Take home messages
Diagnosis should be made by a neurologist, so refer if you suspect it
- Tests to do in GP before referral
- FBC, LFT, TFT, Bone profile, UE, glucose
- ESR and CRP
- Relapses - all relapses should be discussed with a specialist before steroids are prescribed. Patients should not be given stand-by courses of steroids to hold at home.
And a little bit more detail
Symptoms to suggest MS
- Loss or reduction of vision in 1 eye with painful eye movements
- Double Vision
- Ascending sensory disturbance and / or weakness
- Problems with balance / unsteadiness / clumsiness
- Lhermitte’s symptom (when the patient leans their head forwards, they get altered sensation down their back and sometimes into their limbs)
NB – beware younger patients, where symptoms develop over 24 hrs, with a history of previous neurological symptoms and where symptoms persist for days or weeks and then resolve.
General advice to patients
- Support Groups (e.g. MS Society)
- Driving - need to inform DVLA (Advice for Medical Professionals)
- Exercise - may be beneficial
- Smoking - may increase progression to disability
- Pregnancy and pre-conception advice
- Vaccines - some live vaccines may be contraindicated. Flu vaccine may increase risk of relapse.
Managing specific symptoms
I haven't discussed all the treatments here as much of this will be managed in secondary care, but I have outlined some of the first line treatments and things that we may be initiating in primary care.
- Fatigue. Consider other medical causes. Exercise may help, Consider amantadine.
- Spasticity. Baclofen and Gabapentin should be first line and can be used in combination. Benzodiazepines can be useful, especially for nocturnal spasticity.
- Oscillopsia (I hadn't heard of this symptom - Wikipedia explains). Gabapentin can be considered first line.
- Emotional Lability. Consider amitriptyline
- Pain. As per NICE guideline on neuropathic pain
- Cognitive Problems. Can occur with MS, but consider anxiety, depression and sleep problems too.