Multiple Sclerosis Analysis

Multiple sclerosis is an inflammatory disorder which damages fatty myelin sheaths around the axons of the brain and spinal cord. It is mostly common to the young female adults although it also seen in other individuals at any age. The study below is an analysis of Multiple sclerosis in reference to etiology, symptoms and pathophysiology.

Risk factors

The disorder is mostly cause by uncontrollable risk factors for example, genetic and environmental  but there are other controllable risk factors which are mostly vascular problems, infectious and some of the environmental factors. The genetic factor shows that the disease is hereditary although mostly generic validations are held responsible for the occurrence of the complications. The environmental factor refers to the nature of the surrounding in which the individual lives in. natural factors like sunlight are uncontrollable while others like environmental pollution with toxins and other solvents or tobacco smoke are controllable risks (Polman, Thompson & Murray, 2006).  

Etiology

The disorder results from damage of the myelin sheath which protects the nerve cells thus slowing or stopping their impulses. This damage may be caused by inflammation or attack of the nervous system by the immune cells of the body

Rosner and Ross (2008) argue that the cause of multiple sclerosis is not known. However they agree that there are various explanations of probable causes of the illness. In 1849 a German doctor first published a report on MS that is close to the modern concept. In his report he said that the disease is most common in young patients and is characterised by slow progression.

Signs and symptoms

The signs and symptoms of the disease vary with the location and severity of the attack. These are affected by factors such as fever, sun exposure, hot baths and stress. the damage of the nerves in any part of the spinal or brain results to following symptoms: Muscle symptoms like loss of body balance, muscle spasms and others like numbness or abnormal sensation in any part of the body, Bowel and bladder symptoms like constipation and stool leakage, strong urge to urinate and urine leakage, Eye symptoms like double vision and vision loss, Numbness, tingling or facial pain. Other symptoms include decreased attention and difficult in reasoning and solving problems, sexual symptoms include problem in erections and vaginal lubrication (Holland, Murray & Reingold, 2007).

Diagnosis

The disorder may be difficult to diagnose since the signs and symptoms are similar to those of many other disorders. The health practitioners consider keen clinical analysis to diagnose or distinguish the disorder from the other related. The examinations which are considered include: a neurological exam to detect reduced nerve functions, eye examination may be done to show abnormal pupil functioning which are some of the symptoms of the disorder. Other tests to diagnose the disorder include nerve function study, MRI scan of the brain and spinal tap for the tests.

Clinical data alone can be enough for effective diagnosis of the disease especially if the individual has suffered separate episodes of neurological symptoms. The most applicable diagnosis tools are neuroimaging, magnetic resonance imaging. Administration of Gadolinium and testing of the cerebrospinal fluid enables the professionals to get evidence of chronic inflammation of the nervous system (Carruthers, 2008).

The diagnosis of MS involves laboratory tests and radiographic examinations (autopsy and biopsy). Currently there is a widespread use of magnetic resonance imaging (MRI) in the diagnosis of MS. The MRI is able to show MS lesions in the spinal cord and in the brain. Even with this technology MS remains one of the difficult to diagnose diseases.  The neurological evaluation of the disease involves two stages. The first stage is discernment of where the problem is and then evaluation to determine whether the causes of the disease are the identified location. In the diagnosis of MS two clinical criteria should be satisfied by the neurological evaluation (Rosner and Ross, 2008). The two clinical criteria are; course of remissions and attacks, and neurological examination or patient's history that suggest lesions in the spinal cord or the brain.

Signs and symptoms

Some signs and symptoms of multiple sclerosis can attract the attention of patient as well as the doctors immediately they appear while others are not recognizable for a long time. Some of the early symptoms of the disease include axonal destruction and demyelination (Olek, 2004 p. 1). The pathophysiology of multiple sclerosis is not completely understood and hence still under investigation. However it is believed to have five major characteristics that present in tissues of the central nervous system of MS patients. These include; inflammatory lesions on the white matter of the CNS, production of intrathecal Ig with oligoclonal bands which is a conducive environment for immune cell persistence, disruption of the blood-brain barrier, and follicle like aggregates on the meninges (Polman et al, 2006). Intrathecal refers to something occurring or introduced into the space under the arachnoid membrane of the spinal cord or the brain.

