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Background: The MSIS-29 measures the physical and psychological impact of MS. Objective: The associations between MSIS-29 domains and demographic/clinical aspects were examined and trajectories analysed over time. Methods: Data were collected in the Trajectories of Outcome in Neurological Conditions study for a diverse population of people with MS, with follow-up for up to 5 years. Following Rasch analysis, minimal important change (MIC) was computed for ensuing total, physical and psychological domains. Results: Fit to the Rasch model using data from 5921 participants validated physical, psychological and total domains, and the conversion table transforms raw scores to interval-level metric equivalents. These domains showed significant differences across demographic (age, gender, employment, education, and marital status) and clinical (subtype, treatment, and duration) factors with large effect sizes. The MIC scores were physical: 9.1, total: 14.1, which were both above measurement error, and psychological: 5.5 which was not, so 1.6% of participants reported psychological change which was clinically important but not statistically significant. Trajectory analysis showed three groups, one stable and two with significant slopes, improving and deteriorating. Conclusion: The MSIS-29 has shown adequate fit to the Rasch model after accommodating problems with local item dependency, through a bi-factor solution. The domains showed good discrimination across key factors. [ABSTRACT FROM AUTHOR]

Background: Dimethyl fumarate (DMF) has a favorable benefit–risk profile treating people with multiple sclerosis and should be used in pregnant women only if the potential benefits outweigh potential risks to the fetus. Objective: Assess pregnancy outcomes in a completed international registry (TecGistry) of women with MS exposed to DMF. Methods: TecGistry included pregnant women with MS exposed to DMF, with data collected at enrollment, 6–7 months gestation, 4 weeks after estimated due date, and at postpartum weeks 4, 12, and 52. Outcomes included live births, gestational size, pregnancy loss, ectopic/molar pregnancies, birth defects, and infant/maternal death. Results: Of 397 enrolled, median (range) age was 32 years (19–43). Median (range) gestational week at enrollment was 10 (0–39) and at first DMF exposure was 1 (0–13). Median (range) duration of gestational DMF exposure was 5 weeks (0–40). Fifteen (3.8%) spontaneous abortions occurred. Of 360 (89.1%) live births, 323 were full term and 37 were premature. One neonatal death and no maternal deaths occurred. Adjudicator-confirmed EUROCAT birth defects were found in 2.2%. Conclusion: DMF exposure during pregnancy did not adversely affect pregnancy outcomes; birth defects, preterm birth, and spontaneous abortion were in line with rates from the general population. [ABSTRACT FROM AUTHOR]

Background: Higher education is associated with better job opportunities and higher income. Objectives: Herein, the impact of education on the uptake of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in a publicly funded health care system was examined using the UK MS Register. Methods: All adult participants with relapsing remitting MS diagnosed between 2008 and 2021 were included. Those without data regarding their education levels were excluded. Binary, multinomial and Cox regression models were used to examine the association between education levels and uptake of DMTs. Results: A total of 6317 participants fulfilled all inclusion and exclusion criteria. A total of 1826/2923 (62%) participants with a university education were treated with DMTs, compared to 1788/3394 (53%) participants with school/diploma received DMTs with an odds ratio of 1.318 (1.178–1.473). Participants with a university education were more likely to be treated with both moderate- and high-efficacy DMTs, compared to others, with odds ratios of 1.227 (1.087–1.385) and 1.545 (1.325–1.802), respectively. University education was also a positive predictor for faster initiation of DMTs, and, importantly, higher-efficacy DMTs. Conclusion: In a publicly funded health care system, despite intended equality of access, university education was associated with a higher uptake of DMTs. [ABSTRACT FROM AUTHOR]

