All About Multiple Sclerosis — A Guide for Nurse Practitioners (NPs)
Multiple Sclerosis (MS) Awareness Month is recognized every year in March, making now the perfect time to learn how to support your patients by completing MS-focused education in the AANP CE Center.
Approximately 1 million people over the age of 18 in the United States, and more than 2.3 million people worldwide, have been diagnosed with MS. While MS has no known, direct cause, it is thought that some individuals may have an increased risk of developing the disease due to environmental factors or because of their genetic makeup.
While the prevalence of MS in women is two to three times higher than in men, there does not appear to be any evidence that racial or cultural factors play a role in the development of MS. As we continue to face significant national and worldwide health care challenges due to the COVID-19 pandemic, it’s especially important to provide support to patients with chronic diseases such as MS and their families. Many patients with MS depend on the availability of family or community outreach programs for their personal, social and health care needs.
Diagnosing and Treating MS in the Time of COVID-19
MS attacks the cells and tissue which make up the myelin covering of nerve fibers within the central nervous system (CNS), replacing it with sclerotic, hardened tissue. This CNS damage is often compared to when the wiring of electrical cords becomes damaged. These lesions cause impulses to or from the brain and spinal cord to become either distorted or completely interrupted, causing a change, decrease or loss of function to the formerly innervated area.
Diagnosis is based on symptoms, which can come and go and may vary significantly in presentation and severity from person to person. This can result in a diagnosis that is significantly delayed, as MS can be present and be actively causing damage well before symptoms are noted.
Common symptoms of MS include, among others:
- Visual disturbances.
- Loss of sensation.
- Limb weakness.
- Bladder and bowel dysfunction.
- Alteration in memory or speech.
- Depression.
- Spasticity.
MS is known as an "immune-mediated" disease. Current treatments help to alleviate symptoms and may prevent or delay MS attacks and disease progression; however, there is no cure for the disease. Patients who are taking medications that alter the body’s immune response may be at increased risk for infections.
Although it has not been shown that patients with MS are more vulnerable to COVID-19, patients taking immune-modifying medications or steroids may be at an increased risk for infections in general. Patients with mild or seemingly "unconnected" symptoms may be reluctant to seek health care providers due to COVID-19 restrictions, such as limited in-office or face-to-face visits, causing further delay in diagnosis and treatment.
When patients are considering COVID-19 vaccination, it’s important to reinforce that decisions should be made in partnership with a health care provider. While no studies have directly compared vaccine outcomes data between the general population and individuals with MS, guidance suggests that vaccination against COVID-19 outweighs the potential risks. This is especially noted for individuals with higher levels of disability, a progressive type of MS, certain comorbid conditions — such as diabetes, hypertension, obesity, cardiovascular and lung diseases — and for individuals who are Black or Hispanic, populations that are known to be at higher risk for hospitalization and severe illness due to COVID-19.
The COVID-19 vaccine does not contain a live virus and cannot cause COVID-19. However, health care providers should coordinate the administration of the COVID-19 vaccine based on the timing of the patient's last and next scheduled dose of some disease modifying therapy (DMT).
An NP Guide to MS
The American Association of Nurse Practitioners® (AANP) Education Department is focused on bringing NPs working at the forefront of COVID-19 the information, tools and resources needed to optimize the diagnosis and treatment of patients with debilitating, chronic illnesses such as MS.
Currently available in the AANP CE Center until August 31, 2021, is Diagnosing and Managing MS: A Guide for Nurse Practitioners (1.84 contact hours of CE, 0.92 of which may be applied toward pharmacology). Free for members and non-AANP members, this three-part series teaches NPs how to utilize newly updated guidelines to diagnose MS, provides practical decision-making tools to guide early treatment decisions for patients with MS and helps NPs to recognize disease progression, worsening or relapse and recommend appropriate treatment options.