A diagnosis of multiple sclerosis (MS), an incurable condition, introduces great uncertainty into virtually all aspects of a person's life. From early in the disease course, people with MS are vulnerable to disempowerment, poor psychological health, and social exclusion including high unemployment. Current health-care research for people with MS is reviewed here within the context of three philosophies of disability and health-care service provision: the biomedical, biopsychosocial and sociopolitical models. Some of the uncertainties concerning the patient's life that result from MS have been reduced by improved diagnostic tools, advances in immunotherapy, multidisciplinary rehabilitation, community programs, and provision of information specifically designed to facilitate shared decision-making and empowerment. Such progress is modest, however, and substantial improvements to the psychological health, empowerment, and quality of life of people with MS requires more sociopolitically oriented research.
From early in the disease course, people with multiple sclerosis (MS) are at high risk of unemployment, social exclusion and depression
The biomedical model offers the only realistic hope of a cure for MS, but does not address all the difficulties of living with the condition
The biopsychosocial and sociopolitical models of disability and health-care service provision are also needed to improve mental health, social inclusion and quality of life for patients with MS
Relevant data are needed to gain the backing of vital government support programs for financial assistance and social inclusion for patients with MS
Sociopolitical research using volunteers with MS can provide data of direct relevance to political lobbying on behalf of patients
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Matthews, W. B. In McAlpine's Multiple Sclerosis (eds Matthews, W. B. et al.) 43–77 (Churchill Livingstone, Edinburgh, 1991).
Ebers, G. C. Natural history of multiple sclerosis. J. Neurol. Neurosurg. Psychiatr. 71 (Suppl. II), ii16–ii19 (2001).
Weiner, B. K. Editorial. Difficult medical problems: on explanatory models and a pragmatic alternative. Med. Hypotheses 68, 474–479 (2007).
Alonso, Y. The biopsychosocial model in medical research: the evolution of the health concept over the last two decades. Patient Educ. Couns. 53, 239–244 (2004).
Forbes, A., While, A. & Taylor, M. What people with multiple sclerosis perceive to be important to their needs. J. Adv. Nurs. 58, 11–22 (2007).
Engel, G. L. The need for a new medical model: a challenge for biomedicine. Science 196, 129–136 (1977).
Kieffer, R. A. An integrative review of the concept of well-being. Holist. Nurs. Pract. 22, 244–252 (2008).
Novack, D. H. et al. Psychosomatic medicine: the scientific foundation of the biopsychosocial model. Acad. Psychiatry 31, 388–401 (2007).
Mizrachi, N. From causation to correlation: the story of psychosomatic medicine 1939–1979. Cult. Med. Psychiatry 25, 317–343 (2001).
Richardson, M. Addressing barriers: disabled rights and the implications for nursing of the social construct of disability. J. Adv. Nurs. 25, 1269–1275 (1997).
Hubbard, S. Disabilities and the health care curriculum: the great divide. J. Allied Health 33, 184–188 (2004).
Hayes, J. & Hannold, E. M. The road to empowerment: a historical perspective on the medicalization of disability. J. Health Hum. Serv. Adm. 30, 352–377 (2007).
Barker-Collo, S., Cartwright, C. & Read, J. Into the unknown: the experience of individuals living with multiple sclerosis. J. Neurosci. Nurs. 38, 435–446 (2006).
Langgartner, M., Langgartner, I. & Drlicek, M. The patient's journey: multiple sclerosis. BMJ 330, 885–888 (2005).
Burnfield, A. Doctor–patient dilemmas in multiple sclerosis. J. Med. Ethics 1, 21–26 (1984).
Bogosian, A., Moss-Morris, R., Yardley, L. & Dennison, L. Experience of partners of people in the early stages of multiple sclerosis. Mult. Scler. 15, 876–884 (2009).
Johnson, J. On receiving the diagnosis of multiple sclerosis: managing the transition. Mult. Scler. 9, 82–88 (2003).
Isaksson, A.-K. & Ahlström, G. From symptom to diagnosis: illness experiences of multiple sclerosis patients. J. Neurosci. Nurs. 38, 229–237 (2006).
