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Description : Check out this medical presentation on Neurology, which is titled "Multiple Sclerosis: What You Need to Know About the Disease", to know about Multiple Sclerosis.

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Published on : Aug 18, 2021 | Views : 2413 | Downloads : 8

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Slide 1-

Multiple Sclerosis: What You Need to Know About the Disease
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What does MS look like? Julia – a 35yo white married mother of 3 who is exhausted all the time and can’t drive because of vision problems and numbness in her feet Jackson – a 25yo African-American man who stopped working because he can’t control his bladder or remember what he read in the morning paper Maria – a 10yo Hispanic girl who falls down a lot and whose parents just told her she has MS Loretta – a 47yo white single woman who moved into a nursing home because she can no longer care for herself
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19th Century Highlights MS-related central nervous system pathology—Jean Cruveilhier, c 1841 Jean-Martin Charcot (1825–1893) described features of MS
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What MS Is: MS is thought to be a disease of the immune system – perhaps autoimmune. The immune system attacks the myelin coating around the nerves in the central nervous system (CNS – brain, spinal cord, and optic nerves) and the nerve fibers themselves. Its name comes from the scarring caused by inflammatory attacks at multiple sites in the central nervous system.
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What MS Is Not: MS is not: Contagious Directly inherited Always severely disabling Fatal—except in fairly rare instances Being diagnosed with MS is not a reason to: Stop working Stop doing things that one enjoys Not have children
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Who gets MS? Usually diagnosed between 20 and 50 Occasionally diagnosed in young children and older adults More common in women than men (2-3:1) Most common in those of Northern European ancestry More common in Caucasians than Hispanics or African Americans; rare among Asians More common in temperate areas (further from the equator)
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What Causes MS? Genetic Predisposition Environmental Trigger Autoimmunity Loss of myelin & nerve fiber
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What is the genetic factor? The risk of getting MS is approximately: 1/750 for the general population (0.1%) 1/40 for person with a close relative with MS (3%) 1/4 for an identical twin (25%) 20% of people with MS have a blood relative with MS The risk is higher in any family in which there are several family members with the disease (aka multiplex families)
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What is the prognosis? One hallmark of MS is its unpredictability. Approximately 1/3 will have a very mild course Approximately 1/3 will have a moderate course Approximately 1/3 will become more disabled Certain characteristics predict a better outcome: Female Onset before age 35 Sensory symptoms Monofocal rather than multifocal episodes Complete recovery following a relapse
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What happens in MS? ...cross the blood-brain barrier… …launch attack on myelin & nerve fibers... “Activated” T cells... …to obstruct nerve signals.
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What happens to the myelin and nerve fibers?
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What are possible symptoms? Cognitive difficulties (memory, attention, processing) Pain (neurogenic) Heat sensitivity Spasticity Gait, balance, and coordination problems Speech/swallowing problems Tremor Fatigue (most common) Decreased visual acuity, diplopia Bladder and/or bowel dysfunction Sexual dysfunction Paresthesias (tingling, (numbness, burning) Emotional disturbances (depression, mood swings) MS symptoms vary between individuals and are unpredictable
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How is MS diagnosed? MS is a clinical diagnosis: Signs and symptoms Medical history Laboratory tests Requires dissemination in time and space: Space: Evidence of scarring (plaques) in at least two separate areas of the CNS (space) Time: Evidence that the plaques occurred at different points in time There must be no other explanation
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Making the Differential Diagnosis Infection (Lyme, syphilis, PML, HTLV-1 Degenerative spinal disease Motor neuron disease Metabolic (B12 deficiency, familial diseases) CNS Lymphoma Inflammatory (SLE, Sjogren’s, vaculitis, sarcoidosis)
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What tests may be used to help confirm the diagnosis? Magnetic resonance imaging (MRI) Visual evoked potentials (VEP) Lumbar puncture
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What are the Different Patterns (courses) of MS? Relapsing-Remitting MS (RRMS) Secondary Progressive MS (SPMS) Primary Progressive MS (PPMS) Progressive-Relapsing MS (PRMS)
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Adapted with permission from Lublin FD et al. Neurology. 1996;46:907-911. (http://lww.com) Disease Courses in MS
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The Nurse’s Role in Caring for the Newly-Diagnosed MS Patient Familiarity with the normal immune system and the pathological mechanisms of MS Ability to educate and support patients and families Readiness to assist patients in making well-informed treatment decisions
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What are the treatment strategies? Gone are the “Diagnose and Adios” days of MS care Management of MS falls into five general categories: Treatment of relapses (aka exacerbations, flare-ups, attacks—that last at least 24 hours) Symptom management Disease modification Rehabilitation (maintain/improve function) Psychosocial support
