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PML Warning Signs – Patient Education — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationPML Warning Signs – Patient EducationSCE Neurology

A 35-year-old woman with MS on natalizumab asks about the risk of PML and what symptoms to watch for. What should she be told?

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Correct answer: A — Urgent assessment of new progressive neurological or cognitive symptoms for PML

The best answer is “Urgent assessment of new progressive neurological or cognitive symptoms for PML”. MS care requires phenotype confirmation, relapse assessment, symptom management and specialist disease-modifying therapy; ocrelizumab is an NHS option for eligible early inflammatory primary progressive disease. The alternatives “PML has no warning signs, when the phenotype supports it”, “PML causes headache, within the relevant UK pathway, after excluding important mimics”, “PML is immediately fatal, after excluding important mimics, after specialist assessment”, “blood tests can detect PML, after specialist assessment, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations