**1. Introduction**

Multiple sclerosis (lat. sclerosis multiplex) is a chronic disease of the central nervous system caused by the damage of the myelin sheath. The symptoms of the disease depend on the location of the damage in the nervous system and can vary: optic neuritis, paresthesia, motor symp‐ toms (spasticity), impairment of cranial nerves, oculomotor disorders, cerebellar disorders, vertigo, urinary disorders, defecation, sexual dysfunctions, fatigue, depression, cognitive disorders, and paroxysmal symptoms. Multiple sclerosis is the most common cause of chron‐ ic neurological disabilities in young adults. The onset of the disease is usually between the ages of 20 and 40. Its prevalence is higher among women. The highest susceptibility to the disease is

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among Caucasians; the geographic gradient of the incidence increases together with the distance from the equator. Genetic predisposition plays a role.

#### **1.1. Types of the disease**

Four types of the disease are recognized according to their clinical course. In the early years of the disease, the most common type is relapsing‐remitting MS (RRMS), occurring in 80–85% of patients and characterized by attacks and remissions. If a previous attack left no neurological deficit, remissions may be completely asymptomatic at the beginning of the disease. Half of these patients develop into the stage of secondary progression (SPMS) during the first 10 years of the disease's progression. This stage is characterized by a gradual increase in neurological deficits that are already irreversible, with both the presence and absence of relapses that are not as dramatic as in the remitting stage. The relapsing‐progressive (RPMS) form of the disease is characterized by an increased neurological deficit also evident between the relapses; it is thus prognostically the most unfavorable form of the disease. The primary progressive (PPMS) form affects about 10–15% of patients and is characterized by a gradual increase in neurological deficit. This form occurs more frequently among males and with a later onset of the disease [1].

In the relapsing‐remitting forms, approximately 20–30% of patients continue working following their first attack. It is uncommon for patients in the early stages of this form of MS to be physically disabled or to have noticeable alternations in terms of dementia. It is primarily the progressive form of MS, developing at a later age that tends to pose more difficulty in the cognitive domains, compared to the remitting one. Patients with the spinal form of the disease have trouble mostly with motor skills and mobility. This form often occurs in the primary progressive form. Cognitive deficits include impaired attention. The typical cognitive domains impaired in the cerebral forms of MS are described below. Psychosocial and maladaptive problems are described in the case report.

#### *1.1.1. Case report 1*

A woman of 47 years reported the first symptoms of MS (optic neuritis and paresthesia) at the age of 17; later, the attacks recurred about once a year; the problems worsened after two child deliveries. Therefore, she did not breastfeed her children, for which she blames herself for until today. She underwent an abortion 2 years after the second birth due to the above‐mentioned difficulties, then was psychiatrically treated, and still has feelings of guilt. The diagnosis of MS was definitely confirmed about 4 years ago. The patient has since been considerably anxious, unreconciled with the diagnosis, dominated by hostility and distrust of the medical staff (the disease was not diagnosed correctly). MRI scans of the brain and spinal cord showed multiple demyelinating lesions or plaques in the white matter. Nobody in the family had MS. She was entitled to disability pension and has been taking antidepressants for 4 years, based on the psychiatrist's indication of anxiety and depressive problems. Formerly, she worked as a teacher. She feels very tired after only about a 3–4 km walk. She is married, has two adult sons, and lives with her family. When she learned about MS, she was overtaken by fear of dying and felt mentally ill, and thus stopped working. She did not observe any difficulties with cognition. Gradually, a panic anxiety developed; when she wakes up, she feels scared, but this panic is also present while traveling; family members take her everywhere by car. The patient is recommended to systematic cognitive-behavioral psychotherapy.