Janssens, A. C. et al. Patients with multiple sclerosis prefer early diagnosis. Eur. J. Neurol. 11, 335–337 (2004).
Papathanasopoulos, P. G., Nikolakopoulou, A. & Scolding, N. J. Disclosing the diagnosis of MS. J. Neurol. 252, 1307–1309 (2005).
Mushlin, A. I. et al. The value of diagnostic information to patients with suspected multiple sclerosis. Arch. Neurol. 51, 67–72 (1994).
Thompson, A. J. Neurorehabilitation in multiple sclerosis: foundations, facts and fiction. Curr. Opin. Neurol. 18, 267–271 (2005).
Irvine, H., Davidson, C., Hoy, K. & Lowe-Strong, A. Psychosocial adjustment to multiple sclerosis: exploration of identity redefinition. Disabil. Rehabil. 31, 599–606 (2009).
Malcomson, K. S., Lowe-Strong, A. S. & Dunwoody, L. What can we learn from the personal insights of individuals living and coping with multiple sclerosis? Disabil. Rehabil. 30, 662–674 (2008).
Antonak, R. F. & Livneh, H. Psychosocial adaptation to disability and its investigation among persons with multiple sclerosis. Soc. Sci. Med. 40, 1099–1108 (1995).
Yorkston, K. M., McMullan, K. A. Molton, I. & Jensen, M. P. Pathways of change experienced by people aging with disability: a focus group study. Disabil. Rehabil. doi:10.3109/09638281003678317.
Ziemssen, T. Multiple sclerosis beyond EDSS: depression and fatigue. J. Neurol. Sci. 277 (Suppl. 1), S37–S41 (2009).
Gulick, E. E. Emotional distress and activities of daily living functioning in persons with multiple sclerosis. Nurs. Res. 50, 147–154 (2001).
José Sá, M. Psychological aspects of multiple sclerosis. Clin. Neurol. Neurosurg. 110, 866–877 (2008).
Aikens, J. E., Fischer, J. S., Namey, M. & Rudick, R. A. A replicated prospective inverstigation of life stress, coping, and depressive symptoms in multiple sclerosis. J. Behav. Med. 20, 433–445 (1997).
Pakenham, K. I. Adjustment to multiple sclerosis: application of a stress and coping model. Health Psychol. 18, 383–392 (1999).
Dennison, L., Moss-Morris, R. & Chalder, T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin. Psychol. Rev. 29, 141–153 (2009).
Thorne, S., Con, A., McGuinness, L., McPherson, G. & Harris, S. R. Health care communication issues in multiple sclerosis: an interpretive description. Qual. Health Res. 14, 5–22 (2004).
Saba, G. W. et al. Shared decision-making and the experience of partnership in primary care. Ann. Fam. Med. 4, 54–62 (2006).
Joosten, E. A. G. et al. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother. Psychosom. 77, 219–226 (2008).
Heesen, C., Schäffler, N., Kasper, J., Mühlhauser, I. & Köpke, S. Suspected multiple sclerosis—what to do? Evaluation of a patient information leaflet. Mult. Scler. 15, 1103–1112 (2009).
Giordano, A. et al. The multiple sclerosis knowledge questionnaire: a self-administered instrument for recently diagnosed patients. Mult. Scler. 16, 100–111 (2010).
Dilorenzo, T. A., Becker-Feigeles, J., Halper, J. & Picone, M. A. A qualitative investigation of adaptation in older individuals with multiple sclerosis. Disabil. Rehabil. 30, 1088–1097 (2008).
Kouzoupis, A. B., Paparrigopoulos, T., Soldatos, M. & Papadimitriou, G. N. The family of multiple sclerosis patients: a psychosocial perspective. Int. Rev. Psychiatry 22, 83–89 (2010).
Sherman, T. E. et al. Predictors of well-being among significant others of persons with multiple sclerosis. Mult. Scler. 13, 238–249 (2007).
Pakenham, K. I. The positive impact of multiple sclerosis (MS) on carers: Associations between carer benefit finding and positive and negative adjustment domains. Disabil. Rehabil. 27, 985–997 (2005).
