1. Multiple Sclerosis GP Role
Dr James Douglas
Tweeddale Medical Practice
Fort William

2. GP Role in MS First symptoms and diagnosis Epidemiology and sub types
GP role in chronic disease management
Disease trajectories
Further Information and clinical pathways

3. MS is an auto immune disease where the myelin nerve sheath becomes damaged and interferes with the transmission of motor and sensory nerve impulses

4. MS is a disease of the Central Nervous System

5. What do we know about MS?
More common the further north we live in the world
Genetic suscepability and environment
Auto Immune disease
Is it a virus ? Is it about Vit D and sunlight?
In Tweeddale we have 13 Patients with MS

6. First symptoms Motor weakness Sensory disturbance
Visual disturbance ( optic neuritis)
Ataxia and walking difficulty
Mental symptoms
Lhermittes phenomenon tingling in legs with neck flexion
Utoffs Phenomenon – worsening of neurological symptoms with heat or exercise ( warm bath)

7. Dread disease in 10 minutes Consultation Skills ( Ideas ,Concerns, Expectations)
Open questions
What is your worst fear?
What is going through your mind?
What have you found out about this on the internet?
Do you know anybody else with these sorts of symptoms?

8. Dread disease in 10 minutes
Listening and pattern matching
Shared understanding and a plan
Yes, it could be , but we will have to:
- see how things go and review only make such a serious diagnosis with more tests and a specialist opinion

9. Pros and Cons of early diagnosis in any dread disease
Starting an early treatment to reduce disability eg RA
Reducing anxiety with certainty
A label to get services and support
Cons
Blissful ignorance if no effective disease modifying treatment
Life / sickness insurance and date of first knowledge
Wrong data label applied

10. What else can it be? A neurology text book! Poly neuropathies
Motor neurone disease
Huntingdon's Chorea
Lyme Disease
Anxiety causes hyperesthesia lots of people present with “pins and needles”
GP has to find the pin in the hay stack!

11. MS Diagnosis Must have relapsing and remitting nature
Time to be certain – later anger
Neurological examination
Magnetic Resonance Imaging
Lumbar Puncture
Visual Evoked Potential

12. Emotional Adjustment to any serious disease
Bereavement sequence
Denial
Frustration , emotional upset
Anger/guilt/depression.
Understanding and acceptance of loss
Emotional adjustment to new role/situation

13. MS sub types Benign MS ( after 10 -15 years with not much problem)
Relapsing and Remitting MS ( remission and recovery)
Secondary Progressive MS ( follow on form relapsing and remitting)
Primary Progressive ( no clear remission % >40 years onset )

14. GP MS Annual Review

15. Disease Trajectories

16. Summary of GP role Diagnosis Prescribing and co morbidities
Working with specialist team
The long term relationship
The family
The clinical record /coding / decision points
NHS Highland MS guidelines on intranet

18. MS Society UK and Scotland www.mssociety.org.uk

19. Patient with MS for 30 years
Life story with video editing
“Stoory pints”
Sailing > family seperation
Fund raising in Caol for a wheelchair