eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases
Multiple Sclerosis: Follow-up
Updated: Jul 17, 2009
Follow-up
Further Inpatient Care
- Multiple sclerosis is a disease managed primarily in an outpatient setting. Inpatient admissions typically are necessary only to treat such complications as urosepsis, some pneumonias, or infected decubitus. In some treatment settings, admission for intravenous steroids during an exacerbation may be indicated if this option is not available in an outpatient setting or at home.
Further Outpatient Care
- Recommended outpatient follow-up is yearly at a minimum. For those who also provide primary care to the multiple sclerosis patient, routine health maintenance can be performed at these annual visits. For patients with increased symptomatology, a medical cause, such as infection, should be ruled out first before assuming the patient is having an exacerbation. Once a patient/provider relationship is established, a great deal of symptom management can be provided through careful telephone triage. For patients with difficult symptoms, such as intractable spasticity, or those with a less stable social support system, more frequent visits, such as bimonthly or quarterly, may be necessary.
Deterrence
- The best deterrence is early management of symptoms related to bladder, bowel, spasticity, pain, and skin integrity to prevent primary or secondary complications.
Complications
- For a discussion of the potential complications that may be associated with multiple sclerosis, please see the Medical Issues/Complications section.
Prognosis
- Relapsing-remitting - Patients with a relapsing-remitting pattern of multiple sclerosis (MS) account for approximately 85% of patients. This pattern is characterized by recurrent attacks in which neurologic deficits appear in different parts of the nervous system and resolve completely or almost completely over a short period of time, leaving little residual deficit.
- Secondary progressive - Approximately 50% of patients with relapsing-remitting MS convert to a secondary progressive pattern within 10 years after disease onset. This pattern may or may not exhibit relapses, but it is characterized by continued progression over years with increasing disability.
- Primary progressive - In this pattern, function declines steadily without relapses (approximately 10%).
- Progressive relapsing - Persons with this pattern (<5% of patients with MS) have occasional relapses superimposed on progressive disease.
Patient Education
- Include the family members or caregivers in any education provided to ensure a successful outcome. Community agencies, such as the state chapters of the National Multiple Sclerosis Society, can provide valuable information concerning community resources, as well as social support and education. Patients should be educated on the purposes of medications, doses, and adverse effect management. Patients and caregivers need education on appropriate management of symptoms related to pain, fatigue, and spasticity, as well as issues related to bowel, bladder, and sexual function. For patients with advanced disease, caregivers need hands-on training on transfer techniques, as well as management of skin integrity, bowel programs, and urinary collection devices.
- Links
- For excellent patient education resources, visit eMedicine's Muscle Disorders Center and Kidneys and Urinary System Center. Also, see eMedicine's patient education articles Multiple Sclerosis and Bladder Control Problems.
Miscellaneous
Medicolegal Pitfalls
- Multiple sclerosis (MS) is a difficult disease to diagnose. It cannot be diagnosed after only 1 presentation of symptoms. This disease must be diagnosed by lesions separated in time and space; however, the separation of lesions in time can be confirmed by brain MRI performed 3 months after the initial onset by applying the MacDonald criteria as mentioned in Imaging Studies.4 The list of differential diagnoses makes it clear that MS may be confused with other diseases. In the past, the treating physicians were content to "sit back and watch," as it was assumed the disease would "declare" itself. Today, the position is to be aggressive with treatments early in the disease. Therefore, early diagnosis is more important.
- It is known through Dr. Trapp's work that axonal loss is present, even in asymptomatic patients, early in the disease process. In addition, studies with interferons in patients with a first attack of neurological symptoms suggestive of MS have demonstrated decreased disability and lower secondary relapse rates in treated patients. As a result, pressure is mounting to treat all patients with an immunomodulating drug (a DMAMS) once the diagnosis of probable or definite MS is made. As evidence grows that early intervention is useful, legal ramifications to nontreatment may become more relevant.
More on Multiple Sclerosis |
| Overview: Multiple Sclerosis |
| Differential Diagnoses & Workup: Multiple Sclerosis |
| Treatment & Medication: Multiple Sclerosis |
 Follow-up: Multiple Sclerosis |
| Multimedia: Multiple Sclerosis |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Frohman EM, Racke MK, Raine CS. Multiple sclerosis--the plaque and its pathogenesis. N Engl J Med. Mar 2 2006;354(9):942-55. [Medline].
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. Nov 1983;33(11):1444-52. [Medline].
[Best Evidence] Sormani MP, Tintore M, Rovaris M, et al. Will Rogers phenomenon in multiple sclerosis. Ann Neurol. Oct 2008;64(4):428-33. [Medline].
Selkirk SM, Shi J. Relapsing-remitting tumefactive multiple sclerosis. Mult Scler. Dec 2005;11(6):731-4. [Medline].
[Best Evidence] Nicholas RS, Friede T, Hollis S, et al. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev. Jan 21 2009;CD004193. [Medline].
[Best Evidence] Rojas JI, Romano M, Ciapponi A, et al. Interferon beta for primary progressive multiple sclerosis. Cochrane Database Syst Rev. Jan 21 2009;CD006643. [Medline].
