Describe the best early multiple sclerosis workup for a GP.
E.J. Pauls, MD, Abbotsford, BC
I can’t give an all-inclusive answer to this question as multiple sclerosis can begin in such a variety of ways. A patient presenting with acute visual loss with pain on eye movement might well have optic neuritis but if this is the initial presentation, referral to an ophthalmologist would be a good way to begin. The time course of symptoms would also help determine the urgency of investigation. A patient with a story of three weeks of numbness from the waist down that occurred six months ago and recovered completely could be worked up at a very different pace than someone with a two-day history of a worsening myelopathy. Although they both need imaging, the second patient needs urgent imaging to rule out a compressive lesion. It never hurts to check a B12
level in anyone with spinal cord symptoms. A person with vague transient numbness might benefit from some general bloodwork to rule out a metabolic cause. In most cases, a patient whose presentation suggests the possibility of MS deserves referral to a neurologist.