Buchanan, R. J., Radin, D., Chakravorty, B. J. & Tyry, T. Informal caregiving to more disabled people with multiple sclerosis. Disabil. Rehabil. 31, 1244–1256 (2009).
Aronson, K. J. Quality of life among persons with multiple sclerosis and their caregivers. Neurology 48, 74–80 (1997).
McKeown, L. P., Porter-Armstrong, A. P. & Baxter, G. D. The needs and experiences of caregivers of individuals with multiple sclerosis: a systematic review. Clin. Rehabil. 17, 234–248 (2003).
Figved, N., Myhr, K.-M., Larsen, J.-P. & Aarsland, D. Caregiver burden in multiple sclerosis: the impact of neuropsychiatric symptoms. J. Neurol. Neurosurg. Psychiatry 78, 1097–1102 (2007).
Mutch, K. In sickness and in health: experience of caring for a spouse with MS. Brit. J. Nurs. 19, 214–219 (2010).
Pfleger, C. C. H., Flachs, E. M. & Koch-Henriksen, N. Social consequences of multiple sclerosis. Part 2. Divorce and separation: a historical prospective cohort study. Mult. Scler. 16, 878–882 (2010).
Buhse, M. Assessment of caregiver burden in families of persons with multiple sclerosis. J. Neurosci. Nurs. 40, 25–31 (2008).
Rivera-Navarro, J. et al. Burden and health-related quality of life of Spanish caregivers of persons with multiple sclerosis. Mult. Scler. 15, 1347–1355 (2009).
Compston, A. & Coles, A. Multiple sclerosis. Lancet 372, 1502–1517 (2008).
Kappos, L. et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N. Engl. J. Med. 362, 387–401 (2010).
Giovannoni, G. et al. A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis. N. Engl. J. Med. 362, 416–426 (2010).
Patti, F. et al. Effects of a short outpatient rehabilitation treatment on disability of multiple sclerosis patients. J. Neurol. 250, 861–866 (2003).
Kesselring, J. Neurorehabilitation in multiple sclerosis: what is the evidence base? J. Neurol. 251 (Suppl. 4), iv25–iv29 (2004).
Khan, F., Pallant, J. F., Brand, C. & Kilpatrick, T. J. Effectiveness of rehabilitation intervention in persons with multiple sclerosis: a randomised controlled trial. J. Neurol. Neurosurg. Psychiatry 79, 1230–1235 (2008).
Kesselring, J. & Beer, S. Symptomatic therapy and neurorehabilitation in multiple sclerosis. Lancet Neurol. 4, 643–652 (2005).
Storr, L. K., Sørensen, P. S. & Ravnborg, M. The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients. Mult. Scler. 12, 235–242 (2006).
Khan, F., Turner-Stokes, L., Ng, L. & Kilpatrick, T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD006036. doi:10.1002/14651858.CD006036.pub2 (2007).
Borgerson, K. Evidence-based alternative medicine? Perspect. Biol. Med. 48, 502–515 (2005).
Kulkarni, A. V. The challenges of evidence-based medicine: a philosophical perspective. Med. Health Care Philos. 8, 255–260 (2005).
Thompson, R. P. Causality, mathematical models and statistical association: dismantling evidence-based medicine. J. Eval. Clin. Pract. 16, 267–275 (2010).
Ackerman, K. D. et al. Stressful life events precede exacerbations of multiple sclerosis. Psychosom. Med. 64, 916–920 (2002).
Buljevac, D. et al. Self reported stressful life events and exacerbation in multiple sclerosis. BMJ 9, 307–310 (2003).
Brown, R. F. et al. Relationship between stress and relapse in multiple sclerosis: Part 1. Important features. Mult. Scler. 12, 453–464 (2006).
Golan, D., Somer, E., Dishon, S., Cuzin-Disegni, L. & Miller, A. Impact of exposure to war stress on exacerbations of multiple sclerosis. Ann. Neurol. 64, 143–148 (2008).
