Nachinab Gilbert

M.Phil. BSc. Dip.

 Multiple sclerosis (MS) is a chronic, progressive,
degenerative disorder characterised by
disseminated demyelination nerve fibres of the
brain and spinal cord

 This is marked by periods of exacerbations

followed by remissions. In the end, the patient is
chronically disabled and may become wheelchair
bounds

 MS typically presents in young adults ages 20 to

40, and it affects women more frequently than men
 The cause of MS is an area of ongoing research

 However, some research findings suggest MS is

related to viral infections, immunologic and genetic
factors

 Possible precipitating factors include: infection,

physical injury, emotional stress, excessive fatigue,
and pregnancy
 Sensitized T cells typically cross the blood–brain
barrier; their function is to check the CNS for
antigens and then leave

 In MS, the 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) and oligodendroglial cells that
produce myelin in the CNS
 Plaques of sclerotic tissue appear on demyelinated
axons, further interrupting the transmission of
impulses

 Demyelination interrupts the flow of nerve

impulses and results in a variety of manifestations,
depending on which nerves are affected

 Eventually the axons themselves begin to

degenerate, resulting in permanent and irreversible
damage
 Fatigue
 Depression
 Weakness
 Numbness
 difficulty in coordination,
 loss of balance
 Pain
 Visual disturbances ie
blurred vision, diplopia,
patchy blindness
(scotoma), and total
blindness
 Involvement of the cerebellum or basal ganglia can
produce ataxia (impaired coordination of
movements) and tremor

 Bladder, bowel, and sexual dysfunctions

 MRI is the primary diagnostic tool for visualizing
plaques lesions in the white matter

 Cerebrospinal fluids (CSF) analysis reveals

increased T lymphocytes, protein and
Immunoglobulin G (IgG). IgG indicates increased
immune system activity

 EEG studies may show slowed brain activity during

the acute stage of MS
 No cure exists for MS

 An individualized supportive treatment program is

indicated

 Three medications, referred to as the “ABC (and R)

drugs,” which are injections are currently used

 The interferons beta-1a (Avonex) and beta-1b

(Betaseron) reduce the frequency of relapse by 30%
and decrease the appearance of new lesions on MRI
by 80%.

 Glatiramer acetate (Copaxone) also reduces the

number of lesions on MRI and the relapse rate.
 Rebif, for the treatment of relapsing MS

 Steroids are given to decrease inflammation

 Interferon beta-1b (Betaseron) is administered

subcutaneously every other day
 interferon beta-la (Avonex) is given by
intramuscular injection once a week

 glatiramer acetate (Copaxone) is administered by

subcutaneous injection every day

 Rebif is administered subcutaneously three times

a week
Activity Intolerance
 Help patient use assistive devices such as
walking stick, walkers and wheelchair
 Encourage independent ambulation within
limits
 Instruct patient/family how to perform
passive, assisted or active range of motion
exercises
 Instruct patient to slowly stretch and hold
muscles and release slowly to relief spasms
 Encourage patient
express fears and ask
questions
 Reassure and
encourage patient to
try alternative means
of sexual expression
 Include spouse or
sexual partner in
counselling
 Refer patient and
spouse to sex
therapist
 Encourage copious fluid intake to dilute and
reduce risk of UTIs
 Instruct patient to monitor for signs and
symptom of UTIs
 Assist patient develop a toileting routine to
ensure adequate bladder function
 Apply cold water on the abdomen, stroke the
thighs or run tap to stimulate bladder reflex