Multiple sclerosis in adults: management

Context

Multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system, affecting both the brain and spinal cord. It affects approximately 130,000 people in the UK. It is the most common cause of serious physical disability in adults of working age.

People with MS typically develop symptoms in their late 20s, experiencing visual and sensory disturbances, limb weakness, gait problems, and bladder and bowel symptoms. They may initially have partial recovery, but over time develop progressive disability.

The cause of MS is unknown. It is believed that an abnormal immune response to environmental triggers in people who are genetically predisposed results in immune-mediated acute, and then chronic, inflammation. The initial phase of inflammation is followed by a phase of progressive degeneration of the affected cells in the nervous system. MS is a potentially highly disabling disorder with considerable personal, social and economic consequences. People with MS live for many years after diagnosis with a significant impact on their ability to work, as well as an adverse and often highly debilitating effect on their quality of life and that of their families.

This guideline updates and replaces NICE's 2014 guideline (CG186). It includes updated recommendations on diagnosis, information and support, coordination of care and management of MS-related symptoms. The guideline does not cover 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 rehabilitation to alleviate symptoms, such as non-pharmacological interventions for ataxia and tremor, interventions for 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 personalised assessment and management strategies carried out by healthcare professionals with appropriate expertise in rehabilitation and MS.

The guideline does not cover the use of disease-modifying treatments. However, NICE has published technology appraisal guidance on these treatments (see the NICE technology appraisal guidance on multiple sclerosis for more information).

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 to provide and monitor disease-modifying therapies.