MS Clinical Companion

IMPORTANT: This app is intended for use by qualified healthcare professionals only. Always seek the advice of a qualified clinician before making any medical or prescribing decisions. MS Clinical Companion is a comprehensive evidence-based reference for the diagnosis and management of multiple sclerosis. Built for neurologists, MS specialist nurses, general physicians, and allied health professionals. MS DIAGNOSIS - McDonald 2017 criteria: dissemination in space (DIS) and dissemination in time (DIT) - DIS: 4 MS-typical MRI locations - periventricular, cortical, infratentorial, spinal cord - DIT: 4 methods including CSF oligoclonal bands substituting for DIT (2017 update) - MRI protocol: T2 FLAIR, gadolinium, black holes, Dawson fingers, cord imaging - MRI lesion features: open ring sign, lesion size, enhancement patterns - CSF: oligoclonal bands 85-95% sensitivity, IgG index, cell count interpretation - VEP: P100 latency, subclinical optic neuritis detection - Differential diagnosis table: NMOSD, MOG antibody disease, CNS vasculitis, neurosarcoidosis, CADASIL, B12 deficiency, Susac syndrome, Sjogren syndrome - Minimum blood tests at MS diagnosis including AQP4-IgG and MOG-IgG MS PHENOTYPES - Classification table: CIS, RIS, RRMS, SPMS, PPMS per Lublin 2013 - CIS conversion risk - RIS: ARISE 2023 trial - SPMS vs PPMS - Active vs inactive phenotypes and treatment implications RELAPSE MANAGEMENT - Relapse definition - IV methylprednisolone 1g for 3-5 days - Maximum 3 steroid courses per year with bone protection guidance - Plasma exchange: - PE protocol: 5-7 sessions - When not to treat: DISEASE MODIFYING THERAPIES - Three-tier efficacy framework - DMT comparison table - Low/moderate DMTs. - High-efficacy Drugs - JC virus risk stratification - PML recognition and management - DMT selection algorithm - Highly active RRMS first presentation SYMPTOM MANAGEMENT - Fatigue: primary vs secondary, FSS assessment, amantadine, modafinil, energy conservation - Spasticity step-ladder - Bladder: OAB vs retention vs DSD table, oxybutynin, solifenacin, mirabegron, desmopressin, ISC - Detrusor botulinum toxin: NICE approved, post-void residual guidance - Pain: trigeminal neuralgia, central dysaesthesia, Lhermitte phenomenon, painful tonic spasms - Cognition: BICAMS assessment, avoid anticholinergics, cognitive rehabilitation - Depression: SSRIs, CBT, elevated suicide risk in MS - Fampridine (Fampyra): 25-foot walk test criteria, NICE approval MS EMERGENCIES - Tumefactive MS - Acute transverse myelitis: MS vs NMOSD distinction, plasma exchange, respiratory monitoring - Marburg variant and Balo concentric sclerosis - Severe relapse PROGNOSTIC FACTORS - Poor prognostic features - NEDA-3 and NEDA-4 - PIRA significance - Serum neurofilament light chain (sNfL) as biomarker of neurodegeneration PREGNANCY AND MS - Trimester-by-trimester disease activity - Postpartum rebound - DMT safety table - Teriflunomide and fingolimod contraindication and washout protocols - Natalizumab in pregnancy MONITORING IN MS - Annual review: EDSS, MSFC, MRI, relapse count, symptom review, blood tests - MRI surveillance - Blood monitoring table - JCV antibody testing - Alemtuzumab REHABILITATION - MDT roles: neurologist, MS nurse, physiotherapist, OT, SLT, continence nurse, psychologist - Exercise in MS - Energy management - Vocational rehabilitation SOURCES AND REFERENCES 25 plus tappable references including NICE NG220, McDonald 2017, Lublin 2013, CARE-MS I and II, OPERA I and II, ORATORIO, AFFIRM, CLARITY, ASCLEPIOS, ARISE 2023, Weinshenker plasma exchange, PIANO pregnancy registry, PROMISE trial, PIRA and sNfL biomarker studies, NICE TA615 nabiximols and BNF MS prescribing. DISCLAIMER This app is intended for use by qualified healthcare professionals only as a clinical decision-support and educational reference tool. It does not replace individual clinical assessment, local MS protocols or official prescribing information.