{ "schema_version": 1, "kind": "condition", "id": "multiple-sclerosis", "name": "Multiple Sclerosis", "category": "chronic", "sources": "Multiple Sclerosis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK499849/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND65 - condition scope only, no dose", "review_status": "reviewed", "verified_against": "Multiple Sclerosis - StatPearls - NCBI Bookshelf (NBK499849) - https://www.ncbi.nlm.nih.gov/books/NBK499849/, Treatment / Management (acute exacerbation: IV methylprednisolone 500-1000 mg daily for 3-7 days) · Egyptian drug register (methylprednisolone sodium succinate 500 mg and 1 g vials; prednisone 5 mg only)", "verified_date": "2026-09", "treatments": [ { "id": 1229, "generic": "Methylprednisolone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 500.0, "adult_dose": "Intravenous, 500 to 1000 mg daily as a 3 to 7 day course, optionally followed by a short prednisone taper. This is for an acute relapse only, not continuous treatment", "adult_duration": "3-7 days", "dose_source": "Multiple Sclerosis - StatPearls - NCBI Bookshelf (NBK499849) - https://www.ncbi.nlm.nih.gov/books/NBK499849/, Treatment / Management - verbatim: \"IV methylprednisolone: This can be administered as a 3- to 7-day course at 500 to 1000 mg daily, optionally followed by a short prednisone taper.\"", "rationale": "A corticosteroid pulse shortens an acute relapse; it does not alter the course of the disease. The article's threshold for treating a relapse: \"Neurological symptoms may include increased disability, impairments in strength, cerebellar function, vision, or significant sensory disturbances. IV or oral steroids may be prescribed by a physician... depending on a patient's conditions and symptoms.\" It is included because it is the one medicine in multiple sclerosis with a stated amount that a non-neurologist may be asked to give or continue; everything that changes the disease is started by neurology.", "cautions": [ "This treats the relapse, not the disease. It does not reduce future relapses or long-term disability - that is what the disease-modifying therapies do, and they are neurology's to start.", "RED FLAG - Exclude infection before giving a steroid pulse. A relapse and an infective deterioration look alike, a urinary or chest infection commonly worsens existing multiple sclerosis symptoms without being a relapse at all, and a high-dose steroid given into an untreated infection is harmful.", "Expect the short-term effects of a high-dose pulse: hyperglycaemia (check glucose in a diabetic patient), insomnia, mood change including frank agitation, gastric irritation, and a metallic taste during the infusion. They settle when the course ends.", "If the relapse does not respond, the next step is not more steroid. The article: \"Plasma exchange (PLEX) is recommended if a poor glucocorticoid response occurs\", given daily or every other day for a total of 3 to 7 treatments. That is a hospital decision.", "RED FLAG - In a woman who might become pregnant, several disease-modifying drugs must be avoided. The article lists as teratogens: teriflunomide, cladribine, siponimod, fingolimod and ozanimod; and as drugs with a higher risk of rebound symptoms on stopping: fingolimod, siponimod, natalizumab and ozanimod. Do not stop any of these on your own initiative - stopping the rebound group abruptly can be worse than continuing. Discuss with neurology before anything changes." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The article states no paediatric dose and no paediatric amount is printed here. Paediatric-onset multiple sclerosis exists but is uncommon and is managed by paediatric neurology.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SOLU-MEDROL 500MG I.M./I.V.VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 180.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLOBISOLONE 500MG I.V./I.M. LYOPHILIZED POWDER VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 214.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METHYLPREDNISOLONE MYLAN 500MG 10 VIALS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MYLAN S.A.S-FRANCE > RAMCO", "price_egp": 1225.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "multiple-sclerosis" }, { "id": 1230, "generic": "Recognition, referral and the symptoms that need treating (Referral & Advice)", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Chronic demyelinating disease of the central nervous system with relapsing or progressive courses. The GP recognises suggestive episodes - optic neuritis, limb weakness, sensory disturbance - and refers to neurology for MRI and disease-modifying therapy. The article's own summary of what management involves: treating the acute symptoms, a short course of corticosteroids to assist recovery, and rehabilitation programmes involving physical and occupational therapy. The steroid amount is on the row above; the rest of the drug treatment is started by neurology.", "adult_duration": "Refer, with advice", "dose_source": "No dose - the recognition and referral pathway, from Multiple Sclerosis - StatPearls - NCBI Bookshelf (NBK499849) - https://www.ncbi.nlm.nih.gov/books/NBK499849/, Treatment / Management", "rationale": "Chronic demyelinating disease of the central nervous system with relapsing or progressive courses. The GP recognises suggestive episodes - optic neuritis, limb weakness, sensory disturbance - and refers to neurology for MRI and disease-modifying therapy. The article's own summary of what management involves: treating the acute symptoms, a short course of corticosteroids to assist recovery, and rehabilitation programmes involving physical and occupational therapy. The steroid amount is on the row above; the rest of the drug treatment is started by neurology.", "cautions": [ "The disease-modifying drugs are neurology's to start and to stop. The article names glatiramer acetate, dimethyl fumarate, fingolimod, interferon-beta preparations, natalizumab and mitoxantrone among them; no dose is printed here for any of them, because the choice depends on the disease course and on monitoring that primary care does not do.", "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. A first episode of this kind is referred, not observed.", "The symptoms that actually reduce quality of life are often not the ones that get treated. The article's list of concerns to address alongside relapses: bladder and bowel dysfunction, depression, cognitive impairment, fatigue, sexual dysfunction, sleep disturbance and vertigo. Several of these are treatable in primary care on their own cards.", "The diagnosis is not made in primary care and the differential is wide - the article lists seven categories, including lupus, sarcoidosis, Lyme disease, syphilis, HIV, vitamin deficiency, thyroid disease and small-vessel ischaemia. Suspecting it is the GP's job; confirming it is not." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Presentation in childhood is uncommon and goes to paediatric neurology. The pathway is otherwise the same - recognise the episode, refer, and do not start a disease-modifying drug in primary care.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "multiple-sclerosis" } ] }