Instructor's Note: Because of the long time span involved in this case, it is summarized here in table format.
|Age||Symptoms||Diagnostic Testing||Doctor's Conclusions|
|22||Dizzy, loss of equilibrium||None||Anemia|
|25||Headaches, tingling, and numbness||Did not consult doctor||N/A|
|26||Headaches, tingling, and numbness||Did not consult doctor||N/A|
|31||Nauseated, double vision||Visual acuity, visual fields, CAT scan||Probable multiple sclerosis|
|34||Intense tingling and numbness from the waist down||Lumbar puncture, evoked potentials, MRI||Confirmed multiple sclerosis|
1. Multiple sclerosis (MS) is an autoimmune disease in which the body's immune system attacks the myelin sheath surrounding the nerves in the central nervous system. Although some of the myelin may be repaired after an attack, myelin may also disappear and characteristic scarring may form (plaques). Demyelination of the nerves slow or may actually stop nerve impulses.
2. The alteration of nerve impulses may cause varied symptoms. Janet's symptoms included fatigue, dizziness, visual blurring, and sensory disturbances including tingling and numbness. As Janet's disease progressed, her motor skills became impaired causing partial paralysis and leaving her with an awkward, shuffling gait. In advanced multiple sclerosis, symptoms may include bladder dysfunction and mental impairment.
3. MS can be a difficult disease to diagnose. Characteristic plaques may not appear until the disease has progressed for some time. The diagnosis is based upon the patient's history and symptoms, elevated proteins in the CSF, slowing of nerve impulses detected by evoked potentials, and MRI results showing lesions or plaques in the spinal cord, brain stem, and/or cerebral cortex.
4. Steroids or anti-inflammatory drugs are used to shorten the duration of acute attacks. Beta interferons such as Avonex are used to suppress the body's immune response to decrease the attack against myelin. Supportive therapy for individual symptoms is given as needed.
5. There is no known cure for Multiple Sclerosis. The average duration of the disease is 30 years.
6. There is no known prevention for Multiple Sclerosis. Research supports the theory that there is a genetic predisposition to MS which is triggered by an environmental factor such as a virus.
7. A person with MS may see varied health professionals depending upon their symptoms. In Janet's case, her ophthalmologist first suspected MS and referred her to a neurologist who made the diagnosis. Several key health professionals performed the diagnostic testing crucial for diagnosis. These professionals include medical laboratory scientists who evaluated the cerebral spinal fluid and radiological technicians who performed the CT scan and MRI. The radiologist read and interpreted both the CT scan and MRI. Nursing care, in this case, was provided by a home health care nurse. These nurses provide services to individuals in their homes, often to the elderly and those that are homebound. In this case, a home health care nurse assisted Janet during the severe attack that left her unable to walk. Later, the nurse visited weekly to administer medications. The home health link describes requirements for this field as a bachelors degree in nursing. This is required for certification but it should be noted that RN's and LPN's also work as home health nurses.