Clinical coding uses a classification system to assign standard codes to clinical terms and so facilitates good clinical practice through audit, service design and research. However, despite clinical coding being mandatory for inpatient activity, this is often not so for outpatient services, where most neurological care is delivered. Recent reports by the UK National Neurosciences Advisory Group and NHS England's 'Getting It Right First Time' initiative recommend implementing outpatient coding. The UK currently has no standardised system for outpatient neurology diagnostic coding. However, most new attendances at general neurology clinics appear to be classifiable with a limited number of diagnostic terms. We present the rationale for diagnostic coding and its benefits, and the need for clinical engagement to develop a system that is pragmatic, quick and easy to use. We outline a scheme developed in the UK that could be used elsewhere. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is frequently diagnosed in people of reproductive age, many of whom will become pregnant following diagnosis. Although many women report an improvement in symptoms and relapses during pregnancy, symptoms such as fatigue and spasticity are commonly reported and can worsen. Prescribing medications during pregnancy and breastfeeding presents unique challenges and guidance on the use of symptomatic therapies is limited. Objectives: This paper aims to provide a consensus on the current evidence base to facilitate informed decision-making and optimise pre-conception counselling. Methods: A list of most commonly prescribed medications for symptom management in MS was created using pregnancy and MS-related READ codes in the Welsh GP Dataset, followed by a review by MS neurologists. Results: A final list of 24 medications was generated for review. Searches were performed on each medication, and evidence graded using standardised criteria. Evidence-based recommendations were developed and distributed to experts in the field and revised according to feedback using modified Delphi criteria. Conclusions: Our guidelines provide evidence-based recommendations on the safety of symptomatic therapies during pregnancy and breastfeeding for general practitioners and specialist teams working with people with MS who are hoping to embark on pregnancy or are currently pregnant. Individual risk–benefit ratios should be considered during pre-conception counselling to optimise symptom burden and minimise harm to both parent and child. [ABSTRACT FROM AUTHOR]

Neurologists increasingly use anti-CD20 therapies, including for women of childbearing age, despite these medications being unlicensed for use in pregnancy. Current evidence suggests that women can safely conceive while taking anti-CD20 therapy. Women should not be denied treatment during pregnancy when it is clinically indicated, although they should be counselled regarding live vaccinations for their infant. Women receiving regular ocrelizumab for multiple sclerosis should preferably wait 3 months before trying to conceive. There are few data around ofatumumab in pregnancy, and while there is probably a class effect across all anti-CD20 therapies, ofatumumab may need to be continued during pregnancy to maintain efficacy. We recommend that anti-CD20 therapies can be safely given while breast feeding. It is important to make time to discuss treatments with women of childbearing age to help them choose their most suitable treatment. Outcomes should be monitored in pregnancy registries. [ABSTRACT FROM AUTHOR]

Background: Coping in multiple sclerosis (MS) refers to cognitive and behavioural efforts to manage stresses imposed by the illness. Existing generic and disease-specific coping scales do not meet modern guidelines for scale development and cannot produce interval-level metrics to allow for change scores. Objective: The main aim of this study was to develop a brief patient-reported outcome measure for coping in MS, capable of interval-level measurement. Methods: Qualitative work in 43 people with MS leads to a draft scale which was administered to 5747 participants, with longitudinal collection in 2290. A calibration sample of 1000 subjects split into development and validation sets was used to generate three scales consistent with Rasch model expectations. Results: The total Coping Index-MS (CI-MS-T), CI-MS-Internal (CI-MS-I) and CI-MS-External (CI-MS-E) cover total, internal and externally focused coping. All three scales are capable of interval-level measurement. Trajectory analysis of 9000 questionnaires showed two trajectories in CI-MS-T: Group 1 showed a low level of coping with slight decline over 40 months, while Group 2 had a better and stable level of coping due to improving CI-MS-I which compensated for the deteriorating CI-MS-E over time. CI-MS-T < 30 identified group membership at baseline. Conclusion: The CI-MS-T, CI-MS-I and CI-MS-E, comprising 20 items, provide interval-level measurement and are free-for-use in not-for-profit settings. [ABSTRACT FROM AUTHOR]

