What is Myelin?

Myelin forms a layer, the MYELIN SHEATH around the axon of a neuron.
Function
• Myelin is an insulating layer, or sheath that forms around nerves, including those
in the brain and spinal cord.
• It is made up of protein and fatty substances.
• allows electrical impulses to transmit quickly and efficiently along the nerve cells.
If myelin is damaged, these impulses slow down!.

Ex.
Inflammatory
Demyelinative
Disease
 MULTIPLE
SCLEROSIS
PRESENTED BY: M.J OCENA & A.M LIBRES
WHAT IS IT?

• Multiple sclerosis (MS) is a potentially disabling disease

of the brain and spinal cord (central nervous system).

• In MS, the immune system attacks the protective sheath

(myelin) that covers nerve fibers and causes
communication problems between your brain and the
rest of your body. Eventually, the disease can cause
permanent damage or deterioration of the nerves.
CAUSE:

• MS is an autoimmune condition. This is when something goes

wrong with the immune system and it mistakenly attacks a healthy
part of the body – in this case, the brain or spinal cord of the
nervous system.

• In MS, the immune system attacks the layer that surrounds and
protects the nerves called the myelin sheath.

• This damages and scars the sheath, and potentially the

underlying nerves, meaning that messages travelling along the
nerves become slowed or disrupted. Exactly what causes the
immune system to act in this way is unclear, but most experts
think a combination of genetic and environmental factors is
involved.
Pathophysiology
TYPES: 2 General ways

Relapsing Remitting (RR)

&
Primary Progressive(PP)

ReRe & PriPro

 Relapsing Remitting

A relapsing-remitting disorder means the

symptoms are at times worse (relapse) and other times
are improved or gone (remitting). During a chronic pain
relapse, the pain would be present partially or
completely. During a remission, however, the pain
would subside and require little, if any, treatment.
 Primary Progressive

• Primary Progressive MS (PPMS) is called this

because from the first, or primary symptoms, it’s
progressive.

• Early symptoms are often subtle, like problems with

walking, which develop over time. There will usually
be few or no relapses with PPMS. Instead, disability
will gradually increase. There can also be long
periods where symptoms seem to be staying level.
Signs and
Symptoms
Vision Problems Multiple sclerosis can cause vision problems due to damage to the optic nerves — those that connect the eyes to
the brain — or to nerves that control the muscles involved in eye movement, which affects eye coordination.

Fatigue Primary MS fatigue is due to changes in the brain and damage to the central nervous system. The damage affects
the nerves by interrupting messages from the brain and spinal cord to the rest of the body. As a result, your body
has to work harder to function, which can lead to a build-up of MS fatigue.

Secondary MS fatigue occurs from the effects of living with MS. For instance, MS symptoms such as depression,
pain or sleep disturbance from spasms or incontinence can all make MS fatigue worse.

Speech and Swallowing difficulties In MS, the nerves that control these muscles can become damaged causing weakness and incoordination that can
provoke swallowing problems.

Mobility Problems Mobility difficulty is an inevitable complaint for individuals with multiple sclerosis (MS).

Primary neurologic symptoms that lead to mobility impairment are decreased motor control, impaired muscle
strength, spasticity, impaired balance, and ataxia.

Muscle spasms Disrupted nerve messages can also cause over activity of muscles and loss of coordination leading to spasms.
Depending on where in your brain or spinal cord MS affects nerves, spasticity can affect any muscle in the body.
Sexual problems lesions in the cortex and spinal cord which can lead to numbness or paresthesias that directly affect the genitals;
decreased vaginal lubrication in women; and difficulty initiating an erection in men.

Depression and Anxiety For people living with MS, there are additional factors that may lead to depression. Depression can be caused more
directly by MS if the inflammatory lesions are in areas of the brain associated with mood, or due to MS-related
changes in the immune and/or neuroendocrine (hormone) systems.

Bowel Problems Diarrhea may occur due to a loss of sensation in the rectal area, which results in involuntary relaxation, allowing
the release of loose stool.
 Diagnostic and Laboratories

01 02 03
MEDICAL HISTORY CSF analysis
AND Magnetic Resonance
NEUROLOGICAL Imaging
EXAM
The fluid that is drawn off in a lumbar
puncture is analysed to look for a
number of different things. White
blood cells. If you have multiple
Your neurologist will ask you lots A contrast material, called
sclerosis, then the number of white
of questions about your health gadolinium, may be injected
cells in your cerebrospinal fluid is
problems and symptoms, now and intravenously in the patient, to
usually up to seven times higher than
in the past. highlight lesions.
normal.
 4 5
CBC Evoked potential
tests

which record the electrical signals produced by your nervous

to help rule out other diseases with
symptoms similar to .
system in response to stimuli. An evoked potential test may use
visual stimuli or electrical stimuli. In these tests, you watch a
moving visual pattern, or short electrical impulses are applied to
nerves in your legs or arms. Electrodes measure how quickly the
information travels down your nerve pathways.
SURGICAL PROCEDURE
 Implantation of deep brain
stimulator
creating small holes in the
skull to implant the electrodes
into the brain tissue as well as
performing surgery to implant the
device that contains the batteries
under the skin in the chest.
Complications of surgery may
include: Misplacement of leads.
Bleeding in the brain.
 Rhizotomy
a minimally invasive surgical procedure
to remove sensation from a painful nerve
by killing nerve fibers responsible for
sending pain signals to the brain. The
nerve fibers can be destroyed by severing
them with a surgical instrument or burning
them with a chemical or electrical current.
PHARMACOLOGICAL
 Relapsing Remitting Primary Progressive

-Treatment options for relapsing-remitting MS include Ocrelizumab (Ocrevus)

injectable and oral medications:
• is the only FDA-approved disease-modifying therapy
Interferon beta medications ( injectable) (DMT). Those who receive this treatment are slightly less
likely to progress than those who are untreated.
• These drugs are among the most commonly prescribed
medications to treat MS. They are injected under the skin -This medicine may increase your risk of
or into muscle and can reduce the frequency and severity developing infections. Avoid being near
of relapses.
people who are sick or have infections while
you are using this medicine!
-You'll need blood tests to monitor your liver
enzymes because liver damage is a possible
side effect of interferon use!
Fingolimod (Gilenya) – ( oral )
• This once-daily oral medication reduces relapse rate.

-You'll need to have your heart rate and blood

pressure monitored for six hours after the first
dose because your heartbeat may be slowed!
 Nursing Interventions

Provide bed rest during Protect the client from injury by

exacerbation. providing safety measures.

Monitor for potential complications

Place an eye patch on
such as urinary tract infections,
the eye for diplopia calculuses, decubitus ulcers, respiratory
tract infections, and contractures.
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 References
• https://nurseslabs.com/9-multiple-sclerosis-nursing-care-plans/
• https://
www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274
• https://
www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
• https://www.webmd.com/multiple-sclerosis/guide/what-is-multiple-sclerosis