eMedicine Specialties > Emergency Medicine > Neurology

Multiple Sclerosis: Follow-up

Author: Marjorie Lazoff, MD, Editor-in-Chief, Medical Computing Review
Contributor Information and Disclosures

Updated: Jul 16, 2009

Follow-up

Further Inpatient Care

  • Patients with fulminant MS or acute disseminated encephalitis usually are admitted to neurologic ICU.
  • Consider arranging for emergency plasmapheresis.
  • Patients with MS exacerbations may be admitted (eg, neurology, medicine) or discharged, depending on presentation, confidence in diagnosis, and therapy.

Further Outpatient Care

  • Arrange for follow-up with neurology and/or ophthalmology in 1-2 days.

Inpatient & Outpatient Medications

  • As with any chronic condition, medication administration ideally is coordinated with primary care physician or others involved in the patient's long-term care.
  • Spasticity
    • Baclofen (Lioresal), in severe cases, intrathecally
    • Tizanidine (Zanaflex)
    • Diazepam (Valium)
    • Clonazepam (Klonopin)
    • Dantrolene (Dantrium)
  • Trigeminal neuralgia - Carbamazepine (Tegretol)
  • Intense tingling and burning sensations - May respond to antidepressant medication or may require narcotics
  • Depression/fatigue - Amantadine (Symmetrel)

Deterrence/Prevention

  • Consider postvoid residual urine volume test if a patient with known MS and no prior urinary assessment has UTI.
    • If residual is greater than 100 mL, risk of recurrent UTIs is significant.
    • Refer patient to urology and consult patient education/visiting nurse to instruct patient on self-catheterization.

Complications

  • Coma
  • Delirium
  • Emotional lability
  • Nystagmus
  • Optic nerve atrophy
  • Paraplegia
  • Sexual impotence in men
  • UTIs
  • Complications from chronic disability (eg, pneumonia, pulmonary embolism, infected decubiti)

Prognosis

  • Approximately 20-35% of patients with MS who have RR pattern experience complete or nearly complete recovery of acute exacerbation within 8 weeks, particularly when the exacerbation occurs early in disease course.
  • About 90% of patients with ON experience complete recovery of visual acuity within 8-12 weeks. Even so, residual impairment of color vision and abnormal depth perception are common. Recurrence in either eye can be expected in 20-35% of ON patients.

Patient Education

  • Educate patients to always treat fevers aggressively with around-the-clock antipyretics.
  • Support groups and organizations may be excellent patient resources.
  • Discuss referral to research centers, especially for patients with more aggressive forms of MS.
  • With patients on chronic therapy, confirm their familiarity with common adverse effects of interferon-beta-1B (Betaseron) and, to a lesser extent, interferon-beta-1A (Avonex).
    • Flulike symptoms
    • Pain and inflammation at the injection site
    • Less frequently, abnormal liver function tests and severe (even suicidal) depression
  • For patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article, Multiple Sclerosis.

Miscellaneous

Medicolegal Pitfalls

  • Avoid the temptation to diagnose new MS in ED and/or counsel patients prior to diagnosis.
  • Diagnosis of MS progression or new symptoms when another reversible lesion, such as mechanical spinal cord compression, might be causing new symptoms
  • Advocates of medical marijuana believe that MS symptoms can be improved with consumption or use of cannabis. Evidence in the medical literature is anecdotal at present to support patients' subjective sense improvement in spasticity. No studies demonstrate an objective improvement in muscle tone.

Special Concerns

  • Pregnancy
    • Symptoms of MS may stabilize or remit during pregnancy, but 20-40% of patients have relapse within 3 months after delivery.
    • No evidence suggests that pregnancy affects long-term course of MS.
  • Pediatric: MS is an unlikely diagnosis in those younger than 16 years.
  • Geriatric: MS is an unlikely diagnosis in those older than 50 years.
  • Be aware of the controversy surrounding long-term MS therapy with respect to cost-effectiveness, lack of outcomes research, and the impact on future clinical trials.
 


More on Multiple Sclerosis

Overview: Multiple Sclerosis
Differential Diagnoses & Workup: Multiple Sclerosis
Treatment & Medication: Multiple Sclerosis
Follow-up: Multiple Sclerosis
Multimedia: Multiple Sclerosis
References
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References

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Further Reading

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Keywords

multiple sclerosis, MS, central nervous system, CNS, neurologic disorder, idiopathic inflammatory demyelinating disease of the CNS, optic neuritis, transverse myelitis, internuclear ophthalmoplegia, paresthesias, relapse-remitting MS, RR-MS, chronic progressive MS

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Contributor Information and Disclosures

Author

Marjorie Lazoff, MD, Editor-in-Chief, Medical Computing Review
Marjorie Lazoff, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Informatics Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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