General management and advice to patient and family

• Patients should be encouraged to maintain their general health and routine activities. Regular exercise, a healthy diet (emphasising polyunsaturated rather than saturated fats) and prompt treatment of other illness are appropriate.
• Though fatigue is a very common feature (>80% patients) this tends to be improved by regular physical activity and its impact can be limited by pacing of day-to-day activities and maintenance of a good sleep pattern
• Though relapses are often unpredictable, they are more common in the weeks following infection and possibly at times of emotional stress.
• For many patients MS symptoms are temporarily exacerbated by heat (Uhtoff’s phenomenon)
• Pregnancy does not adversely affect the natural history of MS. Relapses tend to be less frequent in the later stages of pregnancy, with a rise in disease activity in the six months post-partum. Epidurals anaesthesia, operative delivery and breast feeding do not influence the risk of relapse. The major issue to consider in relation to pregnancy is the inevitable uncertainty about long-term physical disability.
• Patients should be told to notify the DVLA and their insurers about their diagnosis, in general this will not result in any restriction to their driving licence unless there are specific physical disabilities (eg. visual field loss, poor acuity, severe tremor). If there are concerns about driving ability a formal driving assessment at a recognized centre should be suggested (link to web page).
• Regular medical review of symptoms and their treatment should be encouraged for most patients, ideally by a member of a multi-disciplinary team familiar with the disease and current management strategies.
• The impact of the disease on other family members, particularly children, should be acknowledged and support offered where appropriate
• For patients with moderate or severe disability timely access to appropriate community therapy and social services should be facilitated

Last edited: 1/12/2003

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