11.3: Introduction to Multiple Sclerosis
By the end of this section, you should be able to:
- 11.3.1 Describe the pathophysiology of multiple sclerosis.
- 11.3.2 Identify the clinical manifestations related to multiple sclerosis.
- 11.3.3 Identify the etiology and diagnostic studies related to multiple sclerosis.
Multiple sclerosis (MS) is a debilitating, inflammatory, immune-mediated condition. According to the National Multiple Sclerosis Society (2023), studies have confirmed that nearly 1 million people are living with MS in the United States. This disease is characterized by a progressive and irreversible demyelination and axonal degeneration of the brain, spinal cord, and optic nerves. Myelin is a protective sheath that acts as an insulator of the electrical signal (see Figure 11.4). It allows rapid conduction of a nerve impulse down the axon. Degeneration of the myelin sheath results in the inability of nerves to conduct electrical impulses. As the myelin deteriorates, oligodendrocytes repair the damage but also form scar tissue called gliotic plaques. These plaques will begin to interfere with electrical impulses traveling through the axon. Over time, the myelin cannot regenerate and nerves eventually wither away. Typically, the client experiences remission s and exacerbations throughout the progression. Sensory and motor deficits become worse as the client ages. The disease is progressive and affects nerves in both the CNS and peripheral nervous system (PNS) (Capriotti, 2020).
Pharmacologic Management
There is currently no cure for MS; however, the use of drugs has made a significant difference in the lives of those with MS. Most of the drugs target specific symptoms, reduce relapse rates, and delay progression. In the most common form (relapsing-remitting), early initiation of medications is highly recommended. Several drug classifications are used that work through different mechanisms: corticosteroids can reduce inflammation and speed recovery during acute exacerbations; beta interferons can slow damage; and disease-modifying agents and immunomodulators suppress the immune system to prevent the antibodies from attacking their own cells. Additionally, various components of the immune system are specifically targeted by medications. Some drugs reduce the number of T cells circulating in the periphery; others destroy target B cells or deplete B and T cells; still others prevent leukocyte mobilization to injured tissue. Drugs, such as antispasmodics, antidepressants, and antiepileptics, are prescribed to control symptoms.
Nonpharmacologic Management
Plasmapheresis (removal of abnormal antibodies) can be done for those who do not respond well to drugs. Significant nonpharmacologic management should involve teaching the client coping mechanisms, ensuring support systems are in place, and emphasizing proper nutrition and sufficient rest; the client should be encouraged to incorporate exercise into their daily routine. These actions can promote overall health, which can help the client better deal with symptoms of relapse as well as maintain their quality of life. Finally, physical therapy and occupational therapy can help to maximize functioning in various ways (National Institute of Neurological Disorders and Stroke, 2023a).
Trending Today
Advances in Multiple Sclerosis Treatment
According to the National Institute of Neurological Disorders and Stroke (2023a), researchers continue to study the mechanism of MS to identify ways to prevent or stop the continuous decline in function seen in clients with this progressive disease. Ublituximab (Briumvi) recently became the third anti-CD20 monoclonal antibody approved by the FDA as a treatment for relapsing forms of MS (Cunha, 2023). This drug is administered over 1 hour and given twice a year.
Clinical Tip
Treating an Acute Relapse
A short course of a high-dose intravenous (IV) glucocorticoid (e.g., 500–1000 mg of methylprednisolone daily for 3–5 days) is the preferred treatment for an acute episode. These drugs suppress inflammation and can reduce the severity and duration of an attack. When used short-term, these drugs are safe except for a possible elevation of blood glucose levels. In contrast, long-term use (e.g., over 3 weeks) can cause multiple adverse effects in numerous areas of the body, including adrenal insufficiency leading to fluid and electrolyte imbalances, osteoporosis, high risk for infections, myopathy, and psychological disturbances (agitation, anxiety, or irritability).
Acute relapse may also be treated with IV gamma globulin. This option is especially beneficial for clients who are unable to tolerant or respond adequately to glucocorticoids.