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Introduction   

Multiple sclerosis (MS) is a neurological disease marked by breakdown of the nervous system. This breakdown leads to debilitating changes in neurological function that occur gradually over time and can lower the quality of life for many patients. The goal of treatment is to delay disability and manage symptoms. While many medications help with symptom control, others, like intravenous infusion therapy, are designed to treat exacerbations and/or slow down the progression of the disease. Understanding the role of infusion therapy in MS starts with understanding the basics of the disease.

Definition

MS is a chronic inflammatory neurodegenerative autoimmune condition in which the body damages the brain, spinal cord, and optic nerves [4][7]. The purpose of the neurological system is to transmit electrical impulses (messages) from the brain to the body to carry out various functions within the body (like movements and sensations). Ideally, the brain, spinal cord, and nerves should all work together seamlessly. Multiple sclerosis (MS) occurs when the neurological system struggles to transmit messages, ultimately preventing the body from functioning properly. In particular, the immune system attacks the central nervous system (CNS) by destroying a structure called myelin.

Global and National Findings

Prevalence

MS is fairly common around the world. The World Health Organization (WHO) estimates 1.8 million living with MS globally [13]. Nationally, in 2017 one million people were living with MS [8]. In 1975, this number was about half (400,000 people) [8].

In May 2023, the National MS Society performed a detailed analysis of the current evidence. Researchers could not determine if the rise in MS from 1975 to 2017 was related to the actual increasing incidence of the disease or simply other factors, such as increased longevity of the population, improvement in MS diagnosing, or increased rates of diagnosis among groups who were once underrepresented [9].

Age and Gender

The disease is most common in young adults and females [13].

Ethnicity

For every 1,000 people in the U.S, about four whites (non-Hispanic/Latinx), three Blacks (non-Hispanic/Latinx), 1.5 Hispanics/Latinx, and two of other races combined (Asians, Native Americans, and Alaska Natives) have MS [9].

Current Estimates

While current evidence is limited, the National Multiple Sclerosis Society estimates 2.3 million people living with MS today – a growth of over double the most recent numbers [9]. The National Neurological Conditions Surveillance System – an integrated system that tracks MS epidemiology in the U.S. – is in the early phases of monitoring the disease [12]. Therefore, we may begin to see updated numbers of MS cases in this country in the next 10 years.

Etiology/Pathophysiology

MS is classified as an autoimmune disease as large amounts of T cells are present in spinal fluid and CNS lesions of patients with the disease (found on a magnetic resonance imaging (MRI) scan of the brain) [4]. An antigen triggers T cells to instruct other immune cells to fight a “foreign invader” in the body. This foreign invader happens to be the body’s own nervous system.

The cause of this autoimmunity is unknown. However, researchers believe the disease is triggered by environmental and genetic factors [4][5]. MS heritability (ability to run in families) has been estimated to be between 35% to 75% [4]. Additionally, a person with the “Human Leucocyte Antigen-DRB*15:01” gene (HLA-DRB*15:0) has a high risk of developing MS. Other contributing factors include Vitamin D deficiency and the Epstein Barr virus (EBV) [4].

In MS, the CNS becomes inflamed leading to the breakdown of myelin – a fatty/protein-rich covering that insulates the nerve axon (tail end of nerve fibers). Myelin protects axons and helps to make electrical impulses transmit quicker. The breakdown of myelin (demyelination) eventually leads to the breakdown of the axon itself (neurodegeneration), ultimately causing deterioration of nerves, impaired neurological function, and subsequent symptoms.

Types

MS is characterized by a disease course – slow progressive or episodic. Currently, four primary MS types are outlined by the National Multiple Sclerosis Society. These include Clinically Isolated Syndrome, Relapsing-Remitting MS, Secondary Progressive MS, and Primary Progressive MS [10].

Clinically Isolated Syndrome

Clinically Isolated Syndrome (CIS) is not a diagnosis of MS, but a symptomatic episode related to CNS inflammation and demyelination. In this condition, the patient experiences an initial episode of neurological symptoms lasting at least 24 hours. CIS may progress to MS if the patient has brain lesions similar to those present in MS. Symptoms include vision problems, vertigo, facial sensation loss, unilateral weakness in the extremities, coordination and balance problems, urinary problems, and swallowing and speaking difficulties. Treating CIS can delay MS onset.

