Palliative Care in Multiple Sclerosis

This article reviews palliative care concepts valuable to neurologists caring for people with multiple sclerosis (MS), describes the three stages of palliative principles in care delivery, and suggests triggers to refer for specialized palliative care interventions.

Advances in disease-modifying therapies have extended life expectancy and reduced disability progression in patients with multiple sclerosis. However, palliative care remains underutilized in addressing persistent symptoms, care partner burden, and psychosocial challenges.

Palliative care strategies in MS can be divided into three stages: early-stage palliative care needs and screening after diagnosis; midstage palliative care needs, including symptom management and quality-of-life optimization; and late-stage palliative care needs, including managing severe MS and end-of-life care. Additional foci of specialist palliative care may include end-of-life care, advance care planning, care partner support, and patient consideration of medically assisted death. Neurologists, neurology care teams, and primary care providers can serve as generalist palliative care providers, with referral to specialist palliative care teams when needed. Patient-reported outcome measures and screening symptom scales can aid in the periodic assessment of people with MS and their care partners.