MS Relapse

NOTE: This pathway should be utilized in patients with an established diagnosis of multiple sclerosis (MS). When evaluating patients with established MS with neurologic symptoms, it is key to identify new symptoms versus worsening of existing symptoms, duration of symptoms, and common precipitating factors. MS is a demyelinating disease process. An MS relapse will have corresponding enhancing lesions on MRI. A pseudo-relapse will not show any new lesions on MRI. If it is a pseudo-relapse, treat the underlying cause (e.g. infection). If it is an MS relapse, treat with steroids, and if severe, IVIG/PLEX. Other demylinating diseases to keep on your differential are NMO, MOG, CNS Sjogren's, and toxic, inflammatory and metabolic disorders.