Multiple sclerosis (MS) is a neurologic disorder that injures central nervous system (CNS). It is diagnosed most commonly in adult patients, although the disease can occur in children and teenagers up to eighteen years old. Recent researches show that a great amount of adults suffering from multiple sclerosis has experienced their first attack being a child (Smith, 2012). This paper explores pathophysiology, nursing management of the Pediatric MS and the community resources available for young patients with this disease and their parents.
Pathophysiology of Pediatric Multiple Sclerosis
Multiple sclerosis is considered to be a degenerative and inflammatory neurologic disorder. This disease affects mainly brain, spinal cord and optic nerves. It may cause a range of various damaging effects, such as memory loss, cognitive problems, speech impediment, limb weakness, muscle spasms, loss of hearing or vision and many others.
Multiple sclerosis manifests itself in different way in adult and children. It can be difficult to diagnose pediatric MS because there are other neurologic disorders with the same symptoms. The disease may begin with various pathologic states that include a range of symptoms like headache, fever, and even coma. Many researchers suggest MS in children progresses slower than in adults. Therefore, psychological and cognitive consequences are deeper in young patients. The disease course may have damaging effect on self-image, academic success, communications and social relations.
Damage brought by the disease occurs in two phases (Bennet, 2009, p59). During the first one the areas of hidden injure appear in brain and spine. The second phase begins when inflammatory immune cells break the blood-brain barrier (BBB) and enter the Central nervous system. This process leads to demyelination, which is a step to lesion formation. In its turn lesions or plaques continue destroying oligodendrocytes – cells that create and maintain myelin. Without myelin sheath neurons lose their ability to conduct electrical signals (Smith, 2012).
During the early phases of MS course, remyelination is still possible thanks to neuroplasticity – brain’s ability to compensate for some damage caused by the disease. Despite this fact myelin sheath can’t be completely rebuilt. Repeated attacks make the repair process longer and more difficult over time until plaques make it impossible at all.
Multiple sclerosis can be subdivided into four clinical types. The majority of children suffer from relapsing-remitting (RRMS) subtype with long periods of recovery between attacks. Such periods in young patient may last for a few years, while in adults – not more than 12 months (Bennet, 2009, p.60). In some time adolescents with RRMS will have secondary progressive MS (SPMS) when they suffer from increasing physical disorders. The other type of disease, primary progressive (PPMS), is very rare in children and teenagers.
Nursing Management of Pediatric Multiple Sclerosis
A team of specialists takes part in curing children with multiple sclerosis: pediatric neurologists, nurses, social workers, occupational therapists, physiotherapists, psychiatrists and psychologists. Helping young patients and making their lives easier needs cooperation of medical teams and parents. Pediatric MS nursing management can be divided into 3 parts.
The first one is acute attacks treatment. In most cases corticosteroids are used for this purpose in children. These medicines effectively reduce inflammation accompanying MS attacks. It helps the young patient to recover rapidly. In spite of all benefits, such treatment may have various side effects (Thompson, 2011, p.28). The most frequent of them are sleep disorders, mild tremor, irritability and others. Immunoglobulins are very useful instead of corticosteroids for those patients, who are steroid-resistant or steroid-dependent.
Reducing the number and severity of attacks is the second part of MS treatment. Immunomodulatory therapy often helps to achieve this effect. The use of Interferon beta or Glatiramer acetate decreases the rate of relapses.
The last part of MS management is symptomatic therapy. Within this therapy the non-pharmacologic treatment is acceptable along with medicines. A range of symptoms vary from person to person, especially in children. Nursing management of MS symptoms includes many aspects, from exercises to diet, from lifestyle changes to stress management. Such therapies are based on different disciplines like yoga, herbal healing, fitness and even hypnosis. Counseling, rehabilitation and special education are also used to cure MS symptoms. For instance, occupational and physical therapy improves mobility, helps to control muscle spasms and reduces pain. It also can help a child to use devices for making life easier and allows the young patients to perform their daily activities safely. If a young patient experiences fatigue, a long time rest will be helpful. As MS symptoms may worsen when body temperature is increased, cool baths and swimming are recommended in such cases. Even massages and a balanced diet relieve stress and keep immune system of a child strong.
Community Resources Available to Children with Multiple Sclerosis
Although multiple sclerosis in children and adolescents is diagnosed, many pediatricians are not familiar with this disease. In order to understand pediatric MS better and help the young patients effectively the First-of-its-Kind Network, six Pediatric MS Centers of Excellence were established by the National MS Society. These centers offer a range of services to facilitate children’s life and treat them such as therapeutic camps. They provide financial assistance regardless of the families’ ability to pay. Such centers not only give support to young patients and their families, but also collaborate with other institutions like schools, colleges and clinics. The National MS Society provides a scholarship program that helps the students, who suffer from multiple sclerosis or have a parent with such a disease, to continue education after school.
The International Pediatric MS Study Group was convened in 2002. Nowadays it includes investigators of various disciplines from more than ten countries, such as Canada, United States, Australia, Russia, France, Germany and Italy. This group provides and publishes a range of researches. These articles help to understand the disease process, diagnose it during early stages and treat children and teenagers with MS effectively. The fundamental goal of this organization is to improve the quality of care and increase awareness and understanding of pediatric multiple sclerosis and related disorders (Mayoclinic.com).
Societies dealing with children suffering from MS consider different handbooks to be extremely helpful for children, parents and school personnel. For instance, a handbook Students with MS and the Academic Setting discusses accommodations and modifications needed to facilitate studying process for pupils with MS. It also provides parents with various resources helping their children to study at school. The handbook contains a lot of useful information about pediatric MS for parents and school staff working with pupils who suffer from this disorder.
A wide range of activity books for children with MS, such as Mighty Special Kids – An Activity Book for Children with MS is popular today. Such resources often include interesting articles, educational games and activities. They help young patients understand their diagnosis better and decrease psychological problems.
The Internet allows parents and pediatricians to communicate and cooperate with others all over the world to facilitate their children’s life and treatment or search for alternative management. A lot of websites are established every day and many of them may be useful.
In modern society there is still no cure for multiple sclerosis, especially the pediatric one. In spite of this fact, it is possible to modify the course of disease and make young patients’ lives easier. A range of strategies allows managing symptoms, treating exacerbations and providing support for children and their parents. Combination of medical treatment, non-pharmacologic management and a variety of community resources enable children with MS to lead safer and easier life.
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