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Signs and symptoms

Some signs and symptoms of multiple sclerosis can attract the attention of patient as well as the doctors immediately they appear while others are not recognizable for a long time. Some of the early symptoms of the disease include axonal destruction and demyelination (Olek, 2004 p. 1). The pathophysiology of multiple sclerosis is not completely understood and hence still under investigation. However it is believed to have five major characteristics that present in tissues of the central nervous system of MS patients. These include; inflammatory lesions on the white matter of the CNS, production of intrathecal Ig with oligoclonal bands which is a conducive environment for immune cell persistence, disruption of the blood-brain barrier, and follicle like aggregates on the meninges (Polman et al, 2006). Intrathecal refers to something occurring or introduced into the space under the arachnoid membrane of the spinal cord or the brain.

Lesions in the white matter of the CNS are mainly believed to the first symptoms of MS. These lesions breakdown the myelin surrounding the central axon of the nerves. They destroy highest intellectual functions of a patient which leads to inability to make complex decisions that involves multiple variables.As a result the patient's personality may change. Also the lesions that separate and interrupt neural systems integration are capable of reproducing various psychiatric disorders such as anxiety, depression, loss of inhibitions, paranoia, as well as variants of neurosis. However, the symptoms that a patient or a family member may quickly detect includes; memory impairment, slowing of performance, and reduced ability to handle average tasks.

Etiology

Rosner and Ross (2008) argue that the cause of multiple sclerosis is not known. However they agree that there are various explanations of probable causes of the illness. In 1849 a German doctor first published a report on MS that is close to the modern concept. In his report he said that the disease is most common in young patients and is characterised by slow progression.

Diagnosis

The diagnosis of MS involves laboratory tests and radiographic examinations (autopsy and biopsy). Currently there is a widespread use of magnetic resonance imaging (MRI) in the diagnosis of MS. The MRI is able to show MS lesions in the spinal cord and in the brain. Even with this technology MS remains one of the difficult to diagnose diseases.  The neurological evaluation of the disease involves two stages. The first stage is discernment of where the problem is and then evaluation to determine whether the causes of the disease are the identified location. In the diagnosis of MS two clinical criteria should be satisfied by the neurological evaluation (Rosner and Ross, 2008). The two clinical criteria are; course of remissions and attacks, and neurological examination or patient's history that suggest lesions in the spinal cord or the brain.

Where there is absence of second clinical episode, laboratory tests of cerebrospinal fluid examination can be carried out to supplement evidence. However the accuracy of MRI diagnosis of MRI depends on the doctor's skill in observing as well as soliciting an accurate description of symptoms and history. MRI is largely believed to be the most accurate diagnosis for MS since it is capable of showing demyelination, atrophy and chronic inflammatory process even in the absence of clinical symptoms (Barker, 2008). Laboratory tests do not give sufficient evidence for diagnosing MS. They are mainly combined with other diagnostic tools.

Medical treatment

Rosner and Ross (2008) argue that until the cause of MS is proved then its treatment cannot be scientific. This then means there is no cure foe MS. However new approaches are capable of modifying the course of MS, lessen the severity and frequency of attacks, as well as managing symptoms thus improving the patient's quality of life and that of their families. MS patients are known to have relapse of the attacks even after treatment for causes not known. Corticosteroids have used to treat relapses for several years. They have "immunomodulatory and anti-inflammatory effects" capable of restoring the integrity of the "blood-brain barrier" (Polman et al, 2006 pg 12). Other proven treatments for relapses are rest, and treatment of underlying infection. Surgical interventions such as tonsil and dental extraction have failed the test of time. Currently there are no proven surgical interventions.

Preventive measures include taking a rest, avoiding excessive heat, drinking and smoking to prevent numbness and tingling. "Psychoeducational approach" is very necessary foe all MS patients (Msn, 2007 p.115). It involves counselling and education. It is aimed at helping the patients to problem-solve, self-manage, and plan as comfortably and effectively as possible. They are taught how to identify cognitive and emotional changes in additional to physical changes.

Nursing diagnoses and strategies

The treatment and management of MS patients can be disappointing at times. MS patients need to lead a quality life even though there is no scientifically proven cure for the disease. The most effective nursing diagnoses involve accurate diagnoses of the disease, treatment and management as well as rehabilitation. Inaccurate diagnosis can be fatal because the treatment administered may have negative effects on the patient (Rosner and Ross, 2008 ). The earlier the disease is detected the sooner the management begins. The treatment of underlying infections that can trigger attacks should be treated as soon they are diagnosed. Such infections include "acute sinusitis" and "dental abscess" (Ross and Rosner p.118). An attack triggered by these infections can be treated effectively using antibiotics. As mentioned in this paper, MS leads to memory loss and slowing of progression. Rehabilitation is key to improving these conditions. Physical rehabilitation has a positive impact on disability in MS patients (Stokes, 2004 p.201).

In summary, multiple sclerosis is one of the mystery diseases in the world. This is because neither its cause nor its cure is known. Its symptoms are frequently mistaken for other disorders. However with accurate diagnostic tests such as MRI treatment of underlying infections can commence immediately. The management of the disease is also a key element in reducing the severity and frequency of attacks. Physical rehabilitation has also positive impacts on the disability of MS patients.

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