Pathophysiology
Autoimmune demyelinating disease of CNS. Immune system attacks myelin sheaths, disrupting nerve conduction. Onset ages 20-40, more common in women.
Clinical Patterns
Relapsing-remitting (85%): exacerbations with recovery. Secondary progressive. Primary progressive (10%). Symptoms: optic neuritis, weakness, paresthesia, spasticity, fatigue, Uhthoff sign (heat worsens).
Nursing Management
Disease-modifying therapies: interferons, glatiramer, natalizumab, ocrelizumab. Symptom mgmt: baclofen, anticholinergics, amantadine, dalfampridine. Avoid heat. Exercise, bladder training, fall prevention.
Important Notes
- Avoid hot baths/showers in MS patients — heat can trigger pseudoexacerbations.
- Interferon therapy can cause depression and flu-like symptoms — monitor and premedicate.
Clinical Tips
- Fatigue is the most disabling symptom — energy conservation techniques are essential.
- Bladder dysfunction (neurogenic bladder) is common — teach intermittent self-catheterization if needed.
Summary
Multiple sclerosis requires disease-modifying therapy, symptom management, heat avoidance, and psychosocial support.
