Ever wondered why multiple sclerosis (MS) is such a complex and mystifying condition? How does this disease subtly sneak its way into the nervous system, disrupting nerve impulses, and causing a myriad of symptoms that make it both challenging to diagnose and manage? Our resident expert, Dr. Hobbick, takes us on an educational journey through the tricky landscape of MS, illuminating its demyelinating nature, the distinctive types, and the crucial role of genetics and environment in its onset.
Dr. Hobbick explains how the use of MRIs in diagnosing MS helps identify plaques, indicative of the disease, in different areas of the brain and spinal cord. She provides practical advice on symptom management and a detailed overview of medication options, their effects on the immune system, and the importance of a holistic, interdisciplinary treatment approach. In addition, she steers us towards another neuromuscular disorder, myasthenia gravus - discussing its unique characteristics and treatment options. Join us as we shed light on these neurological conditions, helping you to better understand, manage, and navigate this often complex field.
Ever wondered why multiple sclerosis (MS) is such a complex and mystifying condition? How does this disease subtly sneak its way into the nervous system, disrupting nerve impulses, and causing a myriad of symptoms that make it both challenging to diagnose and manage? Our resident expert, Dr. Hobbick, takes us on an educational journey through the tricky landscape of MS, illuminating its demyelinating nature, the distinctive types, and the crucial role of genetics and environment in its onset.
Dr. Hobbick explains how the use of MRIs in diagnosing MS helps identify plaques, indicative of the disease, in different areas of the brain and spinal cord. She provides practical advice on symptom management and a detailed overview of medication options, their effects on the immune system, and the importance of a holistic, interdisciplinary treatment approach. In addition, she steers us towards another neuromuscular disorder, myasthenia gravus - discussing its unique characteristics and treatment options. Join us as we shed light on these neurological conditions, helping you to better understand, manage, and navigate this often complex field.
Hey and welcome to Nursing with Dr Hobbick. Today I'm thinking about multiple sclerosis. Since we're on the neurologic system, I thought that we could cover this one. It's usually used as an exemplar if you're learning in a concept-based program. Otherwise it's really a good. I mean, it's not a good disease, but it's a good example of neurological conditions. Something you need to keep in mind is that all of these conditions will have some similar symptoms Because they affect the nervous system. Then they're gonna have similar symptoms. What is special or different about the condition that you're thinking about? When we talked about spinal cord injuries, we think about autonomic dysforflexia. We think about spinal cord levels at C3 through C5. We have to think about respiratory With multiple sclerosis. There's some other things that we can pick out that are special for that condition. Those things are the things that are more likely to be asked on a nursing test question or on your NCLEX.
Speaker 1:Remember that multiple sclerosis is demyelinating. It removes the myelin sheath from the central nervous system. What that does is it disrupts the transmission of nerve impulses. Typically it is an insidious onset, and insidious I always think of evil slow, sneaky. So insidious means it's a slow onset. The patient may not notice the initial symptoms right away until they continue to get worse. 50% of patients are still ambulatory 25 years after diagnosis. So half of patients can still walk after they've been diagnosed 25 years later.
Speaker 1:Another characteristic of multiple sclerosis is that it's characterized by periods of remission and exacerbation. So remission the symptoms get better, they maybe go away. Exacerbation is a flare up. There's actually four types. We have relapsing, remitting, primary progressive, secondary progressive and progressive relapsing. Relapsing remitting is the most common type of MS and that's the classic picture. Really, what we have here is the symptoms develop and resolve in a few weeks to months and the patient returns to baseline. So with relapsing remitting, the patient returns to baseline. They have symptoms and then return to baseline. Primary, progressive is a steady, gradual deterioration without any remission. Secondary, progressive starts with relapsing remitting and later turns into a steadily progressive condition. About half of people with relapsing remitting will develop secondary progressive. And then we have progressive relapsing, which is frequent relapses with partial recovery. The patient never returns to baseline. That's only a small percentage of patients.
