Managing bladder symptoms in people with multiple sclerosis

Multiple sclerosis is a chronic disease of the central nervous system (brain and spinal cord). The cause is still unknown but there is evidence that suggests there is an autoimmune component to the disease that causes damage to the myelin sheath, a complex material that surrounds the axon of myelinated nerves (Fig 1). It affects 100-120 people per 100,000 population, approximately 75 per cent of whom will develop urinary symptoms (NICE, 2003). Bladder problems usually occur when the disease involves the spinal cord (Fig 2) and these can get worse as the disease progresses and the patient becomes less mobile. Bladder symptoms affect many aspects of daily life and their management is extremely important. As the disease progresses and symptoms worsen, a well-planned strategy can offer patients the most effective pathway to manage their bladder problems.     

Value of multimodal evoked potentials in the diagnosis of multiple sclerosis

94 Patients diagnosed as having multiple sclerosis (MS) were examined by multimodal evoked potentials. According to the criteria of Bauer and Poser the patients were classified as possible, probable and certain forms of MS. Abnormalities were found in the VEP in 82.6% of cases (possible - 44.4%, probable - 87.5%, certain - 95.2%), in the BAEP in 51.3% of cases (possible - 27.3%, probable - 46.2%, certain - 68.8%) and in the SSEP in 71.1% of cases (possible - 35.3%, probable - 67.7%, certain - 88.1%). Subclinical lesions were detected by VEP in 37.0% of cases, by BAEP in 43.6% and by SSEP in 21.1%. Reclassification according to the results of the evoked potentials studies was required in 21.2% of cases. The value of evoked potentials in the diagnosis of MS is discussed with regard to the different forms of evoked potentials, as well as in comparison with other examination techniques.     

The management of pain in multiple sclerosis: a care-study approach

Pain is a commonly reported symptom of multiple sclerosis (MS). However, the literature surrounding pain management for people with MS appears limited. This article describes how pain was managed for one patient. It suggests that the MS nurse is pivotal in ensuring that patients receive adequate pain control. The MS nurse can coordinate timely assessment, monitor effectiveness and side effects linked with a pain management plan, and provide education and support to patients in order to allow them to take responsibility for their own pain management.     

Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review

Multiple sclerosis (MS) is a chronic disease of the central nervous system without a known cure. Thus the role of complementary and alternative therapies (CATs) for the management of symptoms lies in palliative care and this is borne out by the popularity of these treatments amongst MS sufferers. This review is aimed at determining whether this use is supported by evidence of effectiveness from rigorous clinical trials. Database literature searches were performed and papers were extracted in a pre-defined manner. Twelve randomized controlled trials were located that investigated a CAT for MS: nutritional therapy (4), massage (1), Feldenkrais bodywork (1), reflexology (1), magnetic field therapy (2), neural therapy (1) and psychological counselling (2). The evidence is not compelling for any of these therapies, with many trials suffering from significant methodological flaws. There is evidence to suggest some benefit of nutritional therapy for the physical symptoms of MS. Magnetic field therapy and neural therapy appear to have a short-term beneficial effect on the physical symptoms of MS. Massage/bodywork and psychological counselling seem to improve depression, anxiety and self-esteem. The effectiveness for other CATs is unproven at this time. In all the CATs examined further investigations are needed in the form of rigorous large-scale trials.     

An approach to the management of multiple sclerosis

The role of the physiotherapist working in a multi-disciplinary team helping people suffering from multiple sclerosis is described. The onset and clinical involvement varies considerably, and this process characterises the disease. Consequently, the sensory-motor deficits also vary considerably so that any form of management must be specific to the individual, and be adapted and adjusted as required throughout the course. However, general guidelines to rehabilitation in the different stages are given. The value of accurate assessment and instruction in correct posture, exercises, and general self-care are discussed, along with the importance of support and counselling for the sufferer and family both in the early stages and in long-term management.     

