Multiple sclerosis also known as disseminated sclerosis ) is a disease in which the

fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading
to demyelination and scarring as well as a broad spectrum of signs and symptoms.[1] Disease
onset usually occurs in young adults, and it is more common in females.[1] It has a prevalence
that ranges between 2 and 150 per 100,000. MS typically presents in young adults ages 20 to 40,
and it affects women more frequently than men (MS affects the ability of nerve cells in the brain and
spinal cord to communicate with each other. Nerve cells communicate by sending electrical
signals called action potentials down long fibers called axons, which are wrapped in an
insulating substance called myelin. In MS, the body's own immune system attacks and damages
the myelin. When myelin is lost, the axons can no longer effectively conduct signals.[4] The
name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) in
the white matter of the brain and spinal cord, which is mainly composed of myelin.

Classification

1. relapsing remitting,

2. secondary progressive,

3. primary progressive, and

4. Progressive relapsing.

The relapsing-remitting : subtype is characterized by unpredictable relapses followed by periods

of months to years of relative quiet (remission) with no new signs of disease activity.

Secondary progressive MS (sometimes called "galloping MS"): describes around 65 % of those

with an initial relapsing-remitting MS, who then begin to have progressive neurologic decline
between acute attacks without any definite periods of remission.

The primary progressive :subtype describes the approximately 10–15% of individuals who
never have remission after their initial MS symptoms. It is characterized by progression of
disability from onset, with no, or only occasional and minor, remissions and improvements.

Progressive relapsing MS :describes those individuals who, from onset, have a steady
neurologic decline but also suffer clear superimposed attacks. This is the least common of all
subtypes.

Etiologies and risk factors

Exact cause is unknown. Most likely MS occurs as a result of some combination of genetic,
environmental and infectious factors.

Genetic

MS is not considered a hereditary disease. However, a number of genetic variations have been
shown to increase the risk of developing the disease. The risk of acquiring MS is higher in
relatives of a person with the disease than in the general population, especially in the case
of siblings, parents, and children.[4] The disease has an overall familial recurrence rate of 20%.
 OTHER RISK FACTORS

MS is more common in people who live farther from the equator, although many exceptions
exist.[1] Decreased sunlight exposure has been linked with a higher risk of MS.
[18]
Decreased vitamin D production and intake has been the main biological mechanism used to
explain the higher risk among those less exposed to sun.

• STRESS
• SMOKING
• OCCUPATIONAL TOXINS AND SOLVENTS
• VACCINATION
• DIET
• HORMONE INTAKE
• INFECTION

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS
common signs and symptom include motor, sensory, cerebellar,
and emotional problems
motor symptom include:weakness or paralysis of limb, trunk or
head;diplopia;scanning speech;spasticity of muscle
sensory symptom: tingling and other parasthesias, patchy
blindness(scotomas), blurredd vision, vertigo, tinnitus, deacreased
hearing and chronic neuropathic pain.
lhermitt’s sign: electric shock radiating down the spine or into the
limbs with the flexion of neck
cerrebelar sign:nystagmus , ataxia, dysarthria and dysphagia.
other symptoms
severe fatigue
bowel and bladder dysfunction
spastic bladder
flaccid bladder
urinary urgency, frequency dribbling and incontinence
sexual dysfunction
decreased libido in women and erectile dysfunction in men
anger,depression,or euphoria.

Assessment and Diagnostic Findings

MRI is the primary diagnostic tool for visualizing plaques,
documenting disease activity, and evaluating the effect of
treatment. Electrophoresis of CSF identifies the presence of
oligoclonal banding (several bands of immunoglobulin G bonded
together, indicating an immune system abnormality). Evoked
potential studies can help define the extent of the disease process
and monitor changes. Underlying bladder dysfunction is diagnosed
by urodynamic studies. Neuropsychological testing may be
indicated to assess cognitive impairment. A sexual history helps to
identify changes in sexual function.

Medical Management
No cure exists for MS. An individualized, organized, and rational
treatment program is indicated to relieve the patient’s symptoms
and provide continuing support, particularly for individuals with
cognitive changes (50%), who may need more structure and
support. The goals of treatment are to delay the progression of
the disease, manage chronic symptoms, and treat acute
exacerbations.
“Initiation of therapy with an immunomodulator is advised as soon
as possible following a definite diagnosis of MS with a relapsing
course, and may be considered for selected patients with a first
attack who are at high risk for MS.”
Corticosteroids
Interferons β :
 Betaseron (interferon β -1b)

  Avonex (interferon β -1a)
 Rebif (interferon β -1a)


Immunosuppressants and immunomodulators:


 Copaxone (glatiramer acetate)
Novantrone (mitoxantrone)

SYMPTOMATIC MANAGEMENT
• 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
NURSING MANAGEMENT
DIAGNOSIS
• Impaired physical mobility related to weakness, muscle paresis,
spasticity
• Risk for injury related to sensory and visual impairment
• Impaired urinary and bowel elimination (urgency, frequency,
incontinence (constipation) related to nervous system dysfunction
• Impaired speech and swallowing related to cranial nerve
Involvement.
• Disturbed thought processes (loss of memory, dementia,
euphoria) related to cerebral dysfunction
• Ineffective individual coping related to uncertainty of course of MS
• Impaired home maintenance management related to physical,
psychological, and social limits imposed by MS
• Potential for sexual dysfunction related to spinal cord involvement
or psychological reactions to condition