OVERVIEWThe best treatment for MS involves what is known as comprehensive care. Comprehensive care involves a combination of pharmacological therapy and rehabilitation with supporting roles of complementary and alternative therapies. The goal of comprehensive therapy is to maximize the quality of life and limit the number of relapses for those diagnosed with MS.
PHARMACOLOGICAL THERAPYDrug therapy in MS is known as disease-modifying therapy (DMT). This classification of drugs work to modify the disease course, treat relapses, and manage symptoms. These drugs work to reduce inflammation in the central nervous system (CNS) and are aimed at treating relapses, which are characterized by CNS inflammation. DMTs work by targeting some aspect of the inflammatory process and have been shown reduce the accumulation of lesions in the brain and spinal cord as seen magnetic resonance imaging (MRI) and may slow the accumulation of disability for many people with MS. They are not effective in treating progression of nerve degeneration. Health Canada has approved 11 DMTs for treatment of relapsing-remitting MS and secondary progressive MS with relapses. To date, no DMTs have been approved to treat primary progressive MS (MS that shows steady progression at onset) (Bevan & Cree, 2014; Multiple Sclerosis Society of Canada, 2016).
To view a more detailed description of the pharmaceuticals used to treat MS, please click the button below
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NURSING INTERVENTIONS
As MS is a chronic disease, there are many adverse outcomes that can affect the quality of life and health of a patient. One of the most debilitating and persistent adverse effects of MS is fatigue. Fatigue in MS is often caused by a combination of the disease itself (pain, decreased physical ability etc) and side effects of medication. Fatigue impacts the ability to engage in ADLs and slows recovery time after relapse.
1. Assess need for mobility assistive devices and review proper use for patients already using devices.
Rationale: Movement and mobility in ADLs can induce and increase existing fatigue. The use of mobility assistive devices can help patients reduce their fatigue, while still maintaining independence and comfort. Reviewing the way patient’s use their assistive devices if they already have them can also help reduce fatigue, as many patients use their devices improperly, reducing the efficacy of the device.
Living with a chronic illness has been shown to affect self-esteem, as chronic illness can create changes in physical appearance, body image, and roles at work and home. Low self-esteem can impact self-image, motivation, hope, and coping capabilities.
2. Provide patient education regarding course of disease, prognosis, anticipatory guidance on what to expect in terms of changes and discuss effective ways one may cope with these changes.
Rationale: When a patient’s knowledge about their disease is increased and they become aware that their behaviour can significantly improve their wellbeing and functioning, patients are empowered to feel more in control and experience a reduction in fear of the unknown, improving self esteem/limiting the loss of self esteem.
The course of MS can impair bladder muscle function and control, causing impaired urinary elimination in the form of incontinence, increased urinary frequency, nocturia, urine retention, and risk of recurrent UTIs.
3. Initialize bladder training program and timed voidings in patients who experience incontinence and bladder infection.
Rationale: Because MS can cause weakened pelvic floor muscles, loss of bladder control, and incontinence, bladder training can help patients restore bladder function and train the body/brain to trigger voiding at specific times, allowing patients to plan their voiding schedule, preventing incontinence, retention, and reducing risk for recurrent UTI and bladder infection.