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Multiple Sclerosis

Chapter 4

Abstract

related to this topic.

1. Introduction

59

cognitive neurorehabilitation

Multiple Sclerosis

Lambros Messinis, Grigorios Nasios

and Panagiotis Papathanasopouos

Neuropsychological Functions and

Although cognitive difficulties are not frequently reported by patients among the initial symptoms of Multiple Sclerosis (MS), there is sufficient evidence that cognitive impairment is present from the early stage of the disease. Today it is commonly accepted that roughly one-half of individuals with MS will experience cognitive dysfunction over the course of the disease. Though MS was originally considered a disease of white matter, more recent investigations with advanced immunohistochemistry techniques have revealed that demyelination of gray matter is a common neuropathological feature in MS contributing significantly to cognitive impairment. However, despite now been recognized as a core symptom of MS, evidence up till now is only modest regarding the efficacy of pharmacological agents on cognitive dysfunction and non-pharmacological interventions such as cognitive rehabilitation also provide incomplete evidence on whether they might improve or stabilize cognitive impairment and especially over long follow up periods. Despite this general consensus, there are studies that have reported the efficacy of cognitive neurorehabilitation in reducing MS associated cognitive deficits. In this chapter we provide a selective review of the most relevant features

Keywords: multiple sclerosis, neuropsychological functions, cognition,

Historically the disease today known as multiple sclerosis (MS) has been referred to in the historical medical literature with a variety of terms, including, disseminated sclerosis and sclerose en plaque [1]. Lidwina van Schiedam, was the first potential case of MS dating as far back as 1421, when Jan van Berieren commented on her illness. Records showed that she had difficulties walking, paralysis of the right arm, decreased sensation and visual difficulties [2].

Today we know that MS is a chronic inflammatory autoimmune degenerative disease of the central nervous system (CNS). It is the most common non-traumatic neurological disorder among young adults leading to disability. The etiology of MS involves white matter pathology, cortical atrophy, cortical lesions, and microstructural abnormalities in deep gray matter that impact structural and functional

Cognitive Neurorehabilitation in

## Chapter 4
