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Feature Article

Practical management of multiple sclerosis

Alexandra Seewann, Allan G Kermode

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Abstract

Patients with multiple sclerosis often require high levels of medical input from their GP and treating neurologist. GPs are often their first point of contact regarding symptoms or complications of their disease or its treatment.

Key Points

  • The diagnosis of multiple sclerosis (MS) is based on the principle that MS plaques develop on more than one occasion (dissemination in time) and in more than one part of the CNS (dissemination in space).
  • MS cannot be diagnosed with MRI alone; clinical signs and symptoms must also be present.
  • As a general rule, initiation of therapy in MS is a decision for the neurologist. The GP has a pivotal role in co-management.
  • Immunomodulatory therapies cannot alleviate already existing MS symptoms. They merely prevent the development of acute relapses.
  • Symptoms can influence each other in a negative way: for example, depression negatively affects cognition, and increased effort to overcome a higher muscle tone in spasticity may increase fatigue.

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