Practical consultations: multiple sclerosis

People with multiple sclerosis (MS) are increasingly referred for specialty care to tertiary centers, particularly for advice regarding initiation and monitoring of immunomodulatory therapies. However, the generalist must still be able to apply appropriate skills and technology to diagnose the disease and its complications, provide basic counseling of patients, and be aware of potential treatment options at the time of diagnosis and when therapeutic regimens fail. A general approach, supported by evidence where possible, to common and contemporary clinical issues in MS care is provided in a case-based narrative.