Relapsing-Remitting

The most common of all types, Relapsing-Remitting MS (RRMS) is the “intermittent” type of MS. This type occurs when patients are generally stable but experience relapse (or exacerbation) of neurological symptoms on occasion. During remission periods, there may be little to no symptoms. In some patients, residual symptoms may accumulate over time with each relapse, leading to long-term disability after about 10 to 15 years [11]. RR can be characterized by active (relapses and/or MRI activity), not active, or worsening (increased disability after a relapse).

Secondary Progressive

Secondary Progressive MS (SPMS) is a “gradual” type of MS. Patients with this type of MS start to experience a gradual worsening of symptoms/disability after an initial course of Relapsing-Remitting MS. A patient with SPMS may or may not experience relapses on top of an already worsening progressive course of disease. SPMS can be characterized as active (relapses and/or MRI activity), not active, with progression (increased disability with/without relapses or MRI activity), or without progression.

Primary Progressive

Primary Progressive MS (PPMS) is also a “gradual” type of MS. However, patients with this type of MS experience a gradual worsening of disability from the moment the disease starts (once initial symptoms begin). Symptoms include cognitive difficulties, vision problems, and myelopathy (neurological deficits related to a damaged spinal cord) [11]. PPMS can be characterized as active (occasional relapses and/or MRI activity), not active, with progression (increased disability with/without relapses or MRI activity, or without progression.

Other Types/Conditions

Radiographically Isolated Syndrome: lesions found on MRI that are similar to those seen in MS, but without the presence of symptoms

Fulminant MS: severe MS with multiple relapses and rapid progression toward disability [11]

Physical Manifestations

Clinical manifestations can vary per patient depending on the number and location of CNS, and degree of damage [10][11]. MS can be stable and chronic, or rapidly progressive and debilitating [11]. Some signs and symptoms include vertigo/dizziness, loss of taste, hearing loss, breathing difficulties, seizures, and sexual problems. Others include the following [10][11].

Visual Impairments

Vision problems are one of the first symptoms of MS in many people. These may include:

• Double vision, or diplopia: the result of damage to the nerve that controls eye movements; may be persistent or intermittent; may resolve on its own
• Rapid eye movement, or nystagmus: when the eyes move uncontrollably and can move from side to side, up and down, or in a rotating fashion; may be persistent or intermittent; may resolve on its own
• Optic neuritis (inflammation of the optic nerve): typically occurs in one eye and is painful; can cause blurred vision, color blindness, and temporary or permanent impaired vision

Fatigue

About 80% of people who have MS report fatigue [10]. Fatigue may be disease-associated or related to MS symptoms. Examples include:

• MS lassitude: a type of fatigue that occurs as a direct result of the disease itself; higher-than-normal level of fatigue daily irrespective of sleep satisfaction; typically begins suddenly, worsens as the day progresses, and is triggered by heat and humidity.
• Indirect fatigue: can result from MS symptoms or complications (i.e. people with MS may experience sleep loss due to pain or frequent urination during the night, which can cause fatigue).
• Exhaustion: may occur after performing basic daily tasks due to activity intolerance and mobility issues, ultimately resulting in fatigue.

Pain

MS-associated pain may be directly related to the disease, associated with damaged nerves, or related to body changes. Examples include:

• Musculoskeletal pain: may be associated with stiffness and mobility problems.
• Muscle spasms: sudden painful tightening of muscles occurring at any time of the day or night.
• Trigeminal neuralgia (neuropathic pain) presents as stabbing intermittent pain in the jaw or face caused by damage to the trigeminal nerve.
• L’hermitte’s Sign (neuropathic pain): electric-shock-like sensation that radiates down the back and into the extremities when flexing the neck, caused by damage to the cervical area.
• MS hug (neuropathic pain): squeezing sensation around the torso.

Sensory Impairments

Sensory impairments may be evident in various parts of the body, including the face, arms, and legs. The impairments may be so severe that they interact with a person’s daily functioning and walking (ataxia). Examples include:

• Numbness and tingling (common): numbness in the face can lead to problems with chewing or swallowing, and the inability to sense safe food temperatures.

Coordination Problems

MS can cause damage to the nerve pathways responsible for coordination and movement. This may be evidenced by:

• Ataxia
• Tremors that can occur at rest or with movement
• Difficulty swallowing or speaking (speech can be slow or slurred)

Muscle Tightening

Though MS can cause muscle weakness, it often causes muscle tightening. Examples include:

• Spasticity: a common symptom of MS; involuntary and sudden; can be mild or severe; may be triggered by sudden movements, position changes, temperature extremes, or tight clothing; typically occurs in the lower extremities and may be flexor (extremities remain contracted and difficult to extend) or extensor (extremities remain extended and difficult to bend).

