1. NICE MS Clinical Guideline (CG186) Does it help or not?
Amy Bowen MA (RN)
Director of Service Development
10th October 2014

2. A few words about process An overview of the Guideline
Priorities for implementation
Key recommendations
A Critique of the Guideline
Where it helps
Where it doesn’t
Implications for future research

4. Process 2003 2014 Scope distilled to 18 questions posed to the GDG
No comprehensive description of best practice
RCTs
No consensus expert opinion
MS only
2014
Covered all components of health care along MS journey
Comprehensive description of best practice
Evidence graded A-D
Consensus expert opinion
Similar conditions

6. Priorities for implementation:
Diagnosis
Refer suspected MS to a neurologist
McDonald criteria
Information
Oral and written info at the time of diagnosis
F2f f/u with a HP with expertise in MS within 6 weeks of dx
Coordination of Care
Use a multidisciplinary approach
Neurologists
MS nurses
Physios and OTs
SLT, Psych, dieititians, social care, continence specialists
GPs
Non-pharmacological tx
Consider supervised exercise programmes for mobility and/or fatigue
Tx of relapses
Oral methylprednisolone 0.5g for 5 days
(talk to a specialist before tx of relapse)

7. Other Headlines No to Annual comprehensive review
Sativex
Fampyra
Annual comprehensive review
Symptoms
Disease course
General health
Social activity and participation
Care and carers
Single Point of Contact
Flu vaccine

8. How it helps
Potential to significantly improve diagnosis and experience in early phase
Opportunity to improve equity in some important aspects of care
Recognises role and importance of family members
More mention of cognitive problems and referral to OT or neurpsychology

9. How it doesn’t help
Weak or silent on many vital non-pharmacological interventions
Weak on MS specialist nurses and AHPs with expertise in MS
Silent on transition to SPMS
Implication that what isn’t there doesn’t matter
? Overly medical
Sativex and Fampyra

11. Key Research Recommendations
Cognitive rehab
What is the clinical and cost effectiveness of cognitive rehab?
Continued relapses
Is IV methylpred more clinically and cost-effective than oral?
Mobility
What is the optimal frequency, intensity and form of rehab for mobility problems?

12. Key Research Recommendations
Spasticity
What non-pharmacological interventions are effective in reducing spasticity
Vitamin D
Can Vit D slow progression?

13. So, who is saying what…