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pale green book cover for Multiple Sclerosis guidelines Multiple Sclerosis

National clinical guideline for diagnosis and management in primary and secondary care

Developed by The National Collaborating Centre for Chronic Conditions at the Royal College of Physicians

This is the full version of the guideline developed by the NCC CC on behalf of NICE for the NHS. The guideline sets out specific advice to clinical staff on a wide range of issues from the initial diagnosis of MS to the management of complications. These include the management of muscle spasticity, bladder problems. reduced walking ability and difficulties in swallowing. Clear, unequivocal messages are included on how staff should approach the person with MS in order to rapidly identify their problems and manage the condition effectively. Guidance is also provided on how care can best be provided by teams of healthcare professionals familiar with the needs of people with MS.

Implementing the recommendations in this guideline should result in a much improved service for people with MS and as a bonus will provide benefit for those with other chronic neurological conditions whose needs are similar. Commissioners of Healthcare, managers in the NHS and clinicians must work together to achieve a cohesive service and this full guideline contains all the justification they will need to put in place appropriate measures. The included audit criteria provide pointers against which success of new initiatives can be measured. Finally researchers should find the systematic presentation of the evidence helpful as they plan research studies and in particular it is hoped that the areas without specific evidence will be addressed.

Key recommendations :

Specialised services
specialist neurological and neurological rehabilitation services should be available to every person with MS when they need them, usually when they develop any new symptom, sign, limitation on activities or other problem, or when their circumstances change.

Rapid diagnosis
an individual who is suspected of having MS should be referred to a specialist neurology service and seen rapidly within an audited time. The individual should be seen again after all investigations necessary to confirm or refute the diagnosis have been completed (also rapidly within an audited time).

Seamless services
every health commissioning organisation should ensure that all organisations in a local health area agree and publish protocols for sharing and transferring responsibility for and information about people with MS, so as to make the service seamless from the individual’s perspective.

A responsive service
all services and service personnel within the health care sector should recognise and respond to the varying and unique needs and expectations of each person with MS. The person with MS should be involved actively in all decisions and actions..

Sensitive but thorough problem assessment
health service professionals in regular contact with people with MS should consider in a systematic way whether the person with MS has a ‘hidden’ problem contributing to their clinical situation, such as fatigue, depression, cognitive impairment, impaired sexual function or reduced bladder control.

Self-referral after discharge
every person with MS who has been seen by a specialist neurological or neurological rehabilitation service should be informed about how to make contact with the service when he or she is no longer under regular treatment or review. The individual should be given guidance on when such contact is appropriate.

A summary version of this guideline has been published by NICE

You can download the full document (excepting Appendix I: Evidence tables) as a single PDF file, or you can download individual sections. Please note that blank pages were typically ommitted during the PDF creation process, this is why some page numbers are skipped in the PDF document.

Full document

Individual sections

 

This page last updated on August 13, 2004