Mohr, D. C. Stress and multiple sclerosis. J. Neurol. 254 (Suppl. 2), ii65–ii68 (2007).
Heesen, C. et al. Stress regulation in multiple sclerosis—current issues and concepts. Mult. Scler. 13, 143–148 (2007).
Raison, C. L., Capuron, L. & Miller, A. H. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 27, 24–31 (2006).
Kern, S. & Ziemssen, T. Review: Brain immune communication psychoneuroimmunology of multiple sclerosis. Mult. Scler. 14, 6–21 (2008).
Zacharie, R. Psychoneuroimmunology: a bio-psycho-social approach to health and disease. Scand. J. Psychol. 50, 645–651 (2009).
Apel-Neu, A. & Zettl, U. K. Complementary and alternative medicine in multiple sclerosis. J. Neurol. 255 (Suppl. 6), 82–86 (2008).
Thachil, A. F., Mohan, R. & Bhugra, D. The evidence for complementary and alternative therapies in depression. J. Affect. Dis. 97, 23–35 (2007).
Hansen, K. & Kappel, K. The proper role of evidence in complementary/ alternative medicine. J. Med. Philos. 35, 7–18 (2010).
Lane, R. D. et al. The rebirth of neuroscience in psychosomatic medicine, Part 1: historical context, methods, and relevant basic science. Psychosom. Med. 71, 117–134 (2009).
Prince, P. et al. Global mental health I. No health without mental health. Lancet 370, 859–877 (2007).
Fruehwald, S., Loeffler-Stastka, H., Eher, R, Saletu, B. & Baumhackl, U. Depression and quality of life in multiple sclerosis. Acta Neurol. Scand. 104, 257–261 (2001).
Janardan, V. & Bakshi, R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J. Neurol. Sci. 205, 51–58 (2002).
Patti, F. et al. Health-related quality of life and depression in an Italian sample of multiple sclerosis patients. J. Neurol. Sci. 211, 55–62 (2003).
D'Alisa, S. et al. Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil. Rehabil. 28, 307–314 (2006).
Mitchell, A. J., Benito-Léon, J., Morales-Gonzáles, J.-M. & Rivera-Navarro, J. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol. 4, 556–566 (2005).
Lobentanz, I. S. et al. Factors influencing quality of life in multiple sclerosis patients: disability, depressive mood, fatigue and sleep quality. Acta Neurol. Scand. 110, 6–13 (2004).
Motl, R. W., McAuley, E., Snook, E. M. & Gliottoni, R. C. Physical activity and quality of life in multiple sclerosis: Intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol. Health Med. 14, 111–124 (2009).
Wollin, J. et al. Multiple sclerosis: psychosocial factors that influence quality of life and potential for self-management. Int. J. MS Care (in press).
Krupp, L. B. Fatigue in multiple sclerosis: definition, pathophysiology and treatment. CNS Drugs 17, 225–234 (2003).
Johansson, S., Ytterberg, C., Hillert, J., Widén Holmqvist, L. & von Koch, L. A longitudinal study of variations in and predictors of fatigue in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 79, 454–457 (2008).
Koch, M., Mostert, J., Heerings, M., Uyttenboogaart, M. & De Keyser, J. Fatigue, depression and disability accumulation in multiple sclerosis: a cross-sectional study. Eur. J. Neurol. 16, 348–352 (2009).
Bruce, J. & Arnet, P. MS patients with depressive symptoms exhibit affective memory biases when verbal encoding strategies are suppressed. J. Int. Neuropsych. Soc. 11, 514–521 (2005).
Lester, K., Stepleman, L. & Hughes, M. The association of illness severity, self-reported cognitive impairment, and perceived illness management with depression and anxiety in a multiple sclerosis clinic population. J. Behav. Med. 30, 177–186 (2007).
Chiaravalloti, N. D & DeLuca, J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 7, 1139–1151 (2008).
Airlie, J., Baker, G. A., Smith, S. J. & Young, C. A. Measuring the impact of multiple sclerosis on psychosocial functioning: the development of a new self-efficacy scale. Clin. Rehabil. 15, 259–265 (2001).
