Key Questions for Multiple Sclerosis Follow-Up Appointments
During follow-up appointments for patients with Multiple Sclerosis (MS), healthcare providers should systematically assess disease activity, treatment adherence, functional status, and complications through a structured set of questions that address all domains affecting morbidity, mortality, and quality of life.
Disease Activity Assessment
Relapse Assessment
- Have you experienced any new neurological symptoms or worsening of existing symptoms since your last visit?
- When did these symptoms start? How long did they last?
- Did you require any treatment (such as steroids) for these symptoms?
- Have you fully recovered from these symptoms or do you still have residual deficits?
Symptom Progression
- Have you noticed any gradual worsening of your MS symptoms over time?
- Are you experiencing increased difficulty with walking, balance, or coordination?
- Have you noticed any changes in your vision?
- Are you having more problems with bladder or bowel function?
- Have you experienced any new or worsening cognitive issues (memory, concentration, thinking)?
Treatment Assessment
Disease-Modifying Therapy (DMT) Adherence
- Are you taking your medication as prescribed?
- Have you missed any doses in the past 28 days? If so, how many? 1
- What barriers have you encountered in taking your medication? 2
- What strategies do you use to help remember to take your medication? 2
DMT Side Effects
- Have you experienced any side effects from your medication?
- For specific DMTs, ask targeted questions:
- How are you managing these side effects?
Functional Status Assessment
Mobility and Activities of Daily Living
- How is your walking? Has there been any change in your walking distance or stability?
- Do you use any mobility aids (cane, walker, wheelchair)? Has this changed?
- Are you able to perform your daily activities independently?
- Have you had any falls since your last visit?
Cognitive Function
- Have you noticed any changes in your memory, concentration, or thinking?
- Are you having difficulty with work or home responsibilities due to cognitive issues?
- Do you have trouble finding words or following conversations?
Complications Screening
Dysphagia Assessment
- Do you have difficulty swallowing foods or liquids? 5
- Do you cough or choke during meals?
- Has your diet changed due to swallowing difficulties?
- Have you had any respiratory infections recently? 5
Depression and Anxiety Screening
- How has your mood been since your last visit?
- Have you felt down, depressed, or hopeless?
- Do you have anxiety about your MS or its progression?
- Have you had thoughts of harming yourself?
Quality of Life Assessment
Fatigue
- How would you rate your fatigue on a scale of 0-10?
- How does fatigue impact your daily activities?
- What time of day is your fatigue worst?
- What strategies help manage your fatigue?
Sleep
- How is your sleep quality?
- Do you have trouble falling asleep or staying asleep?
- Do you wake up feeling refreshed?
- Do you have symptoms of restless legs or leg spasms at night?
Pain
- Are you experiencing any pain? Where?
- How would you rate your pain on a scale of 0-10?
- What makes your pain better or worse?
- How effective is your current pain management?
Imaging and Monitoring
- Have you had an MRI since your last visit?
- When is your next scheduled MRI? 5, 6
- For patients on natalizumab: Have you had JCV antibody testing in the past 6 months? 6
Social and Support Assessment
Work and Social Function
- How is your MS affecting your work or school performance?
- Have you needed any accommodations at work or school?
- How is your MS affecting your social life and relationships?
Support System
- Do you have adequate support at home?
- Are you connected with any MS support groups?
- Do you need referrals to any support services?
Therapeutic Relationship Building
- What questions or concerns do you have about your MS or treatment?
- What are your goals for managing your MS?
- What information would be helpful for you to better understand your condition? 5
Important Monitoring Considerations
- Regular MRI monitoring is recommended at least annually, even in the absence of clinical symptoms 5, 6
- Patients on natalizumab who are JCV positive should have more frequent MRI monitoring (every 3-4 months) 5
- Dysphagia screening should be performed regularly, especially in patients with cerebellar dysfunction, severe disabilities, or long disease duration 5
- The DYMUS questionnaire is a useful tool for screening dysphagia in MS patients 5
Documentation Recommendations
Document the following in each follow-up visit:
- Current EDSS (Expanded Disability Status Scale) score 6
- Treatment adherence status
- Presence of relapses or new symptoms
- MRI findings and comparison to previous studies
- Treatment plan adjustments
- Patient education provided
By systematically addressing these areas during follow-up appointments, healthcare providers can comprehensively assess MS disease activity, treatment effectiveness, and quality of life to guide management decisions.