How should I approach the management of a patient with Multiple Sclerosis who presents with new neurological symptoms?

Approach to managing a patient with multiple sclerosis (MS) presenting with new neurological symptoms:

• Confirm that the new symptoms represent a neurological episode consistent with MS by taking a detailed history and performing a physical examination, while excluding alternative diagnoses.
• Recognise that MS symptoms often evolve over more than 24 hours, may persist for days or weeks, and improve thereafter, without associated fever or infection.
• Refer the patient promptly to a consultant neurologist or specialist for assessment and diagnosis if MS is suspected or if the patient is known to have MS and is experiencing a relapse.
• Ensure the patient is under the care of a multidisciplinary MS team including neurologists, specialist MS nurses, physiotherapists, occupational therapists, and other relevant professionals to coordinate care.
• Assess the severity of the relapse; offer inpatient treatment if the relapse is severe or if medical and social care needs cannot be met at home.
• Identify and manage additional symptoms during relapse such as cognitive changes, fatigue, spasticity, pain, bladder problems, and mental health issues, liaising with the MS team as needed.
• Discuss symptom management, rehabilitation, and consider disease-modifying therapies in consultation with the specialist team.
• Provide lifestyle advice including encouragement of regular exercise and smoking cessation to reduce progression of disability.
• Offer information about support groups, legal rights, and social care services, and ensure the patient has a comprehensive review of all aspects of their care at least annually.

This approach ensures timely specialist involvement, comprehensive symptom management, and coordinated multidisciplinary care for patients with MS experiencing new neurological symptoms.

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