Automatic change detection in multimodal serial MRI: application to multiple sclerosis lesion evolution

The automatic analysis of subtle changes between MRI scans is an important tool for assessing disease evolution over time. Manual labeling of evolutions in 3D data sets is tedious and error prone. Automatic change detection, however, remains a challenging image processing problem. A variety of MRI artifacts introduce a wide range of unrepresentative changes between images, making standard change detection methods unreliable. In this study we describe an automatic image processing system that addresses these issues. Registration errors and undesired anatomical deformations are compensated using a versatile multiresolution deformable image matching method that preserves significant changes at a given scale. A nonlinear intensity normalization method is associated with statistical hypothesis test methods to provide reliable change detection. Multimodal data is optionally exploited to reduce the false detection rate. The performance of the system was evaluated on a large database of 3D multimodal, MR images of patients suffering from relapsing remitting multiple sclerosis (MS). The method was assessed using receiver operating characteristics (ROC) analysis, and validated in a protocol involving two neurologists. The automatic system outperforms the human expert, detecting many lesion evolutions that are missed by the expert, including small, subtle changes.     

多模态MRI在复发缓解型多发性硬化深部灰质的应用

目的 使用多模态MRI量化复发缓解型多发性硬化(relapsing-remitting multiple sclerosis,RRMS)患者疾病相对早期脑深部灰质改变,并探究其与白质病变及临床残疾的相关性。材料与方法 前瞻性纳入40例RRMS患者和32例健康对照(healthy controls,HC)组,行3D-T1WI、3D-液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)、定量磁敏感图(quantitative sensitivity mapping,QSM)和扩散张量成像(diffusion tensor imaging,DTI)扫描,获得灰质核团体积、定量磁化率值(quantitative susceptibility value,QSV)、各向异性分数(fractional anisotropy,FA)和平均扩散率(mean diffusivity,MD)值及白质病灶体积(white matter lesion volume,WM-LV)。独立样本t检验比较组间灰质核团体积、QSV、FA和MD值差异,相关分析评估核团各指...     

Managing self-injection difficulties in patients with relapsing-remitting multiple sclerosis.

Difficulties with self-injection, including inabillity to self-inject, are common for individuals taking home-administered injectable medications. In relapsing-remitting multiple sclerosis (MS), all of the currently available disease-modifying medications are injectables marketed for self-injection. Problems with self-injection pose a barrier to treatment adherence for many patients. Clinicians at the University of California, San Francisco (UCSF) Multiple Sclerosis Center have developed a number of strategies to help patients who experience anxiety associated with self-injection. These strategies have been empirically tested and found to be effective and easily implemented by mental health professionals and nurses. This article offers case examples and discussion of the principles of the techniques developed at UCSF to remediate patients' difficulties with self-injection. Nurses are most often the healthcare providers responsible for training MS patients in self-injection and monitoring their compliance. Nurses who are familiar with these tools have the opportunity to have a significant positive impact on patient comfort, confidence, and, ultimately, successful long-term adherence to disease-modifying medications.     

Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis

Introduction  

Few studies have evaluated the contribution of individual symptoms and impairments to the burden of multiple sclerosis (MS). This article reviews the contribution of walking impairment, fatigue, spasticity, depression, and pain, to quality of life (QOL) of the patient and economic burden of MS.     

Spasticity: a common symptom of multiple sclerosis

Spasticity is a common symptom in people with multiple sclerosis. The nurse plays a vital role in the assessment and ongoing management of spasticity.     

Managing chronic oedema: a collaborative community approach

Chronic oedema affects over 100 000 people in the UK and is regularly treated by different health care professionals, most commonly community nurses. The effect of chronic oedema on patients can be both physical and emotional and is a huge financial burden on the NHS. Collaborative working between lymphoedema services and community nurses is outlined in this article, highlighting potential benefits to patient care and substantial cost savings. Modified lymphoedema management strategies to treat chronic oedema effectively are identified with the emphasis on joint packages of care and patient goal setting. The role of health care professionals working collaboratively and empowering patients are also discussed in a case study.