most important course of action when working with a group patient with multiple sclerosis

What is included in the work-up of multiple sclerosis (MS)?

Assist the client to establish a regular exercise and rest program. Instruct the client to balance moderate activity with rest periods. Assess the need for and provide assistive devices. Initiate physical and speech therapy. Instruct the client to avoid …

What is the client experiencing with multiple sclerosis?

The most recent Consortium of Multiple Sclerosis Center (CMSC) guidelines state routine brain MRI should be considered every 6 months to 2 years for all patients with relapsing MS. 10. Multiple variables characterize the different DMTs (eg, mode of administration, frequency of dosing, mechanism of action, and amount of time since drug launch).

How complex is the clinical management of multiple sclerosis (MS)?

2 Nurses working in the Multiple Sclerosis Centers of Excellence (MSCoEs) adopt the precepts of the Patient Aligned Care Team of the VA. Also, nurses who care for patients with multiple sclerosis (MS) establish, maintain, and sustain care that is culturally sensitive and wellness focused and incorporates family and community resources with the ...

How can I help a patient with multiple sclerosis (MS)?

 · Cell-based therapy for multiple sclerosis. Currently, there is no definite cure for MS. However, immunomodulating and antiinflammatory agents can diminish its progression and decrease some of the pathological symptoms. Immunomodulating agents including interferon beta and glatiramer acetate are used in nonsymptomatic MS, RRMS, and SPMS .

How do you deal with a multiple sclerosis patient?

Here are some tips that can make it easier for patients and caregivers alike to deal with MS.Eat for optimal health. Everyone can benefit from a good diet, but especially people with chronic diseases such as MS. ... Commit to regular exercise. ... Address sleep issues. ... Customize your environment. ... Reach out and get involved.

How can a social worker help someone with multiple sclerosis?

Professionally trained peers (people with MS) are available to provide support and information to members facing difficult issues. Through support over the telephone or via email, the peers use their firsthand knowledge to help solve problems and develop coping strategies.

Which of the following plays an important role in multiple sclerosis?

Growing evidence suggests that vitamin D plays an important role in MS. Low vitamin D levels in the blood have been identified as a risk factor for the development of MS. Some researchers believe that sun exposure (the natural source of Vitamin D) may help to explain the north-south distribution of MS.

What is the main treatment objective for MS?

The main goal of treatment is to slow progression of the disease. It's important to treat MS even during remission, when there are no obvious signs of illness. While MS can't be cured, it can be managed. Strategies to slow the progression of MS include a number of different drugs.

What is the mechanism of action of multiple sclerosis?

Its mechanism of action consists on inhibiting dihydroorotate dehydrogenase, which is a rate limiting step in pyrimidine synthesis [49]. Other actions include suppression of pro-inflammatory cytokines, inhibition of tyrosine kinase activity and inhibition of interaction between APCs and T cells [49].

How does MS affect the action potential?

In MS, the loss of myelin produces failure of axonal action-potential conduction that is associated with clinical exacerbations, but axonal conduction can recover as a result of expression of new sodium channels along demyelinated axons, providing a substrate for remission of clinical deficits (5).

Which factors are believed to contribute to the development of multiple sclerosis MS )?

They have identified four primary risk factors for the condition: immune system, genetics, environment, and infection. Other risk factors for MS range from smoking to having obesity. All these factors work together to help influence whether a person develops MS.

What are the main treatment approaches to the management of MS?

Approach Considerations Treatment of multiple sclerosis (MS) has 2 aspects: immunomodulatory therapy (IMT) for the underlying immune disorder and therapies to relieve or modify symptoms. IMT is directed toward reducing the frequency of relapses and slowing progression.

Do I Have Multiple Sclerosis?

Most patients consulting neurology for possible MS have had a clinical event that precipitated a medical evaluation.

What Kind of Multiple Sclerosis do I have?

Classification of MS has evolved as well. 3 The most important questions to ask during initial evaluation will determine whether a relapsing course, a progressive course, or both, apply to the patient (Table 2). It is also relevant to determine whether the course is active or inactive.

