Glasgow Coma Scale

CrufflerJJ, BSN, RN, EMT-P · Jun 9, 2009

hey :)
i have to write an essay on a patient who has MS. and appraise the care recived. i wanna talk about assessments done on the patient. is the glasgow coma scale used on people who have spasms??
the patient has been discharged now and am unsure of some of the assessments and medications etc she had.
she was on clonazepam but had a seizure from it and got admitted to hospital and was having constant spasms.
any help would be greatly appreciated - thanks :)

The GCS can be used on any patient, especially one who's being evaluated by field EMS personnel, or someone who's an acute medical or trauma pt. See Wikipedia:

http://en.wikipedia.org/wiki/Glasgow_Coma_Scale

...or...

http://www.unc.edu/~rowlett/units/scales/glasgow.htm

The MS patient could have been evaluated under the GCS. Other stuff that comes to mind would be pupillary reflexes, ability to follow commands (squeeze your hand, lift your foot,...), deep tendon reflexes, evaluation of what body sections seem affected by the spasms (is it unilateral or bilateral, just arms/legs, or whole body muscular rigidity,...). I'd also think that other potential causes of the spasms (?seizures?) would have been ruled out - tox screen for oddball drugs, blood glucose, CAT scan or MRI of the brain, maybe EEG, past seizure history, blood test to see if anticonvulsant drugs were at therapeutic levels,...

Pediatric Critical Care Columnist · Jun 9, 2009

I can't see that a GCS for an MS patient would be all that valuable... unless that person had suffered a head injury, a stroke, an MI or a drug overdose. The usefulness of the Glasgow Coma Scale in evaluating people with pre-existing neurological conditions is nebulous at best. The person doing the scoring will be misled if they aren't aware of the person's baseline performance. For example, someone with MS may not be able to move their arms or legs spontaneously and purposefully when they're at their best, but that doesn't automatically mean that they should score less than 6 for motor; they may not be able to speak intelligible words if their MS is severe and advanced, but if they can nod their head "yes" when you ask them if the sky is blue, then I'd be scoring them 5 for verbal. Would you? OP, your patient was admitted following a seizure and in that case and at that time the GCS would be applicable and appropriate BUT not necessarily an accurate reflection of their level of consciousness.

The Galsgow Coma Scale was originally developed as a prognosticating tool for recovery following head trauma. It was never intended to be the routine evaluation it has become. I found a really good article on the subject that might hel you understand it better: http://www.actaneurologica.be/acta/download/2008-3/01-matis%20et%20al.pdf. It's free to read online. I've only skimmed it, but I'm going to read it all right after I click "post".