Background: People with MS (pwMS) have had higher rates of anxiety and depression than the general population before the COVID-19 pandemic, placing them at higher risk of experiencing poor psychological wellbeing during the pandemic. Objective: To assess mental health and its social/lifestyle determinants in pwMS during the first wave of the outbreak in the United Kingdom. Methods: This is a community-based, prospective longitudinal cohort and cross-sectional case–control online questionnaire study. It includes 2010 pwMS from the UK MS Register and 380 people without MS. Results: The Hospital Anxiety and Depression Scale scores of pwMS for anxiety and depression during the outbreak did not change from the previous year. PwMS were more likely to have anxiety (using General Anxiety Disorder-7) and/or depression (using Patient Health Questionnaire-9) than controls during the outbreak (OR: 2.14, 95% CI: 1.58–2.91). PwMS felt lonelier (OR: 1.37, 95% CI: 1.04–1.80) reported worse social support (OR: 1.90, 95% CI: 1.18–3.07) and reported worsened exercise habits (OR: 1.65, 95% CI: 1.18–2.32) during the outbreak than controls. Conclusion: Early in the pandemic, pwMS remained at higher risk of experiencing anxiety and depression than the general population. It is important that multidisciplinary teams improve their support for the wellbeing of pwMS, who are vulnerable to the negative effects of the pandemic on their lifestyle and social support. [ABSTRACT FROM AUTHOR]

The negative impact of smoking in multiple sclerosis is well established; however, there is much less evidence as to whether smoking cessation is beneficial to progression in multiple sclerosis. Adults with multiple sclerosis registered on the United Kingdom Multiple Sclerosis Register (2011-20) formed this retrospective and prospective cohort study. Primary outcomes were changes in three patient-reported outcomes: normalized Multiple Sclerosis Physical Impact Scale (MSIS-29-Phys), normalized Multiple Sclerosis Walking Scale (MSWS-12) and the Hospital Anxiety and Depression Scale (HADS). Time to event outcomes were clinically significant increases in the patient-reported outcomes. The study included 7983 participants; 4130 (51.7%) of these had ever smoked, of whom 1315 (16.5%) were current smokers and 2815/4130 (68.2%) were former smokers. For all patient-reported outcomes, current smokers at the time of completing their first questionnaire had higher patient-reported outcomes scores indicating higher disability compared to those who had never smoked (∼10 points difference in MSIS-29-Phys and MSWS-12; 1.5-1.8 points for HADS-Anxiety and HADS-Depression). There was no improvement in patient-reported outcomes scores with increasing time since quitting in former smokers. Nine hundred and twenty-three participants formed the prospective parallel group, which demonstrated that MSIS-29-Phys [median (IQR) 5.03 (3.71, 6.34)], MSWS-12 [median (IQR) 5.28 (3.62, 6.94)] and HADS-Depression [median (IQR) 0.71 (0.47, 0.96)] scores worsened over a period of 4 years, whereas HADS-Anxiety remained stable. Smoking status was significant at Year 4; current smokers had higher MSIS-29-Phys and HADS-Anxiety scores [median (IQR) 3.05 (0.22, 5.88) and 1.14 (0.52, 1.76), respectively] while former smokers had a lower MSIS-29-Phys score of -2.91 (-5.03, -0.79). A total of 4642 participants comprised the time to event analysis. Still smoking was associated with a shorter time to worsening event in all patient-reported outcomes (MSIS-29-Phys: n = 4436, P = 0.0013; MSWS-12: n = 3902, P = 0.0061; HADS-Anxiety: n = 4511, P = 0.0017; HADS-Depression: n = 4511, P < 0.0001). Worsening in motor disability (MSIS-29-Phys and MSWS-12) was independent of baseline HADS-Anxiety and HADS-Depression scores. There was no statistically significant difference in the rate of worsening between never and former smokers. When smokers quit, there is a slowing in the rate of motor disability deterioration so that it matches the rate of motor decline in those who have never smoked. This suggests that smoking cessation is beneficial for people with multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) is a neurodegenerative disease that produces plaques throughout the central nervous system. MS can present in four different clinical courses. Of these, Relapsing-Remitting MS (RRMS) is the main clinical course, especially at early stages of the disease. Rapidly evolving severe (RES) RRMS is a form of RRMS in which an individual has two or more disabling relapses in one year and evidence of increasing lesions on two consecutive MRI scans. MS affects the cortical and subcortical pathways of the brain leading to impairment in both physical and cognitive skills. Speech, language and communication deficits more broadly, have been acknowledged in the MS literature, but relatively little research has focused on these symptoms. Aims: To examine communication deficits in people with (RES) RRMS, with specific focus on anomic symptoms – difficulties in word retrieval, examining measures of both accuracy and latency (time intervals for accurate word retrieval). Methods & Procedures: A communication screening assessment was conducted with 100 participants with (RES) RRMS. This screening assessment consisted of the ACE-R cognitive screen, a bespoke picture naming task, reading words aloud from the National Adult Reading Test (NART) and the Pyramids and Palm Trees Test. The picture naming task obtained timed naming responses for sixty pictures of objects from the International Picture Naming Project (IPNP). Results for participants with MS (PWMS) were compared to matched neurotypical control participants (n = 40) and normative test data. Outcomes & Results: The group mean performance for PWMS was below the lower end of the neuro-typical control range for the cognitive screen and picture naming tasks. The reading aloud and semantic association mean scores were within the neuro-typical range but towards the lower end of this range. Anomic symptoms for PWMS presented as both lapses in word retrieval and reduced speed of word retrieval. Word retrieval latency was on average 26% slower for PWMS. Within the anomic symptoms, there were instances of inaccuracy (42% of participants) as well as slow naming latency (31% of participants) in retrieving words. There was evidence of mild dysarthria for 33% of participants. Regression analyses suggested the anomic symptoms were most strongly associated with semantic processing deficits. Conclusions: Anomic symptoms are common in (RES) RRMS, and present as inaccuracy as well as slow word retrieval latency. The prevalence and cognitive nature of anomic symptoms require further research across the range of presentations of MS. [ABSTRACT FROM AUTHOR]

