Unit 2E: Multiple Sclerosis

Front 1

Chronic, progressive, degenerative disorder of the CNS characterized by disseminated demyelination of nerve tissue fibers of the brain and spinal cord
-effects young to middle-age adults
-women more than men
-characterized by chronic inflammation, demyelination, and gliosis (scarring) in the CNS
-onset is insidious and gradual

Back 1

-Multiple Sclerosis (MS)

Front 2

Describe etiology and pathophysiology of MS:

Back 2

-Possible precipitating factors include infection, physical injury, emotional stress, excessive fatigue, pregnancy, and a poorer state of health
-Activate T-cells migrate to the CNS, causing blood-brain barrier disruption resulting in activation of the inflammatory response and, through multiple effector mechanisms, leads to demyelination of axons
-in the end this results in plaque formation

1.) Initially the myelin sheaths of the neurons in the brain and spinal cord are attacked and damaged
2.) Nerve fiber, at first, is not affected, and nerve impulses are still transmitted; patient may complain of a noticeable impairment of function
3.) Myelin can regenerate, and the symptoms will disappear having the patient experience remission
4.) After time, myelin is replaced by glial scar tissue (sclerotic plaques) and nerve impulses slow down
5.) Total destruction of myelin results in impulses being totally blocked, resulting in permanent loss of function

Front 3

Describe signs and symptoms of MS:

Back 3

-Onset of dz is insidious and gradual
-Symptoms intermittently over months or years
-Characterized by chronic, progressive deterioration in some persons and by remissions and exacerbations in others
-With repeated exacerbations, progressive scarring of the myelin sheath occurs, and the overall trend is progressive deterioration in neurologic function
-Symptoms vary according to the areas of the CNS involved

-Motor: weakness or paralysis of the limbs, trunk, or head; diplopia; scanning speech; and spasticity of the muscles

-Sensory: including numbness and tingling and other paresthesias, patchy blindness (scotomas), blurred vision, vertigo, tinnitus, decreased hearing, and chronic neuropathic pain

-Cerebellar: nystagmus, ataxia, dysarthria, and dysphagia

-Emotional: fatigue, depression

-Elimination control dysfunction: constipation, spastic and flaccid bladder
-Sexual dysfunction
-Anger, depression, or euphoria
-Death usually occurs due to infective complications

Front 4

Describe drug treatment for a patient with MS:

Back 4

-Treating the dz process and providing symptomatic relief

-Corticosteroids such as Medrol and ACTH and pred are used to treat exacerbations by reducing edema and acute inflammation at the site of demyelination; do not affect the ultimate outcome or degree of residual neurologic impairment

-Immunosuppressants such as azathioprine, methotrexate, and cytoxan; reduce both b and t lymphocytes but benefits must outweight the serious side effects

-Immunomodulators such as interferon are use for ambulatory patients

-Antispasmodics for spasticity such as diazepam, Dantrium

-CNS stimulants such as ritalin to fight fatigue

-Amantadine to fight fatigue also (antiviral)

Front 5

What are common tiggers for a patient with MS?

Back 5

-infection (esp URI and UTI)
-trauma
-immunization
-delivery after pregnancy
-stress
-climate changes

Front 6

What are the most common reasons for hospitalization for a person with MS?

Back 6

-diagnostic workup
-treatment of acute exacerbations