GPAtlas🧭 When to suspect
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system (CNS) and the commonest cause of non-traumatic neurological disability in young adults.
• Around 85% have a relapsing–remitting course at onset.
Suspect MS in someone usually under 50 (commonly late 20s to 30s) presenting with focal neurological symptoms that evolve over more than 24 hours:
• Symptoms persist for days to weeks and then improve.
• Symptoms arise in the absence of fever or infection.
• There is often a history of earlier transient episodes.
Classic clinically isolated presentations are:
• Optic neuritis (painful monocular visual loss).
• A partial myelitis (ascending sensory disturbance, weakness, sphincter symptoms).
• Brainstem or cerebellar syndromes (diplopia, vertigo, ataxia).
The primary-care skills are to:
• Recognise a demyelinating episode.
• Exclude commoner mimics.
• Refer to a consultant neurologist.
• Never treat a suspected relapse before excluding infection.
| Phenotype | Pattern |
|---|---|
| Clinically isolated syndrome (CIS) | • A first single episode of CNS demyelination lasting ≥ 24 hours • May or may not progress to MS |
| Relapsing–remitting (RRMS) | • Discrete relapses with full or partial recovery between • The commonest pattern at onset (~85%) |
| Secondary progressive (SPMS) | • Follows RRMS • Gradual accrual of disability, with or without superimposed relapses |
| Primary progressive (PPMS) | Steady progression from onset without distinct relapses (~10–15%). |
|
⚠️ Common pitfall • Over-investigating for MS. • Do not routinely suspect MS when the dominant symptoms are fatigue, depression, dizziness or vague sensory phenomena without a history or signs of focal neurological dysfunction. • MS is frequently over-considered in primary care. • Look for objective, localising CNS involvement before referring along an MS pathway. |
Source: NICE NG220 · NICE NG127
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