Bladder and Bowel Dysfunction

Bladder dysfunction occurs in at least 80% of people who have MS. The dysfunction is caused by damage to the nerves that control the muscles of the bladder. Bladder dysfunction can also be triggered by the bowel symptoms of MS Symptoms include:

• Overactive bladder: may cause symptoms like frequency and urgency, hesitancy in starting urination, and frequent urination at night
• Urinary retention and incontinence (due to weakened bladder muscles)
• Constipation, diarrhea, and incontinence

Psychological Manifestations

Due to the nature of the disease, patients with MS often struggle with psychological impairments and emotional challenges. These include the following [10][11].

Cognitive Difficulties

Cognitive dysfunction in MS, caused by brain atrophy and lesions, often occurs later in the disease process, is more likely with progressive MS, and is caused by brain atrophy (and possibly lesions). The dysfunction may also occur during relapse episodes. Symptoms include:

• Memory (i.e., difficulty remembering daily routines or job tasks)
• Concentration problems (i.e., trouble finding the right words or keeping up with conversions)
• Decision-making problems (i.e., difficulty making decisions, using poor judgment)

Emotional Problems

Due to the difficult challenges faced as the disease progresses, people with MS may struggle with emotional problems. These may include:

• Feelings of grief/loss (associated with loss of independence)
• Irritability (related to feeling frustrated by functional limitations)
• Stress and anxiety (related to the unpredictability of symptoms – worried about when the next relapse will occur)
• Poor coping with the disease
• Mood changes (driven by worry and fear about how MS will impact their future)

Mental Illness

Emotional difficulties can lead to depression. Depression is a common symptom of MS that can occur at any point during the disease course. Research shows that the most severe form of depression – clinical depression – is more common in patients with MS than in the general population or with other chronic conditions [10]. Causes of depression and triggers for worsening depression in people with MS include:

• Emotional difficulties
• Damage to the area of the brain that controls emotional control
• Medications for MS (which can trigger mood changes)
• MS relapses (can worsen depression)
• Changes in the person’s ability to care for themselves (can worsen depression)

Impact on Quality of Life

Evidence shows MS harms functionality, emotional and social health, and work/other life roles. In a 2020 global survey of over 1,000 adult participants with MS, people living with the Relapsing-Remitting type of MS were questioned about the impact that MS had on their overall quality of life [2]. The following are the study results [2].

Activities of Daily Living

Over 40% reported a worsened ability to perform activities of daily living over the course of two years. Over half reported limitations related to fatigue, weakness, balance/coordination problems, heat/cold sensitivity, numbness/tingling, and muscle stiffness. Nearly 40% reported urinary problems as a consideration before planning to leave the house. Almost half listed trouble multitasking as a limiting factor.

Mental Well-Being

Over 70% reported a negative impact of MS on their energy level. Over 45% reported problems with memory and concentration, mood swings, and depression/anxiety. More than 70% reported concerns about disease progression and possible future disability, which may have contributed to the anxiety they had.

Sleep

Over half reported trouble sleeping.

Emotional Wellbeing

Almost half reported a negative impact on their future outlook, 40% on their ability to cope with stress, and 35% on self-esteem.

Social Life

One-fourth of all participants reported a negative impact on relationships with friends and 16% on family. Almost 45% were concerned about matters relating to sexual attractiveness. A fourth worried their partner would leave them. Nearly 35% reported MS affected their roles related to family, friends, and work. More than a third reported that they go out of their way to keep their MS hidden from others.

Job/Career

Nearly 65% reported that MS affected their ability to keep a job and 50% reported that MS affected their career progression.

Nursing Management

Nurses must devise a plan of care for patients with MS that focuses on managing symptoms and maintaining the quality of life. Obtaining an accurate history and performing both general and focused assessments (pain, neurological, neuromuscular, genitourinary, and gastrointestinal) are the first steps. Second, the nurse should develop a plan of care that should address each debilitating symptom, empowering the patient with the knowledge, skills, and resources needed to effectively manage their own lives. The following are ways in which nurses can help patients cope with their disease [10].

