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Symptomatic therapy and neurorehabilitation in multiple sclerosis

Department of Neurology and Neurorehabilitation, Rehabilitation Centre, CH-7317, Valens, Switzerland.
The Lancet Neurology (Impact Factor: 21.82). 11/2005; 4(10):643-52. DOI: 10.1016/S1474-4422(05)70193-9
Source: PubMed

ABSTRACT Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Symptoms that contribute to loss of independence and restrictions in social activities lead to continuing decline in quality of life. Our aim is to give an updated overview on the management of symptoms and rehabilitation measures in MS. Appropriate use of these treatment options might help to reduce long-term consequences of MS in daily life. First, we review treatment of the main symptoms of MS: fatigue, bladder and bowel disturbances, sexual dysfunction, cognitive and affective disorders, and spasticity. Even though these symptomatic therapies have benefits, their use is limited by possible side-effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, neurorehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. Second, we discuss comprehensive multidisciplinary rehabilitation and specific treatment options. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Treatment should be adapted depending on: the individual patient's needs, demands of their surrounding environment, type and degree of disability, and treatment goals. Improvement commonly persists for several months beyond the treatment period, mostly as a result of reconditioning and adaptation and appropriate use of medical and social support at home. These findings suggest that quality of life is determined by disability and handicap more than by functional deficits and disease progression.

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    • "No que se refere ao treinamento cognitivo (TC), o mesmo pode ser compreendido como um processo ativo de educação e capacitação, focado no manejo apropriado de déficits adquiridos. Como uma modalidade da (re)abilitação neuropsicológica, seu objetivo é obter o melhor potencial físico, mental e social do indivíduo, para que ele possa remanescer ou integrar-se em um meio social (Kesselring & Beer, 2005). Em um contexto mais amplo, a reabilitação neuropsicológica visa, então, aprimorar déficits cognitivos, comportamentais e psicossociais, sendo que o TC procura otimizar habilidades cognitivas não necessariamente deficitárias (Wilson, 2008). "
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    • "Living with multiple sclerosis (MS) can be a difficult experience , both physically and psychologically [1] [2], with common symptoms including visual problems, motor abnormalities, bowel and bladder incontinence, loss of balance and sexual dysfunction [2] [3]. Research also indicates that there is an increased prevalence of falls in people with MS (PwMS) [4] [5] and a high proportion of patients who experience debilitating symptoms of fatigue, defined as a 'a subjective lack of physical and/or mental energy that is perceived by the individual or the caregiver to interfere with usual and desired activities' [6]. "
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    • "Unauthorized reproduction of this article is prohibited. a primary concern of patients and their families after an illness or injury (King, 1996; Russell et al., 2002; Lobentanz et al., 2004; Kesselring and Beer, 2005). Thus, the fact that the A-MPAI-4 correlated with a valid and reliable tool measuring functional independence indicates that A-MPAI-4 captures a salient patient-centered aspect of functionality, namely independence, which is also a core principle in rehabilitation. "
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