An Overview of Multiple Sclerosis: Diagnosis and Management Strategies

Kathleen Costello, RN, MS, CRNP, MSCN; Colleen J. Harris, RN, MN, NP, MSCN


Topics in Advanced Practice Nursing eJournal. 2006;6(1) 

In This Article

Classification of MS

The disease course varies, but 85%-90% of individuals begin the disease with a relapsing-remitting course.[2] A relapse is defined as new neurologic symptoms that develop over 24-48 hours that are not triggered by metabolic or other non-MS cause, that persist for several weeks or months, and then remit either partially or completely.[3]

Relapsing-remitting MS is characterized by periods of relapses followed by periods of clinical stability or disease quiescence. On the basis of natural history data, over the first 11-15 years of the disease, half of those with relapsing remitting disease will have fewer relapses, yet more of a progressive change in function over time.[4] This course is known as "secondary-progressive." An individual with this type of MS experiences progressive decline in function, with an ongoing accumulation of neurologic symptoms.

Approximately half of those diagnosed with MS will need ambulatory assistance by 15 years after onset of the disease, and 60% or more will be cognitively impaired. After 20 years, 90% of initially relapsing remitting individuals will have more progressive disease. A smaller percentage of those diagnosed with MS (10%-15%) will never have an actual relapse, but rather will have a progressive change in function over time, mostly evident by increased ambulatory difficulty. This group's disease is defined as "primary-progressive MS."[5]


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