Cognitive Rehabilitation

Cognitive rehabilitation is a group of restorative and compensatory activities that help patients become stronger mentally and make up for cognitive losses [10]. The nurse should perform or arrange for cognitive screening tests as ordered. The screening will address various levels of cognitive functioning and results will help to determine what type of services or therapies are needed to help the patient manage the symptoms.

Physical, Occupational, and Speech Rehabilitation

Physical, occupational, and speech rehabilitation can help patients learn better ways of safely performing daily tasks, moving/walking (to conserve energy and avoid falls/injuries), and communicating and swallowing. The nurse should encourage patients to participate in these rehabilitative activities, provide education on the benefits of each service, and eliminate any barriers to participation (i.e., controlling pain and involving family).

Bladder and Bowel Care

Lifestyle modifications can help promote optimal bladder and bowel care. The nurse should teach patients how to manage symptoms when in public (i.e., wearing easily removable clothing), fluid intake adjustments (like avoiding drinking water right before bedtime), bladder/bowel training, and pelvic floor exercises as needed. The nurse should also perform intermittent urinary catheterization as needed.

Healthy Coping

The nurse should create a supportive safe environment for patients to express their concerns. The nurse’s primary role in this case is to determine the patient’s supportive needs based on the history that was obtained and the assessment performed. Referrals for counseling, stress management, and community resources may be beneficial.

Sleep Care

The nurse should promote sleep health to help with fatigue by addressing problems that can interfere with sleep. These may include limiting environmental distractions, managing pain, and following elimination schedules. Encourage the patient’s family/caregiver to avoid unnecessary sleep interruptions.

Heat Regulation

By keeping patients at a comfortable temperature, the nurse can avoid triggering patient fatigue and muscle spasms. The nurse should also teach the patient and family how to manage heat in the home.

Fall Prevention

Patients with MS can be at risk for falls related to balance/coordination issues, muscle spasticity, fatigue, and weakness. The nurse should make an effort to keep the patient safe by initiating fall prevention strategies (i.e., teaching the patient/family how to keep the home fall-proof).

Skin Care

The nurse should frequently perform skin care (to avoid skin breakdown related to incontinence and limited mobility) and teach the patient/family how to maintain skin integrity while at home.

Pharmacological Treatment: Infusion Therapy

Treatment for MS is aimed at reversing the damage and protecting axons from future damage [5]. MS treatments can also include those focused on symptom management. MS may be treated with medications to modify the disease course and treat relapses/exacerbations. These medications may be administered intravenously (IV), intramuscularly (IM), subcutaneously (SQ), intradermally, and orally. In this Infusion Therapy course, we will focus on IV infusion therapy, particularly three IV medications: alemtuzumab, ublituximab, and mitoxantrone [3][10].

Alemtuzumab

Alemtuzumab is an immunotherapy IV medication effective in the treatment of relapsing forms of MS. Alemtuzumab is typically used as a last resort (after two or more other MS therapies are infective) due to its serious complications. Drug information includes [3][10]:

• Drug Type: humanized monoclonal antibody, immunosuppressant
• Mechanism of Action: targets CD52 (a protein on the surface of immune cells); causes depletion of lymphocytes.
• Dosing: The initial dose is 15mg IV/day for five days; subsequent doses are 5mg IV/day for three days 12 months after the initial dose
• Contraindications and Precautions: should not be administered to patients with an allergy to the medication or to patients with MS who have action infections; may cause fetal harm during pregnancy
• Adverse Effects: low lymphocyte count (in 99.9% of patients with MS), anemia, headache, fever, nasopharyngitis, cough, nausea, weakness, hepatitis B reactivation (in patients with hepatitis), herpes reactivation (in patients with herpes)
• Black Box Warning: can cause life-threatening autoimmune disorders (autoimmune thyroid disorder, immune thrombocytopenia, anti-glomerular basement membrane disease), infusion reactions during and after administration, and cancer (thyroid cancer, melanoma, blood cancers)

Ublituximab

Ublituximab is an immunotherapy IV medication effective in the treatment of relapsing forms of MS and clinically isolated syndrome. Drug information includes [3][10]:

