Executive summary
- Think MS in adults with a typical demyelinating history such as optic neuritis, diplopia, ascending sensory symptoms, limb weakness, or balance/cerebellar symptoms, especially when episodes are separated in time.
- Diagnosis is specialist-led: NICE expects diagnosis to be confirmed by a consultant neurologist using the clinical picture, MRI, and other investigations as needed.
- Relapse treatment: for relapses affecting usual function, treatment should be offered as early as possible and within 14 days. Standard treatment is oral methylprednisolone 500 mg once daily for 5 days.
Primary care recognition and referral
- Common first presentations: painful unilateral visual loss, internuclear ophthalmoplegia/diplopia, sensory level, limb weakness, gait disturbance, or brainstem symptoms.
- Do not try to “rule it out” in primary care with ad hoc tests if the story sounds typical. Arrange specialist neurology assessment.
- Urgency increases if there is rapidly progressive neurological deficit, marked gait impairment, or diagnostic uncertainty with a possible alternative serious neurological cause.
Managing relapse and ongoing symptoms
- Before labelling a relapse, exclude infection, pseudo-relapse, and other explanations. Non-specialists should discuss steroid treatment with an MS-experienced clinician because not all relapses need steroids.
- Acute relapse: offer oral methylprednisolone 500 mg daily for 5 days. Consider IV methylprednisolone 1 g daily for 3–5 days if oral treatment fails, is not tolerated, or admission is needed.
- Do not prescribe lower steroid doses for relapse treatment and do not issue a standby supply for self-treatment of future relapses.
- Long-term GP value: watch for spasticity, bladder dysfunction, mood symptoms, neuropathic pain, falls risk, and fatigue, and coordinate with the MS team rather than trying to run disease-modifying treatment from primary care.
Frequently asked questions
Should every relapse be treated with steroids?
No. Steroids are generally used for relapses that meaningfully affect function. NICE advises discussion with an MS-experienced clinician because not every symptom worsening is a true relapse or needs steroid treatment.
What is the standard steroid regimen for an acute MS relapse?
Oral methylprednisolone 500 mg once daily for 5 days. Intravenous methylprednisolone 1 g daily for 3–5 days can be considered when oral treatment fails, is not tolerated, or hospital-level monitoring is needed.
Can I give patients rescue steroids to keep at home?
No. NICE advises against giving a supply of steroids to self-administer for future relapses.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.