Multiple sclerosis (MS) is a disease affecting nerves in the brain and spinal cord, causing problems with muscle movement, balance and vision

1. HARSHITA
II ND YEAR
A.B.C.O.N

3. Multiple sclerosis (MS) is a disease
affecting nerves in the brain and spinal
cord, causing problems with muscle
movement, balance and vision.
Multiple sclerosis (MS), also known
as disseminated
sclerosis or encephalomyelitis disseminate,
is an inflammatory disease in which the
insulating cover of nerve cell in
the brain and spinal cord are damaged

5. This damage disrupts the ability of parts of
the nervous system to communicate,
resulting in a wide range of sometimes
psychiatric problem.

6. Multiple sclerosis (MS) occurs because of
damage to the nerve fibres of the central
nervous system. Central nervous system
consists of the brain and spinal cord and is
responsible for controlling every action,
conscious and unconscious, of our body.

7. Myelin
When you perform an action, your brain
sends messages to the appropriate part of
your body through the nerve fibres in
your spinal cord. These nerve fibres are
covered by a substance called myelin.
Myelin insulates the nerve fibres and
helps carry messages to and from your
brain quickly and smoothly. In MS, the
myelin around your nerve fibres becomes
damaged. This disturbs the messages
coming to and from your brain.

8. Autoimmune condition
MS is an autoimmune
condition. This means your immune
system mistakes the myelin for a
foreign substance and attacks it.
The myelin becomes inflamed in
small patches (called plaques or
lesions), which can be seen on an
MRI scan. This process is called
demyelination.

9. The three main characteristics of MS are the
formation of lesions in the central nervous
system (also called plaques), inflammation, and
the destruction of myelin sheath of neurons.
These features interact in a complex and not
yet fully understood manner to produce the
breakdown of nerve tissue and in turn the signs
and symptoms of the disease.
Additionally MS is believed to be an immune
mediates disorder that develops from an
interaction of the individual's genetics and as yet
unidentified environmental causes.
Damage is believed to be caused, at least in
part, by the person's own immune system
attacking the nervous system.[1]

10. lesions
The name multiple sclerosis refers to the
scars that form in the nervous system.
These lesions most commonly affect
the white matter in the optic nerve, brain
stem, basal ganglia and spinal cord, or
white matter tracts close to the
lateral ventricles.
The function of white matter cells is to
carry signals between grey matter areas,
where the processing is done, and the rest
of the body. The peripheral nervous
system is rarely involved.[2]

11. INFLAMMATION
Apart from demyelination, the other sign of
the disease is inflammation. Fitting with
an immunological explanation, the
inflammatory process is caused by T cells, a
kind of lymphocyte that plays an important
role in the body's defenses. T cells gain
entry into the brain via disruptions in
the blood–brain barrier. The T cells
recognize myelin as foreign and attack it,
explaining why these cells are also called
"autoreactive lymphocytes".

12. Blood–brain barrier
The blood–brain barrier is a part of
the capillary system that prevents the
entry of T cells into the central nervous
system. It may become permeable to these
types of cells secondary to an infection by
a virus or bacteria. After it repairs itself,
typically once the infection has cleared, T
cells may remain trapped inside the brain.
Gadolinium cannot cross a normal BBB and
therefore Gadolinium-enhanced MRI is used
to show BBB breakdowns.

13. The central nervous system (brain and spinal
cord) controls all of your body's actions. When
MS damages the nerve fibres that carry
messages to and from your brain, symptoms
can occur in any part of your body.
There are many different symptoms of MS and
they affect each person differently. Some of the
most common symptoms include:
numbness and tingling
blurring of vision
problems with mobility and balance
muscle weakness and tightness

15.  RELAPSING REMITTING MS
It is characterized by periods of worsening
symptoms followed by periods of improvement.
It affects 90% of patients with MS.
 PROGRESSIVE MS
the disease keeps on getting worse without any
improvement. About half the patients with the
first type end up having the progressive MS within
15 years if they are not treated.

16. Animation showing dissemination of brain
lesions in time and space as demonstrated by
monthly MRI studies along a year.
Multiple sclerosis is typically diagnosed based
on the presenting signs and symptoms, in
combination with supporting medical
imaging and laboratory testing.
It can be difficult to confirm, especially
early on, since the signs and symptoms may
be similar to other medical problems.

18. The criteria which focus on clinical,
laboratory and radiologic evidence of lesions
at different times and in different areas is
the most commonly used method of
diagnosis with the Schumacher and Poser
criteria being of mostly historical
significance. While the above criteria allow
for a non-invasive diagnosis, some state that
the only definitive proof is an autopsy or
biopsy where lesions typical of MS are
detected.