• Drug Type: chimeric monoclonal antibody, immune suppressant
• Mechanism of Action: not fully understood but likely targets CD20 (protein on surface of immune cells); causes cell lysis
• Dosing: initial dose: 150mg IV; second dose: 450mg IV two weeks later and every 24 weeks subsequently
• Contraindications and Precautions: should not be administered to patients with a prior allergy to the medication or those with an active hepatitis B infection; patients who are already immunocompromised should be closely monitored while on this medication; may cause fetal harm during pregnancy
• Adverse Effects: may reduce immunoglobin levels, neutropenia, chills, fever, headache, nausea, diarrhea, throat irritation, alopecia, sinus tachycardia

Mitoxantrone

Mitoxantrone is a chemotherapy IV medication effective in the treatment of relapsing forms of MS. This medication may be given via other routes as well (i.e., intramuscular or intraperitoneal). Drug information includes [3][10]:

• Drug Type: anthracenedione, synthetic antineoplastic/chemotherapeutic agent
• Mechanism of Action: inhibits DNA and RNA synthesis by binding to DNA and inhibiting topoisomerase II (enzyme important in repairing damaged DNA)
• Dosing: 12 mg/ m2 IV every three months (m2 is a calculation of body surface area based on height and weight)
• Contraindications and Precautions: should not be administered to patients with a prior allergy to the medication; patients with cardiac disease, prior radiation therapy to the mediastinal/pericardial area, prior therapy with anthracycline or anthracenedione agents, or those who are receiving concurrent cardiotoxic agents should be monitored closely while on this medication (increased risk for cardiotoxicity); may cause fetal harm during pregnancy
• Adverse Effects: may cause fatal congestive heart failure, severe left ventricular dysfunction, infections, neutropenia, leukemia, pancytopenia, thrombocytopenia, hypotension, sinus tachycardia

The Nurse’s Role in Infusion Therapy

The infusion nurse plays a vital role in the safe administration of immunotherapy medications. Various safety measures should be taken before, during, and after infusion of MS medications. For example, the nurse should ensure the patient has not had any live or live-attenuated vaccines just before therapy. The following are additional nursing roles in infusion therapy [3].

Prior to Administration

• Labs and Diagnostic Tests: first, the nurse should obtain appropriate laboratory and diagnostic reports to assess the patient’s baseline. A complete blood count (white blood cells and platelets) and immunoglobins should be obtained (depending on the type of medication) as abnormalities in these values may be worsened with infusion therapy. In patients taking ublituximab, the nurse should screen for the hepatitis B virus as this medication is contraindicated in patients with an active hepatitis B infection. An ECG (electrocardiogram) is required before administering alemtuzumab and mitoxantrone as these medications can cause abnormal heart rhythms. A pregnancy test is required before mitoxantrone administration as it is a chemotherapy medication. Any abnormal labs and tests should be reported to the clinician prior to administration.
• Monitoring Equipment: when the clinician’s order has been obtained to begin the infusion, the room should be prepared with monitoring equipment (such as a blood pressure machine). Protocols/medications for managing anaphylaxis should be available, particularly when patients are taking the medications for the first time.
• Medication Inspection: the nurse should visually inspect the medication to ensure the solution is the correct color and is free from particles. Alemtuzumab is clear and colorless (or light yellow). Ublituximab is clear to opalescent and colorless (or light yellow). The nurse should ensure the medication has been diluted prior to administration if indicated and administer within the appropriate time frame (immediately after dilution for some infusions and within 8 hours for others).
• Pre-Medication: patients with MS should be pre-medicated with a high-dose corticosteroid (i.e., methylprednisolone IV 1000 mg) immediately prior to administration (may be required for subsequent doses depending on the medication).

During Administration

• Administration Techniques: IV medications for MS should be administered as an IV infusion (not IV push or bolus) through its own IV line (not infused with other medications). The nurse should wear chemotherapy gloves as appropriate (particularly with mitoxantrone – a chemotherapy agent), draw up the prescribed amount, and inject the dose into the appropriate solution and amount if not already prepared (i.e., 100 ml 5% dextrose or 250 ml 0.9% sodium chloride). The nurse should infuse the medication over the prescribed number of hours.
• Safety Measures: the nurse should take the appropriate precautions to protect the solution, such as avoiding shaking the vial, gently inverting the bag to mix the solution, keeping the solution at the appropriate temperature, and protecting the solution from light. The nurse should also monitor for signs of extravasation at the IV site and stop the infusion immediately.
• Patient Monitoring: The patient should be monitored closely as MS infusion medications can lead to serious sometimes fatal adverse effects. Keeping an eye on the patient’s blood pressure during alemtuzumab administration is imperative as the patient may become hypotensive, especially in those with ischemic cardiac disease. Antihistamines and antipyretics may need to be administered along with the infusion. Anti-infective and anti-viral prophylaxis may be indicated as well. The infusion should be stopped, and the clinician notified if the patient develops a serious reaction.

