NurseSavvy Cheat SheetDisease
Multiple Sclerosis
Pathophysiology & Risk Factors
Autoimmune demyelination of the CNS: the immune system attacks the myelin sheath in the brain and spinal cord, forming plaques (scleroses) that disrupt nerve signal transmission. The hallmark is lesions disseminated in time and space — symptoms appear, resolve, and recur in different CNS locations. Relapsing-remitting MS (~85%) is most common, with acute exacerbations followed by partial or full recovery.
Uhthoff phenomenon: heat transiently worsens MS
- Heat exposurehot bath, fever, exertion
- Demyelinated neurons conduct poorlyworse at higher temperature
- Symptoms temporarily worsenpseudo-relapse
- Cool the clientsymptoms improve
Signs & Symptoms
EarlyProgresses →
fatigue Hallmark
most common and disabling; worsens through the dayoptic neuritis Hallmark
unilateral vision loss with eye pain; common first signparesthesias
numbness, tinglingLhermitte sign Hallmark
electric shock down spine with neck flexionblurred or double vision
intention tremor
Late / Severe
spastic weakness
UMN signsataxia
neurogenic bladder
urgency, retentionbowel dysfunction
Diagnostics & Labs
Diagnostic
MRI white matter lesions Hallmark
disseminated in time and space (McDonald criteria)CSF oligoclonal bands
supportive findingMonitor
JC virus antibody
before/during natalizumab; PML riskCBC
interferon leukopenialiver function tests
interferon hepatotoxicityInterventions & Priorities
treat acute relapse with IV corticosteroids
high-dose IV methylprednisolone over 3-5 dayskeep environment cool
avoid heat/Uhthoffenergy conservation and pacing
scheduled rest periodsfall and safety precautions
weakness, ataxiatimed voiding bladder program
intermittent catheterization for retentionmoderate activity as tolerated
avoid strict bed rest and deconditioningTreatments & Medications
IV methylprednisolone
acute exacerbation; over 3-5 daysinterferon beta
disease-modifying; reduces relapse frequencyglatiramer acetate
disease-modifyingnatalizumabBlack Box
disease-modifying; FDA boxed warning for PMLPatient Teaching
avoid hot baths and overheating
heat transiently worsens symptomsschedule demanding tasks in the morning
fatigue worsens later in the daymoderate exercise within tolerance
avoid vigorous overexertionstress management
avoid infection exposure
report fever, chills, or bruising on interferon
leukopenia, hepatotoxicitydo not stop disease-modifying therapy abruptly
without provider guidanceComplications
progressive disability
urinary tract infection
from neurogenic bladder/retentionaspiration
from dysphagiaprogressive multifocal leukoencephalopathy
natalizumab; JC virusReport Nowescalate immediately
severe acute relapse
new or worsening neurologic deficitsswallowing involvement
aspiration riskrespiratory involvement
signs of infection
relapse trigger; immunosuppression risknew cognitive or behavioral decline on natalizumab
possible PMLClinical Pearl
MS hates heat: if neuro symptoms flare after a hot shower, think MS first — cool the client down and the symptoms improve.