multiple scleoris (EXAM 1)

• -chronic, degenerative, progressive, CNS disease
• -disseminate demyelination of nerve fibers of brain and spinal cord

• -15-50, insidious and gradual
• -more women than men

unknown

immunologic, genetic and infectious. Tcells, autoimmune

• -long term, chronic disease
• -genetically susceptible person is exposed to environmental trigger

• infection
• injury
• stress
• smoking
• pregnancy
• insomnia
• immigration

• 1. chronic inflammation
• 2. demyelination
• 3. gliosis(scaring) of the nerves. myelin is replaced with plaques

exacerbations and remissions

initial attack→myelin damaged, but impulses able to transmit→myelin regenerate and replaced with scaring(gilia cells)→eventually axon is damaged

• motor and sensory problems
• cerebellar problems
• emotional problems
• intention tremors
• ataxia

• muscle weakness
• intention tremors
• spasticity(legs)(tight muscles that are hard to move)

• paresthesis(pins and needles)
• lhermittes sign(electric shock w/ fexion of neck)

electric shock radiating down spine or into limbs w/ neck flexion

tight muscles that are hard to move

• blurred
• diplopia(double)
• Scotomas(blind patches)
• blindness

double vision

blind patches

• ataxia
• nysagmus
• dysphagia

impaired corrdination

eye coordination, vibrate

anger/depression

• very common
• heart exacerbates
• recommended pt to take naps or breaks

• constipation
• diararehha, involuntary bowel
• spastic bladder
• flaccid bladder
• UTI ARE COMMON

• erectile dysfunction
• decreased libido

• large capacity for urine because there is no sensation or urgency to void, no pressure, no pain
• urinary retention

• no definitive
• MRI
• CSF
• ruling out

• 1. 2 plaque lesions on MRI
• 2. 2 dif attacks at 2 diff times(exacerbation)
• 3. rule out all other possible causes

- helps with exacerbations, decrease inflammation at site of demyelination, slows new plaque formation

- teach pt how to self inject

• glatiramer(copaxone)
• interferon B-1a

• immunodulator
• -rotate injection site
• -self inject
• -sub q

• immunodulator
• -avonex: self inject, IM
• -Refib: self inject, sub q

mioxantrone

natalizumab(tysabri)

for more active and aggressive forms

• -treat acute exacerbations
• -decrease inflammation
• -prednisone and mthylprednisone

• for spacicity
• -valium and Baclofen

Provigil and ritalin

• for bladder
• -ditropan9oxybutynin)

• -for nerve pain
• neurotontin(gabapentin)
• Topamax(topiramate)

dalfampridine (ampyra)

• -nerve conduction enhancer
• -improve nerve conduction

BUN and creatnine

• -avoid extreme heat and cold
• -naps
• -rest

• -prevent uti
• -self cath
• -independence
• -decrease factors that precipitate exacerbations
• -pt/ot

• -helps with exacerbation
• -decrease inflammation at the site of demyelination

• -corticosteroids
• -immunoduolators
• -nerve conduction enhancer
• -muscle relaxant
• -cns stimulant
• -anticholenergenic
• -pain
• -immunosuppressive
• -monoclonal antibody

partially remyleinated lessions