Background: Premature discontinuation and poor treatment adherence are problems in chronic conditions, such as multiple sclerosis in which patients must take long-term treatment in order to receive maximum benefit from their medication. The Assessing needs In Multiple Sclerosis (AIMS) study explored factors related to premature treatment discontinuation and patients’ experiences of subcutaneous (sc) interferon (IFN) β-1a treatment in the UK. Methods: A questionnaire-based survey was integrated into the Bupa Home Healthcare patient-support program, which delivers sc IFN β-1a to patients in their home. Data were collected via patient questionnaires incorporated into routine clinical care and administered upon registration of a new patient by the coordinator, following initial delivery of treatment, prior to each delivery during therapy and at the end of treatment. Univariate and multivariate analyses were performed to identify factors associated with premature discontinuation. Results: Data were collected from 2,390 patients (1,267 new; 1,123 existing) from 59 UK prescribing centers (November 2006–April 2011). Following the first delivery of sc IFN β-1a, 94% (1,149/1,225) of patients had received training, and 73% (818/1,120) reported that they had no concerns. In total, 24% of new patients discontinued therapy by the end of the study. In the univariate model, none of the candidate variables tested were significant predictors of treatment discontinuation. The strongest predictors of discontinuation in multivariate analyses were lack of information prior to starting treatment and patients feeling unwell on treatment and geographic region (P,0.05 for each variable). Conclusion: This study suggests that patients feeling well on treatment and provision of high-quality information are the main determinants of persistence with sc IFN β-1a therapy. A package of care that targets these issues should therefore be considered when initiating sc IFN β-1a therapy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 50-year-old who has 1-week hisory of unsteadiness and has brain stem encephalopathy. She undergo magnetic resonance imaging (MRI) scan on the brain, which revealed high signal intensity on the thoraric cord. She was diagnosed with longitudinally extensive transverse myelitis (LETM) and discovered on having Neuromyelitis optica immunoglobulin G (NMO-IgG) antibody.

The article discusses the use of first-line disease modifying treatments for the management of multiple sclerosis (MS).