After Administration

• Patient Monitoring: infusion reactions may occur for up to 24 hours after the infusion is complete. The nurse should continue monitoring for reactions and checking appropriate vital signs up to 2 hours after infusion (time depends on each medication).
• Patient Education: patients should be instructed to report lingering adverse reactions to their clinician and/or visit an emergency room.
• Labs: labs should be monitored regularly as often as prescribed.

New Research

Researchers are attempting to better understand MS, find new treatment strategies, and improve accuracy in diagnosing MS [7]. The following are MS topics that are currently under study [7].

Topics of Research

• Role of genetics and the environment as risk factors for MS
• Diagnosis and monitoring of MS through biomarkers (signs that might show MS risk or help to monitor disease progression)
• Strategies to improve MRI testing in people with MS
• The role diet and gut biome play in MS
• Reason for gender differences in how MS presents
• Disparities in the care of people with MS, particularly African American and Hispanic populations
• Function of the immune system in the CNS of people with MS
• Basics of myelination and demyelination, and strategies to limit myelin and axonal loss

Current Updates

While there are many topics of study surrounding MS, scientists have already made grand discoveries that have proven to be effective in the management of MS. Many studies are conducted by the National Institute of Neurological Diseases and Stroke and sponsored and funded by groups like the National Institute of Health and the National Institute of Allergy and Infectious Diseases. The following are research updates on MS [7].

• Genetic Testing: There are genes associated with an increased risk for MS, for example the earlier mentioned HLA-DRB*15:0 gene. Scientists are studying the function of these genes in the nervous system and the role they play in MS development.
• Diagnostic Studies: The body naturally attempts to repair itself, and with MS, the body’s repair mechanisms may obscure evidence of active lesions on MRIs (lesions may appear to come and go) [11]. For this reason, symptoms may not be reflective of MRI results as they might with many other diseases and conditions. Scientists are studying ways to develop more powerful MRI methods to diagnose and monitor MS and assess the effectiveness of MS treatments. To do this, scientists are conducting years-long studies comparing MRIs of over 100 patients with MS with MRIs of those without MS. Scientists are also studying how detection of a “central vein” passing through brain lesions/plaques on MRIs can help differentiate between MS and other neurological disorders that might mimic MS (to prevent misdiagnosis).
• Blood Tests: Scientists are studying a blood test that measures neurofilaments (proteins derived from nerve cells) to determine MS severity and effectiveness of treatments.
• New Medications: Through clinical trials, scientists tested a drug called “Ibudilast” for neuroprotective properties in progressive MS. The trials found that the drug slowed down the rate of brain atrophy.
• Stem Cell Treatment: Scientists are testing a stem cell treatment called “autologous hematopoietic stem cell transplantation” (AHSCT) for severe forms of relapsing MS. The treatment involves removing some of a person’s immune cells and replacing them with their own stem cells as a way to “reset” the immune system.

Resources for Patients and Families 

Multiple community and professional groups and organizations provide support and education to patients with MS and their families. Nurses can support patients and families by referring them to the following groups.  

Multiple Sclerosis Association of America 
Multiple Sclerosis Association of America (MSAA) aims to improve the lives of people living with MS and their families. The organization hosts a helpline, online forum, blog, and podcast [6]. 

National Multiple Sclerosis Society 
The National Multiple Sclerosis Society (NMSS) aims to find a cure for MS and provides education to patients, families, and professionals. The group provides statistical data on MS and is a source for detailed and extensive education on the disease. 

Autoimmune Association 
The Autoimmune Association advocates for patients with autoimmune diseases and supports research that aims to find a cure. The group raises awareness about autoimmune diseases, and advocates for federal and state level changes that improve the lives of patients living with the disease [1].

Conclusion

Many therapies, treatments, and resources are available to help patients maintain their quality of life. Although the population of people with MS has more than doubled over the last 50 years or so, new and innovative developments are underway. Nurses can contribute by performing thorough assessments, asking the right questions, arranging appropriate referrals, educating patients on disease management, and following safety recommendations for the administration of infusion therapy.

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