Effective Multiple Sclerosis Management Through Improved Patient Assessment

Amy Perrin Ross, MSN, MSCN, APRN, CNRN, Natalie Hackbarth MSCN, RN, Christine Rohl, MSN, CNS, CNRN, FNP, Kristi Whitmyre, BA

Disclosures

J Neurosci Nurs. 2008;40(3):150-157. 

In This Article

Abstract and Introduction

Multiple sclerosis (MS) is a complex disease with a wide range of clinical manifestations. Current disease-modifying drugs (DMDs) are effective, but they are associated with effects that may negatively influence treatment compliance. A recent nursing advisory board of MS nurse experts from the Midwest discussed management approaches that can enhance DMD compliance and improve patient satisfaction and quality of life. One such approach is the use of patient questionnaires as tools to assess signs and symptoms of MS and treatment-related adverse effects. Information gained in this manner is beneficial to MS healthcare professionals as well as patients and has the potential to improve treatment compliance and outcomes and disease management.

Multiple sclerosis (MS) is a chronic, progressive inflammatory disease of the central nervous system (CNS) that affects approximately 2.5 million people worldwide (National Multiple Sclerosis Society [NMSS], 2006a). According to recent estimates, approximately 400,000 people in the United States have MS (NMSS, 2006a). MS is a heterogeneous disease entity with a highly variable course. Most patients initially present with a relapsing-remitting form (RRMS) characterized by discrete attacks or relapses followed by periods of complete or relative improvement (Keegan & Noseworthy, 2002; Lublin & Reingold, 1996; Weinshenker et al., 1989). After many years, about 50% of patients with RRMS will develop secondary progressive MS, during which neurologic deterioration is slow, insidious, and progressive, and during which discrete clinical attacks may or may not occur (Keegan & Noseworthy; Lublin & Reingold; Runmarker & Andersen, 1993; Weinshenker et al.). Two other forms of MS are less common: progressive relapsing MS, in which patients have progressive disease from disease onset with relapses; and primary progressive MS, in which patients have continuously progressive disease from the outset, with temporary, minor improvements or occasional symptom plateaus (Lublin & Reingold).

In addition to the complexity associated with the highly variable disease course and multiple disease forms, patients with MS experience a wide range of symptoms classified as primary, secondary, or tertiary. Primary symptoms are direct manifestations of the disease, such as fatigue, bowel and bladder dysfunction, sexual dysfunction, spasticity, cognitive dysfunction, weakness, and visual problems (Schapiro, 1994, 2002). Secondary symptoms are indirect manifestations of MS and include fatigue related to sleep disorders or deconditioning, urinary tract infections, muscle atrophy, and osteoporosis. Tertiary symptoms stem from the chronicity of MS and may be psychological, vocational, or social in nature (Schapiro, 1994). The signs and symptoms of MS vary depending on the site of the lesion(s) within the CNS ( Table 1 ; Compston & Coles, 2002).

MS symptoms should be addressed as part of a comprehensive treatment strategy. Symptom management typically includes a combination of nonpharmacologic and pharmacologic approaches ( Table 2 ). In addition, several disease-modifying drugs (DMDs) currently are approved for MS treatment ( Table 3 ) to help lessen the severity of symptoms (Berlex, Inc., 2006; Biogen Idec, Inc., 2004, 2006; EMD Serono, Inc., 2006; Pfizer, Inc, 2006; Teva Neuroscience, Inc., 2006). However, effective management of this complicated array of symptoms and treatment- related adverse effects requires tools that can identify and address the varied aspects of patient health and life that are affected by MS and its treatment. A multidisciplinary approach that combines pharmacologic and nonpharmacologic treatment modalities with patient education strategies to minimize adverse effects, patient support groups, and efforts to maintain open communication between patients and healthcare professionals is recommended.

This article describes and discusses the use of two patient questionnaires as tools in MS disease management. Patient questionnaires can increase communication between patients and healthcare providers and may help to increase patient satisfaction, improve disease management, and enhance compliance.

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