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Rated a Top 10 free iPhone app by iMedicalApps
 
Neurology
Multiple Sclerosis Edition
Table of Contents  |  CME Information  | Technical Requirements  | Login
  /2023/iPhoneAd/2023iPhoneAd.gif [true]
Chapter 1
Multiple Sclerosis Basics

Last Updated: April 25, 2013
Chapter 2
MRI and New Imaging Technologies in Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 3
Currently Available Treatments for Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 4
Small-Molecule Treatments In Development for Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 5
Monoclonal Antibodies in Development for Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 6
Managing Symptoms in Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 7
Prognostic Factors in Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 8
Improving Immunosuppression and Immunomodulation Treatment Strategies in Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 9
Neuroprotection and Neuroregeneration in MS

Last Updated: April 25, 2013
Chapter 10
Complementary and Alternative Medicine in Multiple Sclerosis

Last Updated: April 25, 2013
Chapter 11
Adherence and Compliance in Multiple Sclerosis: Understanding Challenges and Implementing Solutions

Last Updated: April 25, 2013
Chapter 12
Cognitive Impairment in Multiple Sclerosis: Early Detection and Management

Last Updated: April 25, 2013
Chapter 13
Genetics of Multiple Sclerosis: Implications for MS Susceptibility, Prognosis, and Treatment Response

Last Updated: April 25, 2013

iPhone App



 
Table of Contents

Chapter 13 - Genetics of Multiple Sclerosis: Implications for MS Susceptibility, Prognosis, and Treatment Response

In the past 5 years, technological advances, especially identification of single nucleotide polymorphisms and the ability to genotype them efficiently in large numbers of patients, have improved our ability to associate genes with disease. Genome-wide association studies have identified multiple genetic variants associated convincingly with susceptibility to multiple sclerosis (MS). The association of genetic variants with disease course has only recently been studied and will undoubtedly be the subject of further investigation. In parallel with efforts in other diseases, pharmacogenomics has been applied to analysis of treatment response in MS. Another emerging area of interest is the study of how susceptibility genes and environmental risk factors interact. In the future, these avenues of research may personalize care of MS patients. In Chapter 13 of the Living Medical eTextbook, Brian G. Weinshenker, MD, FRCP, discusses the state-of-the-science in this rapidly evolving field, explaining new methodologies and the current data in MS.
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Chapter 12 - Cognitive Impairment in Multiple Sclerosis: Early Detection and Management

Cognitive impairment (CI) is a common symptom of multiple sclerosis, and the magnitude of its impact on functional disability is significant. What factors can be considered relevant to its prognosis? How can cognitive functioning be measured in a reliable but practical and time-efficient manner? What, if any, effect does disease-modifying treatment have on progression of CI? Are symptomatic treatments—both pharmacologic and nonpharmacologic—of any benefit? In this chapter, Ralph H. B. Benedict, PhD, explores these issues in a review of the current data.
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Chapter 11 - Adherence and Compliance in Multiple Sclerosis: Understanding Challenges and Implementing Solutions

Poor adherence to disease-modifying therapies (DMTs) is common in patients with multiple sclerosis, and can lead to increased rates of relapse and hospitalization. In this chapter of the Living Medical eTextbook Neurology: Multiple Sclerosis Edition, Bruce A. Cohen, MD, reviews factors that contribute to nonadherence and presents various strategies that providers can use to address and improve adherence in their patients. He also comments on the potential impact of new and emerging oral and intravenous DMTs on adherence.
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Chapter 10 - Complementary and Alternative Medicine in Multiple Sclerosis

Complementary and alternative medicine (CAM) is widely used among patients with multiple sclerosis (MS). How knowledgeable are you about CAM and its potential effects—both beneficial and adverse—in MS? In this chapter, Dennis Bourdette, MD, gives an overview of some of the more popular CAM therapies used by MS patients and describes the importance of communicating with patients about CAM.
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Chapter 9 - Neuroprotection and Neuroregeneration in MS

The primary goal of treatment for multiple sclerosis (MS) is to improve or at least maintain function by healing and protecting vulnerable neurons. Is neuroprotection—or, better yet, neuroregeneration—an achievable goal in MS? What protection do available and emerging MS therapies offer with regard to reducing or reversing axonal damage? Are there uniquely neuroprotective therapies on the horizon? What role is stem cell therapy likely to play? How is neuroprotection best defined and measured? This chapter of the MS Living Medical eTextbook addresses these questions and reviews the current state of knowledge on this important topic.
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Chapter 8 - Improving Immunosuppression and Immunomodulation Treatment Strategies in Multiple Sclerosis

In multiple sclerosis (MS), disability accrues during both acute inflammatory events and progressive phases of disease. In short to intermediate-term studies, suppression of acute inflammatory events reduced the risk of disability progression in MS. Therefore, early recognition of suboptimal response to disease-modifying therapy (DMT) and prompt intervention may limit future impairment. This chapter of the MS Living Medical eTextbook focuses on how to recognize suboptimal response and considers the timing of switching DMTs. Novel strategies for immunosuppression/immunomodulation, such as induction regimens, combination therapies, and alternative dosing are also discussed.
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Chapter 7 - Prognostic Factors in Multiple Sclerosis

