Excerpt

Multiple sclerosis (MS) is a condition of the central nervous system (brain and spinal cord) that usually starts in early adult life. Once present the disease never goes; there is no cure and the person lives with the condition for life but a significant proportion of people have few or no problems. The impact of MS on the individual is variable but one constant feature is uncertainty. The condition also has an impact on family members.

Many people with MS may need to make extensive use of health services and social services. Consequently, the aim of this guideline is to ensure that people with MS benefit from a coherent and consistent response from services, to minimise their problems as far as can be achieved.

Contents

• Membership of development groups
• Preface
• Executive summary
• Glossary
• Development of the Guideline
  • 1. Introduction
    • 1.1 Guideline aim
    • 1.2 Who is the guideline intended for?
    • 1.3 Clinical context
    • 1.4 The challenge
    • 1.5 Underlying guideline principles
    • 1.6 How to use this document
    • 1.7 The structure of the document
    • 1.8 Guideline limitations
    • 1.9 Plans for guideline revision
  • 2. Methodology
    • 2.1 The developers
    • 2.2 The scope of the guideline
    • 2.3 Involvement of people with MS
    • 2.4 Searching for the evidence
    • 2.5 Synthesising the evidence
    • 2.6 Health economics evidence
    • 2.7 Drafting the recommendations
    • 2.8 Agreeing the recommendations
    • 2.9 Writing the guideline
• The Guideline
  • 3. General principles of care
    • 3.1 Interaction between the professional and person with MS
    • 3.2 Team approaches to rehabilitation
    • 3.3 Service organisation
    • 3.4 Within-team communication
    • 3.5 Provision of services over time (rehabilitation, maintenance, prevention and palliative care)
  • 4. Disease diagnosis and specific treatment
    • 4.1 Making the diagnosis of MS
    • 4.2 Involving the person with MS in the diagnostic process
    • 4.3 Acute episodes: diagnosis
    • 4.4 Treatment of acute episodes
    • 4.5 Acute episodes: rehabilitation
    • 4.6 Interventions affecting disease progression
    • 4.7 Other issues around altering the risk of relapses
  • 5. Rehabilitation and maintenance: functional activities and social participation
    • 5.1 General introduction
    • 5.2 General rehabilitation
    • 5.3 Vocational activities: employment and education
    • 5.4 Leisure and social interaction
    • 5.5 Mobility
    • 5.6 Activities of daily living
    • 5.7 Equipment, adaptations and personal support
  • 6. Diagnosis and treatment of specific impairments
    • 6.1 Fatigue
    • 6.2 Bladder problems
    • 6.3 Bowel problems
    • 6.4 Weakness and cardiorespiratory fitness
    • 6.5 Spasticity, spasms and contractures at joints
    • 6.6 Ataxia and tremor
    • 6.7 Sensory losses
    • 6.8 Visual problems
    • 6.9 Pain
    • 6.10 Cognitive losses
    • 6.11 Emotionalism
    • 6.12 Depression
    • 6.13 Anxiety
    • 6.14 Swallowing difficulties
    • 6.15 Speech difficulties
    • 6.16 Sexual dysfunction
    • 6.17 Pressure ulcers
    • 6.18 Other treatments including complementary therapies
  • 7. Monitoring quality: audit and governance
  • 8. Research questions
    • 8.1 Epidemiology of relapses, impairments and activity limitations
    • 8.2 Diagnosing multiple sclerosis
    • 8.3 Rehabilitation assessment protocols
    • 8.4 Specialist neurological rehabilitation services
    • 8.5 Acute relapse management: methylprednisolone and rehabilitation
    • 8.6 Disease-modifying therapies
    • 8.7 Relationship between impairments and limitations in activities
• Appendices
  • Appendix A Expanded model of illness (WHO ICF plus),
  • Appendix B Issues for people with MS and their carers
  • Appendix C Literature searches
  • Appendix D Searching for health economics evidence
  • Appendix E Health economics of comparing different methods of administration of methylprednisolone in the treatment of acute relapses in multiple sclerosis
  • Appendix F Economic evidence for nuclear magnetic resonance imaging scans in the diagnosis of MS
  • Appendix G The McDonald Criteria
  • Appendix H Assessments and measures
  • Appendix I Evidence tables
  • Appendix J The scope of the clinical guideline
• References

Acknowledgements: The NCC-CC and the development groups would like to acknowledge the help and support provided by Michael Pearson (joint executive lead at the Royal College of Physicians), Judy Mead (Joint Executive Lead, Chartered Society of Physiotherapy), Ailsa Mayes (Reviewer) and Rob Grant (Administrator NCC-CC). Also, all those who commented on drafts of this guideline via the NICE stakeholder consultation process.