Multiple Sclerosis Is a Disease That Destroys the Nervous System

Multiple sclerosis (MS) is a chronic autoimmune disorder that slowly destroys the myelin sheath of nerves which can cause irreversible nerve damage and potentially be disabling. Multiple sclerosis has two forms, primary progressive which means that the patient progressively deteriorates and relapsing-remitting, which means the patient will have periods of remission followed by periods of exacerbation. Relapsing-remitting disease is the most common type of MS, however, 60-70% of these patients will develop secondary progressive disease, which means after a time of relapses followed by remissions, the patient will no longer experience remissions but progress in the disease process (Mayo Clinic, 2019). According to the National MS Society (2016), there are only around 2.3 million cases worldwide. There are no exact numbers of prevalence in the United States due to no mandate to report cases. Also, because MS can be a subtle disease, patients may be unaware that they have MS; this is due to little or no symptoms of the disease. While the amount of people affected globally is low, MS is an important disease to understand, as it can be progressive and requires early treatment to prevent complications.

Unlike other chronic illnesses MS does not have a cure or set treatment, which requires nurses to care for MS patients slightly differently than other chronically ill patients, as treatment is palliative not curative. Treatment is palliative instead of curative as there is no known cause of MS, thus symptom management is the focus. Similar to other chronic illnesses, MS can cause fatigue and depression which can impact the quality of life of patients. Multiple sclerosis can also cause mobility problems and hinder activities of daily living, so it is important to seek early treatment and support caregivers to keep the optimal quality of life for patients (National Multiple Sclerosis Society, 2020f).

Multiple sclerosis is a complex disease that does not follow a typical disease progression due to entire body involvement, which leads patients to experience different levels of severity and differing levels of disability (Mayo Clinic, 2019). To provide and implement the best possible patient care, it is important to consider literature surrounding MS such as the ability to perform activities of daily living, diet, exercise, quality of life, and medication adherence. Additionally, the nurse must consider the individual impact of the disease, family involvement, community resources, research around the disease, and the leadership and change processes.

Multiple sclerosis is a chronic and progressive demyelination disease that causes most patients to experience sensory and/or motor deficits, which can impact their ability to perform activities of daily living. A study conducted by Dehghani, Khoramkish, and Isfahani (2019), researched how MS affects activities of daily living (ADL). The purpose of the study was to examine the progression of the disease, patient symptoms, and how these two things affected activities of daily living and quality of life. The study was conducted in Iran and used a qualitative design to focus on fourteen individuals from a wide range of demographics. These demographics included ages 24-45, education level ranging from diploma to associate degree, and disease duration of at least one year. To be included in the study participants had to be willing to participate, have a diagnosis of MS by a neurologist, possess the ability to describe their experience with the disease, be one year from diagnosis and be a member of the MS Society. Participants were excluded if they were experiencing acute or critical attacks.

To conduct the study, researchers performed interviews that were semi-formal and face to face. The participants were only interviewed one time, for 30-45 minutes, and at a time and place which they were comfortable. The interview questions were simple questions that focused on the individuals’ experience with MS and the impact on his or her life, daily care, and difficulties he or she faces in day to day life. Because the study was interview-based, the researchers had to spend more time with the data and in the field to enhance credibility. Researchers also had peer reviews done on the data and external audits done by two independent researchers. The study found that the most common fear was the ambiguity of the disease, although there were other findings including physical, emotional and behavioral changes, fear of being crippled, financial burden, and socio-cultural beliefs. For physical, emotional, and behavioral changes, there were reports of lethargy, stress, anxiety, and depression. For the fear of being crippled related to disease progression, participants were afraid of needing mobility aids, such as wheelchairs. The fear of finances was found to relate to the reliance on family to help pay for bills. Socio-cultural findings dealt with misconceptions about the disease, such as it being contagious, a negative attitude about the disease, and early death (Dehghani, Khoramkish, & Isfahani, 2019).

Although the study gained insight into patient experiences, there were some limitations to the study. One limitation was only utilizing participants from Jarhom, Iran, as the study only considered the culture from this area. Another limitation was only utilizing patient perspectives, not family members as perspectives may differ. The study could be implemented in the United States, however the limitations to Jarhom, Iran is challenging as the US has different cultural beliefs than Iran does, which may make the data less significant in the United States.

