# Multiple Sclerosis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND65 - condition scope only, no dose · Multiple Sclerosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499849/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text MULTIPLE SCLEROSIS Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND65 - condition scope only, no dose · Multiple Sclerosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499849/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (10) - Monocular or homonymous vision loss with painful eye movement points to optic neuritis [eye pain] - Vertigo together with gait imbalance suggests vestibular involvement [vertigo] - Slurred speech and swallowing trouble reflect bulbar dysfunction [slurred speech] - Limb weakness, tremor, spasticity, and fatigue are common motor complaints [fatigue · spasticity · tremor] - Numbness, paresthesias, and a band-like sensation around the trunk can occur [numbness] - Bladder and bowel complaints range from urgency and retention to constipation [constipation] - Memory and concentration difficulty reflect cognitive involvement - Depression and anxiety are recognized psychiatric features [anxiety · low mood] - Facial weakness or numbness with double vision suggests brainstem involvement [double vision · facial weakness · numbness] - A relapse typically evolves over days to weeks and lasts 24 to 48 hours [relapse] SIGNS - what you find (6) - Optic neuritis on exam shows subacute monocular central vision loss with pain on eye movement - Impaired adduction on lateral gaze indicates internuclear ophthalmoplegia [ophthalmoplegia] - Sensory disturbance from partial transverse myelitis may be one- or two-sided - Hyperreflexia, tremor, muscle spasm, and weakness are found on neurological exam [hyperreflexia · muscle cramps · tremor] - A shock-like sensation down the body on neck flexion is the Lhermitte sign [shock] - Bladder exam for incontinence or retention should include a residual volume check TESTS (9) - MRI lesions appear T2-hyperintense and T1-hypointense, termed black holes - Periventricular lesions oriented perpendicular to the ventricle wall form Dawson fingers - Active plaques typically enhance with gadolinium on MRI - Dissemination in space needs a T2 lesion in 2 of 4 regions: spinal cord, infratentorial, juxtacortical, periventricular - CSF typically shows raised protein, oligoclonal bands, and elevated IgG - Evoked potentials show slowed, often asymmetric conduction - Baseline labs include CBC, thyroid function, B12, ESR, and ANA to exclude mimics - Atypical presentations get tested for AQP4-IgG and MOG-IgG autoantibodies - Spinal cord plaques on MRI span 3 mm up to under 2 vertebral segments in length IF NOT THIS - what else fits (12) - Acute disseminated encephalomyelitis is a demyelinating mimic - Neuromyelitis optica (Devic disease) is a demyelinating differential - Susac syndrome is listed among demyelinating mimics - CLIPPERS is a rare steroid-responsive encephalomyelitis of the spinal cord, cerebellum, and brainstem - Systemic lupus erythematosus is an autoimmune mimic to exclude - Antiphospholipid antibody syndrome is on the differential - A dural arteriovenous fistula is a vascular mimic - Arteritic or nonarteritic ischemic optic neuropathy can mimic the visual involvement - Vascular malformations and emboli belong on the vascular differential - Vitamin deficiencies are a metabolic differential to exclude - Adult-onset adrenoleukodystrophy is a genetic leukodystrophy mimic - Primary CNS tumors such as gliomas, meningiomas, or metastasis can mimic it Source StatPearls "Multiple Sclerosis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Chronic demyelinating disease of the central nervous system with relapsing or progressive courses; the GP should recognise suggestive episodes (optic neuritis, limb weakness, sensory disturbance) and refer to neurology for MRI and disease-modifying therapy, while a short corticosteroid course may treat an acute relapse and baclofen may ease spasticity under specialist guidance. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Chronic demyelinating disease of the central nervous system with relapsing or progressive courses; the GP should recognise suggestive episodes (optic neuritis, limb weakness, sensory disturbance) and refer to neurology for MRI and disease-modifying therapy, while a short corticosteroid course may treat an acute relapse and baclofen may ease spasticity under specialist guidance. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Acute visual loss or pain on eye movement (possible optic neuritis), new limb weakness or sensory loss, or bladder dysfunction together with limb symptoms suggesting spinal cord involvement. 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