MULTIPLE SCLEROSIS. Mary Beth Rensberger, RN, BSN, MPH Author

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1 MULTIPLE SCLEROSIS Mary Beth Rensberger, RN, BSN, MPH Author All rights reserved. Purchasers of this module are permitted to reproduce the forms contained herein for their individual internal use only. Other than that encouraged exception, no part of this publication may be reproduced, in any form or by any means, electronic or mechanical including photocopying, recording or by any information storage and retrieval system without prior written permission of the authors. MEG Associates Consulting Group, Inc. will share 50% of net proceeds of settlements or jury awards for essential evidence of illegal copyright infringement. For information address Meg Associates Consulting Group, Inc., 227 Bernard Court, Fort Lupton, CO COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 1

2 MULTIPLE SCLEROSIS INSTRUCTIONS 1. Review the following materials. 2. Answer all questions on the post- test. 3. Return the post-test to your supervisor. OBJECTIVE Upon completion of this module, the participant will understand the disease process and will be able to identify ways to effectively assist the patient who has Multiple Sclerosis. COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 2

3 MULTIPLE SCLEROSIS The Disease Multiple sclerosis (MS) is a progressive disabling illness that affects nerve cells in the brain and spinal cord. Normally, an insulating cover made of fatty myelin, which acts much like the covering of an electric wire and speeds the passage of nerve impulses, surrounds these nerve cells. It is the speed and efficiency with which these impulses are conducted that permits smooth, rapid, and coordinated movements to be performed with little conscious effort. In MS, this myelin sheath is inflamed or damaged, disrupting nerve impulses and leaving many areas of scarring ( sclerosis ). The term Multiple Sclerosis literally means many scars. The interruption of nerve signals within the brain and spinal cord causes a variety of symptoms that may affect vision, sensation, and body movements. These symptoms usually increase and decrease through a series of relapses (when symptoms get worse) alternating with remissions (when symptoms improve). For many patients, a long history of MS attacks over several decades leads to slowly progressing disability. For others, the disability is more rapid and severe. In still other groups of patients (about 10%), the disease is relatively harmless. MS is the most common nerve disease to develop in young persons after birth, and affects over one million young adults worldwide. It is 5 times more common in temperate climates (farther from the equator) than in the tropics (close to the equator), and strikes 50% more women than men (three women for every two men). In northern Europe, particularly Scandinavia and Scotland, there is a high incidence of MS, which may indicate a specific weakness of the native population. MS is a disease of young people, with the average age of onset being years. However, the disease attacks a broad range of people from ages years. With today s technology, there are cases of MS being diagnosed in childhood rather than in adolescence or young adulthood. MS is not contagious, which means it cannot be caught from a person with the disease. It is also not an inherited disease. There does, however, seem to be some genetic susceptibility to the disease, which explains the fact that there is a slightly higher risk of MS in families where it has already occurred. Scientists suspect that MS develops, not from one gene, but because of the influence of several genes acting together. The cause of Multiple Sclerosis is not known, but thousands of researchers all over the world are researching the disease, trying to unlock its mysteries. The damage to myelin may be due to an abnormal response of the body s immune system, which normally defends the body against bacteria and viruses. Many of the characteristics of MS suggest an autoimmune disease where the body attacks its own cells and tissues, which in the case of MS is myelin. Experts do not know what triggers the immune system to attack myelin, but it is thought to be combinations of several factors. COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 3

4 One theory is that a virus, possibly lying dormant in the body, may play a major role in the development of the disease and may disturb the immune system or indirectly start the autoimmune process. There has been a great deal of research trying to identify an MS virus. It is probable that there is no one MS virus, but that a common virus, such as measles or herpes (chicken pox), may act as a trigger for MS. This trigger activates white blood cells in the blood stream, which enter the brain by weakening the brain s defense mechanisms. Once inside the brain, these cells activate other elements of the immune system in such a way that they attack and destroy myelin. Another theory is that physical or emotional stress is the cause of MS. Symptoms of MS will vary depending on which areas of the brain and spinal cord are affected. In the brain, MS can cause any of the following problems: Sudden loss of vision; blurred or double vision Slurred speech Dizziness Problem with memory, concentration, judgment, reasoning Clumsiness Unsteady gait Trembling of a hand Muscle weakness A feeling of extreme tiredness Facial symptoms, including numbness, weakness, or pain If MS damages the spinal cord symptoms may include: Loss of bladder control Inability to empty the bladder Feeling of tingling, numbness, or tightening in the arms, legs, or elsewhere Weakness or a heavy feeling in the arms or legs. Early MS may present itself as a history of vague symptoms, which may have subsided. Many of the symptoms could be attributed to a number of medical conditions. Therefore, a period of time may go by, and a prolonged diagnostic process may be involved, before MS is suggested. On the other hand, a possible diagnosis of MS may be clearer with classic symptoms like vision problems and a distinct pattern of attacks. The neurologist requires evidence that the types of neurological problems indicate involvement of at least two different areas of the central nervous system with effects occuring at two separate times. There are no specific tests that are specific for MS and no single diagnostic test is 100% conclusive. Therefore, several tests and observations are needed to establish a diagnosis of MS. The doctor would ask for a medical history, which would include a past record of signs and symptoms, as well as the current status of the patient s health. He or she would look for a sudden appearance of symptoms that signal nerve damage in the brain and/or spinal cord. Although these symptoms usually begin in someone who is younger than age 40, older persons between ages 40 and 60 are also sometimes affected. During an examination, the doctor would look for COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 4

