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MS Acute Myelitis – Urgent Management — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS Acute Myelitis – Urgent ManagementSCE Neurology

A patient with motor neurone disease has progressive dysphagia, 8% weight loss and declining respiratory reserve but still eats some meals safely. What is the best gastrostomy approach?

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Correct answer: D — Discuss and plan gastrostomy now while respiratory risk remains manageable

NICE advises early, repeated gastrostomy discussion that incorporates swallowing, weight, respiratory function, effort of feeding, choking risk and patient preference. The combination of progressive dysphagia, weight loss and declining respiratory reserve justifies planning now even though some oral intake remains safe. Waiting for complete oral failure, an arbitrary weight or lung-function threshold, or aspiration pneumonia increases nutritional and procedural risk without adding a required indication.

Reference: NICE NG42 motor neurone disease: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng42/chapter/Recommendations