CGTC FAQs: Academic Support

Multiple sclerosis (MS) is an autoimmune disorder that causes damage to the myelin sheath, which is the fatty substance that surrounds and protects the axon of the nerve.  It damages the sheath, and then it also damages the underlying nerve.  Where that damage occurs, we have inflammation and the formation of scar tissue of plaques.  If you look at the disease name multiple sclerosis that means many scars.  Sclerosis means scars.  Because you have all of that scar tissue forming secondary to the damage.  Multiple sclerosis is characterized by periods of relapsing and remitting.  A patient may go a while without any problems and then relapse.  This disease is more common in women than men.  It is common between the ages of 20 - 40.  Patients with MS tend to have diplopia or double vision.  Or nystagmus, which is the involuntary movement of an eye.  Patients will also have multiple spasticity and/or weakness.  It can also cause balance issues as well as bowel and bladder dysfunction.  It can cause fatigue, as well as, cognitive changes such as difficulty concentrating.  It can also cause emotional changes, such as depression or anxiety.  It causes pain as well as difficulty swallowing, and dysphagia.  In terms of diagnosis, plaques are visualized on MRI.  A lumbar puncture will reveal increased protein in CSF.  In terms of treatment, treat with immunosuppressants because it is an autoimmune disorder.  During an exacerbation. typically treated with corticosteroids.  Long-term treatment with a medication such as interferon beta, which will help to prevent relapses of MS.  May also use muscle relaxants if the patient is having muscle spasticity.  Advice patients to avoid triggers.  Triggers can include stress, fatigue, illness, and extremes in temperature -- very hot or very cold temperatures.  

Amyotrophic lateral sclerosis is a relentlessly progressive disorder involving degeneration of the motor neurons in the spinal cord, brainstem, and corticospinal tract.  Amyotrophic lateral sclerosis, ALS, is a neurodegenerative disease that causes progressive muscle weakness.  The exact cause of ALS is not known, but it results in gradual deterioration.  It results in the gradual deterioration of the upper and lower motor neurons.  Upper motor neuron findings include spasticity, hypertonia, rigidity, hyperreflexia, abnormal reflexes such as Babinski's, and late regression of weakness.  Lower motor neuron findings include  early weakness, atrophy, decreased muscle tone, hyporeflexia, and fasciculations in the affected muscle.  May see a loss of voluntary movement and muscle control.  Patient may lose their ability to speak, eat, move, and eventually breathe.  Symptoms of ALS include muscle weakness and atrophy as well as muscle cramps and twitching.  Dysphagia is another symptom of difficulty swallowing.  Eventually, the patient will have respiratory paralysis, which occurs 3-5 years after being diagnosed.  Diagnoses are done based on patients' symptoms and ruling out other causes.  In terms of treatment, medications such as Riluzole can be used to slow the deterioration of those motor neurons.  In terms of nursing care, your number one priority is to maintain a patent airway.  Monitor the patient for pneumonia, as well as, respiratory failure.  Those respiratory muscles will get progressively weaker such that the patient will become dependent on a ventilator.  The palliative team should be onboard as well.  

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