5 signs of nerve damage, including: vision problems, changes in eye movements, difficulty in walking or in coordinating body movements, muscle weakness, balance problems, changes in speech, trembling hands, or loss of sensation. This neurological examination cannot conclude what is causing the abnormality and so other possible causes of illness, which produce similar symptoms to MS, must be eliminated. The doctor may suspect the diagnosis of MS based on the patient s age, the history of sudden onset of neurological symptoms, and the results of physical and neurological examinations. Other possible diagnostic tests include: a detailed eye examination by an eye specialist, a CT scan of the brain, a spinal tap to remove spinal fluid for lab testing, or evoked potential tests to check for abnormalities in specific nerve pathways. When scarring occurs the conduction of messages along the nerves may be slowed. Evoked potentials measure the time taken for the brain to receive and interpret messages. This is done by placing small electrodes on the head, which monitor brain waves in response to visual and auditory (hearing) stimuli. Normally, the brain s reaction to these stimuli is almost instantaneous, but if there is demyelination in the central nervous system, a delay may occur. This test is not invasive or painful and therefore does not require a stay in the hospital. To confirm the diagnosis of MS, the doctor will order a MRI examination of the brain and/or spinal cord to check for scars or damage. The MRI scanner is a diagnostic test and takes very detailed pictures of the brain and spinal cord, showing any existing areas of scarring. The MRI shows the size, quantity and distribution of scars and is a very significant indicator toward confirming the diagnosis. As a rule, the timing, duration and damage of MS attacks are unpredictable. The disease may have a minimal affect on some people. Others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms, there are a number of distinct patterns relating to the course of the disease. The three most common patterns are: 1. Relapsing remitting MS. In this form of MS, there are relapses (when symptoms suddenly get worse), followed by remissions (periods of recovery). Between relapses, the patient s condition is fairly stable, without deterioration. 2. Primary progressive MS. In this form, there is a gradual and continuous worsening of symptoms from the time when the illness first begins. There are no episodes of relapses and remissions. 3. Secondary progressive MS. In this form, someone who originally had relapsing remitting MS now begins to suffer gradual deterioration in nerve function, with or without relapses. Secondary progressive MS ultimately affects 50% of those with relapsing remitting MS. COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 5

6 MS is a lifelong illness that has no cure. There is currently no way to prevent MS. There are, however, several medication treatments available, which change immune system activity and/ or have anti-inflammatory effects. The most common treatment for MS relapses is the injection of steroids directly into the vein. Steroids shorten the duration of MS relapses and speed up the recovery in an attack, but their long-term affect on the course of the illness is not known. There are also several other medications that can be prescribed for a patient who is having a relapse of MS. In general, MS is a progressive illness that may last 30 to 40 years, and the degree of progression and eventual disability varies from patient to patient. There is great hope that newer forms of treatment will have significant long-term effects in improving the lives of MS patients. Many MS patients live productive, fulfilling, and relatively normal lives. For many, it is unnecessary to give up work, education, and social activities. How the aide can help the patient with MS: Encourage the patient to be as independent as possible. Follow the care plan regarding range of motion or strengthening exercises to help the patient maintain functioning as long as possible. Always be aware of safety precautions when assisting an MS patient. Strength and function of muscles can vary and a sudden spell of weakness may occur. Use proper positioning and turning techniques. While providing personal care, pay close attention to the person s skin condition and note any reddened areas. COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 6

7 TEST MULTIPLE SCLEROSIS You are required to turn this in for your file. Circle the correct answer: 1. Multiple Sclerosis is: a. a chronic disease with no cure b. a disease which affects those over 60 c. prevented by the use of universal precautions d. both a and b 2. Typically, MS produces: a. intolerable pain in the joints b. periods of relapses and remissions c. severe thirst and frequent urination d. all of the above 3. The average age of onset of MS is: a years b years c years d. over 60 years 4. The cause of MS is: e. unknown f. inherited g. E coli bacteria h. food poisoning 5. Three common symptoms of multiple sclerosis are: a. nasal congestion, watery eyes, sneezing b. chest pain, shortness of breath, nausea c. vision changes, muscle weakness, trembling d. diarrhea, stomach cramps, hunger 6. With damage to the spinal cord, these symptoms might occur: a. weakness or heaviness in arms or legs b. loss of bladder control c. slurred speech d. facial pain e. both a and b f. both c and d COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 7

8 7. The specific test used to diagnose MS is: a. ultrasound b. spinal x-ray c. liver scan d. none of the above e. 8. The following drugs are used to treat MS: a. aspirin or tylenol b. nitroglycerine c. steroids by IV d. all of the above 9. The aide who works with MS patients should do these things: a. offer emotional support and encouragement b. do everything for the patient so she can rest c. be sure to check skin for breakdown d. encourage fluids and fiber e. all of the above except b 10. The MS patient may experience changes in mood because: a. she has lost control of many aspects of her life b. she is dehydrated c. she is having a drug reaction d. none of the above I have received, read and understand the handout in-service for this month. Signed: Name (printed): Title: Date: Time Started: Time Completed: Total Time: Total Time Allowed: Two Hours COPYRIGHT - Mary Beth Rensberger RN BSN MPH - Multiple Sclerosis - All Rights Reserved 8