MS: Nursing Management, Pharmacology, & Considerations

In this multiple sclerosis lecture, we’ll be discussing the condition’s nursing management, pharmacology, nursing considerations, and more.

Multiple Sclerosis: Defined

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) which involves the brain and the spinal cord. The main component that is affected with multiple sclerosis is the myelin sheath.

Multiple sclerosis is an autoimmune condition wherein the body attacks itself, and in this case, the myelin sheath of the brain and the spinal cord.

Tip: How can you easily associate multiple sclerosis with myelin sheath? You can remember this by thinking of their acronyms – both are MS.

Functions of Myelin Sheaths

Myelin sheaths primarily aid in the action potential of the neurons. An action potential is just a fancy word for electrical impulses. Without myelin sheaths covering the neurons, electricity won’t be able to travel efficiently through multiple systems; therefore, function, movement, and range of motion are affected and disrupted.

In multiple sclerosis, there is a degradation of myelin sheaths, and this condition usually occurs in people who are 20 to 30 years old.

Multiple Sclerosis: Diagnosis

Multiple sclerosis is diagnosed by analyzing specimens taken from the brain stem and spinal cord. What is the process of diagnosis?

1. A CT scan is done to check for plaques on neurons of the central nervous system.
2. A lumbar puncture or lumbar spinal puncture is done to the client to get samples of the cerebrospinal fluid (CSF).

The CSF will be tested for gamma globulins or immunoglobulin to assess if the body is making an immune response that affects the myelin sheath to the point of degradation. This degradation will present as plaques around the neurons where the myelin sheaths are located.

Multiple Sclerosis: Signs and Symptoms

When thinking about the signs and symptoms of certain diseases, you should always consider its pathophysiology. In the case of multiple sclerosis, the components responsible for transferring electrical impulses are compromised, resulting to slow energy transfer. Therefore, the apparent manifestations would be the following:

• Fatigue
• Numbness and tingling
• Low dexterity
• Altered sensations
• Burning or hot feeling

Multiple Sclerosis versus Other Neurological Diseases

Unlike other types of neurological diseases, like amyotrophic lateral sclerosis (ALS) or popularly known as Lou Gehrig’s disease, that are progressive, multiple sclerosis is a neurodegenerative disorder that causes problematic relay with episodes of remissions.

Multiple sclerosis is similar to Cushing’s disease or Lupus wherein some triggers can cause outbreaks; like an intermission or ebb and flow. So, the body will attack itself then will back down, then attack itself again due to specific triggers that healthcare providers should watch out for.

Multiple Sclerosis: Medications

There are different types of medications given to MS clients.

1. Interferon

The most common medication that is given to MS clients is Interferon. Interferon interferes with the body’s attack on the myelin sheaths. By getting in the way of these recurring attacks on the myelin sheaths, Interferon helps in preventing myelin sheath degradation.

2. IVIG

Intravenous immunoglobulin (IVIG) is another medication given to MS clients. When IVIG is given to an MS client, it acts as bait; deceiving the body and convincing it to attack the IVIG instead of the myelin sheaths. IVIG is given every two to three months.

Though effective, IVIG is quite expensive that medical insurance companies, like Medicare, do not like it when they see this medication in their statement. 

3. Copaxone

Another drug of choice for MS is Copaxone. You can remember this by thinking of the drug packing the myelin sheaths, coating and protecting them from attacks. Copaxone is composed of amino acids that create a protective layer around the myelin sheaths, allowing repair and regeneration.

4. Steroids

Acting as an anti-inflammatory, steroids like Solu-Medrol, are effective in decreasing immune response; thus, preventing the body from attacking the myelin sheaths.

5. Stool Softeners

To help MS clients address constipation brought about by the condition, stool softeners are also prescribed.

Multiple Sclerosis: Considerations

Client goals for MS clients include the following:

1. Keep a functional state, maintaining a good range of motion.
2. Avoid exacerbations due to the intermittent nature of the disease.
3. Avoid stress or aggravating situations that will trigger or push the body to increase immune response.
4. Strenuous activities like marathons or exercises like CrossFit.
5. Instruct clients to keep up with their medication regimen.
6. Alternate activities with periods of rest.

For more easy-to-understand nursing-related topics, drop by our SimpleNursing website and our YouTube channel.