In this article, we update management measures for patients with multiple sclerosis (MS) that can improve or prevent impairment, disability, and handicap and include those factors that a primary-care physician can implement or facilitate. The medical literature since 1989 was reviewed. Although new drug trials hold promise to decrease impairment from MS, well- coordinated interdisciplinary care to minimize disability and handicap most profoundly affect the quality of life for patients with MS, MS is usually not severely disabling, and appropriately timed intervention can prevent secondary impairment and reduce disability and handicap. Pharmacologic, physical, and psychosocial issues-ranging from spasticity, pain, weakness, and tremor to neurogenic bowel management and sexuality-are addressed. General wellness measures remain important. The influence of the Americans With Disabilities Act is discussed, and specific adaptive equipment and social resources are outlined. The ultimate goals of management of patients with MS are functional independence and efficient use of medical and community resources: a focus on 'ability' rather than 'disability.' Although impairment can limit function, wellness and adjustment have no boundaries.
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