Management of multiple sclerosis

5th March 2015 by Louise Hudman

Management of multiple sclerosis

Nice’s latest MS guideline does not cover DMARDs, and a lot of this is not new to us.

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
    • B12
    • HIV
  • 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

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