Intended for healthcare professionals

Practice Guidelines

Multiple sclerosis: summary of NICE guidance

BMJ 2014; 349 doi: (Published 08 October 2014) Cite this as: BMJ 2014;349:g5701
  1. Mark Perry, senior research fellow1,
  2. Sharon Swain, senior research fellow1,
  3. Sophia Kemmis-Betty, health economist1,
  4. Paul Cooper, chair of guideline development group, consultant neurologist, honorary senior lecturer23
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Neurology Department, Salford Royal Foundation Trust, Salford, UK
  3. 3Department of Medicine, University of Manchester, Manchester, UK
  1. Correspondence to: M Perry mark.perry{at}

Multiple sclerosis (MS) is the most common cause of serious physical disability in working age adults and affects over 100 000 people in the United Kingdom.1 It causes a range of symptoms and disability and requires a broad multidisciplinary approach. A 2008 report, however, suggested delays and limited access to specialist services for affected people.2 This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).3 The guideline scope does not include disease modifying drugs as these have been covered in other NICE guidance.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.

Diagnosing multiple sclerosis

  • MS should be diagnosed only after careful assessment by a consultant neurologist, using the McDonald4 criteria (table). The criteria include the need to rule out alternative diagnoses, and clinical judgment is often required to consider these and decide on what is, or is not, an attack.

View this table:

McDonald criteria4 for diagnosis of multiple sclerosis

  • The diagnosis should not be made on the basis of the results of magnetic resonance imaging alone. Be aware that common clinical presentations include:

    • -Loss or reduction of vision in one eye with painful eye movements

    • -Double vision

    • -Ascending sensory disturbance or weakness, or both

    • -Problems with balance, unsteadiness, or clumsiness

    • -Altered sensation travelling down the back and sometimes into the limbs when the patient bends the neck forwards (Lhermitte’s symptom).

  • As well as these symptoms, people with MS:

    • -Are often aged under 50 and

    • -Might have a history of previous neurological symptoms and

    • -Often have symptoms that have evolved over more …

View Full Text

Log in

Log in through your institution


* For online subscription