Multiple Sclerosis CE/CME ACCREDITED Watch Time: 33 mins

touchMDT Integrating practice to enhance care of patients with multiple sclerosis

Watch leading neurologists, an imaging specialist and a patient advocate discuss the importance of integrated practice to enhance care of people with multiple sclerosis (MS).

Overview & Learning Objectives

An MDT and a patient advocate consider the management of patients with MS with a focus on integrated care

Neurologist and Neurologist

Two neurologists specializing in MS care discuss the management of MS throughout the lifetime of patients and consider treatment switching strategies at key milestones (e.g. during the paediatric, childbearing and elderly years).

Expert Spotlight
Prof. Tjalf Ziemssen
University Clinic Carl-Gustav Carus, Dresden, Germany
Prof. Tobias Derfuss
University Hospital Basel, Switzerland

Watch Prof. Tjalf Ziemssen and Prof. Tobias Derfuss share their expert insights on the management of MS in patients over their lifetime.

Listen on the Go

Learn more Back to MDT Hub Time: 10:54
 
Imaging Specialist and Neurologists

An imaging specialist and two neurologists specializing in MS care discuss the imaging modalities available to assess disease progression in MS.

Expert Spotlight
Prof. Tobias Derfuss
University Hospital Basel, Switzerland
Dr Francesca Bagnato
Vanderbilt University Medical Center, Nashville, TN, USA
Prof. Tjalf Ziemssen
University Clinic Carl-Gustav Carus, Dresden, Germany

Watch Dr Francesca Bagnato, Prof. Tjalf Ziemssen and Prof. Tobias Derfuss share their expert insights on imaging disease progression in MS.

Listen on the Go

Learn more Back to MDT Hub Time: 10:40
 
Patient Advocate and Neurologists

A patient advocate and person living with MS joins two MS specialist neurologists to discuss the importance of understanding the needs and preferences of patients at each treatment decision-making moment.

Expert Spotlight
Prof. Tjalf Ziemssen
University Clinic Carl-Gustav Carus, Dresden, Germany
Ms Nele Handwerker
MS-Perspektive, Marne, Germany
Prof. Tobias Derfuss
University Hospital Basel, Switzerland

Watch Ms Nele Handwerker, Prof. Tjalf Ziemssen and Prof. Tobias Derfuss share their expert insights on the importance of physician–patient collaborative techniques to improve overall patient satisfaction with their care.

Listen on the Go

Learn more Back to MDT Hub Time: 11:43
 
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Learning Objectives & Overview
Overview

In this activity, neurologists and an imaging specialist involved in caring for patients with MS, as well as a person living with MS, share their perspectives on the management of MS. They consider treatment switching strategies at key lifetime milestones (paediatric, childbearing and elderly), imaging modalities available to assess disease progression in MS, and the importance of understanding the needs and preferences of patients at each treatment decision-making moment.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of general neurologists, MS specialists, MS nurses, neuroradiologists and primary care physicians involved in the management of patients with MS globally, with a focus on Europe.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Tjalf Ziemssen discloses: Advisory board or panel fees from Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Consultancy fees from Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Grants research support from Biogen, Novartis, Roche and Teva. Speaker bureau fees from Bayer, Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Stock/Shareholder (self-managed) of Bayer and Roche.

Prof. Tobias Derfuss discloses: Advisory board or panel fees from Alexion, Biogen, Celgene, GeNeuro, MedDay, Merck, Novartis and Sanofi. Consultancy fees from Merck, Novartis and Roche. Grants/research support from Alexion, Biogen and Roche.

Dr Francesca Bagnato discloses: Advisory board or panel fees from Biogen and Sanofi. Consultancy fees from Sanofi. Grants/research support from Biogen and Merck Serono.

Ms Nele Handwerker discloses: Consultancy fees from Coloplast GmbH, Janssen-Cilag GmbH, Lumanity, Merck and Roche Pharma AG.

Content reviewer

Angela Hill, PharmD, CRPh, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 29 September 2022. Date credits expire: 29 September 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Assess the potential strategies for switching treatment options in patients with MS
  • Appraise the imaging modalities for the assessment of disease in patients with MS
  • Apply collaborative techniques with patients to improve patient satisfaction with their care
Faculty & Disclosures
Prof. Tjalf Ziemssen

University Clinic Carl-Gustav Carus, Dresden, Germany

Prof. Tjalf Ziemssen is the director of the Center of Clinical Neuroscience with its Multiple Sclerosis Center (MSC), neuroimmunological lab (NIL) and autonomic lab (ANF) at the Carl-Gustav Carus University Hospital, in Dresden, Germany. read more

He obtained his medical degree from the University of Bochum, Germany in 1998, and completed his doctoral thesis in 1999 at the Institute of Clinical Chemistry, University of Bochum, Germany. He then underwent training as a fellow of neurology at the Carl-Gustav Carus University Hospital in Dresden and as a research fellow at the Max-Planck Institute of Neurobiology in Martinsried, Germany. In 2011, he received a full professorship for clinical neuroscience at a newly established center at Dresden University and is director of the center of clinical neuroscience. Since 2015, he has served as vice director of the neurological university clinic. 

Prof. Ziemssen’s research interests include collecting real-word data in neurology and the development of new eHealth tools. In addition, he is interested in the autonomic nervous system in health and disease. He is involved in clinical studies, has published over 400 papers and has received several awards, including awards from the European Charcot Foundation and the German Ophthalmological Society. 