Prognostic factors can be useful tools for making treatment decisions, guiding the choice of when to use more aggressive therapeutic agents and when/whether to change treatments in multiple sclerosis (MS). In this chapter of the MS Living Medical eTextbook, learn about clinical, genetic, radiologic, and laboratory factors that predict conversion from clinically isolated syndrome to clinically definite MS, future disability, and response to treatment.
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Chapter 6 - Managing Symptoms in Multiple Sclerosis

Many patients with multiple sclerosis (MS) live with symptoms that can increase disability and reduce quality of life. Clinicians should review and address these symptoms at each visit to ensure a comprehensive approach to the management of MS. This chapter of Living Medical Textbook Neurology: Multiple Sclerosis Edition reviews the management of a number of common symptoms: spasticity, gait impairment, fatigue, cognitive impairment, depression, and bladder dysfunction.
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Chapter 5 - Monoclonal Antibodies in Development for Multiple Sclerosis

Monoclonal antibodies (mAbs) targeting specific cell-surface molecules on immune system cells have proven to be a successful strategy for development of novel treatments for multiple sclerosis (MS). mAbs currently in late-stage development offer the potential for increased efficacy and more convenient dosing schedules, and are helping to expand knowledge of MS pathogenesis. In this chapter of the Living Medical Textbook: Multiple Sclerosis Edition, Dr. Clyde Markowitz describes the mechanism of action, efficacy, and safety profile of mAbs in late-stage clinical trials.
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Chapter 4 - Small-Molecule Treatments In Development for Multiple Sclerosis

Improved understanding of multiple sclerosis (MS) pathophysiology has led to identification of new targets and development of numerous new therapies. Small molecules offer the potential for the imminent introduction of oral therapies into the armamentarium for MS. In this chapter of Living Medical eTextbook: Multiple Sclerosis Edition, Dr. Clyde Markowitz reports on a number of emerging MS therapies in development, focusing on study data, mechanism of action, and side effects of each agent.
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Chapter 3 - Currently Available Treatments for Multiple Sclerosis

Dr. Cohen provides an up-to-date account of available therapies for treating acute relapse and use of disease-modifying therapies to prevent relapse and disease progression. He describes the mechanism of action, efficacy, safety, dosing, and administration of each therapy. Comparative data are considered, along with individualized patient factors that should influence choice of initial therapy. Dr. Cohen also discusses candidacy for treatment and timing of therapy, including the latest data on the merits of initiating therapy in patients with clinically isolated syndrome.
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Chapter 2 - MRI and New Imaging Technologies in Multiple Sclerosis

MRI is the primary imaging technology used in the diagnosis and monitoring of multiple sclerosis (MS). This second chapter of the MS Living Medical eTextbook reviews how to interpret conventional MRI and discusses current thinking on the use of serial MRI to monitor MS patients and how the findings should influence management. The 2009 update to the Consortium of Multiple Sclerosis Centers standardized protocol, which facilitates comparison of serial MRIs, is discussed. This chapter also covers emerging imaging technologies that may eventually complement conventional MRI, including atrophy measures, magnetic resonance spectroscopy, magnetic transfer ratios, diffusion tensor imaging, and susceptibility weighted imaging, among others.
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Chapter 1 - Multiple Sclerosis Basics

Multiple Sclerosis Basics is the first chapter of a Living Medical eTextbook on the comprehensive management of multiple sclerosis (MS). In this chapter, Scott Zamvil, MD, provides a broad overview of current thinking and controversies regarding the etiology, pathogenesis, classification, and diagnosis of MS. Hyperlinks throughout the chapter lead the reader to more detailed and specific information on these topics from a variety of sources on the Internet in a multitude of formats. The discussion of immunopathogenesis and disease course of MS in this chapter sets the stage for subsequent chapters of this book, which focus on current and emerging MS therapies, including their mechanisms of action, efficacy, and safety.
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CME INFORMATION

ACTIVITY GOAL
The goal of this CME/CE activity is to examine the pathophysiology, etiologic factors, classification, diagnostic criteria, and current and emerging strategies for treating and managing patients with multiple sclerosis.
  

TARGET AUDIENCE
This CME/CE activity is designed for neurologists, internal medicine specialists, family practice/primary care physicians, nurse specialists/nurse practitioners, physician assistants, and pharmacists who interact with and are involved in the management and treatment of patients with multiple sclerosis.
  

LEARNING OBJECTIVES
  • Analyze the contributions of proposed etiologies and pathogenetic processes in multiple sclerosis (MS) based on current data in order to appropriately counsel patients and form the basis of an understanding of potential therapeutic targets.

  • Diagnose and classify MS in patients with neurologic symptoms, using clinical, radiologic, and other tools, in accordance with the modified McDonald Criteria.