Kroencke, D. C., Denney, D. R. & Lynch, S. G. Depresion during exacerbations in multiple sclerosis: the importance of uncertainty. Mult. Scler. 7, 237–242 (2001).
Paparrigopoulos, T., Ferentinos, P., Kouzoupis, A., Koutsis, G. & Papadimitriou, G. N. The neuropsychiatry of multiple sclerosis: focus on disorders of mood, affect and behaviour. Int. Rev. Psychiatry 22, 14–21 (2010).
Brown, R. F. et al. Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships. Mult. Scler. 12, 465–475 (2006).
Kern, S. et al. Neurological disability, psychological distress, and health-related quality of life in MS patients within the first three years after diagnosis. Mult. Scler. 15, 752–758 (2009).
Putzki, N. et al. Quality of life in 1000 patients with early relapsing–remitting multiple sclerosis. Eur. J. Neurol. 16, 713–720 (2009).
LaRocca, N. G., Scheinberg, L. C. & Kaplan, S. R. Disease characteristics and psychological status in multiple sclerosis. Neurol. Rehabil. Neural Repair 1, 171–178 (1987).
McCabe, M. P. Mood and self-esteem of persons with multiple sclerosis following an exacerbation. J. Psychosom. Res. 59, 161–166 (2005).
Gold, S. M. & Irwin, M. R. Depression and immunity: inflammation and depressive symptoms in multiple sclerosis. Immunol. Allergy Clin. N. Am. 29, 309–320 (2009).
Arnet, P. A. & Randolph, J. J. Longitudinal course of depression symptoms in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 77, 606–610 (2006).
Thomas, P. W., Thomas, S., Hillier, C., Galvin, K. & Baker, R. Psychological interventions for multiple sclerosis. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD004431. doi:10.1002/14651858.CD004431.pub2 (2006).
Barlow, J., Turner, A., Edwards, R. & Gilchrist, M. A randomised controlled trial of lay-led self-management for people with multiple sclerosis. Pat. Educ. Counsel. 77, 81–89 (2009).
Reeves, D. et al. Predicting who will benefit from an Expert Patient Programme self-management course. Brit. J. Gen. Pract. 58, 198–203 (2008).
Buchanan, R. J., Wang, S., Tal-Seale, M. & Ju, H. Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set. Mult. Scler. 9, 171–188 (2003).
Australian Institute of Health and Welfare 2010. Younger people with disability in residential aged care program: report on the 2008–2009 Minimum Data Set. Disability Series, Cat. No. DIS57, Canberra, AIHW. [online], (2010).
Bartley, M., Sacker, A. & Clarke, P. Employment status, employment conditions, and limiting illness: prospective evidence from the British household panel survey 1991–2001. J. Epidemiol. Community Health 58, 501–506 (2004).
Gottlieb, L., Waitzkin, H. & Miranda, J. Depressive symptoms and their social contexts: a qualitative systematic literature review of contextual interventions. Int. J. Soc. Psychiat. doi:10.1177/0020764010362863.
Okoro, C., Strine, T., McGuire, L., Balluz, L. & Mokdad, A. Employment status and frequent mental distress among adults with disabilities. Occup. Med. 57, 217–220 (2007).
Lauber, C. & Bowen, J. L. Low mood and employment: when affective disorders are intertwined with the workplace—a UK perspective. Int. Rev. Psychiatry 22, 173–182 (2010).
Patti, F. et al. Effects of education level and employment status on HRQOL in early relapsing–remitting multiple sclerosis. Mult. Scler. 13, 783–791 (2007).
Yorkston, K. M., Johnson, K. L. & Klasner, E. R. Taking part in life: enhancing participation in multiple sclerosis. Phys. Med. Rehabil. Clin. N. Am. 16, 583–594 (2005).
LaRocca, N., Kalb, R., Scheinberg, L. & Kendall, P. Factors associated with unemployment in multiple sclerosis. J. Chron. Dis. 38, 203–210 (1985).