What Is My Prognosis?

MS is an unpredictable and heterogeneous disease making accurate prognosis over time challenging. Certain presenting signs and symptoms portend a worsened prognosis, and these factors should be considered in prognosticating disease course.

Is There a Best Medication for Me?

The choice of initial therapy has been made increasingly complicated by the varied choices of DMTs. Multiple products with unique mechanisms of action and a lack of biomarkers to determine the best strategy for treatment result in variable choices of therapy among health care providers.

How Will We Know if This Medication Is Working?

Even before initiating a DMT, it is vital to discuss the goals of treatment:

Conclusion

The clinical management of persons with MS is often thought to be highly complex, and given the unpredictable clinical course and the wide variety of presentations and progression of the disease, this reputation is well earned. However, consensus on the diagnosis has been updated with the 2017 McDonalds criteria.

Edward Fox, MD, PhD

Clinical Associate Professor#N#Department of Neurology#N#The University of Texas at Austin#N#Dell Medical School#N#Austin, TX#N#Central Texas Neurology Consultants#N#Round Rock, TX

Establishing Care

Educating patients and their families about MS, its symptoms, and self-management skills at the time of diagnosis is paramount. That said, nurses are less concerned with MS immune pathology and white matter lesion count and are more concerned with helping patients maintain hope and optimism.

William's Story

As William walked into the nurse’s office, careful to allow one finger to linger on the wall and backs of furniture, the nurse recognized a young man heavy with a new MS diagnosis. William was tentative, bristly, and trying to maintain his balance. The nurse noted William’s too-big clothes, part army fatigues, part athletic wear.

Next Article

Multidisciplinary Management of a Patient With Multiple Sclerosis: Part 1. Neurologists’ and Physiatrists’ Perspectives

What is MS in the brain?

ADVERTISEMENTS. Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. MS is a progressive disease caused by demyelination of the white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination throughout ...

What is the cause of MS?

MS is a progressive disease caused by demyelination of the white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination throughout the central nervous system induce widely disseminated and varied neurologic dysfunction. MS is characterized by exacerbations and remissions, MS is a major cause ...

Who is Matt Vera?

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible.

Why is it important to stop exercising?

Reduces fatigue and promotes a sense of wellness. Stress need for stopping exercise or activity just short of fatigue. Pushing self beyond individual physical limits can result in excessive or prolonged fatigue and discouragement. In time, the patient can become very adept at knowing limitations.

What is the best medication for spinal cord pain?

Steroids: prednisone (Deltasone), dexamethasone (Decadron), methylprednisolone (Solu-Medrol) May be used during acute exacerbations to reduce and prevent edema formation at the sclerotic plaques.

Is amantadine a positive antiviral?

Amantadine (Symmetrel); pemoline (Cylert) Useful in treatment of fatigue. Positive antiviral drug effect in 30%–50% of patients. Use may be limited by side effects of increased spasticity, insomnia, paresthesias of hands and feet.

What is the most common demyelinating disorder?

Multiple sclerosis (MS) is the most common of the demyelinating disorders and the predominant CNS disease among young adults. MS is a progressive disease caused by demyelination of the white matter of the brain and spinal cord. In this disease, sporadic patches of demyelination throughout the central nervous system induce widely disseminated ...

What are the best exercises for MS?

Diana: The best MS exercises are aerobic exercises, stretching, and progressive strength training. Aerobic exercise is any activity that increases your heart rate, like walking, jogging, or swimming. You just don’t want to overdo it—it should be done at a moderate level.

How to treat MS symptoms?

Diana: It’s extremely important to stay hydrated and cool. Getting too hot when you’re exercising can temporarily increase your MS symptoms, like fatigue or spasticity. Start slowly and drink plenty of water. Use a fan, wear a cooling device like a vest, or exercise in a cool room.

How does MS affect your body?

When you have MS and you exercise, it can improve your fitness, endurance, and strength in your arms and legs. Studies have shown that this can also give you better control over your bowel and bladder function, and decreased overall fatigue. And it can give your mood a boost.

What is aerobic exercise?

