Degenerative Neurologic Disorders
MS, myasthenia gravis, Guillain-Barré, Parkinson's and ALS
| Disorder | What happens | Key signs | Treatment and nursing |
|---|---|---|---|
| Multiple sclerosis | Autoimmune loss of myelin in the brain and spinal cord; relapses and remissions | Vision problems (optic neuritis, double vision), numbness, weakness, spasticity, fatigue, bladder problems; worse with heat | Disease-modifying therapies (e.g., ocrelizumab); steroids for relapses; avoid overheating; energy conservation; fall prevention |
| Myasthenia gravis | Antibodies block acetylcholine receptors at the muscle | Weakness that worsens with activity and later in the day; drooping eyelids, double vision, trouble chewing and swallowing | Pyridostigmine (before meals), immunotherapy, thymectomy. Crisis → respiratory failure: airway first. Avoid aminoglycosides, fluoroquinolones, magnesium |
| Guillain-Barré syndrome | Autoimmune attack on peripheral nerves, often after an infection | Ascending weakness (legs → up), lost reflexes, autonomic instability (BP and HR swings) | IVIG or plasma exchange; monitor breathing (vital capacity, ability to cough); most recover over months |
| Parkinson's disease | Loss of dopamine-producing neurons | Resting "pill-rolling" tremor, rigidity, slow movement, shuffling gait, masked face, soft voice, postural instability | Carbidopa-levodopa; fall prevention; swallowing safety; time meds precisely; exercise and PT |
| ALS | Loss of upper and lower motor neurons | Progressive weakness, cramps, twitching, trouble speaking and swallowing; thinking usually intact | Riluzole, edaravone, tofersen (SOD1 type); breathing support; nutrition (feeding tube); advance care planning |
Myasthenic vs. cholinergic crisis
| Myasthenic | Not enough medication or illness/stress: weakness, respiratory failure; HR and BP may rise |
| Cholinergic | Too much pyridostigmine: weakness plus SLUDGE (salivation, tearing, urination, diarrhea, GI cramps, vomiting), bradycardia, small pupils → atropine |
Both can stop breathing: support ventilation first. (The old edrophonium test is no longer used.)
Parkinson's nursing
- Give doses on time (late doses → freezing, falls).
- High-protein meals reduce levodopa absorption: spread protein through the day.
- Upright for meals; thickened liquids if needed; small bites.
- Avoid haloperidol and metoclopramide (worsen symptoms).
- Watch for orthostatic hypotension, constipation, depression, hallucinations.
Memory hooks
Parkinson's "TRAP": Tremor, Rigidity, Akinesia (slow movement), Postural instability.
Guillain-Barré goes up like a "GB ladder" from the feet; watch the breathing as it climbs.
Guillain-Barré goes up like a "GB ladder" from the feet; watch the breathing as it climbs.