Multiple Sclerosis: A Family Practice Perspective

Multiple sclerosis (MS) is a chronic disease that predominately attacks the myelin sheath of the central nervous system. Demyelination occurs often along with scarring at multiple sites throughout the central nervous system. Multiple sclerosis may produce mild symptoms such as numbness, tingling, or changes in writing patterns or other times with severe symptoms such as loss of vision or paralysis. Patients with MS are often seen first by primary care physicians and may have only a few subtle symptoms. The diagnosis of MS made by the primary care physician is done with a high index of suspicion and managed with the aid of neurology consultation. A diagnosis of MS is frightening news to the patient and their loved ones and often provokes a variety of emotional responses. An understanding of these responses can be of tremendous benefit to primary care physicians who are often first to break the news to the patient about the diagnosis. Patient’s thoughts are blocked after hearing this sad news. It becomes the duty of the primary care physician to discuss plans for long term care of the patient considering an integrative and bio-psycho-social approach to care for the individual. Patients and family members should be encouraged to document concerns and instructions to prepare for each medical appointment with any member of their healthcare team. This manuscript discusses MS from a family practice perspective with the case history of a patient who presented with only complaints of difficulty writing and typing with the right hand. An extensive workup proved a diagnosis of MS. The patient was managed in consultation with a neurologist. Care from the primary physician provided the patient not only neurological management but also general medical, psychological, and social needs as well.