Understanding Multiple Sclerosis

What is Multiple Sclerosis (MS)?

Multiple Sclerosis is a progressive, inflammatory degenerative disease of the central nervous system (brain and spinal cord) that results in the loss of myelin (the protective insulation on nerves that aids in conduction and transmission of information) and eventually damages the nerves themselves.

While the cause of MS is unknown, there appears to be an abnormal autoimmune response to the myelin in the central nervous system that eventually destroys the myelin and can result in neurological damage. Where neurological damage occurs depends on which part of the brain and/or spinal cord is involved. Eventually the nerve cells that were protected by the myelin will become damaged and that can result in neurological symptoms and or permanent nerve impairment.

Types of MS

There are generally four types of MS that are described by relapses, remissions, and chronic progression (increasing impairment or disability). Relapses can be followed by full or partial recovery. Over time, the relapses and recovery become less and the patient experiences more continued progression of their symptoms.

Some patients never experience relapses instead their disease presents as a slow progression of symptoms over time. The rarest type of MS presents with frequent relapses with limited recovery and progression between relapses.

The four defined clinical types of MS are: 

  1. Relapsing Remitting MS
  2. Secondary Progressive MS
  3. Primary Progressive MS
  4. Progressive Relapsing MS

Symptoms of MS

MS is associated with numerous neurological and cognitive symptoms that vary from individual to individual. Symptoms of MS are caused by damage done to a certain region or area of the central nervous system that may or may not improve over time. MS symptoms include, but are not limited to spasticity (tightness in arms and legs), fatigue, pain, heat or cold sensitivity, disturbance of bowel, bladder or sexual functioning, vision loss or disturbances, vertigo, numbness or tingling in arms, legs or neck, cognitive (thinking) issues, balance problems, tremors, depression, speech and swallowing issues, and very rarely seizures.

Managing Symptoms

Because each patient is an individual and MS looks different on everyone, so too is the process of managing MS symptoms. The approach in managing MS symptoms is often a combination of pharmacological, non- pharmacological, and at times complementary methods of care. There are many approved medications that help with many MS symptoms, including Ampyra (dafampridine) that can aid in walking, endurance and gait speed. Our medical and nursing team works with patients and families to help manage the many symptoms that may affect patients with MS.

Treatment Options

The options related to treating MS primarily focus on the Relapsing Remitting form of MS and the inflammatory aspect of the disease. The medications used are known as immunomodulators. Generally the medications work to decrease the frequency of the attacks and destruction of the myelin and have been shown to reduce the number of relapses by 30% - 60% per year. The medications that are currently approved for the treatment of Relapsing Remitting MS include the following:

  1. Betaseron (interferon beta 1b)
  2. Avonex (interferon beta 1a in low dose) and Rebif (interferon beta 1a high dose)
  3. Copaxone (glatiramer acetate)
  4. Gilenya (fingolimod)
  5. Tysabri (natalizimab)
  6. Mitozantrone (chemotherapy for Secondary Progressive MS)
  7. Aubagio (Teriflunomide)
  8. Tecfidera (BG-12 or dimethyl fumarate)

Some medications are injections, some are IV infusions, and there are oral medications. There are other new medications in development that will soon offer more options for MS patients.

MS is a very individual disease and no two patients are the same. It’s important to discuss your care plan on an ongoing basis to determine which medication is right for you.

Nursing Management of the Patient with Multiple Sclerosis: American Association of Neurological Nurses and Association of Rehabilitation Nurses Clinical Practice Guideline Series 2011



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