Quality statement 5: Managing relapses | Multiple sclerosis | Quality standards

Quality statement

Adults with multiple sclerosis (MS) who have a relapse that would benefit from treatment are offered treatment as soon as possible and within 14 days of the onset of symptoms.

Rationale

Rapid treatment of relapse can improve recovery and long‑term outcomes of people with MS and prevent unplanned hospital admissions. Local pathways for managing relapse can help to identify relapses early and improve response times. Recognition of relapses by the multidisciplinary team, based on effective assessment, is important because relapse frequency may influence which disease‑modifying therapies are chosen and whether they need to be changed.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local pathways to ensure that adults with MS who have a relapse that would benefit from treatment are offered treatment as soon as possible and within 14 days of the onset of symptoms.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications, NHS trust directories of services and clinical commissioning group pathways.

Process

a) Length of time between onset of symptoms of relapse and receiving treatment for adults with MS.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of relapses in adults with MS that would benefit from treatment and are treated within 14 days of the onset of symptoms.

Numerator – the number in the denominator treated within 14 days of the onset of symptoms.

Denominator – the number of relapses in adults with MS that would benefit from treatment.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Unplanned hospital admissions for MS.

Data source: NHS Digital Hospital Admitted Patient Care Activity, using ICD-10 code G35.

What the quality statement means for different audiences

Service providers (GPs, community health teams, and neurology services) ensure that local pathways for managing relapse are in place so that adults with MS who have a relapse that would benefit from treatment are offered treatment as soon as possible and within 14 days of the onset of symptoms.

Health and social care practitioners (those involved in the care of adults with MS) ensure that they are aware of local pathways for managing relapse so that adults with MS who have a relapse that would benefit from treatment are offered treatment as soon as possible and within 14 days of the onset of symptoms.

Commissioners (NHS England, integrated care systems and clinical commissioning groups) ensure that they commission services that have local pathways for managing relapse for adults with MS so that treatment is offered, for relapses that would benefit, as soon as possible and within 14 days of the onset of symptoms.

Adults with MS who have new symptoms or symptoms that suddenly get worse (a relapse) are offered treatment if this is likely to help. The treatment is offered as soon as possible and within 14 days of the symptoms starting. They can get the treatment through their single point of contact. Quicker treatment should help them get better sooner and may mean they don't have to go to hospital.

Source guidance

Multiple sclerosis in adults: management. NICE guideline NG220 (2022), recommendation 1.7.5

Definitions of terms used in this quality statement

Relapse

A relapse should be diagnosed if the person develops new symptoms or their existing symptoms get worse and last for more than 24 hours in the absence of infection or any other cause after a stable period of at least 1 month. Relapses should be assessed and diagnosed by a healthcare professional with expertise in MS because not all relapses need treating with steroids. [NICE's guideline on multiple sclerosis in adults, recommendations 1.7.1 and 1.7.6]

Treatment for relapse

Treatment should be offered for relapses of MS that affect the person's ability to perform their usual tasks. Adults with MS who have a relapse should be offered treatment with oral methylprednisolone 0.5 g daily for 5 days. Intravenous methylprednisolone should be considered if oral steroids have failed or are not tolerated or for people who need admitting to hospital for a severe relapse or monitoring of medical or psychological conditions. People should not be given a supply of steroids to self‑administer at home for future relapses. [NICE's guideline on multiple sclerosis in adults, recommendations 1.7.5, 1.7.7, 1.7.8 and 1.7.10]