When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Multiple sclerosis

Last reviewed: 5 Oct 2024
Last updated: 24 Aug 2023

Summary

Definition

History and exam

Key diagnostic factors

  • visual disturbance in one eye
  • peculiar sensory phenomena
Full details

Other diagnostic factors

  • female sex
  • age 20-40 years
  • foot dragging or slapping
  • leg cramping
  • fatigue
  • urinary frequency
  • bowel dysfunction
  • spasticity/increased muscle tone
  • increased deep tendon reflexes
  • imbalance/incoordination
  • pale optic disk or noncorrectable visual loss
  • incorrect responses to Ishihara color blindness test plates
  • abnormal eye movements
Full details

Risk factors

  • female sex
  • family history of MS
  • northern latitude
  • genetic factors
  • smoking
  • vitamin D deficiency
  • autoimmune disease
  • Epstein-Barr virus
  • overweight/obesity in children and adolescents
Full details

Diagnostic tests

1st tests to order

  • MRI - brain
  • MRI - spinal cord
  • CBC
  • comprehensive metabolic panel
  • thyroid-stimulating hormone
  • vitamin B12
Full details

Tests to consider

  • antibody testing for neuromyelitis optica spectrum disorders (NMOSD)
  • cerebrospinal fluid evaluation
  • evoked potentials
Full details

Treatment algorithm

ACUTE

acute relapse affecting function

ONGOING

relapsing-remitting MS

secondary progressive MS

primary progressive MS

Contributors

Authors

Mary Alissa Willis, MD

Associate Professor and Chair

Department of Neurology

University of Mississippi Medical Center

Jackson

MS

Disclosures

MAW has been compensated for Speakers' Bureau participation with Alexion, Biogen, Bristol-Myers Squibb, Genzyme, and Genentech, and advisory board participation with Alexion, Biogen, Greenwich Biosciences, Genentech, and Horizon.

Acknowledgements

Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. We have since been made aware that Dr Stone is deceased.

Peer reviewers

Alex Rae-Grant, MD

Project Leader for Neurology

Neurological Institute

Cleveland Clinic

Cleveland

OH

Disclosures

ARG declares that he has no competing interests.

Sarah A. Morrow, MD, FRCPC, MS

Associate Professor of Neurology

Department of Clinical Neurological Sciences

London Health Sciences Centre

University Hospital

Ontario

Canada

Disclosures

SAM declares that she has no competing interests.

Marcelo Kremenchutzky, MD

Director

The London Multiple Sclerosis Clinic

Associate Professor

Schulich School of Medicine

University of Western Ontario

Neurologist

Clinical Neurological Sciences Department

University Hospital

London Health Sciences Centre

Ontario

Canada

Disclosures

MK declares that he has no competing interests.

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCPGlasg, FRCPLond

Consultant Neurologist

Department of Neurology

Queen’s Hospital

Romford

UK

Disclosures

AC declares that he has no competing interests.

  • Multiple sclerosis images
  • Differentials

    • Myelopathy due to cervical spondylosis
    • Fibromyalgia
    • Postural orthostatic tachycardia syndrome with or without cervicogenic migraine
    More Differentials
  • Guidelines

    • Clinical guidance in neuropalliative care: an AAN position statement
    • Multiple sclerosis in adults: management
    More Guidelines
  • Patient information

    Multiple sclerosis

    Multiple sclerosis: questions to ask your doctor

    More Patient information
  • Videos

    Diagnostic lumbar puncture in adults: animated demonstration

    Venepuncture and phlebotomy: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer