Multiple sclerosis (MS)
is the most common of the demyelinating disorders and the predominant CNS disease among
young adults. It is a chronic disorder in which irregular demyelination of the CNS (brain and spinal cord) results in
emotional changes and varying degree of cognitive, motor, and sensory dysfunction at the central and peripheral level.
It is a perivascular inflammatory response, possibly to chronic viral infection in genetically susceptible individuals,
producing a limited disruption in the blood-brain barrier, allowing [beta]-lymphocyte clones to colonize the CNS.
Research suggests that in addition to destruction of myelin sheaths (which facilitate the movement of nerve impulses),
some underlying nerve fibers are also damaged or severed, which may account for the permanent neurological
MS is grouped into the following four types:
Periods of neurological dysfunction followed by partial or full recovery.
Steady decline with periods of minimal recovery (fairly uncommon).
Initial pattern of relapse and recovery, which becomes steadily progressive over time.
Progressive from onset with clear exacerbations (rare).
MS is characterized by periods of exacerabations and remissions and is progressive in approximately 60% of patients.
Individual prognosis is variable and unpredictable, presenting complex physical, psychosocial, and rehabilitative issues.
Community or long-term care with intermittent hospitalization for disease-related complications.
Psychosocial aspects of care
Patient Assessment Database
Degree of symptomatology depends on the stage and extent of disease, areas of neuronal involvement.
Extreme fatigue/weakness, exaggerated intolerance to activity, needing to rest
after even simple activities such as shaving/showering; increased
weakness/intolerance to temperature extremes, especially heat (e.g., summer
weather, hot tubs)
Limitation in usual activities, employment, hobbies
Numbness, tingling in the extremities
Sleep disturbances, may awaken early or frequently for multiple reasons (e.g.,
nocturia, nocturnal spasticity, pain, worry, depression)
Absence of predictable pattern of symptoms
Generalized weakness, decreased muscle tone/mass (disuse), spasticity, tremors
Staggering, dragging of feet, ataxia
Intention tremors, decreased fine motor skills
Dependent edema (steroid therapy or inactivity)
Blue/mottled, puffy extremities (inactivity)
Capillary fragility (especially on face)
Statements of reflecting loss of self-esteem/body image
Expressions of grief
Anxiety/fear of exacerbations/progression of symptoms, pain, disability,