From the Research
Definition and Presentation of Multiple Sclerosis (MS)
- Multiple Sclerosis (MS) is a rare but serious autoimmune disorder targeting the central nervous system (CNS), characterized by clinical relapses and radiological lesions disseminated in time and location 1.
- Patients with MS most commonly present with long tract signs, optic neuritis, or brainstem syndromes, while cortical syndromes or multifocal presentations are less common 1.
Emergency Department (ED) Visits and Management
- MS patients may present to the ED with acute non-neurological problems, and those with severe MS tend to present more often due to medical issues indirectly related to MS 2.
- Management of clinically isolated syndrome (CIS) and acute flares of MS in the ED includes corticosteroid therapy, ideally after diagnostic testing with imaging and lumbar puncture for cerebrospinal fluid analysis 1.
- Emergency clinicians should evaluate whether patients with MS are presenting with new-onset debilitating neurological symptoms to avoid unnecessary testing and admissions 1.
Non-Inflammatory Causes of Emergency Consultation
- Non-relapse-related emergency consultations of patients with MS can be caused by various factors, including neurological, infectious, psychiatric, vertigo, trauma, and miscellaneous conditions 3.
- MS-related symptoms constitute the most frequent cause of non-inflammatory emergency consultations, and close follow-up of relapse and pseudo-relapse is necessary to detect incorrect initial diagnoses and avoid unnecessary treatments 3.
Diagnosis and Treatment
- Prompt diagnosis and early initiation of disease-modifying treatment improve long-term outcomes in MS patients, and ED presentations for acute neurologic symptoms are an important opportunity to diagnose and treat early MS 4.
- Disease modification, symptom management, preservation of function, and treatment of psychosocial issues are paramount to enhance the quality of life for patients affected with MS 5.