  • Use conventional MRI to accurately diagnose and monitor MS in accordance with a standardized protocol from the Consortium of MS Centers.

  • Evaluate new imaging technologies to determine their potential future utility in diagnosis and monitoring of MS patients.

  • Formulate strategies to manage major acute relapses of MS that will shorten the duration of the exacerbation and minimize disruption of the patient’s life, while minimizing the risk of adverse effects.

  • Choose a disease-modifying therapy for patients with MS based on mechanism of action, efficacy, safety, dosing/administration, and individual patient-related factors, in order to reduce the occurrence of relapses and minimize progression of disability.

  • Initiate disease-modifying therapy in patients with clinically isolated syndrome likely to convert to MS in order to prevent or delay conversion to clinically definite MS.

  • Evaluate small-molecule therapies for MS based on the most current information regarding efficacy, safety, dosing/administration, and mechanism of action, to determine their potential role in future MS therapy.

  • Evaluate monoclonal antibodies for MS based on the most current information regarding efficacy, safety, dosing/administration, and mechanism of action to determine their potential role in future MS therapy.

  • Integrate management of MS symptoms relating to mobility, cognitive/emotional state, and bladder function into the overall care of MS patients in order to reduce disability and improve quality of life.

  • List reported prognostic factors for disease progression, disability, and response to therapeutic interventions and consider their application to facilitate optimization of individual treatment intervention in multiple sclerosis.

  • Assess and manage suboptimal response to disease-modifying therapy in patients with multiple sclerosis (MS).

  • Evaluate strategies for improving immunosuppression/immunomodulation in MS patients who have an aggressive disease course or suboptimal response to first-line treatments.

  • Evaluate methods of measuring neuroprotective activity of therapeutic agents in multiple sclerosis (MS) in order to recognize their strengths and limitations.

  • Assess the neuroprotective potential of current and emerging MS therapies, novel agents, and stem cell therapy based on available in vitro, in vivo, and clinical data.

  • Assess complementary and alternative therapies in multiple sclerosis to determine their role in the practice setting.

  • Examine barriers faced by MS patients in complying with disease-modifying therapies and implement strategies to overcome these challenges.

  • Evaluate the potential impact and challenges of new and emerging therapies on adherence and compliance.

  • Evaluate the problem of cognitive impairment in MS and recognize the importance of early detection.

  • Describe strategies to identify and quantify cognitive impairment and its impact on disability in MS

  • Address the management of cognitive impairment in MS and assess the potential impact of current and emerging treatments on cognition.

top2023
 
 
Projects In Knowledge®

Peer Reviewed

These independent CME/CE activities are supported by an educational grant from Teva Neuroscience.

Teva


EDITORIAL BOARD

EDITOR-IN-CHIEF
Bruce A. Cohen, MD
Bruce A. Cohen, MD
Professor
Davee Department of
Neurology and
Clinical Neurosciences
Feinberg School of Medicine
Northwestern University
Chicago, Illinois
 
CONTRIBUTING EDITOR
Ralph H. B. Benedict, PhD
Ralph H. B. Benedict, PhD
Professor of Neurology, Psychiatry
  and Psychology University at Buffalo
Buffalo General Hospital
Department of Neurology
Buffalo, New York
 
CONTRIBUTING EDITOR
Dennis N. Bourdette, MD
Dennis N. Bourdette, MD
Chair and Roy & Eulalia Swank Family Research Professor
Oregon Health & Science University
Portland, Oregon
 
CONTRIBUTING EDITOR
Bruce A. C. Cree, MD, PhD, MCR
Bruce A. C. Cree, MD, PhD, MCR
Assistant Professor of Clinical Neurology
Department of Neurology
University of California—
   San Francisco
San Francisco, California
 
CONTRIBUTING EDITOR
Clyde E. Markowitz, MD
Clyde E. Markowitz, MD
Associate Professor of Medicine
Director, Multiple Sclerosis
 Center
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
 
CONTRIBUTING EDITOR
Daniel Pelletier, MD
Daniel Pelletier, MD
Professor of Neurology and Radiology
Chief, Neuro-Immunology Division and USC Multiple Sclerosis Center
Keck School of Medicine of USC
Los Angeles, California
 
CONTRIBUTING EDITOR
Michael K. Racke, MD
Michael K. Racke, MD
Professor and Chairman
The Ohio State University Medical Center
Columbus, Ohio
 
CONTRIBUTING EDITOR
Brian G. Weinshenker, MD, FRCPC
Brian G. Weinshenker, MD, FRCPC
Professor of Neurology
Department of Neurology
Mayo Clinic
Rochester, Minnesota
 
CONTRIBUTING EDITOR
Scott S. Zamvil, MD, PhD
Scott S. Zamvil, MD, PhD
Professor of Neurology
Department of Neurology
Faculty Member
Program in Immunology
University of California, San Francisco
San Francisco, California
 
 
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