Multiple sclerosis referral pathway

Patient is known by the Multiple Sclerosis team

If the patient is already known by the Multiple Sclerosis (MS) team in the West Midlands​, the first point of contact should be the patient’s MS nurse.

Most of the region's larger trusts have an MS nurse and the patient will most likely be known by their local MS nurse.​

• MS nurses

Common issues can be dealt with by reading the MS frequently asked questions page:

• MS FAQs

If your issue is not covered in the FAQs page and the patient's MS nurse is unavailable, please contact the Neurology department at University Hospitals Birmingham NHS Foundation Trust via the advice and refer (A&R) service and include the following information:

• The name of the Neurologist the patient usually sees
• Details of the current problem and examination findings
• If you think the patient is having a relapse, please confirm that you have completed a urine dip/culture

Patient diagnosed elsewhere and needs integrating into local multiple sclerosis services

If the patient has been diagnosed with multiple sclerosis (MS) outside of the West Midlands or in the private sector and need to be integrated into local MS services, please refer the patient via the advice and refer (A&R) service and include the following information:

• Where the patient has been previously seen
• The name of their previous MS consultant or neurologist (if possible)
• What disease modifying treatment (see table) the patient is on and the last time they had it (if applicable and possible)

Immunomodulatory treatments

Patient scan reported as showing demyelination or possible demyelination

If the patient's scan has been reported as showing demyelination or possible demyelination, please refer the patient via the advice and refer (A&R) service and include the following information:

• History and examination findings
• Has the patient already seen a neurologist and if so, which hospital?
• Where and when the scan was completed

The scan will need to be reviewed if the patient's local neurology service is provided by University Hospitals Birmingham NHS Foundation Trust (UHB).

If the scan:

• can not be imported into the UHB radiology system, the patient will be offered an up-to-date scan
• is consistent with a diagnosis of multiple sclerosis (MS), or is considered high risk for developing MS, the patient will be offered an MS service appointment
• is not considered to be consistent with a diagnosis of MS, appropriate advice will be issued. This may simply be reassurance

Not every patient with a demyelination reported scan will have MS or need to be seen by the Neurology services.

Patient (or their primary care team) is worried they have multiple sclerosis

Patients should be advised to visit the Emergency Department if they have a sudden onset of the following symptoms, as this could be a stroke:

• weakness
• numbness
• balance problems, or
• dizziness

If the patient has:

• severe weakness or balance problems, please arrange for them to be admitted at their local district general hospital, which may be via an Acute Medical Unit or Emergency Department
• new visual loss, they will need to visit their local emergency eye department. For Birmingham this is the Birmingham Midland Eye Centre (BMEC)
• neurological symptoms, but they are not acutely unwell, please refer the patient to their local neurology service via the advice and refer (A&R) service. Please see the 'How to make a good neurology referral' page for details of what information we require

Multiple sclerosis (MS) can cause lots of different symptoms. Most of the time, patient's symptoms are not caused by MS. Usually, if the patient and/or primary care clinicians are worried about MS, a scan will be needed and not a neurology appointment.

For more information, please visit the 'MS diagnosis and symptoms' page.