MS nurse specialists can also plan appointments and education sessions, and provide access for a client diagnosed with MS to seek unplanned support via nurse advice lines or digital services. Interventions from the nurse must focus on assessment, measurement, and advice on lifestyle management. The scores from 0-to 4 are determined using functional systems (FS) scales that evaluate dysfunction in eight neurologic systems.Ĭognitive changes are common among clients diagnosed with MS. The EDSS assigns a severity score to the client’s clinical status that ranges from 0–10 in increments of 0.5. The most widely accepted clinical rating scale on the basis of findings from the history and physical examination is the 10-point Kurtzke Expanded Disability Status Scale (EDSS). Over time, the inflammatory process subsides, resulting in an astrocytic scar. The blood-brain barrier disruption during active plaque inflammation corresponds to the enhancement seen on MRI. Myelin loss, edema, and axonal injury are the chief components of plaque pathology. MS plaques predominantly center around small veins and venules and show sharp margins. Lesions referred to as plaques occur in waves throughout the disease course and result from focal inflammation. Together, these two primary processes result in microscopic and macroscopic injury. Two fundamental processes constitute the general pathological processes seen in MS clients: focal inflammation resulting in macroscopic plaques and injury to the blood-brain barrier and neurodegeneration with a microscopic injury involving different components of the CNS. In pathologic specimens, the demyelinating lesions of MS called plaques, appear as indurated areas-thus the term sclerosis. Multiple sclerosis is an inflammatory, demyelinating disease of the CNS. There is a 2% concordance in parents and children, and this is still a 10 to 20-fold higher risk than in the general population. Monozygotic twins have a concordance rate of 5%. Heritability is estimated to be between 35 and 75%. There is a high risk of MS clients with biological relatives with MS. If an individual lives in an area with a low incidence of MS until 15 years of age, that person’s risk remains low even if the individual subsequently moves to an area of high incidence. Whatever environmental factor is involved must exert its effect in early childhood. The incidence of the disease is lower in the equatorial regions of the world than in the southernmost and northernmost regions. Geography is clearly an important factor in the etiology of MS. Researchers hypothesize that an unknown antigen triggers and activates both TH1 and Th17, leading to CNS endothelium attachment, the crossing of the blood-brain barrier, and subsequent immune attack through cross-reactivity. Although there are various proposed hypothetical mechanisms, the postulated “out-side-in” mechanism involves CD+4 proinflammatory T cells. Dysimmunity with an autoimmune attack on the CNS is the leading hypothesized etiology of MS. Factors involved in pathogenesis are broadly grouped into three categories. The cause of MS is unknown, but it is likely that multiple factors act in concert to trigger or perpetuate the disease. In 5% of clients, a gradual deterioration with superimposed relapses occurs. SP without relapses does not seem to be responsive to currently available disease-modifying agents. This is characterized by a more gradual neurologic deterioration after an initial RR course. 15 to 20% of clients present with a gradual deterioration from the onset, with an absence of relapses. This is characterized by severe MS with multiple relapses and rapid progression towards disability.MS with almost complete remission between relapses and little if any accumulation of physical disability over time. A single episode of neurologic symptoms or inflammatory CNS demyelination. The following subgroups are sometimes included in RR: Clients diagnosed with a relapsing-remitting pattern account for approximately 85% of MS cases. RR is characterized by recurrent attacks in which neurologic deficits appear in different parts of the nervous system and resolve completely or almost completely over a short period of time, leaving little residual deficit.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |