Current RMA Instruments
| Reasonable Hypothesis SOP | 11 of 2020 |
| Balance of Probabilities SOP | 12 of 2020 |
Changes from previous instruments
ICD Coding
- ICD-9-CM Codes: 340
- ICD-10-AM Codes: G35
Brief description
Multiple sclerosis is an immune-mediated demyelinating disease of the central nervous system, typically affecting young to middle aged adults. It causes a range of symptoms, such as muscle weakness, numbness and changes in vision. The course of the disease is highly variable, but there are often episodes (attacks) of symptoms with partial or complete recovery periods in between.
Confirming the diagnosis
The diagnosis can be relatively straightforward in people who present with typical symptoms and have characteristic MRI findings. In such people the diagnosis may be made at the time of the first attack. In others the diagnosis can be difficult and may be delayed. A range of addition investigations may be performed, particularly to rule out other causes for the presentation. Specialist diagnosis will be routine for this condition.
The relevant medical specialist is a neurologist.
Additional diagnoses covered by SOP
- Disseminated sclerosis
Conditions not covered by SOP
- clinically isolated syndrome#
- radiologically isolated syndrome#
- neuromyelitis optica#
- acute disseminated encephalomyelitis#
- Marburg disease#
- Balo concentric sclerosis#
- Schilder disease#
# Non-SOP condition
Clinical onset
The most common presentation is a young adult with one or more distinct episodes of central nervous system dysfunction, with at least partial recovery. Motor symptoms can include weakness, visual changes, gait disturbance and balance problems. Sensory symptoms (e.g. numbness) tend to involve the face and limbs. Diagnois requires both clinical manifestations and imaging findings, but onset may be backdatable to when just clinical manifestations, or just radiological changes (found incidentally) were first noted.
Clinical worsening
The condition can follow a relapsing/remitting course, or be progressive. The tendency is for a relapsing pattern in the early years, then a progressive decline later on. The rate of worsening is slow in most patients. Worsening may be evidenced by an increase in the frequency or severity of relapses, or an increase in the rate of progression. Disease modifying therapy is now available for multiple sclerosis.