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, persist for days to weeks and then improve, in the absence of fever or infection, often with 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) and 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, and 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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