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 NICE NG220.
• 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 NICE CKS.
• 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 NICE NG220.
• If neuropathic pain is present and requires specialist pain services beyond initial pharmacological management, refer accordingly NICE CKS,NICE NG220.
• For sexual dysfunction, which is common but often underreported, consider referral to secondary care or psychosexual counselling services NICE CKS.
• When symptoms such as oscillopsia do not improve with first- and second-line treatments, refer for specialist advice NICE NG220.
• 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 NICE CKS,NICE NG220.
• 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 NICE CKS.

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.