[Best Evidence] Goodman AD, Brown TR, Krupp LB, et al. Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet. Feb 28 2009;373(9665):732-8. [Medline].
[Best Evidence] Havrdova E, Galetta S, Hutchinson M, et al. Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol. Mar 2009;8(3):254-60. [Medline].
Cutter NC, Scott DD, Johnson JC, et al. Gabapentin effect on spasticity in multiple sclerosis: a placebo- controlled, randomized trial. Arch Phys Med Rehabil. Feb 2000;81(2):164-9. [Medline].
European Study Group on interferon beta-1b in secondary progressive MS. Placebo-controlled multicentre randomised trial of interferon beta-1b in treatment of secondary progressive multiple sclerosis. Lancet. Nov 7 1998;352(9139):1491-7. [Medline].
Goodkin DE, Rudick RA, VanderBrug Medendorp S, et al. Low-dose (7.5 mg) oral methotrexate reduces the rate of progression in chronic progressive multiple sclerosis. Ann Neurol. Jan 1995;37(1):30-40. [Medline].
Halper J, Holland NJ. Comprehensive nursing care in multiple sclerosis. New York, NY:. Demos Vermande;1997:chap 2, 5.
Lechtenberg R. Multiple Sclerosis Fact Book. 2nd ed. Philadelphia, Pa:. FA Davis Co;1995:29-66.
Miller AE. Diagnosis, classification and prognosis. Multiple sclerosis: clinical issues and decisions. Paper presented at: Western Regional Conference. February 1996.
Paty DW, Noseworthy JH, Ebers GC. Multiple Sclerosis. Philadelphia, Pa:. FA Davis Co;1998:48-134.
Rice GP, Filippi M, Comi G. Cladribine and progressive MS: clinical and MRI outcomes of a multicenter controlled trial. Cladribine MRI Study Group. Neurology. Mar 14 2000;54(5):1145-55. [Medline].
Schapiro RT. Symptom Management in Multiple Sclerosis. 3rd ed. New York, NY: Demos Medical Publishing;. 1998:25-124.
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Simon JH. From enhancing lesions to brain atrophy in relapsing MS. J Neuroimmunol. Jul 1 1999;98(1):7-15. [Medline].
Talbot PJ, Paquette JS, Ciurli C, et al. Myelin basic protein and human coronavirus 229E cross-reactive T cells in multiple sclerosis. Ann Neurol. Feb 1996;39(2):233-40. [Medline].
The Canadian Cooperative Multiple Sclerosis Study Group. The Canadian cooperative trial of cyclophosphamide and plasma exchange in progressive multiple sclerosis. Lancet. Feb 23 1991;337(8739):441-6. [Medline].
Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med. Jan 29 1998;338(5):278-85. [Medline]. [Full Text].
Trapp BD, Ransohoff RM, Fisher E. Neurodegeneration in multiple sclerosis: relationship to neurological disability. Neuroscientist. 1999;5(1):48-57.
Further Reading
Related eMedicine topics:
Acute Disseminated Encephalomyelitis
Brain, Multiple Sclerosis
Diffuse Sclerosis
Mental Disorders Secondary to General Medical Conditions
Multiple Sclerosis [Emergency Medicine]
Multiple Sclerosis [Neurology]
Multiple Sclerosis [Ophthalmology]
Multiple Sclerosis, Spine
Optic Neuritis
Optic Neuritis, Adult
Optic Neuritis, Childhood
Spasticity [Neurology]
Spasticity [Physical Medicine and Rehabilitation]
Clinical guidelines:
Assessment: the use of natalizumab (Tysabri) for the treatment of multiple sclerosis (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. American Academy of Neurology - Medical Specialty Society. 2008 Sep 2. 8 pages. NGC:006705
Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. American Academy of Neurology - Medical Specialty Society
Multiple Sclerosis Council - Disease Specific Society. 2002 Jan 22 (reviewed 2003 Oct). 10 pages. NGC:003144
EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. European Federation of Neurological Societies - Medical Specialty Society. 2005 Dec. 8 pages. NGC:005169
Natalizumab for the treatment of adults with highly active relapsing-remitting multiple sclerosis. National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]. 2007 Aug. 21 pages. NGC:005899
The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. American Academy of Neurology - Medical Specialty Society
Child Neurology Society - Medical Specialty Society. 2003 Sep 9. 10 pages. NGC:003154
Clinical trials:
A Safety Study of Combination Treatment With Avonex and Placebo-Controlled Dosing of Topamax in Relapsing-Remitting Multiple Sclerosis
Gene Expression Profiles in Multiple Sclerosis (MS)
Safety/Effectiveness of Adding Monthly Dexamethasone to Weekly Avonex for MS
Study to Evaluate Intravenous and Oral Steroids for Multiple Sclerosis Attacks
Trial of Memantine for Cognitive Impairment in Multiple Sclerosis
Keywords
multiple sclerosis, sclerosis, MS symptoms, MS Society, multiple sclerosis symptoms, demyelinating, demyelination, multiple sclerosis treatment, multiple sclerosis diagnosis, multiple sclerosis pain, multiple sclerosis MRI, multiple sclerosis therapy, multiple sclerosis research, MS early symptoms, disseminated sclerosis, insular sclerosis, Marburg's disease, Balo's concentric sclerosis