Speaker 1:Now what puts you at risk for multiple sclerosis? It is super complicated. We know that it involves multiple immune, genetic and or infectious factors, although changes in immunity are most likely the cause. The environment can contribute because we know that it's seen more often in colder climates like northeastern Great Lakes, pacific Northwestern States and Canada. Ms is also common in areas that are inhabited by people of Northern European ancestry. We've had over a large number of genome studies of families. We have seen over a hundred gene variants. But if you have a first degree relative which be a parent, child, sibling, you're more likely to develop the disease, something that makes multiple sclerosis harder to diagnosis, that it can look like other diseases. For example, als is also a progressive neurodegenerative disease that affects the neurons in the brain and the spinal cord. It's probably caused by genetic mutations, but there's no established treatment or cure and it's 100% fatal. Unfortunately, these patients may see multiple providers and have many diagnostic tests before they're actually able to be diagnosed.
Speaker 1:Some of the key features of multiple sclerosis are muscle weakness and spasticity. They often have fatigue, maybe intention tremors, so that's a tremor when the muscles are being used. Flexor, muscle spasms, the inability to direct or limit movement, which is called dysmetria, hypoalgesia, so increased sensitivity to pain. Dysarthria, trouble speaking or slurred speech, dysphagia, difficulty swallowing, diplopia, double vision, nystagmus. This is an involuntary condition where the eyes make repetitive, uncontrolled movements. The patient may not notice, but someone else can see it Skitomas, which are changes in their peripheral vision, and tinnitus or vertigo, which is like dizziness. An MRI is usually Diagnostic if the patient has plaques in at least two areas. So they might have an MRI of the brain, in the spinal cord, and that's going to show those plaques. An MRI with contrast, it's going to show active plaques and look, you'll be able to see older lesions that are not associated with the current symptoms. Something you can help the patient with if they experience Diplopia, using an eye patch, alternated from eye to eye every few hours, usually helps with that. If they have peripheral visual deficits, you want to teach them to scan the environment by moving their head side to side. Maybe they can get corrective lenses.
Speaker 1:Other things that we're going to see are some anti neoplastic medications, those you would think of as chemotherapy agents, immunomodulators. There are some biologics that they're using and in fact we even have one IV On a clonal antibody that's approved for MS. It actually binds to white blood cells and helps to stop further damage to the myelin. These medications All have one big thing in common they're going to affect the immunity of the patient. So we're going to educate the patient on how to properly wash your hands, use hand sanitizer, educate them to stay away from people who might be sick, especially children, and to stay away from crowds so that they can avoid getting sick because their immune system may not Function as well once they're taking these medications. A good interdisciplinary plan involving occupational therapy, physical therapy, speech, language pathology, to help with muscle spasticity, swallowing problems, is something that's going to be super important for these patients. And then, of course, there's always things like massage, yoga, relaxation, helping the patient to maintain plenty of good fluids, lots of fiber and a good, healthy diet. That will help maintain their urinary function and, you know, keep the bowels moving well and not In a way that we would rather avoid. This patient may experience bowel and bladder Effect. So we may need to teach the female patient on how to self catheter eyes appropriately, the male patient perhaps a condom catheter or self catheterization, and Just making sure that we put them in touch with a support group and encourage them to contact their local MS society, and we may Do a home health referral as well.
Speaker 1:Let's talk about myasthenia gravus while we're here, another condition that affects neuromuscular transmission of impulses. This one affects the voluntary muscles of the body. It's considered an autoimmune disorder and is characterized by the presence of acetylcholine receptor antibodies, which interferes with neuronal transmission. This one typically affects females between the ages of 10 and 40 and males between the ages of 50 and 70. The most severe involvement for a patient with myasthenia gravus is going to be respiratory. So we need to keep a close eye on that and we need to have a tracheostomy kit available at the bedside For possible myasthenic crisis.
Speaker 1:This patient is going to receive cholinergic drugs. Remember that they have anti-cholinergic receptor Antibodies. So they're going to receive those cholinergic medications. Those are going to inhibit the action of cholinesterase at the cholinergic nerve ending. So an example would be Pyridostigmine bromide and what we want to do is promote the accumulation of acetylcholine at those cholinergic receptor sites. We need to monitor the patient for cholinergic crisis, so an overdose. Basically, atropine is the antidote for drug-induced bradycardia, so if the patient experienced bradycardia as a result of having too much of this pyridostigmine, then we will give them atropine. We do want to make sure the patient takes this medicine with food or drink, usually milk and Just keep an eye on them for those symptoms of cholinergic crisis abdominal cramps, diarrhea, incontinence, hypotension, bradycardia, respiratory depression, lacrimation, blurred vision, and they're going to need to take this medication for their whole life. That's all I've got for you today on nursing with dr Hobbock. Thanks for hanging out with me and I'll see you next time.