Dysphagia o bowel incontinence o constipation

Dysphagia
o Bowel incontinence
o Constipation
• Musculoskeletal
o Fatigue
o Weakness
o Ataxic Movements
o Spasticity
o Foot Drop
• Neuro
o Emotional lability
o Scanning Speech
o Impaired judgment
• Sensory
o Blurred vision
o Numbness/Paresthesia
o Diminished sense of temperature
• Reproductive
o Loss of sensation
Males – impotence
Diagnosis of MS • Symptoms
o 2 or more episodes lasting 24 hours separated by one month
o Exacerbations & remissions with worsening of symptoms over 6
months OR
o Gradual worsening of symptoms without recovery over 6 months
• LP – CSF shows increase in protein
• MRI – lesions visible
o Shows lesions that aren’t normally seen on CT scan
o Actually measures the size of lesions
Treatment of MS
Disease Modifying
Drugs
*S/E: flu-like
symptoms 24-48 hrs,
but subside within 2-
3 months
• Drugs that modify course of the Disease:
o Avonex (Interferon beta 1-a)
 IM  Q week
o Betaseron (Interferon beta 1-b)
 SC  Q other Day
o Copaxone (Glatiramer acetate)
 SC  QD
o Rebif (Interferon beta 1-a)
 SC  3 times a week
o Tysabri
 Every four weeks by IV
 Infusion in a registered infusion center
Treatment for
Exacerbations
• Solu-Medrol (methylprednisolone)
o Most commonly used corticosteroids in MS
o Shortens duration of relapse by its anti-inflammatory effects
• Plasmapheresis (Plasma Exchange)
o Only considered for the 10% or so who do not respond to
the standard steroids
Plasmapheresis • Blood is cycled through a machine
• Plasma portion of the blood is separated and removed
• This removes harmful antibodies – Immunoglobulins
• Plasma is replaced with plasmanate, NSS or albumin.
Symptom Treating
Drugs
• Baclofen (Lioresal) – spasticity  or diazepam
• Amitriptyline (Elavil) – pain/paresthesia
• Bupropion (Wellbutrin) – depression/fatigue
• Oxybutynin (Ditropan) – bladder dysfunction
Ataxia treated with :
• Neurontin – antiseizure med.
• Inderal – beta adrenergic blockers
• Klonopin – benzodiazepines
Goals of Treatment • Promotion of physical mobility
• Avoidance of injury
• Achievement of bowel and bladder continence
• Improvement in cognitive function
• Promotion of speech and swallowing mechanisms
• Development of coping strengths
• Improved home maintenance
• Adaptation to sexual function
Collaborative
Management
• Promote mobility / water exercise
• Promote nutrition
• Promote rest and comfort measures
• Education
o Bladder/Bowel training
o Avoidance of infection
2

Degenerative Neurologic Disorders
o Avoidance of heat/humidity
Myasthenia Gravis
Overview • Autoimmune disease
• Antibody mediated destruction of acetylcholine
receptors at the neuromuscular junction
• Can occur at any age
Risk Factors:
• Peak incidence in the 20 to 30 age range
• Three times more common in women
Clinical
Manifestations
• Initial Symptoms in 50% of pts.:
o Ptosis – drooping of upper eyelid
o Diplopia – double vision
• As disease progresses additional symptoms appear:
o Difficulty chewing or swallowing
o Proximal extremity weakness
o Respiratory muscle weakness (May require mechanical
ventilation)
o