Aerobic exercise is any activity that increases your heart rate, like walking, jogging, or swimming. You just don’t want to overdo it—it should be done at a moderate level. I tell patients to get to a level where you can talk but not sing—you’ll be breathing heavily and may be sweating.

How much aerobic activity should I do a week?

I tell patients to get to a level where you can talk but not sing—you’ll be breathing heavily and may be sweating. It is recommended you get in at least 150 minutes of total moderate-intensity aerobic activity per week. Stretching is recommended for at least 10 minutes per day.

How long should I stretch my muscles?

Stretching is recommended for at least 10 minutes per day. It’s the best way to maintain your range of motion, and ease symptoms that are related to spasticity (muscle tightness or stiffness, or a lack of muscle control). Yoga or tai chi are great ways to get your stretching in.

How to get rid of spasms?

It’s the best way to maintain your range of motion, and ease symptoms that are related to spasticity (muscle tightness or stiffness, or a lack of muscle control). Yoga or tai chi are great ways to get your stretching in. Strength or resistance training helps you maintain and improve your muscle strength.

What are the goals of MS treatment?

In MS treatment there are three overall goals – preventing/shortening relapses, preventing or delaying disability accumulation and addressing existing disabilities. As mentioned above, there are several potential oral therapies (see Figure 2) in different stages of development for the treatment of MS and three of these drugs are currently undergoing Phase III trials. Teriflunomide, a DNA synthesis inhibitor, is currently undergoing trials versus placebo, versus IFNβ and is also being assessed for use in clinically isolated syndrome (CIS). In the Phase III TEMSO trial, teriflunomide reduced annualised relapse rate (ARR) in MS by 31 % versus placebo. 9 Laquinimod, an oral immunomodulator, was compared with placebo in the Phase III ALLEGRO trial where it reduced ARR by 23 % and disability progression by 36 %. 10 BG-12, an oral formulation of dimethyl fumurate, has achieved its primary outcome measures in the Phase III DEFINE study. 11 Development of another potential therapy, oral cladribine, has recently been discontinued owing to adverse event concerns and it has been withdrawn from the market in countries where it was already approved. 12#N#Fingolimod is the first of these novel agents to have gained approval in the EU and US and is now approved in more than 40 countries although licensed indications vary by country (e.g. ‘relapsing forms’ of MS in US, relapsing-remitting MS [RRMS] in Canada and either highly active RRMS despite IFNβ treatment or rapidly evolving severe MS in the EU). For fingolimod, data from the Phase III FREEDOMS (versus placebo) 13 and TRANSFORMS (versus IFNβ) studies 14 support its use in RRMS. In the FREEDOMS trial, 13 ARR was reduced by 54 % (p<0.001), time to disability progression confirmed after six months was reduced by 37 % and Gd-enhancing lesions were reduced by 82 % compared with placebo at two years. In the TRANSFORMS trial, ARR was reduced by 52 % (p<0.001), there was a 40 % reduction in brain volume loss (p <0.001) and Gd-enhancing lesions were reduced by 55 % compared with IFNβ at 12 months. 14 Some very common AEs (occurring in >1 in 10 patients) were observed including: increased gamma-glutamyl transferase and liver enzymes; viral infections; headache; diarrhoea; and cough. With the exception of disturbed liver function tests, all these AEs were reported with similar frequency in the placebo arm. Bradycardia, hypertension, macular oedema, disturbed liver function, teratogenicity and infections are all safety/risk areas of special interest with fingolimod and it should not be used in patients with active malignancy, immunocompromised with HIV or those with, or at risk of, severe infections. Assessment including full blood count, liver enzymes, ophthalmologic or cardiovascular examination (in some circumstances), varicella zoster virus (VZV) immune status and pregnancy testing should be completed before initiating therapy and monitoring should occur during treatment. A pre-treatment ECG is recommended by some centres. A risk-management programme is in place for fingolimod use in MS and Phase IV trials are in progress to assess treatment satisfaction, safety and tolerability, effects of the treatment on activities of daily living, and on depression and coping in people with MS. 15

What is MS-NEED study group?

