What is the assessment, plan, education, and follow-up for a patient presenting to the Emergency Room (ER) with Multiple Sclerosis (MS)?

From the Guidelines

For a patient presenting to the ER with multiple sclerosis (MS), the assessment should focus on determining if they're experiencing an acute exacerbation or if symptoms are due to another cause, and management should prioritize reducing morbidity, mortality, and improving quality of life. The assessment includes a thorough neurological examination, MRI of the brain and spinal cord with and without contrast, and possibly lumbar puncture if diagnosis is uncertain, as recommended by the MAGNIMS consensus guidelines 1. Blood tests should be performed to rule out infections or other conditions that can mimic MS symptoms. For acute MS exacerbations, high-dose corticosteroids like methylprednisolone 1000mg IV daily for 3-5 days, followed by an oral prednisone taper, are typically administered. Symptomatic treatments include baclofen 5-25mg three times daily for spasticity, gabapentin 300-1200mg three times daily for neuropathic pain, and amantadine 100mg twice daily for fatigue.

Patient Education and Follow-up

Patient education should cover the chronic nature of MS, importance of medication adherence, recognition of exacerbation signs, and lifestyle modifications including regular exercise and stress management. Follow-up should be arranged with a neurologist within 1-2 weeks of discharge, with subsequent visits every 3-6 months. Regular MRIs (typically annually) are needed to monitor disease progression, as outlined in the guidelines 1, and patients should be connected with MS support groups and rehabilitation services as needed.

Telehealth Considerations

In cases where in-person follow-up is not feasible, telehealth visits can be an effective alternative, as demonstrated by the concept analysis of therapeutic relational connection in telehealth 1. This approach allows for the establishment of care, discussion of treatment plans, and education on disease management, all while maintaining a therapeutic relationship with the patient.

Key Recommendations

• Annual MRI scans to monitor disease progression 1
• High-dose corticosteroids for acute MS exacerbations
• Symptomatic treatments for spasticity, neuropathic pain, and fatigue
• Patient education on disease management and lifestyle modifications
• Follow-up with a neurologist every 3-6 months
• Telehealth visits as a viable alternative for follow-up care when necessary 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Assessment

• The assessment of a patient presenting to the ER with multiple sclerosis involves evaluating the patient's symptoms, medical history, and current treatment regimen 2, 3.
• The patient's symptoms should be assessed to determine if they are experiencing a relapse, and if so, the severity of the relapse should be evaluated 2.
• The patient's medical history should be reviewed to determine the type and severity of their multiple sclerosis, as well as any previous treatments they have received 3.
• The patient's current treatment regimen should be evaluated to determine if any changes need to be made to manage their symptoms and prevent further relapses 2, 3.

Plan

• The plan for a patient presenting to the ER with multiple sclerosis should include treatment to manage their symptoms and prevent further relapses 2, 3.
• Corticosteroids, such as methylprednisolone, may be prescribed to reduce inflammation and manage symptoms 2.
• Disease-modifying therapies, such as interferon beta or glatiramer acetate, may be prescribed to reduce the frequency and severity of relapses 3, 4.
• The patient should be monitored closely to evaluate the effectiveness of their treatment plan and make any necessary adjustments 2, 3.

Education

• Patients with multiple sclerosis should be educated on their treatment options and the importance of adhering to their treatment plan 3, 4.
• Patients should be informed about the potential side effects of their medications and how to manage them 2, 3.
• Patients should be educated on how to recognize the signs of a relapse and what to do if they experience one 2, 3.
• Patients should be encouraged to maintain a healthy lifestyle, including a balanced diet and regular exercise, to help manage their symptoms and prevent further relapses 3.

Follow-up

• Patients with multiple sclerosis should be followed up regularly to monitor their condition and adjust their treatment plan as needed 2, 3.
• Follow-up appointments should include a thorough evaluation of the patient's symptoms, medical history, and current treatment regimen 2, 3.
• Patients should be encouraged to keep a symptom journal to track their symptoms and identify any patterns or changes 3.
• Patients should be referred to a specialist, such as a neurologist, for further evaluation and management if necessary 3, 4.