Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Diagnosing MS

  • Do not diagnose MS on the basis of MRI findings alone. [1.1.5]

  • 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. [1.1.6]

  • 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[1], 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. [1.1.7]

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. [1.2.2]

  • 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. [1.2.4]

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. [1.3.1]

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. [1.5.11]

Treating acute relapse of MS with steroids

  • Offer treatment for relapse of MS with oral methylprednisolone 0.5 g daily for 5 days. [1.7.7]

[1] Polman CH, Reingold SC, Banwell B et al. (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Annals of Neurology 69: 292–302.

  • National Institute for Health and Care Excellence (NICE)