Feature Article

Multiple sclerosis: early diagnosis and comprehensive management

Michael P Pender



The GP has a key role in the early diagnosis of multiple sclerosis (MS). Knowledge of the characteristic time course of the symptoms of an attack of MS allows the GP to suspect a first episode and refer the patient early to a neurologist, ophthalmologist or urologist.

Key Points

  • MS is an autoimmune disease, with genetic factors and environmental factors having important roles.
  • Characteristically, MS affects the spinal cord, brain and optic nerves in the central nervous system and spares the nerve roots and peripheral nerves in the peripheral nervous system.
  • Usually MS has a relapsing–remitting course with repeated neurological episodes, each followed by partial or complete recovery and a period free of new symptoms. Most patients with relapsing–remitting MS eventually develop secondary progressive MS, with progressive deterioration independent of relapses.
  • In about 10% of patients, MS follows a primary progressive course, with progressive deterioration from onset without discrete attacks.
  • Interferon beta and glatiramer acetate reduce the attacks of relapsing–remitting MS by one-third but are not beneficial in primary or secondary progressive MS.
  • Major depression occurs at some stage in 50% of patients with MS; a high index of suspicion is needed to ensure early diagnosis and treatment.