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How are relapses treated? Not all relapses require treatment Mild, sensory sx are allowed to resolve on their own. Sx that interfere with function (e.g., visual or walking problems) are usually treated 3-5 day course of IV methylprednisolone—with/without an oral taper of prednisone High-dose oral steroids used by some neurologists Rehabilitation to restore/maintain function Psychosocial support
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MS Symptoms vs. Relapses… How Are They Different? MS symptoms are chronic or ongoing indicators of MS lesion damage in the brain, spinal cord, and/or optic nerve MS relapses are sudden flare-ups of disease activity (including new or worsening symptoms) that typically last several days to several weeks or months
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Cycle of MS Symptoms: Related and Interdependent  Sleep  Fatigue Depression  Bladder & Bowel problems  Sexuality issues  Spasticity Constipation  Cognitive function
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MS Symptoms Sort out / prioritize Not always MS – rule out other causes Any symptom can be related to side effects of medications Refer to appropriate discipline as needed
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The Recommended Approach to Managing MS Symptoms Prescription medications MS symptom management Specialists Physical activities Patient education
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Managing MS Symptoms
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Managing MS Symptoms
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Managing MS Symptoms
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Managing MS Symptoms
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The Nurse’s Role In Symptom Management Recognize symptoms Encourage communication about symptoms Discuss treatments and options Set realistic expectations Follow-up to assess treatment outcomes
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Who is on the MS “Treatment Team”? Neurologist Urologist Nurse Physiatrist Physical therapist Occupational therapist Speech/language pathologist Psychiatrist Psychotherapist Neuropsychologist Social worker/Care manager Pharmacist
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How is the disease course treated? Thirteen disease-modifying therapies are FDA-approved for relapsing forms of MS: glatiramer acetate (Copaxone®; Glatopa™ - generic equivalent) [inj.] interferon beta-1a (Avonex®, Plegridy™, Rebif®) [inj.] interferon beta-1b (Betaseron® and Extavia®) [inj.] dimethyl fumarate (Tecfidera™) [oral] fingolimod (Gilenya™) [oral] teriflunomide (Aubagio®) [oral] alemtuzumab (Lemtrada™) [inf] natalizumab (Tysabri®) [inf] mitoxantrone (Novantrone®) [inf]
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What do the disease-modifying drugs do? All reduce attack frequency and severity, reduce lesions on MRI, and probably slow disease progression. These medications are not designed to: Cure the disease Make people feel better Alleviate symptoms
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How important is early treatment? The Society’s National Medical Advisory Committee recommends that treatment be considered as soon as a dx of relapsing MS has been confirmed. Irreversible damage to axons occurs even in the earliest stages of the illness. Tx is most effective during early, inflammatory phase Tx is least effective during later, neurodegenerative phase No treatment has been approved for primary-progressive MS. Approximately 60% of PwMS are on Tx
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What is a clinically-isolated syndrome (CIS)? First neurologic episode caused by demyelination in the CNS May be monofocal or multifocal May or may not go on to become MS CIS accompanied by MS-like lesions on MRI is more likely to become MS than CIS without lesions on MRI All four injectable medications delay second episode
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Treatment Adherence Issues Patient readiness is key Factors affecting adherence include: Lack of knowledge about MS Unrealistic expectations Denial of illness Side effects Cultural factors Lack of support (medical team, family) Distrust of medical community
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The Nurse’s Role as Patient Advocate Educate Patients Empower Patients - educate patients on insurance coverage - educate patients how to achieve optimal benefits from healthcare team Connect patients with community programs Assist with life planning - advance directives, living wills, healthcare proxies
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So What Do We Know About MS? MS is a chronic, unpredictable disease. The cause of MS is still unknown MS affects each person differently; symptoms vary widely. MS is not fatal, contagious, directly inherited, or always disabling. Early diagnosis and treatment are important: Significant, irreversible damage can occur early on Available treatments reduce the number of relapses and may slow progression Treatment includes: relapse management, symptom management, disease modification, rehabilitation, emotional support.
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What can people do to feel their best? Reach out to their support system; no one needs to be alone in coping with MS. Stay connected with others; avoid isolation. Become an educated consumer. Make thoughtful decisions regarding: Disclosure Choice of physician Employment choices Financial planning Be aware of common emotional reactions.
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National MS Society Resources for Your Patients Nationwide network of chapters around the country Web site (www.nationalmssociety.org) Access to information and referrals (1-800-344-4867) Educational programs (in-person, online) Support programs (self-help groups, peer and professional counseling, friendly visitors) Consultation (legal, employment, insurance, long-term care Financial assistance
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National MS Society Resources for You Professional Resource Center www.nationalMSsociety.org/PRC healthprof_info@nmss.org Clinical consultations with MS specialists Literature search services Professional publications Professional education programs (medical, rehab, nursing, mental health) Consultation on insurance and long-term care issues