Multiple Sclerosis
15.2.2 Care Needs and Mobility Considerations
15.2.1 Introduction
(i) Multiple sclerosis (MS) is a chronic, progressive, degenerative disease, characterized in the early stages by remissions and relapses in its clinical course leading in some, though not all cases, to persisting and progressive disablement. Destruction of areas of myelin (a substance surrounding nerve fibres which enables nerve impulses to travel along the fibre) throughout the brain and spinal cord is followed by scar formation [known as a "plaque"]. Nerve fibres eventually degenerate, leading to failure of transmission of nerve impulses. The optic nerves (the nerves to the eyes) and spinal cord in the neck region are most frequently affected.
(ii) Multiple sclerosis affects 30-80 people per 100,000 of population. The incidence of the disease rises throughout the second decade of life and is at its highest in the thirties. Slightly more women than men are affected. The disease rarely begins in people aged over 65.
15.2.2 Care Needs and Mobility Considerations
(i) The principal manifestations of MS are weakness of one or more limbs, spasticity (muscle rigidity or pronounced stiffness), muscle fatigue, unsteadiness of gait, and difficulties with speech. Tremor sufficient to interfere with the use of the upper limbs may develop. Loss of sensation may occur. Difficulty in bladder control is common, the person having to rush to reach the toilet in time and often being incontinent.
(ii) As the disease progresses walking may become increasingly difficult either because of weakness and spasticity or because of unsteadiness leading to falls. This may be compounded by impaired vision and by weakness or tremor in the upper limbs which make the use of walking aids difficult or impossible. When walking, the severity of the muscle fatigue may result in the person's having to stop and rest frequently.
(iii) Short-term memory defects, impairment of speech, and mood swings are features of the more advanced stages of the condition.
(iv) The person may ultimately become chair or bed-bound. If this stage is reached there may be need for moving them frequently to prevent the occurrence of pressure sores.
15.2.3 Duration of Need
The average survival of patients from the time of diagnosis is 30 years. The average age at onset is 32 years, and so there is probably a slight reduction in overall life expectancy. However, course and effects of MS vary widely from one person to another and are unpredictable. Spontaneous remissions of varying length are common particularly in the early years of the disease, and in some instances appear to be life-long. Very rarely, multiple sclerosis takes a very rapid downhill course. However, the most common pattern is of frequently recurring relapses leading to chronic disability, dependency and complications. This process may take 20 years or more. Although the needs may change dramatically in the early years, if after two years there is a persistence or increase in needs, it is unlikely that there will be further improvements.
15.2.4 Further Evidence
A medical report may be helpful where the needs over any period of time are not clear because of the variable nature and progress of the disease.