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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Neurology/Multiple sclerosis/Rapid
RapidMLAMSRAFoundation

Multiple sclerosis

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Rapidly progressive weakness, respiratory compromise, severe brainstem dysfunction, acute urinary retention with a sensory level, major new visual loss or reduced consciousness requires urgent neurological assessment. Fever and neurological worsening may be infection-related pseudo-relapse or sepsis; do not assume every deterioration is inflammatory multiple sclerosis or give high-dose steroids before excluding important infection.

Synopsis

Recognise typical central demyelinating syndromes, confirm dissemination without overcalling non-specific MRI lesions, treat relapses safely, and organise disease-modifying, symptomatic and reproductive care through a specialist team.

  • Multiple sclerosis is an immune-mediated inflammatory and neurodegenerative disorder diagnosed by a specialist using the 2024 revised McDonald criteria after reasonable alternatives are excluded; defined diagnostic routes do not always require the classic demonstration of dissemination in time.
  • Typical attacks include painful monocular optic neuritis, partial transverse myelitis, a brainstem syndrome such as internuclear ophthalmoplegia, and a cerebellar or sensory syndrome developing over hours to days.
  • A relapse is new or worsening neurological dysfunction lasting more than 24 hours without fever or infection, usually after at least a month of stability; transient heat-related worsening is a pseudo-relapse.

Key red flags

Severe acute syndrome

Rapid paraplegia, respiratory weakness, bilateral visual loss or disabling ataxia needs urgent admission and assessment for severe relapse and alternative inflammatory disease.

Investigation priorities

01
MRI brain with multiple-sclerosis protocolFirst step

Demonstrate characteristic lesion morphology, dissemination and active enhancement.

Management branches

Possible first eventConfirm a typical central syndrome

A person develops a new focal neurological deficit over hours or days.

  1. Localise the syndrome to optic nerve, brainstem, cerebellum or spinal cord, document objective signs and seek vascular, compressive, metabolic, infectious and antibody-mediated warning features.
  2. Arrange neurology review and protocol MRI of brain and relevant spine, adding cerebrospinal fluid and targeted mimic tests when criteria or phenotype require them.

Key medicines

Methylprednisolone oralNICE recommends 0.5 g orally once daily for 5 days for a functionally significant acute relapse, prescribed through an appropriate relapse pathway.
Methylprednisolone intravenousNICE advises considering 1 g intravenously once daily for 3 to 5 days when oral treatment fails, is not tolerated or admission and monitoring are needed.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom