Multiple Sclerosis and Myasthenia Gravis

Send us a text

Ever wondered why multiple sclerosis (MS) is such a complex and mystifying condition? How does this disease subtly sneak its way into the nervous system, disrupting nerve impulses, and causing a myriad of symptoms that make it both challenging to diagnose and manage? Our resident expert, Dr. Hobbick, takes us on an educational journey through the tricky landscape of MS, illuminating its demyelinating nature, the distinctive types, and the crucial role of genetics and environment in its onset.

Dr. Hobbick explains how the use of MRIs in diagnosing MS helps identify plaques, indicative of the disease, in different areas of the brain and spinal cord. She provides practical advice on symptom management and a detailed overview of medication options, their effects on the immune system, and the importance of a holistic, interdisciplinary treatment approach. In addition, she steers us towards another neuromuscular disorder, myasthenia gravus - discussing its unique characteristics and treatment options. Join us as we shed light on these neurological conditions, helping you to better understand, manage, and navigate this often complex field.

Episode Transcript

Speaker 1 (00:02):
Hey and welcome to Nursing with Dr Hobbick.
Today I'm thinking aboutmultiple sclerosis.
Since we're on the neurologicsystem, I thought that we could
cover this one.
It's usually used as anexemplar if you're learning in a
concept-based program.
Otherwise it's really a good.
I mean, it's not a good disease, but it's a good example of

(00:24):
neurological conditions.
Something you need to keep inmind is that all of these
conditions will have somesimilar symptoms Because they
affect the nervous system.
Then they're gonna have similarsymptoms.
What is special or differentabout the condition that you're
thinking about?
When we talked about spinalcord injuries, we think about

(00:46):
autonomic dysforflexia.
We think about spinal cordlevels at C3 through C5.
We have to think aboutrespiratory With multiple
sclerosis.
There's some other things thatwe can pick out that are special
for that condition.
Those things are the thingsthat are more likely to be asked
on a nursing test question oron your NCLEX.

(01:09):
Remember that multiple sclerosisis demyelinating.
It removes the myelin sheathfrom the central nervous system.
What that does is it disruptsthe transmission of nerve
impulses.
Typically it is an insidiousonset, and insidious I always
think of evil slow, sneaky.

(01:30):
So insidious means it's a slowonset.
The patient may not notice theinitial symptoms right away
until they continue to get worse.
50% of patients are stillambulatory 25 years after
diagnosis.
So half of patients can stillwalk after they've been
diagnosed 25 years later.
Another characteristic ofmultiple sclerosis is that it's

(01:53):
characterized by periods ofremission and exacerbation.
So remission the symptoms getbetter, they maybe go away.
Exacerbation is a flare up.
There's actually four types.
We have relapsing, remitting,primary progressive, secondary
progressive and progressiverelapsing.
Relapsing remitting is the mostcommon type of MS and that's

(02:17):
the classic picture.
Really, what we have here isthe symptoms develop and resolve
in a few weeks to months andthe patient returns to baseline.
So with relapsing remitting,the patient returns to baseline.
They have symptoms and thenreturn to baseline.
Primary, progressive is asteady, gradual deterioration

(02:39):
without any remission.
Secondary, progressive startswith relapsing remitting and
later turns into a steadilyprogressive condition.
About half of people withrelapsing remitting will develop
secondary progressive.
And then we have progressiverelapsing, which is frequent

(02:59):
relapses with partial recovery.
The patient never returns tobaseline.
That's only a small percentageof patients.
Now what puts you at risk formultiple sclerosis?
It is super complicated.
We know that it involvesmultiple immune, genetic and or
infectious factors, althoughchanges in immunity are most

(03:20):
likely the cause.
The environment can contributebecause we know that it's seen
more often in colder climateslike northeastern Great Lakes,
pacific Northwestern States andCanada.
Ms is also common in areas thatare inhabited by people of
Northern European ancestry.
We've had over a large numberof genome studies of families.

(03:41):
We have seen over a hundredgene variants.
But if you have a first degreerelative which be a parent,
child, sibling, you're morelikely to develop the disease,
something that makes multiplesclerosis harder to diagnosis,
that it can look like otherdiseases.
For example, als is also aprogressive neurodegenerative

(04:03):
disease that affects the neuronsin the brain and the spinal
cord.
It's probably caused by geneticmutations, but there's no
established treatment or cureand it's 100% fatal.
Unfortunately, these patientsmay see multiple providers and
have many diagnostic testsbefore they're actually able to
be diagnosed.
Some of the key features ofmultiple sclerosis are muscle

(04:24):
weakness and spasticity.
They often have fatigue, maybeintention tremors, so that's a
tremor when the muscles arebeing used.
Flexor, muscle spasms, theinability to direct or limit
movement, which is calleddysmetria, hypoalgesia, so
increased sensitivity to pain.