• Deprivation negatively affects the access to DMTs for MS. • Living in more deprived areas reduced the likelihood of receiving DMTs for MS. • Barriers to housing and services contributed to this disparity in accessing DMTs. • Overall, effects of deprivation were small in a publicly funded healthcare system. Deprivation can impact the access to health interventions in publicly funded health systems where cost is not the dominant barrier. In this study we examined whether deprivation affected the access to disease modifying therapies (DMTs) for multiple sclerosis (MS). All English adults on the UK MS register with relapsing remitting MS who were diagnosed between 2010 and 2017, and after the age of 29 years were included. Deprivation was measured using postcode-based 2015 English index of multiple deprivation (IMD), which was divided into quintiles. A total of 1449 participants were eligible and 531/1449 (36.6%) received DMTs. Participants who lived in more deprived areas, based on their IMD scores, were significantly less likely to receive DMTs (odds ratio = 0.69, 95% Confidence interval = 0.49 to 0.98); barriers to housing and services contributed to this disparity. The Nagelkerke R2 value of these models showed that 2% of variation in accessing DMTs were dependant on deprivation. Deprivation, as measured by IMD, negatively influences the access to DMTs in England. Our findings also suggest that the lack of access to local MS DMT clinics in deprived areas may contribute to this disparity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Central neuropathic pain (CNP), pain initiated or caused by a primary lesion or dysfunction of the central nervous system, occurs in ~28% of patients with multiple sclerosis (MS). Δ9-Tetrahydrocannabinol/cannabidiol (THC/CBD), an endocannabinoid system modulator, has demonstrated efficacy for up to 4 weeks in randomized controlled trials in the treatment of CNP in patients with MS. Objective: The purpose of this extension was to establish long-term tolerability and effectiveness profiles for THC/CBD (Sativex ®, GW Pharmaceuticals plc, Salisbury, United Kingdom) oromucosal spray in CNP associated with MS. Methods: This uncontrolled, open-label trial was an indefinite-duration extension of a previously reported 5-week randomized study in patients with MS and CNP. In the initial trial, patients were randomized to placebo or THC/CBD. Patients were only required to maintain their existing analgesia in the randomized study. In the open-label trial they could vary their other analgesia as required. All patients (placebo and THC/CBD) who completed the randomized trial commenced the open-label follow-up on THC/CBD (27 mg/mL: 25 mg/mL). Patients titrated their dosage, maintaining their existing analgesia. The primary end point of the trial was the number, frequency, and type of adverse events (AEs) reported by patients. Secondary end points included changes from baseline in 11-point numerical rating scale (NRS-11) neuropathic pain score, hematology and clinical chemistry test results, vital signs, trial drug usage, and intoxication visual analogue scale scores. Results: Sixty-six patients were enrolled in the randomized trial; 64 (97%) completed the randomized trial and 63 (95%) entered the open-label extension (race, white, 100%; sex, male, 14 [22%]; mean [SD] age, 49 [8.4] years [range, 27–71 years[). The mean (SD) duration of open-label treatment was 463 (378) days (median, 638 days; range, 3–917 days), with 34 (54%) patients completing >1 year of treatment with THC/CBD and 28 (44%) patients completing the open-label trial with a mean (SD) duration of treatment of 839 (42) days (median, 845 days; range, 701–917 days). Mean NRS-11 pain scores in the final week of the randomized trial were 3.8 in the treatment group and 5.0 in the placebo group. In the 28 (44%) patients who completed the 2-year follow up, the mean (SD) NRS-11 pain score in the final week of treatment was 2.9 (2.0) (range, 0-8.0). Fifty-eight (92%) patients experienced ≥1 treatment-related AE. These AEs were rated by the investigator as mild in 47 (75%) patients, moderate in 49 (78%), and severe in 32 (51%). The most commonly reported AEs were dizziness (27%), nausea (18 %), and feeling intoxicated (11%). Two treatmentrelated serious AEs (ventricular bigeminy and circulatory collapse) were judged to be treatment-related. Both serious AEs occurred in the same patient and resolved completely following a period of discontinuation. Eleven (17%) patients experienced oral discomfort, 4 persistently. Regular oral examinations revealed that 7 (11%) patients developed white buccal mucosal patches and 2 (3%) developed red buccal mucosal patches; all cases were deemed mild and resolved. Seventeen (25%) patients withdrew due to AEs. The mean number of sprays and patients experiencing intoxication remained stable throughout the follow-up trial. Conclusions: THC/CBD was effective, with no evidence of tolerance, in these select patients with CNP and MS who completed ∼2 years of treatment (n = 28). Ninety-two percent of patients experienced an AE, the most common of which were dizziness and nausea. The majority of AEs were deemed to be of mild to moderate severity by the investigators. [Copyright &y& Elsevier]

