Question

Neurologic System: Multiple Sclerosis  

Discussion Assignment:

• What is the effect of the demyelization on the nerves of an individual who has Multiple Sclerosis?
• Why are the medications appropriate?
• Why do you think females are at greater risk for MS?

Case Study:

Patient: Myrtle, Newly Diagnosed, (25 years old)

Social History:   Homeless, Unemployed, Single,

Nonsmoker; no ETOH (ETOH is an acronym for ethyl alcohol); no illicit drugs

On line college student-struggles to understand material

Symptoms

2006: blurred & double vision

2013: Double vision; urinary urgency; poor attention

2012: Numbness in both legs

Diagnosis: RRMS - Relapse-Remitting Multiple Sclerosis

• (2 episodes of neurological symptoms referable to the CNS, separated in space and in time)
• Memory problems past 6 months; fatigue; heat intolerance; problems with balance
• Prevalence by Cognitive Domains
• Memory 40%
• Information Processing 35%
• Attention/concentration 30%
• Problem Solving 20%
• Visuospastial Abilities 20%
• Verbal fluency 10%
• Multiple domains (average) 22%

Supporting the Diagnosis:

• Findings on exam:
  • left INO internuclear ophthalmoplegia abbreviation: INO Loss of the normal paired movements of the eyes when tracking an object to the left or right. An INO is marked by the failure of one eye, e.g., the left, to cross the midline during an attempt to see an object on the opposite side of the body, e.g., the right.
  • vertical nystagmus (a repetitive, involuntary, to-and-fro oscillation of the eyes. It may be physiological or pathological and may be congenital or acquired.),
  • right ptosis,
  • MRI Brain and T spine:
    • Multiple enhancing white matter lesions
    • High T2 signal in the right optic nerve
    • Rim enhancing lesion at T6-7CSF
    • Bands notes in CSF and not in serum

Medications

• IM Interferon beta-1a
• Gabapentin 300mg tid
• Oxybutynin Chloride 5mg tid

Subject Pathophysiology

Answer 1

Multiple sclerosis is an auto immune disease which causes chronic progressive inflammation and destruction of myelin sheaths of neurons. In multiple sclerosis demyelination occur when the bodys immune system start to attack the myelin which cover the nuerons and casuses hardening ans plaque formation all over the brain and spinal cord.

The effect of the demyelization on the nerves of an individual who has Multiple Sclerosis

If the neurons are myelinated, the nerve impulses transmission become fast and the myelin sheath will protect loss of impulse during transmission. In multiple sclerosis the myelin sheaths are damaged, thus make the impulse transmission slow and reduce the quality of nerve impulses.

The medications

The patients with multiple sclerosis are usually treated with beta interferon. The action of beta interferon in an immune response is to stop the action by reducing the inflammation process. As the multiple sclerosis occur in the same way where the bodys auto immunity cause inflammation in the myelin sheaths, use of Interferon beta-1a Gabapentin is appropriate in treatment of this condition. These medications increase the duration between relapses and reduce the severity of the symptoms and slow down the changes in the brain and spinal cord.

Oxybutynin chloride is a antimuscarinic class of drug which act on muscles of bladder to help to reduce frequent urination. It is used in patients with Multiple sclerosis to reduce frequent urination caused by progression of disease condition.

Reasons for females at risk of more chances to get Multiple sclerosis.

The real reason for females to be more prone to get multiple sclerosis is unknown but some studies have found that in adolescence and adulthood, female show more chance of getting MS comparing to male before puberty. That could be because of changes in the body metabolism and hormone variations. The men and women are different in their body built and metabolism, women have to undergo so many changes during menstrual cycles, pregnancy and lactation and during menopause due to the hormonal variations. we can say that female body has to undergo lot of changes in a life time .The genetic pattern of men and women are also different. Thus it may leads to the higher chances of incidence of Multiple sclerosis in women than men.