Edgley, K., Sullivan, M. J. L. & Dehoux, E. A survey of multiple sclerosis. Part 2. Determinants of employment status. Can. J. Rehabil. 4, 127–132 (1991).
Morales-Gonzáles, J. M., Benito-León, J., Rivera-Navarro, J. & Mitchell, A. J. A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study. Mult. Scler. 10, 47–54 (2004).
Julian, L. J., Vella, L., Vollmer, T., Hadjmichael, O. & Mohr, D. C. Employment in multiple sclerosis: exiting and re-entering the workforce. J. Neurol. 255, 1354–1360 (2008).
Messmer Uccelli, M., Specchia, C., Battaglia, M. A. & Miller, D. M. Factors that influence the employment status of people with multiple sclerosis: a multi-national study. J. Neurol. 256, 1989–1996 (2009).
Simmons, R. D., Tribe, K. L. & McDonald, E. A. Living with multiple sclerosis: longitudinal changes in employment and the importance of symptom management. J. Neurol. 257, 926–936 (2010).
Varekamp, I., de Vries, G., Heutink, A. & van Dijk, F. J. H. Empowering employees with chronic diseases; development of an intervention aimed at job retention and design of a randomised controlled trial. BMC Health Serv. Res. 8, 224 (2008).
Townsend, G. Supporting people with multiple sclerosis in employment: a United Kingdom survey of current practice and experience. Brit. J. Occup. Ther. 71, 103–111 (2008).
Pompeii, L. A., Moon, S. D. & McCrory, D. C. Measures of physical and cognitive function and work status among individuals with multiple sclerosis: a review of the literature. J. Occup. Rehabil. 15, 69–84 (2005).
Wu, N., Minden, S., Hoaglin, D. C., Hadden, L & Frankel, D. Quality of life in people with multiple sclerosis: data from the Sonya Slifka Longitudinal Multiple Sclerosis Study. J. Health Hum. Serv. Adm. 30, 233–267 (2007).
Sweetland, J., Riazi, A., Cano, S. J. & Playford, E. D. Vocational rehabilitation services for people with multiple sclerosis: what patients want from clinicians and employers. Mult. Scler. 13, 1183–1189 (2007).
Rumrill, P., Roessler, R., Vierstra, C., Hennessey, M. & Staples, L. Workplace barriers and job satisfaction among employed people with multiple sclerosis: an empirical rationale for early intervention. J. Vocat. Rehabil. 20, 177–183 (2004).
Thomas, S. et al. Development and preliminary evaluation of a cognitive behavioural approach to fatigue in people with multiple sclerosis. Pat. Educ. Counsel. 78, 240–249 (2010).
Hugos, C. L. et al. Clinical trial of a formal group fatigue program in multiple sclerosis. Mult. Scler. doi:10.1177/1352458510364536.
Australian Government, Department of Human Services. Jobs in Jeopardy, [online].
Pfleger, C. C. H., Flachs, E. M. & Koch-Henricksen, N. Social consequences of multiple sclerosis. (1): early pension and temporary unemployment—a historical prospective cohort study. Mult. Scler. 16, 121–126 (2010).
Summers, M. & Simmons, R. Keeping cool survey: air conditioner use by Australians with MS. Public policy related results & recommendations. MS Society, [online].
This work was made possible by financial support from MS Research Australia (MSRA) for the Australian MS Longitudinal Study (AMSLS). I thank Jeremy Wright and Christine Remediakis at MSRA for their excellent support, likewise Dr. Elizabeth McDonald for her support and for reading the manuscript. I also thank Chris Porter, Librarian at MS Australia, for archival assistance. Last but not least, I thank the thousands of Australians with MS who have generously helped with data collection for the AMSLS and with raising awareness of the condition.
The author declares no competing financial interests.
About this article
Cite this article
Simmons, R. Life issues in multiple sclerosis. Nat Rev Neurol 6, 603–610 (2010). https://doi.org/10.1038/nrneurol.2010.143
Journal of Neurology (2021)
Journal of Neurology (2020)
Acta Neurologica Belgica (2020)
BMC Neurology (2017)
Annals of Behavioral Medicine (2015)