Background: Teriflunomide is a once-daily oral immunomodulator approved for the treatment of relapsing forms of multiple sclerosis (MS) or relapsing-remitting MS (RRMS), depending on the local label. Objectives: To assess the long-term efficacy and safety of teriflunomide in patients with RRMS stratified by disease duration. Methods: This was a pooled efficacy and safety analysis using data from the phase 2 study (trial registration: NCT01487096) and the phase 3 TEMSO (NCT00134563, NCT00803049), TOWER (NCT00751881), and TENERE (NCT00883337) core and extension studies. Patients receiving placebo or teriflunomide 14 mg were stratified by disease duration at baseline (≤1 year, >1 to 5 years, >5 to 10 years, and >10 years). Study end points included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score, 6-month confirmed disability worsening (CDW), and safety. Results: In the core period, ARR was lower in patients treated with teriflunomide 14 mg compared with placebo across disease duration subgroups: ≤1 year (0.33 [n = 272] vs 0.56 [n = 251], P = .0013), >1 to 5 years (0.46 [n = 278] vs 0.70 [n = 268], P = .0011), >5 to 10 years (0.39 [n = 191] vs 0.52 [n = 164], P = .0571), and >10 years (0.33 [n = 154] vs 0.58 [n = 129], P = .0005). In the core+extension period (up to year 13), ARRs in teriflunomide-treated patients were similar regardless of disease duration: ≤1 year (0.19; n = 276), >1 to 5 years (0.22; n = 699), >5 to 10 years (0.26; n = 393), and >10 years (0.25; n = 325). At year 13, 6-month CDW rates for each group were 48.3% (≤1 year), 37.1% (>1 to 5 years), 52.6% (>5 to 10 years), and 36.8% (>10 years). From core study baseline to year 10 (the last time point at which all groups had at least 10 patients), EDSS scores were stable across teriflunomide-treated patients of different disease durations: ≤1 year, +0.27; >1 to 5 years, +1.11; >5 to 10 years, +0.05; and >10 years, +0.7. Overall incidences of adverse events through year 13 were 93.1% (≤1 year), 87.2% (>1 to 5 years), 88.0% (>5 to 10 years), and 88.7% (>10 years); incidences of serious adverse events during this period were 21.2% (≤1 year), 19.1% (>1 to 5 years), 15.5% (>5 to 10 years), and 18.0% (>10 years). Conclusions: Teriflunomide 14 mg reduced relapses across all patients regardless of disease duration vs placebo in the core studies. Over 13 years, ARR remained low and EDSS score increased minimally. Safety outcomes from baseline to year 13 were consistent across disease duration subgroups. [ABSTRACT FROM AUTHOR]

• We performed a nationwide survey in order to assess the impact of the UK MS pregnancy guidelines and variation in practice across the UK. • The survey consisted of 27 questions about MS management and disease modifying treatment (DMT) prescribing prior to and during pregnancy. • We were able to obtain responses from a significant number of MS specialists from across the UK. • Whilst practice is evolving, significant variation is still seen between neurologists regarding treatment of MS in pregnancy. There is a need to continually update and communicate guidelines, particularly as recommendations change with increasing evidence. The ABN Multiple Sclerosis (MS) pregnancy guidelines set out to combine best current evidence with expert consensus. They were developed to provide a practical framework to support neurologists when counselling women with MS regarding pregnancy. A key objective was to reduce variation in practice and increase clarity for patients in an area of uncertainty. In order to assess the impact of these guidelines on practice, and assess ongoing areas of need, we conducted an online survey about MS and pregnancy. This survey was cascaded via email to UK neurologists between December 2019 and January 2020. Individuals completed this questionnaire anonymously. The majority of respondents reported changing their prescribing practice with interferon-beta preparations (IFN-B) and natalizumab. The ABN guidelines were the most commonly cited reason for change (76%). However, there was considerable variation in advice regarding the use of both DMTs in pregnancy. There is substantial variation in advice given to women with MS around pregnancy, and this is reflected in prescribing practice by UK Neurologists. Awareness of national guidelines is good, and these have driven change in a majority of MS neurologists. There remains the need to continually update and communicate these guidelines, particularly as recommendations evolve with increasing evidence. [ABSTRACT FROM AUTHOR]