Multiple Sclerosis (MS) Overview

Multiple Sclerosis (MS)

• MS affects the myelin and nerve fibers of the brain and spinal cord
• MS is a leading cause of neurologic disability in young and middle-aged adults
• Multiple factors of MS can include; immune, genetic, and/or infections
• Change in immunity is a likely etiology
• MS is common in colder climates
• MS typically occurs between ages 20 to 50
• Women are 2 to 3 times more likely to develop MS than men
• 1 million people in the US have MS
• 2.3 million people worldwide have MS
• 900,000 people in Canada have MS

Types of MS

• Clinically isolated syndrome (CIS) lasts 24 hours, may or may not show up on MRI, over half diagnosed with CIS develop MS within 10 years
• Relapsing-remitting (RRMS) occurs most often, may be mild-moderate, symptoms develop then resolve in a few weeks/months, patient returns to his baseline
• During relapsing phase: loss of function and onset of new symptoms
• Primary progressive (PPMS): progressive disability without acute attacks or remission
• Common onset of PPMS is 40-60 years of age
• Secondary progressive MS (SPMS): Begins with RRMS that later becomes steadily progressive, usually within 10 years of RRMS diagnosis

Assessment

• Vision, mobility, sensory perception changes can be early indicators of MS
• It is important to ask about intermittent or progressive conditions
• Document the month and year the condition occurs, factors that aggravate symptoms (fatigue, stress), personality changes, history of MS or autoimmune disease
• Physical assessment may reveal muscle weakness, fatigue, diplopia, depression, vertigo, pain, emotional changes, tinnitus
• Psychosocial assessments are important, as diagnosis can take a long time and feelings of frustration, anger and anxiety are common
• Loss of independence can be a concern
• Loss of urine and bowel control can cause self-esteem issues, depression, euphoria (diseas or drugs used to treat)

Laboratory & Diagnostic Assessment

• MS can be confused with amyotrophic lateral sclerosis (ALS)
• CSF: elevated protein (oligoclonal bands), elevated WBC, increase in myelin basic protein and increased IgG in lab results
• An MRI of the brain that shows the presence of plaques in at least 2 areas is considered diagnostic
• Evoked potential testing: NONINVASIVE test can identify impaired transmission along the optic nerve pathway.

Analysis

• Impaired immunity is common in people with MS due to the disease and drug therapy used for disease management
• Decreased or impaired mobility occurs due to muscle spasticity, intention tremors, and/or fatigue
• Decreased visual acuity and cognition results from dysfunctional brain neurons

Planning & Implementation

• Spasticity, tremors, pain, and fatigue can cause mobility issues
• PT/OT can help manage functional deficits from MS (utensils)
• Plan an exercise program that includes ROM exercises and strengthening and stretching exercises to manage spasticity and tremor
• Rigorous activities that increase body temperature should be avoided as they can cause fatigue, diminished motor ability and decreased visual acuity
• The team should collaborate with the Case Manager, PT, OT, and Family to ensure the home is safe from hazards before discharge - remove throw rugs, encourage a home environment that is structured and free of clutter; it may eventually need to be wheelchair modified.
• Modifying the kitchen, bathroom, and bedroom helps maintain self-care for longer
• Teach the importance of planning activities to save energy and decrease stress
• Speech therapist can assist with dysarthria (difficulty speaking) and/or dysphagia (difficulty swallowing)
• Medications, like Baclofen or tizanidine can be used to lesson the effects of spasticity, and can be given intrathecally via a surgically inserted pump
• Paresthesia- carbamazepine or tricyclic antidepressants can be used

Care Coordination & Transition Management

• People with MS can typically live independently with some assistance
• Using the multidisciplinary team helps maintain maximum strength, function, and independence
• It is important to emphasize the importance of avoiding overexertion, stress, extremes of temperatures (fever, hot baths, sauna bath, excessive chilling), humidity, people with infections
• Ensure that all medications, the time and route of taking, dosage, purpose, and side effects are explained, in particular, how to differentiate between expected side effects and adverse/allergic reactions, as well as who to contact for issues or questions, and provide written instructions
• A physical therapist develops and exercise program that can be completed at home and emphasize the importance of continuing an exercise program, and teaches them self-care, daily living skills, and use of required equipment (walkers, electric carts)
• Teach bowel and bladder management, skin care, nutrition, and positioning techniques
• Teach conservation strategies that balance rest periods with periods of activity, including regular social interactions with family and friends, assistive devices, and modifying the environment to avoid fatigue, as well as stress management techniques
• Remind the family of personality changes that can happen with this disease and the need for a non-verbal connection that can be made to let the patient know behavior is inappropriate
• National Multiple Sclerosis Society, Meal-delivery services, transportation services for disabled and home-maker services are all community groups that can help.