Our MS services 

Demyelinating diagnostic clinic (DDC)

This consultant neurologist-led clinic is held twice per month for people with suspected MS. The clinic involves two appointments: one for assessment and tests, and a follow-up to receive test results and diagnosis.

Patients coming to the clinic will also see specialist MS nurses and have tests such as MRI scans, blood tests and brain electrical activity measurements (visual evoked potentials) on the same day.

Nurse-led clinics

Our team of specialist MS nurses run clinics which primarily focus on managing medication referred to collectively as Disease Modifying Drugs (DMDs) They also provide a wide range of information and advice including:

  • Information about MS or details on first-line disease modifying medication for newly diagnosed patients
  • Education for second-line medication candidates
  • DMD initiation clinic that starts patients on injectable treatments

Follow-up clinics vary according to which DMD a patient is taking, but can focus on:

  • Update of clinical tests such as blood tests and vital signs
  • Follow up assessments to assess how treatment is going

Relapse clinic

The relapse clinic is led by one of our specialist consultants and a specialist nurse. It is a rapid access clinic, offering treatment from the onset of symptoms. Patients go either to the day-care unit and receive medication via intravenous drip or are given tablets which can be collected from the hospital pharmacy.

Post-relapse telephone clinic

The purpose of this nurse-led clinic is to find out if the steroids have worked, if you are feeling better or if there is anything else we need to do. It’s also an opportunity for patients to tell us about their experience of our service.

Multi-disciplinary clinics

Sometimes, people living with MS need to see more than one health professional at a time. To avoid you having to come for lots of individual appointments we have created a multi-disciplinary clinic where all of the healthcare professionals are present and can work together with you to design a treatment plan.

Spasticity clinic

This is a weekly face-to-face clinic staffed by a consultant neurologist, a clinical specialist in physiotherapy and a clinical nurse specialist in spasticity management.

The spasticity team see adults with any neurological condition and spasticity. Most patients are referred from other specialists either within NHNN, from other hospitals or directly from their GPs.

At the end of the clinic appointment the team will discuss their recommendations with the patient. There are many different possible outcomes to an assessment including advice on trigger and aggravating factors, medication, treatment with Botulinum toxin, outpatient physiotherapy, community rehabilitation team input or inpatient rehabilitation at NHNN.

An admission to NHNN will be arranged for some patients for further assessment and trial of Intrathecal Phenol or Baclofen.

A spasticity management nurse specialist is available to discuss any management issues in the clinic and also by telephone to aid in decision making about future therapeutic interventions.

Physiotherapy

MS physiotherapists support patients through:

  • Assessing difficulties patients may be having with movement, strength, mobility and balance
  • Giving advice about ways to improve or maintain functional ability
  • Giving advice on what exercises may be of benefit to help guide self-management techniques
  • Giving advice on any equipment that may be of help, such as splints and walking aids
  • Exploring options for on-going physiotherapy and exercise as required
  • Making referrals to other health professionals, if required

Occupational Therapy

Occupational therapists support individuals to achieve participation in daily activities that are relevant and meaningful to them. This includes:

  • Analysing how well patients can perform everyday tasks
  • Assisting individual patients to adapt the way an activity is done
  • Identifying environmental modifications and equipment
  • Educating and advising on appropriate alternative activities or occupations
  • Assisting an individual to resume their daily routine following a relapse
  • Referring to external agencies such as social services, the Access to Work scheme, wheelchair services or local rehabilitation teams.

Vocational Rehabilitation

Vocational rehabilitation provides help and support with aspects that people with MS sometimes find difficult at work.

These can include disclosure about your diagnosis, asking for reasonable adjustments and education for colleagues around the condition.

We can write letters of support and also come and meet your line manager, human resources department or any other relevant person/s. The ultimate goal is to work with you and your employers to optimise your working potential.

You can be referred by your GP or by a health professional within UCLH.

The team consists of consultant neurologists, clinical psychologists and occupational therapists

  • The consultant neurologist will review your diagnosis. They will look at how this impacts on your work
  • The clinical psychologist will identify any changes in your thinking skills and how these may be supported at work. They can also offer help with developing coping strategies and any mood difficulties
  • The occupational therapists will provide practical support. They will look at things such as returning to work after time off, negotiating adjustments in the work place and managing fatigue and other physical difficulties

Recommendations to physiotherapists or a speech and language therapist are made if an assessment shows this would be beneficial.

