# Multiple Sclerosis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 - Verified date: 2026-09 ## 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) ## Treatment metadata - Methylprednisolone — 500 mg — injection - Recognition, referral and the symptoms that need treating (Referral & Advice) ## Complete treatment card ```text MULTIPLE SCLEROSIS 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 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) (2026-09) 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 Source StatPearls "Multiple Sclerosis" - disease-level clinical article Status traced to the source above Rx: Acute relapse - the one drug amount primary care may handle | Recognition, referral and symptom control ACUTE RELAPSE - THE ONE DRUG AMOUNT PRIMARY CARE MAY HANDLE 1. METHYLPREDNISOLONE [1st line] Adult 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 x 3-7 days Peds 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. Choice Alternatives from the same article, both oral: "Oral prednisone: This can be administered at a dosage of 1250 mg/d of prednisone, with/without a short taper, and is an alternative to 3 to 7 days of oral methylprednisolone administered at 1000 mg/d." Neither is practical on the Egyptian register. Prednisone is listed here as a single 5 mg product (HOSTACORTIN, 30 tablets), so 1250 mg a day is 250 tablets a day; oral methylprednisolone comes as 4 mg and 16 mg tablets, so 1000 mg a day is over 60 tablets of the largest strength. The intravenous route is the one that can actually be given here, and it is well stocked. 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." Why 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. Caution 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. Egypt SOLU-MEDROL 500MG I.M./I.V.VIAL PFIZER 180.00 EGP GLOBISOLONE 500MG I.V./I.M. LYOPHILIZED POWDER VIAL GLOBAL PHARMACEUTICA... 214.00 EGP METHYLPREDNISOLONE MYLAN 500MG 10 VIALS MYLAN S.A.S-FRANCE > RAMCO 1225.00 EGP RECOGNITION, REFERRAL AND SYMPTOM CONTROL 2. RECOGNITION, REFERRAL AND THE SYMPTOMS THAT NEED TREATING (REFERRAL & ADVICE)[2nd line] Adult 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. - Refer, with advice Peds 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. 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 Why 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. Caution 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. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)