- Diagnosing MS can be complex due to the variety of symptoms and clinical overlap with similar conditions.
- With many new treatment options available, treatment decisions have also become more complex.
- The MS specialist group of the Australian and New Zealand Association of Neurologists, along with input from other experts, has developed best practice guidelines for managing MS in local healthcare settings.
- These offer a practical guide to healthcare professionals to support safe, timely, and effective care for adults with MS in Australia and New Zealand.
MS landscape in Australia and New Zealand
There are over 33,300 people living with MS in Australia and over 4,000 people living with MS in New Zealand. Unfortunately, the prevalence and incidence have been increasing over time. The likely reasons for this increase include improved diagnosis, improved registry data, improved life expectancy of people with MS, and potentially increased exposure to risk factors for MS such as adolescent obesity, smoking, reduced sun exposure, and fewer pregnancies.
To diagnose MS, a combination of clinical symptoms, imaging tests, and laboratory results are assessed using guidelines called the 2017 revised McDonald Criteria. These specify a need for evidence of at least two separate attacks in different parts of the brain or spinal cord at different times. This is supported by magnetic resonance imaging (MRI) scans and sometimes by testing the cerebrospinal fluid (CSF) to confirm the diagnosis and rule out other possible causes.
Why can MS diagnosis and management be so complex?
During diagnosis, it is important that the diagnostic criteria are used carefully to avoid misdiagnosis, as this can lead to unnecessary treatments which can have a negative impact. Common reasons for misdiagnosis include misunderstanding general neurological symptoms and misinterpreting MRI results. Other inflammatory disorders of the brain and spinal cord with different underlying causes can also be mistaken for MS and need different treatment approaches.
Although new treatments have greatly improved outcomes in recent years, the variety of disease-modifying therapies (DMTs) available and their safety concerns have made treatment options more complex.
While there are international guidelines available, up-to-date national guidelines detailing locally available treatments, government subsidies, and local practice are needed for healthcare professionals such as general practitioners (GPs) and general neurologists.
How were the recommendations made?
The need for clinical practice guidelines on the management of MS in Australia and New Zealand was identified by the MS specialist group of the Australian and New Zealand Association of Neurologists (ANZAN).
Several rounds of feedback and revisions were made, gathering input from MS neurologists, people living with MS, MS nurses, allied healthcare professionals including a physiotherapist and psychologist with experience in MS, MS Australia, MS Plus, an infectious diseases physician, an immunologist, and a GP.
What are the key recommendations?
Published in The Medical Journal of Australia in two parts (part 1 and part 2), a total of 81 recommendations were made to guide healthcare professionals on various aspects of MS care. These include choosing and advising on DMTs, initial assessments, reducing risks, monitoring the disease, changing or stopping DMTs, and managing DMTs in special situations like pregnancy, breastfeeding, infections and cancer. The recommendations also cover general lifestyle advice, handling sudden symptom flare-ups, and treating symptoms.
What does this mean for people living with MS?
The recommendations in this resource are based on current evidence and the consensus of a specialist group working in MS in Australia and New Zealand. They offer a practical guide for healthcare professionals on the best ways to provide safe, timely, and effective care for people with MS.
As treatment options evolve, and more long-term safety data becomes available, updated guidelines will be necessary.
It is important to remember that MS affects everyone differently, so personalised clinical assessment and application of these guidelines to each individual is essential.
