When should I consider referring a patient with Multiple Sclerosis to a specialist for further management?

Consider referring a patient with multiple sclerosis (MS) to a specialist for further management in the following situations:

• At the time of initial diagnosis or if MS is suspected, refer to a consultant neurologist or a specialist under their supervision for confirmation and further assessment. Urgent referral may be needed if clinical urgency is suspected ².
• If the patient develops urinary dysfunction, refer to the MS team and consider referral to urology, neurourology, or urogynaecology specialists as appropriate due to the complexity of management ¹.
• For management of spasticity causing significant impairments in mobility, posture, or function when initial treatments fail, refer to a multidisciplinary team experienced in spasticity management ².
• If neuropathic pain is present and requires specialist pain services beyond initial pharmacological management, refer accordingly ¹,².
• For sexual dysfunction, which is common but often underreported, consider referral to secondary care or psychosexual counselling services ¹.
• When symptoms such as oscillopsia do not improve with first- and second-line treatments, refer for specialist advice ².
• For comprehensive care, patients with confirmed MS should be under the care of a consultant neurologist and a multidisciplinary MS team including specialist MS nurses, physiotherapists, occupational therapists, psychologists, and other relevant professionals ¹,².
• Annual comprehensive reviews of all aspects of care are usually arranged in secondary care; ensure the patient has had such a review within the preceding 12 months or refer if not ¹.

In summary, referral to specialist care is essential at diagnosis, for complex symptom management, multidisciplinary care coordination, and when initial treatments in primary care are insufficient.