Master Multiple Sclerosis Assessment with Picmonic for Nursing RN

Multiple sclerosis is a chronic, progressive, and degenerative disorder that affects the central nervous system. Environmental factors or viral infections may trigger chronic inflammation, leading to disseminated demyelination of nerve fibers in the brain and spinal cord.

Multiple sclerosis causes motor symptoms such as tremors and weakness of the limbs, trunk, or head. Weakness may progress to paralysis. This weakness results from slowed transmission of nerve impulses due to inflammatory damage to the myelin sheath. Chronic inflammation can impair the myelin’s ability to regenerate, leading to axonal injury and permanent loss of nerve function, which may result in paralysis.

Chronic inflammation may lead to the development of glial scar tissue and the formation of hard, sclerotic plaques. These plaques can occur throughout the white matter of the central nervous system and may involve the cerebellum. Nystagmus, or involuntary eye movement, is a common sign of cerebellar involvement. Additional cerebellar manifestations include scanning speech, ataxia, dysarthria, and dysphagia.

A significant proportion of patients with multiple sclerosis experience fatigue that can interfere with their ability to perform activities of daily living. Fatigue may be exacerbated by heat, humidity, or medication side effects. Pharmacologic options for managing fatigue include amantadine (Symmetrel) and modafinil (Provigil). Methylphenidate (Ritalin) may also be used in select cases. Pemoline (Cylert) is no longer recommended due to the risk of hepatotoxicity.

Paresthesia refers to a tingling or numb sensation and is a common symptom associated with demyelination of nerve fibers. Patients may experience sensory disturbances such as tingling, numbness, or pain.

Patients with multiple sclerosis may experience muscle spasticity in areas chronically affected by demyelination of nerve fibers. Muscle relaxants are indicated to help manage spasticity.

If sclerotic plaques resulting from chronic inflammation are located in areas of the central nervous system that regulate elimination, the patient may experience bowel and bladder dysfunction. Patients with multiple sclerosis may develop a spastic or uninhibited bladder, leading to urinary urgency and frequency. In contrast, a lesion involving the reflex arc that controls bladder function can result in a flaccid or hypotonic bladder. Because these patients lack the sensation or urge to void, they often develop a large bladder capacity. Anticholinergic medications may be used to manage bladder dysfunction.

Patients with multiple sclerosis may develop optic neuritis, an inflammation of the optic nerve that causes visual disturbances. Evoked potential testing, which records electrical activity in response to visual stimuli, can help detect abnormalities such as optic neuritis.

Multiple sclerosis most commonly affects adults between the ages of 20 and 50. Adult females are affected two to three times more often than males. Although less common, multiple sclerosis can also occur in adolescents and older adults.

Individuals with multiple sclerosis often experience periods of symptom relapse and remission. Demyelination causes neurologic symptoms such as weakness; however, partial remyelination may occur, leading to temporary improvement. Symptom remission may be followed by relapse when the inflammatory process reactivates and causes further damage to the myelin. Over time, repeated exacerbations can lead to progressive deterioration of neurologic function.