(04:45):
Dysarthria, trouble speaking orslurred speech, dysphagia,
difficulty swallowing, diplopia,double vision, nystagmus.
This is an involuntarycondition where the eyes make
repetitive, uncontrolledmovements.
The patient may not notice, butsomeone else can see it
Skitomas, which are changes intheir peripheral vision, and

(05:07):
tinnitus or vertigo, which islike dizziness.
An MRI is usually Diagnostic ifthe patient has plaques in at
least two areas.
So they might have an MRI ofthe brain, in the spinal cord,
and that's going to show thoseplaques.
An MRI with contrast, it'sgoing to show active plaques and
look, you'll be able to seeolder lesions that are not

(05:28):
associated with the currentsymptoms.
Something you can help thepatient with if they experience
Diplopia, using an eye patch,alternated from eye to eye every
few hours, usually helps withthat.
If they have peripheral visualdeficits, you want to teach them
to scan the environment bymoving their head side to side.
Maybe they can get correctivelenses.

(05:50):
Other things that we're going tosee are some anti neoplastic
medications, those you wouldthink of as chemotherapy agents,
immunomodulators.
There are some biologics thatthey're using and in fact we
even have one IV On a clonalantibody that's approved for MS.
It actually binds to whiteblood cells and helps to stop
further damage to the myelin.
These medications All have onebig thing in common they're

(06:14):
going to affect the immunity ofthe patient.
So we're going to educate thepatient on how to properly wash
your hands, use hand sanitizer,educate them to stay away from
people who might be sick,especially children, and to stay
away from crowds so that theycan avoid getting sick because
their immune system may notFunction as well once they're
taking these medications.

(06:34):
A good interdisciplinary planinvolving occupational therapy,
physical therapy, speech,language pathology, to help with
muscle spasticity, swallowingproblems, is something that's
going to be super important forthese patients.
And then, of course, there'salways things like massage, yoga
, relaxation, helping thepatient to maintain plenty of

(06:57):
good fluids, lots of fiber and agood, healthy diet.
That will help maintain theirurinary function and, you know,
keep the bowels moving well andnot In a way that we would
rather avoid.
This patient may experiencebowel and bladder Effect.
So we may need to teach thefemale patient on how to self

(07:17):
catheter eyes appropriately, themale patient perhaps a condom
catheter or self catheterization, and Just making sure that we
put them in touch with a supportgroup and encourage them to
contact their local MS society,and we may Do a home health
referral as well.
Let's talk about myastheniagravus while we're here, another

(07:39):
condition that affectsneuromuscular transmission of
impulses.
This one affects the voluntarymuscles of the body.
It's considered an autoimmunedisorder and is characterized by
the presence of acetylcholinereceptor antibodies, which
interferes with neuronaltransmission.
This one typically affectsfemales between the ages of 10

(08:00):
and 40 and males between theages of 50 and 70.
The most severe involvement fora patient with myasthenia
gravus is going to berespiratory.
So we need to keep a close eyeon that and we need to have a
tracheostomy kit available atthe bedside For possible
myasthenic crisis.
This patient is going to receivecholinergic drugs.

(08:20):
Remember that they haveanti-cholinergic receptor
Antibodies.
So they're going to receivethose cholinergic medications.
Those are going to inhibit theaction of cholinesterase at the
cholinergic nerve ending.
So an example would bePyridostigmine bromide and what
we want to do is promote theaccumulation of acetylcholine at

(08:42):
those cholinergic receptorsites.
We need to monitor the patientfor cholinergic crisis, so an
overdose.
Basically, atropine is theantidote for drug-induced
bradycardia, so if the patientexperienced bradycardia as a
result of having too much ofthis pyridostigmine, then we
will give them atropine.
We do want to make sure thepatient takes this medicine with

(09:04):
food or drink, usually milk andJust keep an eye on them for
those symptoms of cholinergiccrisis abdominal cramps,
diarrhea, incontinence,hypotension, bradycardia,
respiratory depression,lacrimation, blurred vision, and
they're going to need to takethis medication for their whole
life.
That's all I've got for youtoday on nursing with dr Hobbock

(09:26):
.
Thanks for hanging out with meand I'll see you next time.