Case Study, Muscle, BIOS 252

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Chamberlain College of Nursing *

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Feb 20, 2024

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Ashton Alexander Professor McFarlane BIOS 252 November 12, 2023 Case Study: Multiple Sclerosis 1. What cellular structure is degenerating and rebuilding in MS? As we learned in class this week, the myelin sheath, which is a material covering around nerves, is the cellular structure that is primarily affected by MS (Saladin et al., 2021). The immune system mistakenly degrades the myelin sheath in a process of demyelination. To restore proper functioning, the body tries to remyelinate only for it to be damaged by the “confused” immune system again. 2. Does this explain the progression we see with the signs and symptoms? Explain why. This would explain the progression we see with the signs and symptoms. Demyelination disrupts the normal transmissions of action potentials, causing them to be slowed or blocked- this leads to abnormal sensations like the tingling the patient was experiencing. Also, when the immune system attacks the myelin, sometimes deeper structures like nerve fibers can be affected, which results in pain sensations ( Villines & Akers, 2023). The loss of coordination is because, obviously, the brain is the “control center,” specifically the central nervous system—when her immune system was spontaneously and intermittently initially attacking the myelin, action potentials were being impaired in transit, whether slowed down or stopped. Hence, the patient

was, in effect, losing voluntary control over her limbs, leading to incoordination, which, of course, progressed as the disease fully bloomed. Over time, myelination repair slows and nerve damage becomes irreversible. 3. When there are issues with the neural tissue like this, they will often look into the eye. Why? I follow an MS advocate on social media and remember when she told her story of figuring out she had MS; she said part of the symptoms was her going blind for several weeks before finally regaining her eyesight. It was not until I found out this week that most patient assessments when trying to diagnose MS include a look into the eye. After doing some research, I found that this is because of the optic nerve, since it is part of the central nervous system, it is commonly affected by demyelination caused by MS (Costello & Burton, 2018). Optic nerve inflammation is specifically what healthcare professionals look for, which also includes symptoms of double vision, blurred vision, or pain when moving the eyes. This assessment process is known as the optical coherence tomography, which involves a simple scan of the optical nerve fibers—it's painless, uses simple machinery, and is convenient (estimate of 5 minutes to complete). 4. Here are three early symptoms. that we might see in MS., Assign them to whether they are a part of the sensory, motor, or autonomic nervous system. Afterward, try to describe how MS would cause these symptoms. Please view the following (Freiha et al., 2020): o Dysarthria: This is a motor issue. Patients with Dysarthria have difficulty speaking and enunciating due to problems with the muscles of their speech. For

muscle movement, there must be action potentials, with MS making Action potentials travel slower or are distorted, it is harder to speak and articulate. o Paresthesia: This is a sensory disorder. It manifests in abnormal sensations like tingling or numbness. In MS, demyelination disrupts the normal conduction of sensory signals, leading to spontaneous feeling of tingling/numbness— Paresthesia. o Constipation: Affiliated with the autonomic nervous system. Neural communication that controls bowel function is also disrupted by MS, causing the immune system to attack myelin. This, in turn, leads to bowel movements not occurring as they should, causing constipation.

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References Costello, F., & Burton, J. M. (2018). Retinal imaging with optical coherence tomography: a biomarker in multiple sclerosis? . Eye and brain, 10, 47–63. https://doi.org/10.2147/EB.S139417 Freiha, J., Riachi, N., Chalah, M. A., Zoghaib, R., Ayache, S. S., & Ahdab, R. (2020). Paroxysmal Symptoms in Multiple Sclerosis-A Review of the Literature . Journal of clinical medicine, 9(10), 3100. https://doi.org/10.3390/jcm9103100 Saladin, S. K., Gan, A. C., & Cushman, N. H. (2021). Anatomy & physiology: The unity of form and function. McGraw-Hill Education. Villines, Z., & Akers, R . MS. (2023). Tingling Patterns: What to know and how to cope. Medical News Today. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/ms-tingling-patterns

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