a. Chronic, irregular demyelination of the brain and spinal
cord, resulting in varying degrees of cognitive, motor, and
b. Often characterized by periods of exacerbations and
remissions, but is unrelenting in some individuals.
c. Research suggests that in addition to destruction of myelin
sheaths, underlying nerve fibers are also damaged or
severed, which may account for the permanent neurological
impairment (Lazoff, 2008).
II. Classification (Lubin, 1996)
a. Relapsing-remitting multiple sclerosis (RRMS): periods of
dysfunction in which neurological deficits occur in different
parts of the body, followed by partial or full recovery,
leaving little residual deficit; accounts for the initial course
in approximately 85% to 90% of persons with MS
b. Primary-progressive multiple sclerosis (PPMS): Function
declines steadily with periods of minimal recovery and
increasing disability in about 10% of cases.
c. Secondary-progressive multiple sclerosis (SPMS): After
a period of time, RRMS may convert to a secondary
progressive pattern characterized by continued progression,
with increasing disability in approximately 80% of cases
d. Progressive-relapsing multiple sclerosis (PRMS): rare form
with progressive neurological deficits from onset with clear
a. An autoimmune inflammatory disease, possibly related to
viral infection that produces a limited disruption in the
blood-brain barrier, thus allowing beta-lymphocyte clones
to colonize the central nervous system (CNS).
b. Genetics may play a role in person’s susceptibility.
c. Environmental and geographic factors are being investigated.
d. Predominant CNS disorder among young adults, difficult to
diagnose, and cannot be diagnosed after only one presentation
of symptoms, but rather over time.
e. Individual prognosis variable and unpredictable, thereby
presenting complex physical, psychosocial, and rehabilitative
a. Morbidity: Approximately 350,000 people in the United
States have MS, with 25,000 new cases diagnosed annually
(Lazoff, 2008). MS affects women almost three times as
often as men (National Institute for Neurological Disorders
and Stroke [NINDS], 1996).
b. Mortality: Estimated 2,800 deaths annually, usually due to
fulminating MS (rare) or complications of chronic disability,
such as pneumonia, pulmonary emboli, or infected decubitus
ulcer (Lazoff, 2008); however, average life expectancy is
35 years after onset or approximately 95% of normal.
c. Cost: Because MS is a lifelong, chronic disease—diagnosed
primarily in young adults who have an otherwise normal life
expectancy—estimates place the annual cost in the United
States in the billions of dollars (NINDS, 1996).
Clients often require community or long-term care with
intermittent hospitalization for disease-related exacerbations
Psychosocial aspects of care
1. Maintain optimal functioning.
2. Assist with or provide for maintenance of ADLs.
3. Support acceptance of changes in body image, selfesteem,
and role performance.
4. Provide information about disease process, prognosis,
therapeutic needs, and available resources.
1. Remain active within limits of individual situation.
2. ADLs are managed by client and caregivers.
3. Changes in self-concept are acknowledged and being
4. Disease process, prognosis, and therapeutic regimen are
understood and resources identified.
5. Plan in place to meet needs after discharge.