Neuro-psychology services

This service provides highly specialised neuro-psychological assessment of cognitive function which may be affected by MS, strategies for managing or compensating for deficits and appropriate psychotherapeutic intervention. There are four main components to the service:

  1. Neuro-psychology: The diagnostic neuropsychology service involves a detailed assessment of cognitive functions such as memory, language, perception, planning and attention. Usually an assessment takes approximately 1½ hours
  2. Individual feedback sessions: Feedback for patients and relatives in individual sessions addressing psycho-educational issues related to neuropsychological consequences of MS as well as specific strategies to reduce the impact of memory and attention and other cognitive disorders on daily living are provided
  3. Cognitive Behavioural Therapy (CBT): Following an initial assessment, CBT offers emotional support to people with Multiple Sclerosis. CBT is a short-term, goal-focused individual therapy which looks at the relationship between thoughts, feelings and behaviours. CBT is particularly helpful for adjustment to recent diagnosis of MS or for management of anxiety or depression
  4. Supportive psychotherapy: This can take the form of:
  • Group-based intervention which consists of eight two-hour sessions and addresses issues associated with adjusting to living with MS including: adjustment; symptom management; cognitive skills; managing stress and mood; and relationships; and preparing for the future
  • Individual psychotherapy for adjustment to a diagnosis of MS
  • Introduction to Mindfulness, which is the practice of paying attention, in a particular way, on purpose in the present and non-judgmentally. Mindfulness has shown to be of benefit to people coping with MS and to help prevent relapses in depression
  • Liaising with support services for self-help and to appropriate local services as well as establishing ways of accessing support in the future

Neuro-psychiatry service

Neuro-psychiatry is a medical specialty which has a role in the diagnosis and pharmacological treatment of moderate to severe mood disorders associated with MS.

We offer general and specialised outpatient clinics, inpatient admissions and a consultation-liaison.

Where appropriate, Cognitive Behavioural Therapy (CBT) or drug treatments may be offered.

In more complex cases, a multidisciplinary inpatient rehabilitation programme is available.

Neuro-gastroenterology service

We understand what a burden bowel symptoms can be for MS patients. Gastroenterology aims to treat these bowel symptoms, and is based jointly at the NHNN and University College Hospital which is located at Euston Road. This treatment is dependent on a detailed assessment which entails a clinic session and sometimes some (painless) testing of gut nerve function. With this information a treatment plan is devised.

A range of treatments have been proven to work once the specific problems of an individual’s bowel symptoms are understood. This range of treatments includes:

  • Diet and laxative manipulation
  • Pelvic floor and bowel retraining (biofeedback)
  • Transanal irrigation
  • Neuromodulation
  • Surgery

Not all these treatments are needed. The key is to tailor treatment to the individual patient. Gastroenterology specialists work closely with the Neuro-urology unit as patients often experience both bowel and bladder symptoms.

As a research unit, patients may be invited to participate in research projects. There is no obligation to do so and care continues as normal in either case.

Neuro-urology team

Bladder symptoms are very common in MS patients and tend to be problems with storage and/or emptying. They are often easily treated or at least manageable following the right assessment, treatment and advice.

The Neuro-urology team are able to fully assess any symptoms and suggest an appropriate, individually tailored treatment course. This may involve:

  • Lifestyle changes, such as alteration to fluid intake
  • Non-pharmacological treatments, such as the learning of intermittent self-catheterization, bladder retraining or pelvic floor exercises, or Percutaneous Tibial Nerve Stimulation (PTNS)
  • Medications, such as anti-muscarinics that relax the bladder, or Botox

The team is comprised of clinical nurse specialists and consultant neuro-urologists.

Dietetics

Dieticians look at your diet to ensure you are receiving all the nutrients you need.

They offer advice for people who are losing weight, underweight or have a poor appetite. They also provide general healthy eating and weight management advice, dietary information to help with bowel symptom management and for those following alternative/complementary diets.

A dietetic assessment will entail obtaining past medical history, any medications you may be on, social history and weight history. The dietician will look at your food and drink intake from a typical day and make any relevant suggestions based upon your dietary goals.

Complementary therapies


A lot of people with MS are interested in complementary therapies.

The Royal London Hospital for Integrated Medicine (RLHIM) offers a range of complementary therapies including help with pain and spasticity.

Planned telephone review

Some people with MS are happy to remain under annual review with their consultant neurologist. On occasion we may agree to have a telephone assessment during the year to catch up and make sure that things are still going to plan.

If things are not goin to plan the MS Nurse can bring your annual appointment forward.

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