Multiple Sclerosis - Lecture notes Neuro PDF

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Summary

MS lecture/book notes. Symptoms, diagnostics, management...

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Manifestations/S&S Etiology - chronic, progressive, degenerative, neuro-immune disorder of the CNS - disseminated demyelination of nerve fibers in the myelin sheath of the brain, optic nerve & spinal cord - later affecting other organs - myelin can regenerate at first, but may lead to further damage - chronic inflammation, gliosis, demyelination (3 main processes) - unknown cause/trigger, autoimmune - trigger activates inflammatory response, leads to the demyelination of axons - Risk Factors: smoking, pregnancy, infection, excessive fatigue, emotional stress, poor state of health - risk increased if have 1st degree relative - myelin can be replaced by glial scar tissue, but nerve impulses slow down without myelin - by the time axons are destructed, impulses can become totally blocked - results in permanent loss of nerve function when at worse stage - vague sx can occur intermittently over months & years - may not be dx until after the onset of the first sx - depending on location of affected nerve fibers, wide variety of manifestations occur - chronic progressive deterioration - Periods of Remission - Relapses/Exacerbations Levels of Progression: (the number of exacerbations, the worsening the sx become, faster) 1. Relapsing Remitting (RRMS) 2. Primary Progressive (PPMS) 3. Secondary Progressive (SPMS) 4. Progression Relapsing (PRMS)

Motor, Sensory, Cerebellar & Emotional - diplopia - numbness/weakness uni/bilateral - pain w/ eye movements - optic neuritis - blurred vision - tingling pain - electric shock sensation - dizzy - tremors - unsteady gait - fatigue - lack of coordination - weakness of limbs, head & trunk - Ataxia - vertigo & tinnitus - chronic neuropathic pain - loss of proprioception - LHermitte's Sign (shock like pain down spine or limbs when flexing neck) - speech difficulty - nystagmus - patchy blindness - Dysphagia - Mood Alterations, Anger, Depression - Cognitive Decline - Constipation - Spastic Bladder: small capacity for urine which results in incontinence - Flaccid Bladder: large capacity for urine with no sensation to urinate, retention

Multiple Sclerosis Diagnostic Testing: MS can mimic other neuro diseases, making it hard to dx, it is based primarily on hx & manifestations, presence of multiple lesions or scar tissue over time seen on MRI/CT MRI - can visualize the areas of demyelination & Lesions, most definitive results CT - shows atrophy & white matter lesions Lumbar Puncture (LP) - shows increase in Oligoclonal Immunoglobulin (IgG), contains higher number of lymphocytes & monocytes  Pts can have severe headache after LP, tx with Tylenol

Nursing Care/Management: relieve spasticity, administer all meds, increase coordination, prevent infection/stasis, manage risk for skin integrity break down, help with ADLs, self care, prevent excessive stress, exertion, prevent exposure to hot temps, prevent fevers, prevent fatigue, bear weight daily, all vaccines up to date (pneumo & flu), good nutrition, avoid hazards of immobility, teach self cath if necessary, fiber intake

Corticosteroids

Methylprednisolone, Prednisone  Reduce edema & inflammation at site of demyelination  Oral or IV  May require ST Hospitalization or IV therapy

Disease Modifying Agents (immunomodulators/biologic response modulators)

Interferon B-1a (Avonex, Rebif) Interferon B-1b (Betaseron) Glatiramer (Copaxone) Natalizumab (Antegren) Mitoxantrone (Novantrone)  Very expensive  Require injections  More effective when initiated early on in disease process  Prevent relapses

Antispasmodic, Muscle Relaxants

Baclofen (Lioresal) Dantrolene (Dantrium)  Decrease muscle spasticity  Relax muscles

Depression Treatment

SSRI’s & Antidepressants

Receptor Modulator (reduce relapses)

Gilenya (Fingolimod)  Delays disability progression

Nerve Conduction Enhancer

Dalfampridine (Ampyra)  Improves walking speed...