This guideline covers diagnosing and managing multiple sclerosis (MS) in people aged 18 and over. It aims to improve the quality of life for adults with multiple sclerosis by promoting symptom management, comprehensive reviews and effective relapse treatment.
MS affects approximately 100,000 people in the UK. It is the commonest cause of serious physical disability in adults of working age.
This guideline replaces NICE clinical guideline 8 (2003) and covers diagnosis, information and support, treatment of relapse and management of MS‑related symptoms. The guideline does not address all symptoms and problems associated with MS. Some areas are addressed in other NICE guidance for example urinary symptoms and swallowing, and these are referenced where appropriate. Many of the interventions used in a rehabilitation setting to alleviate symptoms such as tremor, weakness, cardiorespiratory fitness, sensory loss, visual problems (apart from oscillopsia), and secondary complications of immobility such as deconditioning and contractures have not been covered because these are beyond the scope of the guideline. Many of these problems are complex and need individual assessment and management strategies. These assessments and treatments need to be carried out by healthcare professionals with appropriate expertise in rehabilitation and MS.
The guideline does not address the use of disease‑modifying treatments; there are NICE technology appraisals about these treatments.
The guideline is aimed primarily at services provided in primary and secondary care. It does not map out a model of service delivery. Many people with MS may also attend specialised tertiary services, often established particularly to provide and monitor disease‑modifying therapies.
You can read the guideline on NICE's website.
Diagnosing MS
- Do not diagnose MS on the basis of MRI findings alone.
- Refer people suspected of having MS to a consultant neurologist. Speak to the consultant neurologist if you think a person needs to be seen urgently.
- Only a consultant neurologist should make the diagnosis of MS on the basis of established up‑to‑date criteria, such as the revised 2010 McDonald criteria, after:
- assessing that episodes are consistent with an inflammatory process
- excluding alternative diagnoses
- establishing that lesions have developed at different times and are in different anatomical locations for a diagnosis of relapsing–remitting MS
- establishing progressive neurological deterioration over 1 year or more for a diagnosis of primary progressive MS.
Information and support
- The consultant neurologist should ensure that people with MS and, with their agreement their family members or carers, are offered oral and written information at the time of diagnosis. This should include, but not be limited to, information about:
- what MS is
- treatments, including disease‑modifying therapies
- symptom management
- how support groups, local services, social services and national charities are organised and how to get in touch with them
- legal requirements such as notifying the Driver and Vehicle Licensing Agency (DVLA) and legal rights including social care, employment rights and benefits.
- Offer the person with MS a face‑to‑face follow‑up appointment with a healthcare professional with expertise in MS to take place within 6 weeks of diagnosis.
Coordination of care
- Care for people with MS using a coordinated multidisciplinary approach. Involve professionals who can best meet the needs of the person with MS and who have expertise in managing MS including:
- consultant neurologists
- MS nurses
- physiotherapists and occupational therapists
- speech and language therapists, psychologists, dietitians, social care and continence specialists
- GPs.
MS symptom management and rehabilitation
- Consider supervised exercise programmes involving moderate progressive resistance training and aerobic exercise to treat people with MS who have mobility problems and/or fatigue.
Treating acute relapse of MS with steroids
- Offer treatment for relapse of MS with oral methylprednisolone 0.5 g daily for 5 days.