MS-NEED study group, European nurse survey demonstrates significant disparities in nursing of multiple sclerosis patients and the need to benchmark standards for improved patient care (European Multiple Sclerosis Platform), 2011;The Evolving Role of the MS Nurse: Implications of Future Management Directions Athens, Greece, 22–24 September.

What is MS nurse?

Article: Multiple sclerosis (MS ) specialist nurses are pivotal members of the multidisciplinary team, all having varying responsibilities such as symptom management, drug initiation and drug monitoring in people with MS.

What are the factors that contribute to MS?

The aetiology of this complex disease is only partially understood. Various genetic factors have been identified that may contribute to the development of MS, 2 with the risk of acquiring the disease being up to 20–40 fold higher in direct relatives of a person with the disease than in the general population, 3 suggesting that susceptibility is partially genetic, with a polygenic pattern of transmission. In addition to genetic factors, environmental factors such as vitamin D deficiency, smoking, viral infection, temperature/climate and location (latitude) have been associated with higher rates of the disease and are likely risk factors. 4–7#N#In MS, there is a balance between central nervous system (CNS) injury (due to inflammation) and repair and the equilibrium between these two processes determines disease progression. Multiple sclerosis involves an autoimmune process in which T-cell lymphocytes recognise myelin as foreign and attack it, leading to damage, inflammation and neurodegeneration. The critical role of T cells in MS has led to these cells and associated factors providing key targets for disease-modifying therapies (DMTs). The main objective when treating MS is halting the immune attack on myelin and this can be achieved through either a general reduction of the immune response (e.g. mitoxantrone) or using a selective approach to inhibit a single effect (e.g. interferon betas [IFNβs], natalizumab or fingolimod). However, it is also important that this effect on the immune system is reversible. Novel oral agents currently available or in late-stage development for the treatment of MS are shown in Figure 1 and although all have been shown to act on lymphocytes, they do so in a variety of different ways. Fingolimod, for example modulates S1P receptors, reducing inflammation. 8 Activated lymphocytes are ‘locked up’ in lymph nodes and kept out of the bloodstream, reducing their ability to infiltrate the CNS. After stopping fingolimod treatment, lymphocyte levels return to normal in one to two months. BG-12, teriflunomide, laquinimod and alemtuzumab are all novel MS agents currently in development and have varying mechanisms of action (summarised in Figure 1 ). Teriflunomide reversibly blocks DNA synthesis; laquinimod suppresses antigen presentation although its molecular target is unknown; BG-12 has several possible modes of action on cytokines and apoptosis; and alemtuzumab is a CD52-specific monoclonal antibody leading to depletion of B cells, T cells and monocytes.

What are the activities of MS nurses?

MS nurses’ activities within the clinic include clinical management, patient care and mentoring, referrals and professional development. Multiple sclerosis nurses operate an ‘Easy Call’ phone service for patient enquiries and raising concerns, and are responsible for knowing how to handle and interpret problems from patients often very remote from the clinic. They also provide expert advice, deal with triaging problems and discuss patient problems with neurologists. In summary, MS nurses need to be involved in patient education, clinical practice, patient support and advocacy. They are required to work in partnership and collaborate with other healthcare professionals and they must have current knowledge, expertise in MS symptom management and new MS treatments. Lastly, MS nurses need to establish successful networks with MS support organisations and societies, and be able to provide support materials and contribute to advisory boards.

Does MS evolve?

In MS, the disease evolves and the patient also needs to evolve as the illness progresses. Multiple sclerosis care lasts throughout the course of the disease and not just when relapses occur and therefore MS requires a system of comprehensive care that empowers the patient at all stages.

How many people are affected by multiple sclerosis?

Multiple sclerosis (MS) is a chronic neuro-inflammatory condition estimated to affect over two million people worldwide. Several subtypes of MS have been described, and they are defined by their clinical phenotypes.1 The majority of patients initially exhibit relapsing remitting MS (RRMS), which is characterized by acute episodes of overt inflammation associated with abrupt clinical decline, most ]