20. Although there is still no cure for MS,
effective strategies are available to modify
the disease course, treat exacerbations (also
called attacks, relapses, or flare-ups),
manage symptoms, improve function
and safety, and provide emotional support. In
combination, these treatments enhance the
quality of life for people living with MS.

21. Spasticity- Baclofen, Tizanidine, Diazepam, Dantrolene
Optic Neuritis- Methlyprednisolone, Oral steroids
Fatigue- Antidepressant, Amantadine
Pain- Codeine, Aspirin
Sexual Dysfunction- Viagra, Pravatine
Tremor- Isoniazid, Primidone, Propranolol
Disease-Modifying Drugs- Interferon beta 1a and 1b,
and Glatiramer acetate

22. Interferon Beta 1a
(Avonex and Rebif): is
a protein that is a replica of
human interferon. It
suppress the immune system
and helps to maintain the
blood-brain barrier. You
inject Avonex into the
muscle once a week and
Rebif is injected under the
skin three times a week.
This drug is useful to people
who have definite
progressive MS. One side
effect of the drug is a flu
like symptom.
Interferon Beta 1b
(Betaseron): is slightly
different from our own
interferon. This
medication does the same
thing as beta 1a, but is
injected just under the
skin every two days. Side
effects include irritation,
bruising, and redness at
the site of injection and
the flu like symptoms.
This is also given to
people who have definite
progressive MS.

23. Glatiramer Acetate ( Copaxone):
“is a small fragment of a protein that resembles a
protein in myelin” ( O’Connor 106). It decrease the
reoccurrence of relapse. It is injected just under
the skin every day. There is no flu like symptoms but
occasional redness may occur at the injection site. A
few amount of people do experience brief shortness
of breathe.
In summary all three of these drugs decrease
relapses by 33%, have manageable side effect, are
injected, stabilize the disease, and tend to be costly.

24. Beta interferons:Interferons can cause many
side effects, including reactions in the
injection area and liver damage. However,
it's rare to have serious, permanent side
effects. You'll likely need blood tests to
monitor your liver function and blood count.
Glatiramer acetate (Copaxone):Side effects
are uncommon, but may include flushing,
chest pain or heart palpitations after
injection and reactions at the injection sites.

25. Acupuncture
Aromatherapy
Cannabis (Marijuana)
Chiropractic
Cold Immersion
Dietary Supplements
Herbal Medication
Homeotherapy
Injection of Venom such
as snake and bee
Massage
Meditation
Reflexology
Tai Chi
Yoga

27. Assessment
Assess actual and potential problems.
Observe the patient’s movements and walking to
determine if there is danger of falling.
Assess the patient for weakness, spasticity, visual
impairment, incontinence, and disorders of swallowing
and speech.
Assess the effect of MS on the patient’s lifestyle.
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28. Nursing diagnoses
Risk for injury related to sensory and visual impairment
Impaired speech and swallowing related to cranial nerve
involvement
Planning and goals
Avoidance of injury.
Promotion of speech and swallowing mechanisms.
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29. Nursing Interventions (Preventing injury)
If the patient is at risk for falling, he is taught to walk with feet
wide apart to widen the base of support.
If there is loss of position sense, the patient is taught to watch
the feet while walking.
Gait training may require assistive devices (walker, crutches)
and instruction about their use by a physical therapist. If the
gait remains inefficient, a wheelchair or motorized scooter may
be the solution.
The patient is trained in transfer and activities of daily living.
Because sensory loss may occur in addition to motor loss,
pressure ulcers are a continuing threat to skin integrity.
Confinement to a wheelchair increases the risk.
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30. Managing speech and swallowing difficulties
A speech therapist evaluates speech and swallowing and
instructs the patient, family, and health team members about
strategies to compensate for speech and swallowing problems.
The nurse reinforces this instruction and encourages the patient
and family to adhere to the plan.
Impaired swallowing increases the patient’s risk for aspiration;
therefore, strategies (eg, having suction apparatus available,
careful feeding, proper positioning for eating) are needed to
reduce that risk.
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31. Evaluation (Expected patient outcomes)
The patient is free of injury
 Uses visual cues to compensate for decreased sense of touch or
position
 Asks for assistance when necessary
The patient participates in strategies to improve speech and
swallowing
 Practices exercises recommended by speech therapist
 Maintains adequate nutritional intake without aspiration
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