vascular sclerosis

About half of all patients with MS become unable to work within 10 to 15 years of the first onset of symptoms. Within 25 years of the first symptoms, half of these patients cannot walk.

Etiology

The cause of the disease is unknown although much evidence suggests that T lymphocytes that injure nerve cells and nerve sheaths play an important role, that is, that the disease has an autoimmune basis. Some evidence links MS to hypovitaminosis of vitamin D.

Symptoms

Nearly a quarter of all patients with MS initially develop visual disturbances or blindness. Other consequences of the disease include sudden or progressive weakness in one or more limbs, muscular spasticity, nystagmus, fatigue, tremor, gait instability, recurrent urinary tract infections (caused by bladder dysfunction), incontinence, and alterations in mood, including euphoria, irritability, and depression. See: retrobulbar neuritis

Diagnosis

Diagnosis is usually based on the patient’s history. MRI may detect areas of the brain and/or spinal cord with demyelination. Lumbar puncture is often performed to assess patients for oligoclonal bands (immunoglobulins released into the cerebrospinal fluid due to inflammation).

Treatment

Although there is no known cure for MS, corticosteroids, interferon-alpha, and glatiramer may be used in specific settings to reduce disability or the frequency of relapses and the progression of disease in patients with some variants of MS. Treatment should be individualized because these therapies may be expensive, ineffective in benign or primary progressive disease, and poorly tolerated by some patients. Symptomatic relief (e.g., of spasticity with muscle relaxants, or of bladder dysfunction with anticholinergic drugs) is provided as needed.

Patient care

The health care professional provides support to patients with MS and their families. The patient is advised to avoid fatigue, overexertion, exposure to extreme heat or cold, and stressful situations, and is encouraged to follow a regular plan of daily activity and exercise based on levels of tolerance. The patient is taught about symptoms that may occur during exacerbations of the disease and the need to adapt the plan of care to changing needs, as well as about the administration of prescribed medications. Physical and occupational therapy referral assist the patient to maintain muscle tone and joint mobility, decrease spasticity, improve balance and coordination, and increase morale. Massages, relaxing baths, yoga, and tai chi may prove helpful. A nutritious, well-balanced diet with adequate roughage and fluids is recommended. Bladder and bowel training programs, self-catheterization, and the use of condom catheters may be required. Independence is encouraged by assisting the patient to develop new methods for activities of daily living (ADL) performance and optimal functioning. Both the patient and family are encouraged to promote safety in the home and the work environment. For support and information, the patient and family should be referred to the National Multiple Sclerosis Society (800-FIGHT-MS; www.nmss.org).

Treatment

There is no specific therapy. General supportive therapy is indicated. A great number of drugs including corticosteroids, vasodilators, d-penicillamine, and immunosuppressive agents have been tried. Physical therapy will help maintain range of motion and muscular strength but will not influence the course of joint disease.