Lesions in the white matter of the CNS are mainly believed to the first symptoms of MS. These lesions breakdown the myelin surrounding the central axon of the nerves. They destroy highest intellectual functions of a patient which leads to inability to make complex decisions that involves multiple variables.As a result the patient's personality may change. Also the lesions that separate and interrupt neural systems integration are capable of reproducing various psychiatric disorders such as anxiety, depression, loss of inhibitions, paranoia, as well as variants of neurosis. However, the symptoms that a patient or a family member may quickly detect includes; memory impairment, slowing of performance, and reduced ability to handle average tasks.

Where there is absence of second clinical episode, laboratory tests of cerebrospinal fluid examination can be carried out to supplement evidence. However the accuracy of MRI diagnosis of MRI depends on the doctor's skill in observing as well as soliciting an accurate description of symptoms and history. MRI is largely believed to be the most accurate diagnosis for MS since it is capable of showing demyelination, atrophy and chronic inflammatory process even in the absence of clinical symptoms (Barker, 2008). Laboratory tests do not give sufficient evidence for diagnosing MS. They are mainly combined with other diagnostic tools.

Medical treatment

Rosner and Ross (2008) argue that until the cause of MS is proved then its treatment cannot be scientific. This then means there is no cure foe MS. However new approaches are capable of modifying the course of MS, lessen the severity and frequency of attacks, as well as managing symptoms thus improving the patient's quality of life and that of their families. MS patients are known to have relapse of the attacks even after treatment for causes not known. Corticosteroids have used to treat relapses for several years. They have "immunomodulatory and anti-inflammatory effects" capable of restoring the integrity of the "blood-brain barrier" (Polman et al, 2006 pg 12). Other proven treatments for relapses are rest, and treatment of underlying infection. Surgical interventions such as tonsil and dental extraction have failed the test of time. Currently there are no proven surgical interventions.

Preventive measures include taking a rest, avoiding excessive heat, drinking and smoking to prevent numbness and tingling. "Psychoeducational approach" is very necessary foe all MS patients (Msn, 2007 p.115). It involves counselling and education. It is aimed at helping the patients to problem-solve, self-manage, and plan as comfortably and effectively as possible. They are taught how to identify cognitive and emotional changes in additional to physical changes.

Nursing diagnoses and strategies

The treatment and management of MS patients can be disappointing at times. MS patients need to lead a quality life even though there is no scientifically proven cure for the disease. The most effective nursing diagnoses involve accurate diagnoses of the disease, treatment and management as well as rehabilitation. Inaccurate diagnosis can be fatal because the treatment administered may have negative effects on the patient (Rosner and Ross, 2008 ). The earlier the disease is detected the sooner the management begins. The treatment of underlying infections that can trigger attacks should be treated as soon they are diagnosed. Such infections include "acute sinusitis" and "dental abscess" (Ross and Rosner p.118). An attack triggered by these infections can be treated effectively using antibiotics. As mentioned in this paper, MS leads to memory loss and slowing of progression. Rehabilitation is key to improving these conditions. Physical rehabilitation has a positive impact on disability in MS patients (Stokes, 2004 p.201).

In summary, multiple sclerosis is one of the mystery diseases in the world. This is because neither its cause nor its cure is known. Its symptoms are frequently mistaken for other disorders. However with accurate diagnostic tests such as MRI treatment of underlying infections can commence immediately. The management of the disease is also a key element in reducing the severity and frequency of attacks. Physical rehabilitation has also positive impacts on the disability of MS patients.