Multiple sclerosis in adults: management

National Institute for Health and Care Excellence


  • This Guidelines summary includes recommendations that are relevant to the primary care setting. Please refer to the full guideline for the complete set of recommendations

Diagnosing MS

  • Be aware that clinical presentations in multiple sclerosis (MS) include:
    • loss or reduction of vision in one eye with painful eye movements
    • double vision
    • ascending sensory disturbance and/or weakness
    • problems with balance, unsteadiness or clumsiness
    • altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte's symptom)
  • Be aware that usually people with MS present with neurological symptoms or signs as described above, and:
    • are often aged under 50 and
    • may have a history of previous neurological symptoms and
    • have symptoms that have evolved over more than 24 hours and
    • have symptoms that may persist over several days or weeks and then improve
  • Do not routinely suspect MS if a person's main symptoms are fatigue, depression or dizziness unless they have a history or evidence of focal neurological symptoms or signs

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