ACTRIMS-ECTRIMS MSBoston 2014: Oral Presentations

2014 Multiple Sclerosis  
Two highly experienced MS physicians address a series of highly controversial issues in the management of patients with MS, using the format of case discussions with an audience response system to enable participants to express their own opinions about management and to compare them immediately with those of their peers, as well as the faculty. The course will be very practical, particularly emphasizing treatment decisions. The faculty will address selection of specific disease-modifying
more » ... (DMT) for individual patients, emphasizing prognostic factors and risk-benefit analysis, particularly with regard to the use of natalizumab. They will also indicate their approach to the current controversy surrounding management of risk factors, including Vitamin D, smoking, and dietary factors, including salt. The course will also address the difficult decisions about when to switch DMT and what agent(s) to consider. In a discussion of progressive MS, the faculty will not only discuss the controversial use of DMTs, but will also review important areas of symptom management. Should clinicians prescribe cannabinoids for spasticity or pain? Is the use of fampridine (dalfampridine) worthwhile for gait disturbance? Is there a role for cognitive rehabilitation in patients with MS? Controversy is not confined to therapeutics alone. Diagnostic issues such as the radiologically isolated syndrome and clinically isolated syndrome will be considered. The classification of MS phenotypes as relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing, widely used for nearly 20 years, has recently been revised. The faculty will bring course participants up to speed on this brand new schema. By the end of the course, participants will have gained greater understanding of these areas of clinical controversy. They will have made their own decisions and seen how these compare with those of their peers and of the faculty. Registrants will have better insight into the nuances of DMT selection, the new diagnostic classification, and specific symptom management. They will also gain greater understanding of which clinical areas have more controversy than consensus and vice versa. The 2010 McDonald diagnostic criteria for MS allow us to be able to diagnose MS accurately and more rapidly than in the past with fewer clinical attacks and fewer MRIs. This has created the opportunity to treat patients with disease-modifying therapy (DMT) early in their disease course. Clinically isolated syndrome (CIS) is a central nervous system demyelinating event isolated in time that is compatible with the possible future development of MS. Patients that present with a CIS raise challenging questions regarding when to initiate therapy. Early risk stratification for conversion to MS helps with treatment decisions. Several clinical trials of DMTs in CIS patients have shown that four of the firstline injectable DMTs delay the conversion to clinically definite MS (CDMS) and reduce the number of new MRI lesions. This has encouraged some neurologists to recommend initiating DMTs for CIS patients. We will review the current definitions of CIS and CDMS, possible neurodiagnostics that can assist in risk stratification, and the evidence demonstrating possible benefits DMTs may afford both groups of patients. We will also consider the possible risks doctors and their patients take on with early DMT initiation. TC2.2 Choosing the right treatment for the right patient RJ Fox 1 Despite few head-to-head comparison treatment trials, the comparability of many long-term MS disease modifying agents is emerging, which in turn is helping to guide treatment choice. Patients need to develop appropriate expectations regarding the anticipated benefits of therapy. Despite apparent differences in efficacy at the population level, predictors of treatment response at the individual patient level are generally lacking. However, risk stratification has become an important component in choosing treatment in individual patients. Risk mitigation strategies can be used to reduce the chances of many serious complications associated with MS disease modifying therapies. Risk mitigation includes assessments prior to treatment initiation and over the course of treatment. With the ultimate goal of personalized disease management, risk mitigation has become an important aspect of MS care with current medications, and its importance is expected to continue as new
doi:10.1177/1352458514547850 pmid:25205046 pmcid:PMC4244174 fatcat:slfrrcwtozbfldgoio6kgacvgm