Vincenza Zurlo Dietetic Intern Sage Graduate School

Multiple

sclerosis: chronic condition affecting the central nervous system by replacing the myelin sheath with scar tissue. Likely autoimmune. The most common demyelinating disorder.

 Myelin:

acts as insulation material around

nerves

Made of protein and lipid

Myelin

sheath is degenerated and replaced with hardened scar tissue (sclera) Diffuse effects

 Largely

unknown Possible genetic predisposition Geographic location

Vitamin D

Childhood

BMI

Girls who were 95th percentile for BMI had a 1.611.95-fold increased risk of MS as compared to girls <85th percentile

 McDonald
MRI

criteria

Lesions, plaques evident of demyelination

Symptoms may be similar to other neurological diseases

 Weakness,

numbness, fatigue, dizziness, slurred speech, blurred/double vision, heat sensitivity

Sub-types:

Relapsing remitting Secondary progressive Primary progressive Progressive relapsing

Acute attack, relapses

Corticosteroids Teraflunomide Interfereon beta 1a Mitoxantrone Dimethyl fumerate Natlizumab

Modify disease

Managing symptoms

Botox-bladder Anti-depressants Antibitotics Lanizid-nydrazid -tremors Ampyra-gait problems Gablofen-spascity Dilantin-pain

 Dysphagia
Altered

GI function Medication interaction

HPI
37 year old male Admit 2/20/2014 Decreased PO intake, fatigue Intractable UTI

PMHx

Advanced MS

Weight: 149 lbs Height: 71 BMI: 20.6 (normal) Social hx

wheelchair bound Family

Diet: Dysphagia IV (soft chopped, nectar) Medications

Baclofen, Gabapentin, glatiramer, methenamine hippurate, vitamin c, zofran

 2/22-first

note

Consult for TF recommendations Estimated needs: 1650-1980 kcal (25-30 kcal/kg)

80 gm protein (1.2 gm/kg) 1980-2,310 mL fluid (30 35mL/kg)

Added Boost pudding, magic cup, Resource thickened shake Isosource 1.5 at 65 ml/hr , 12 hrs nocturnally (1170 kcal, 53 g protein, 608 mL free water) 250 mL water bolus 6h Could not fill out menu

 2/25-2/28

Attempted to place PEG tube in VIR Attempted to place PEG in endoscopy

 3/4:

Laprotomy, open Stamm gastrostomy insertion Colonscopic decompression sigmoid volvulus TF started Isosource 1.5 at 10 mL/hr, goal: 120 mL/hr Distention/discomfort/nausea at 10 mL/hr Constipation

3/06:

 3/11:

Advance TF to 120 mL/hr Goal: 250 mL TID = 1 can 3x/day or 375 mL BID = 1.5 cans 2x /day. Flush 30 mL before and after feeds. May need up to 1.5 L supplemental fluid if PO fluid is minimal Trial gravity feeds

 http://www.youtube.com/watch?v=GhVXPnJ

gsd8

 Resveratrol

Pharmaceutical grade Decrease inflammation Decrease demyelination

New treatment:

stimulate oligodendrocytes to produce myelin protect oligodendrocytes and myelin from further damage.

http://www.nationalmssociety.org/What-is-

MS

Mahan, LK, Escott-Stump, S, Raymond, JL. Krauses Food and Nutrition Care Process. 13th ed. St. Louis, MO: Saunders; 2012. Munger K, Bentzen J, et al. Childhood body mass index and multiple sclerosis risk: a long-term cohort study. Multiple Sclerosis Journal. 2013. 19 (1). 1323-1329 doi: 10.1177/1352458513483889 Bhuller K, Rupasinghe H. Polyphenols: Multipotent Therapeutic Agents in Neurodegenerative Diseases. Oxidative Medicine and Cellular Longevity. 2013. doi:10.1155/2013/891748