Question

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Case Scenario Mrs. S, who is 35 years old, reports numbness, tingling, and weakness in her lower extremities. She is extremely worried because she remembers that her mother had these symptoms prior to being diagnosed with multiple sclerosis (MS). 1. What is multiple sclerosis? 2. Why does the nurse think Mrs. S is so concerned that it could be MS? 3. What diagnostic testing would be helpful to confirm or rule out MS? Within 24 hours, Mrs. S started to develop paralysis, which was moving up her legs. A tentative diagnosis of Guillain-Barré syndrome was made. 4. What is Guillain-Barré syndrome? 5. How is Guillain-Barré is typically treated?

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Answer 1

1. Multiple sclerosis is a disease in which the insulating myelin sheath covering the neurons or the nerve cells of the central nervous system are damaged. Damaged insulation of nerve cells impairs the conduction of nerve impulses. This affects the ability of nerve cells to communicate with one another. It is one of the most common immune mediated disorder affecting the central nervous system.

Most common symptoms of multiple sclerosis are loss of sensitivity, numbness, muscular weakness and blurred vision. Multiple sclerosis does not have any cure. Physical therapy and certain medications may alleviate some of the symptoms and allow the patient to have less frequent attacks and improve their functioning.

2. Multiple sclerosis is not typically a hereditary disease. However, it does have a strong genetic component. Relatives of those affected with multiple sclerosis is more likely to be affected. Thus, Mrs. S, whose mother was affected by multiple sclerosis is significantly more likely than the general population to develop multiple sclerosis.

The symptoms described here is generally associated with multiple sclerosis. Further, the patient's mother had similar set of symptoms which ultimately lead to the diagnosis of multiple sclerosis. Since, risk of having multiple sclerosis is higher than the general population in the relatives of patient, this could be the possible reason why the nurse thinks Mrs S is concerned that she could have multiple sclerosis.

3. The most common way of confirming or ruling out multiple sclerosis is by a MRI (magnetic resonance imaging) of the brain. Multiple sclerosis is associated with production of lesions in certain parts of the brain. A patient might be injected with a contrast material which highlights lesions in the brain. Imaging of lesions, along with symptoms which cannot be explained by any other neurological disease is usually how multiple sclerosis is confirmed.

Other ways of diagnosing if a patient has multiple sclerosis are:

• Blood tests may be done to identify specific biomarkers associated with multiple sclerosis. This is done to confirm or rule out other diseases with similar symptoms.
• Lumbar puncture of the spinal cord is done and a small amount of spinal fluid is removed and tested for specific antibodies associated with multiple sclerosis. This test is also used to confirm or rule out the possibility of other diseases with similar symptoms.

4. Guillain–Barré syndrome is a rare immune mediated peripheral nervous system disorder. It is an autoimmune disorder, where the body's immune system attacks the insulating mylein sheath present in the peripheral neurons.

Most common symptoms of Guillain-Barré syndrome is numbness, muscle weakness and tingling. About 25% of the affected patients develop respiratory disorders due to weakness in lung muscles.

Diagnosis of Guillain-Barré syndrome is usually done by excluding the possibility of all other disorders with related symptoms. It is supported by nerve conduction test (which examines the ability of nerve cells to conduct electrical impulses) and/or testing cerebrospinal fluid for presence of certain antibodies.

5. The two most common ways of treating Guillain-Barré syndrome are:

• Plasmapheresis - This process filters out the antibodies from the bloodstream which are attacking the mylein sheath of the nerve cells.
• IVIG - Intravenous immunoglobulin administration is another important way of treating Guillain-Barré syndrome. In this process, suitable immunoglobulins are administered intravenously in the body which neutralizes the antibodies responsible for the Guillain-Barré syndrome.