Multiple Sclerosis in Adults: Management

National Institute for Health and Care Excellence. (2022).

London (United Kingdom): National Institute for Health and Care Excellence, (NG220), 1-55.

This evidence-based guideline provides recommendations for the diagnosis and management of multiple sclerosis (MS). The audience for the guideline is health care professionals. Specific recommendations pertaining to the field of speech-language pathology and audiology involve cognitive losses, speech difficulties, and balance problems. This document was partially updated by the National Institute for Health and Care Excellence in 2022. For more information, please see the Notes on This Article section.

National Institute for Health and Care Excellence (United Kingdom)

This guideline is a partial update of: <br /> <ul> <li><span style="color: #333333;">National Institute for Health and Care Excellence. (2014). <em>Multiple sclerosis in adults: Management.</em> Retrieved from www.nice.org.uk</span></li> </ul>

<span style="color: #333333;">Individuals with MS should be educated regarding the need for at least yearly comprehensive reviews, what a comprehensive review entails, and how to request a review. Comprehensive </span>reviews should be tailored to the needs of the person with MS and assess:<br /> <ul> <li><span style="color: #333333;"><strong>MS symptoms </strong>(e.g. mobility and balance, speech and swallowing, fatigue, depression and anxiety, sleep, respiratory function), </span></li> <li><span style="color: #333333;"><strong>MS disease course</strong> (e.g., evidence of progression or active disease, nature and extent of disability, or history of relapse), </span></li> <li><span style="color: #333333;"><strong>general health </strong>(e.g. comorbidities, health care access, body habitus, etc.), </span></li> <li><span style="color: #333333;"><strong>social activity and participation</strong>, and </span></li> <li><span style="color: #333333;"><strong>care and carepartner considerations</strong>.&nbsp; </span></li> </ul> <span style="color: #333333;">Additional recommendations include referral to members of the MS multidisciplinary team and other appropriate teams if any issues are identified during the comprehensive review. Providers should regularly review patient and carer needs regarding information, support, and social care, with provision of information and support even if it has previously been declined by the patient or their carepartners (Low to Very Low Quality of Evidence).</span>

Individuals with MS and their carepartners should be provided with information regarding the possibility that the condition might lead to cognitive problems and be aware of the potential impacts of anxiety, depression, difficulty sleeping, fatigue and medication on cognition. Individuals with MS should receive a cognitive assessment as part of the comprehensive review, with adjustment based upon their specific needs, receive treatment for cognitive or memory problems, and be referred to an occupational therapist and/or a neuropsychologist, as needed, to assess and manage persisting cognitive impairments according to the person's needs (e.g. functional impact of cognition, return to work planning; Low to Very Low Quality of Evidence).

<span style="color: #333333;">Individuals with MS should be provided with coordinated multidisciplinary care involving professionals who can best meet their needs and who have expertise in managing MS, including MS nurses, consultant neurologists, physiotherapists with expertise in MS, occupational therapists, speech and language therapists, psychologists, dietitians, social care, continence specialists, specialist neuropharmacists or specialist MS pharmacists, consultants in rehabilitation medicine, and the primary healthcare team (Very Low Quality of Evidence). </span>Individuals with MS should be offered an appropriate single point of contact with knowledge of MS services to coordinate care and help them access services (Low to Moderate Quality of Evidence).

Determinations regarding treatment dosage should be made based upon the patient&rsquo;s needs, the needs of their carepartner(s), and the frequency of visits needed for different types of treatment (Low to Very Low Quality of Evidence).

Individuals with MS should be provided with individualized education regarding fatigue management. This should include goal and priority identification, energy conservation, lifestyle factors, stress management, and wellbeing approaches (High to Very Low Quality of Evidence).

Vestibular rehabilitation should be considered for people with MS who have fatigue or mobility problems associated with limited standing balance (Low to Very Low Quality of Evidence).

For individuals with MS and their carepartners, recommendations pertaining to relapse should include: <br /> <ul> <li><span style="color: #333333;">a management plan with a point of contact if symptoms change significantly,</span></li> <li><span style="color: #333333;">education regarding the possible causes of symptom changes (e.g. illness, relapse, or change in disease status) and potential short-term effects on cognitive function,&nbsp;</span></li> <li><span style="color: #333333;">assessment and treatment when relapse affects the ability to perform usual tasks, as early as possible and within 14 days of onset of symptoms, and</span></li> <li><span style="color: #333333;">additional symptom management, rehabilitation or consideration for disease-modifying treatments (Moderate to Very Low Quality of Evidence).&nbsp;</span></li> </ul>