Dawaa Reference

Clinical reference

Multiple Sclerosis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND65 - condition scope only, no dose · Multiple Sclerosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499849/ · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (10)

  • Monocular or homonymous vision loss with painful eye movement points to optic neuritis [eye pain]
  • Vertigo together with gait imbalance suggests vestibular involvement [vertigo]
  • Slurred speech and swallowing trouble reflect bulbar dysfunction [slurred speech]
  • Limb weakness, tremor, spasticity, and fatigue are common motor complaints [fatigue · spasticity · tremor]
  • Numbness, paresthesias, and a band-like sensation around the trunk can occur [numbness]
  • Bladder and bowel complaints range from urgency and retention to constipation [constipation]
  • Memory and concentration difficulty reflect cognitive involvement
  • Depression and anxiety are recognized psychiatric features [anxiety · low mood]
  • Facial weakness or numbness with double vision suggests brainstem involvement [double vision · facial weakness · numbness]
  • A relapse typically evolves over days to weeks and lasts 24 to 48 hours [relapse]

Signs — what you find (6)

  • Optic neuritis on exam shows subacute monocular central vision loss with pain on eye movement
  • Impaired adduction on lateral gaze indicates internuclear ophthalmoplegia [ophthalmoplegia]
  • Sensory disturbance from partial transverse myelitis may be one- or two-sided
  • Hyperreflexia, tremor, muscle spasm, and weakness are found on neurological exam [hyperreflexia · muscle cramps · tremor]
  • A shock-like sensation down the body on neck flexion is the Lhermitte sign [shock]
  • Bladder exam for incontinence or retention should include a residual volume check

Tests (9)

  • MRI lesions appear T2-hyperintense and T1-hypointense, termed black holes
  • Periventricular lesions oriented perpendicular to the ventricle wall form Dawson fingers
  • Active plaques typically enhance with gadolinium on MRI
  • Dissemination in space needs a T2 lesion in 2 of 4 regions: spinal cord, infratentorial, juxtacortical, periventricular
  • CSF typically shows raised protein, oligoclonal bands, and elevated IgG
  • Evoked potentials show slowed, often asymmetric conduction
  • Baseline labs include CBC, thyroid function, B12, ESR, and ANA to exclude mimics
  • Atypical presentations get tested for AQP4-IgG and MOG-IgG autoantibodies
  • Spinal cord plaques on MRI span 3 mm up to under 2 vertebral segments in length

If not this — what else fits (12)

  • Acute disseminated encephalomyelitis is a demyelinating mimic
  • Neuromyelitis optica (Devic disease) is a demyelinating differential
  • Susac syndrome is listed among demyelinating mimics
  • CLIPPERS is a rare steroid-responsive encephalomyelitis of the spinal cord, cerebellum, and brainstem
  • Systemic lupus erythematosus is an autoimmune mimic to exclude
  • Antiphospholipid antibody syndrome is on the differential
  • A dural arteriovenous fistula is a vascular mimic
  • Arteritic or nonarteritic ischemic optic neuropathy can mimic the visual involvement
  • Vascular malformations and emboli belong on the vascular differential
  • Vitamin deficiencies are a metabolic differential to exclude
  • Adult-onset adrenoleukodystrophy is a genetic leukodystrophy mimic
  • Primary CNS tumors such as gliomas, meningiomas, or metastasis can mimic it

SourceStatPearls "Multiple Sclerosis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Chronic demyelinating disease of the central nervous system with relapsing or progressive courses; the GP should recognise suggestive episodes (optic neuritis, limb weakness, sensory disturbance) and refer to neurology for MRI and disease-modifying therapy, while a short corticosteroid course may treat an acute relapse and baclofen may ease spasticity under specialist guidance. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Chronic demyelinating disease of the central nervous system with relapsing or progressive courses; the GP should recognise suggestive episodes (optic neuritis, limb weakness, sensory disturbance) and refer to neurology for MRI and disease-modifying therapy, while a short corticosteroid course may treat an acute relapse and baclofen may ease spasticity under specialist guidance.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Acute visual loss or pain on eye movement (possible optic neuritis), new limb weakness or sensory loss, or bladder dysfunction together with limb symptoms suggesting spinal cord involvement.

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