MS is an incurable neurological condition involving an immune-mediated process. It causes an abnormal response from the body’s immune system against the central nervous system in which the myelin (the covering of the nerve fibres) and the nerve fibres themselves are attacked resulting in the formation of scar tissue or sclerosis. Consequently the nerve impulses that need to travel through these damaged nerve fibres are disrupted and this is what causes MS symptoms (National Multiple Sclerosis Society 2016).
The cause of MS remains unknown but it is thought to involve both genetic and environmental factors. There is no single test for diagnosing MS, with methods often relying on the elimination of other causes first (Better Health Channel 2015). Because the symptoms of MS vary between individuals, there needs to be evidence of at least two areas of damage in the central nervous system occurring at different times for a diagnosis of MS to be made (National Multiple Sclerosis Society 2016).
MS is a progressive and unpredictable disease. Effects in some patients can be marginal, whilst others have a quick progression towards disability. There are four types of MS:
Most common form of MS in which there are unpredictable relapses following by partial or total remission.
Where there is progressive development of disability.
There are no distinct attacks but there is a slow onset and steadily worsening symptoms.
There is a gradual progression of disability and also relapses (MS Australia 2016).
The symptoms of MS vary between individuals and are often unpredictable. One of the most common symptoms of MS is fatigue which occurs in about 80 per cent of sufferers (National Multiple Sclerosis Society 2016). Fatigue is often the most prominent symptom and can impact on an individuals ability to work and function at home.
They can also have difficulty with motor control and experience muscle spasms, weakness and problems with coordination, balance and limb functions (Better Health Channel 2015). As MS affects the central nervous system, patients can also experience other neurological symptoms such as vertigo, pins and needles, neuralgia and visual disturbances. 80 per cent of people with MS experience bladder and bowel dysfunction including incontinence and constipation (National Multiple Sclerosis Society 2016).
People with MS can also experience neuropsychological symptoms such as memory loss, depression and cognitive difficulties (Better Health Channel 2015).
Other symptoms including heat sensitivity, sexual difficulties, pain, vision problems, spasticity, speech problems, swallowing problems, tremors, seizures, breathing problems, pruritus, headaches and hearing loss (National Multiple Sclerosis Society 2016).
MS is multifaceted in nature so it is important that the mode of treatment reflects this, with patients often benefitting from a multidisciplinary rehabilitation program.
The main goal of treatment is to maximise the quality of life by managing specific symptoms, shortening any exacerbations and slowing the progression of the disease. Rehabilitation can help prevent complications and secondary disabilities from developing, whilst also increasing patient safety, and is an integral part of improving the patient’s quality of life (Burks, Bigley & Hill 2009).
Immunotherapy treatments can be used to slow the frequency and severity of attacks for people with relapsing-remitting MS (Better Health Channel 2015). Corticosteroids can also be used which helps the individual improve quicker following a relapse (Greenwood 2013).
The prevalence of suicide, depression and other mental health disorders such as anxiety and bipolar disorder, is higher in people with MS then the general population (Minden 2013). These conditions can be addressed within a rehabilitation program by a neuropsychologist and psychiatrist if necessary. Neuropsychologists can also assist with any memory or cognitive difficulties present in the individual.
Physiotherapists and certain medications treat muscle problems to ease spasms, tremors and stiffness (Better Health Channel 2015). They can help provide exercise programs that will improve the strength, balance, co-ordination and flexibility of the individual (Better Health Channel 2015).
Fatigue can be managed by sleep regulation and also by medications which treat narcolepsy (Better Health Channel 2015). Occupational therapists can also assist by helping patients learn energy saving skills (which may involve the use of aids) and coping strategies to manage fatigue.
Other alternative therapies which may be used include acupuncture, chiropractic, massage, meditation, yoga and use of supplements.
The nurse plays an integral role in providing ongoing support to the patient whilst also participating in the prevention and management of symptoms (MacLean 2004). Nurses can help provide information, support and advice to the patient during their disease progression.
Nurses can assist with fatigue management by reinforcing any pacing and energy conservation techniques learned from the occupational therapist. They can ensure any mobility equipment is readily available and that the patient understands how to use it correctly. They can also assist by controlling factors which may be interfering with sleep (such as urinary problems).
Nurses can assess in the management of bowel and bladder dysfunction. This may involve the use of a toileting regime, education on continence management techniques and even teaching patients to self catheterise.
The unpredictable nature of multiple sclerosis and a lack of a strong diagnosis method poses a multitude of challenges to medical professionals, from nurses, to doctors, to pharmacists. Therefore it is imperative that when nursing these patients we ensure it entails a multidisciplinary, as well as an individualised approach, to achieve the highest level of patient care.