerve damage resulting from myelin destruction and associated scaring. •Severe Fatigue Identification and Confirmation of Multiple Sclerosis •Magnetic resonance imaging detects plaques suggestive of multiple sclerosis. •Evoked potential (electrical test) assesses the time it takes a nerve impulse from an area of the body to reach the brain. Management of Multiple Sclerosis •Lifelong condition.•No established pattern of functional change.•No unpredictable outcome. •Varying degrees of progression rates of functional change. •No cure and deterioration that has taken place cannot be reversed.Management of MultipleSclerosis (Cont.)•Approximately 65% develop relapsing-remitting form of MS. •Interventions directed toward:-Managing individual manifestations.-Preventing exacerbations and complication. -Maintaining function. Management of Multiple Sclerosis (Cont.) •Management of Exacerbations -Maintain healthy lifestyle -Identify potential triggers -Medications •Interferons •Immunosuppressants •Steroids
Management of MultipleSclerosis (Cont.)•Managing Systemic Manifestations-Chronic pain -Motor difficulties-Spasticity -Speech and swallowing difficulties -Cognitive difficulties-Bladder and bowel management -Depression Functional Implicationsof Multiple Sclerosis•Personal and Psychosocial Issues•Activities and Participation -Social and family participation -Sexuality -Assistive devices and home modification Vocational Issues in Multiple Sclerosis •Usually identified during peak years of employment. •Can significantly affect individuals' ability to remain in the workforce. •Functional abilities related to mobility, communication, vision, and cognitive function need to be addressed. Vocational Issues in Multiple Sclerosis (Cont.) •Emotional stress and physical stress can cause temporary worsening of manifestations. •Individuals with multiple sclerosis should avoid hot and humid environments. •Increased susceptibility to complications from infectious conditions.