Clinical implications of the findings illustrate that in addition to physical limitations, patients also suffer from emotional limitations which can restrict their ability to care for themselves independently. Although patients cannot be cured, support groups and community awareness can be done to allow patients to discuss their disease and disprove misconceptions (Dehghani et al., 2019).

Another area of interest in MS patients is the effect of diet and the development of the disease, as it has been found that a diet lacking in vitamin D, or a poor diet overall, may be a potential cause of the disease. However, it is crucial to consider how diet affects current MS patients and if there is a best practice diet for symptoms. Thus, a study by Bromley, Horvath, Bennett, Weinstock-Guttman, and Ray (2019) was conducted to examine how diet affects the quality of life, daily function, ambulation, and fatigue. The study design was a cross-sectional study that had participants from neurology offices in New York. A convenience sample was used to gather twenty participants from both sexes with an inclusion criterion of age twenty or older, the ability to walk 100 meters, and an Expanded Disability Status Scale (EDSS) score of mild to moderate.

Testing methods were not explicitly listed; however, participants were required to be tested for two days with the days separated by a week. To test ambulation and physical function, the study tested mobility, speed of walking, and the ability to sit then stand quickly. Mobility was measured by the 6MWT test, which measured the patient’s ability to cover as much distance as possible in six minutes. To test the speed of walking, the T25FW test was used to time how long it took participants to walk twenty-five feet. To test sit to stand ability, the TUG test was used which had patients stand up from a chair as quickly as possible, walk ten feet, and sit down. Quality of life was measured by the SF-36 test which utilized a scale to measure physical functioning, pain, health perception, vitality, social functioning, and role limitations due to emotional problems. To assess fatigue, self-measurement scales were used. Additionally, participants had to keep a three-day food diary and answer food frequency questions, which had the patients specify how much of a food they ate daily, out of 116 items, over the past twelve months (Bromley, Horvath, Bennett, Weinstock-Guttman, & Ray, 2019)

Results from the food diary and tests found that saturated fats positively correlated to the physical functioning of the SF-36 scale (r = 0.47, P = .03). Carbohydrates were found to reduce the distance covered in the 6MWT test and have lowered levels of physical activity. However, diets higher in fat were found to increase the distance covered in the 6MWT test and reduce TUG times. High sugar intake was also found to cause lower T25FW results and lower physical activity. Finally, higher iron was found to improve 6MWT distance, self-perceived walking ability, and TUG times while higher magnesium was associated with improved 6MWT distance and physical activity (Bromley et al., 2019).

There were a few limitations of the study such as the utilization of a cross-section study, as it did not allow for causation to be concluded, small sample size, and utilizing food diaries as a measurement tool, as there can be discrepancies with patients reporting. The small sample size of the study is a limitation as it could potentially decrease reliability and create a bias. Clinical implications illustrate that diets higher in saturated fat can improve or keep the patient functioning at a higher level than patients that eat a more carbohydrate-dense diet, and that iron and magnesium help functioning as well and improve ambulation and consequently the quality of life (Bromley et al., 2019).

An important consideration that has been discussed for patients that have MS is how exercise affects their disease course, specifically with fatigue and depression. A study by Razazian et al. (2016) analyzed if exercise can improve the symptoms of fatigue and depression levels, as fatigue occurs in two-thirds of patients, and depression has been found to occur at 40-50% greater prevalence than the general population. The design of the study was blind randomization, with participants being separated into three groups: the control group, a yoga group, and an aquatic exercise group which was done by random selection. The sample consisted of 54 women diagnosed with MS, with an inclusion criterion of stability of the disease, a confirmed diagnosis of MS by a neurologist, female gender, between ages 25-50 years old, having a score of six or less on the expanded disability status scale, and undergoing an immune modulator treatment that is monitored regularly. The method used was a questionnaire that the patient filled out once in the beginning and once in the end but with two different sets of questions each time.

At the start of the study, participants answered questions about social-demographic information, bodyweight/height information, and illness difficulties along with a self-rating questionnaire of fatigue, depression, and paresthesia. The fatigue questionnaire was a nine-question scale to analyze levels of fatigue. The depression questionnaire utilized the Beck Depression inventory which used twenty-one questions to establish a baseline depression score. These questionnaires were completed again at the end of the study eight weeks later, which was compared to baseline levels of fatigue, depression, and paresthesia.

The study did not find important statistical differences between age, weight, length of disease, social demographic background, and severity of the disease. However, the study found that while there were no important statistical differences of baseline levels of fatigue,