One important research area is digital neurology and applying its use in MS. Multidimensional patient phenotyping applying AI (artificial intelligence) into the concept of MS digital twin to predict disease course and treatment response is a component of several funded projects. These concepts are developed and distributed in multiple international networks. In 2019, Prof. Ziemssen developed the master’s course ‘Multiple Sclerosis Management’ together with the Dresden International University, which is now held in German and English language.

He is an active member of several neurological societies, including the German Neurological Society, the European Academy of Neurology, the American Academy of Neurology and the European Federation of Autonomic Societies.

Prof. Tjalf Ziemssen discloses: Advisory board or panel fees from Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Consultancy fees from Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Grants research support from Biogen, Novartis, Roche and Teva. Speaker bureau fees from Bayer, Biogen, Bristol Myers Squibb (BMS), Hexal, Merck, Novartis, Roche, Teva and Viatris. Stock/Shareholder (self-managed) of Bayer and Roche.

Prof. Tobias Derfuss

University Hospital Basel, Switzerland

Prof. Tobias Derfuss is a head of the outpatient care unit and deputy head of the MS Center in the Department of Neurology, University Hospital Basel, and research group leader in clinical neuroimmunology in the Department of Biomedicine at the University of Basel. read more

He is a clinical neurologist with a specialization in neuroimmunology. He received his clinical training at the Department of Neurology, Klinikum Grosshadern in Munich. His research at the Max-Planck Institute for Neurobiology, Department of Neuroimmunology, was focused on the discovery of new autoantigens in MS and the characterization of the immune response against latent herpes viruses. After training in neuromuscular diseases at the Friedrich-Baur Institute and in psychiatry at the Max-Planck Institute for Psychiatry in Munich, he was appointed head of the out-patient department and MS clinic in the Department of Neurology of the university clinic in Erlangen in 2009. 

Since 2010, he has been professor and senior physician at the Department of Neurology and research group leader at the Department of Biomedicine of the university clinic in Basel. His main research focus is the discovery of biomarkers and analysing the mode of action of disease-modifying treatments in neuroinflammatory diseases. Dr Derfuss is also involved in the design and conduct of clinical trials for newly emerging therapies in MS.

Prof. Tobias Derfuss discloses: Advisory board or panel fees from Alexion, Biogen, Celgene, GeNeuro, MedDay, Merck, Novartis and Sanofi. Consultancy fees from Merck, Novartis and Roche. Grants/research support from Alexion, Biogen and Roche.

Dr Francesca Bagnato

Vanderbilt University Medical Center, Nashville, TN, USA

Dr Francesca Bagnato is a dual-board (European and American) neurology certified physician, currently on faculty at Vanderbilt University Medical Center (VUMC). read more

Dr Bagnato sees patients with neuroimmunological diseases at the Neuroimmunology Clinic of VUMC as well as the Nashville VA HealthCare System. She joined Vanderbilt in October 2015 where she is now the head of the neuroimaging programme of the Neuroimmunology Division, co-director of Research-MSCoE-East for the VA, and associate vice-chair of research at VUMC. Dr Bagnato has authored more than 100 publications focused on MS.

Dr Francesca Bagnato discloses: Advisory board or panel fees from Biogen and Sanofi. Consultancy fees from Sanofi. Grants/research support from Biogen and Merck Serono.

Nele Handwerker

MS-Perspektive, Marne, Germany

Nele Handwerker is an internationally experienced marketing specialist who was diagnosed with MS in 2004.  read more

Author of the blog ms-perspektive.de and the podcast ‘MS-Perspektive – der Multiple Sklerose Podcast’, her personal mission is to educate other people with MS about the disease and how to influence its course, so that they can live self-determined, free and happy lives.  

Most recently, Nele was the winner of the MS Brain Health Patient Advocate Award 2022.

Ms Nele Handwerker discloses: Consultancy fees from Coloplast GmbH, Janssen-Cilag GmbH, Lumanity, Merck and Roche Pharma AG.

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Question 1/5
You are currently treating your 31-year-old female patient with MS, who has incomplete control of disease activity, with an S1PR modulator (fingolimod). At follow-up, she expresses her wish to start a family. Laboratory tests show she has no profound lymphopenia. Which of the following would you consider next in the management of this patient?

MS, multiple sclerosis, S1PR, sphingosine-1-phosphate receptor.
Correct

According to current consensus guidance, women with MS planning to become pregnant should be advised to stop fingolimod at least 2 months before conception and alternative treatments should be discussed.1 Consensus guidelines on pregnancy in MS highlight proactively discussing family planning and pregnancy, and their treatment options, as good clinical practice when managing women of child-bearing age with MS.2 Discontinuing high-efficacy DMT, including S1PR modulators such as fingolimod, is associated with rebound risk in MS.3,4 However, delaying DMT until women with MS have completed their families can lead to the development of irreversible disability.1 In patients with incomplete control of disease, switching from an S1PR modulator to a B-cell depleting (anti-CD20) agent as a bridging therapy before contraception may be considered.3

Abbreviations

DMT, disease-modifying therapy; MS, multiple sclerosis; S1PR, sphingosine-1-phosphate receptor.

References

  1. Dobson R, et al. Pract Neurol. 2019;19:106–14.
  2. Rae-Grant A, et al. Neurology. 2018;90:777–88.
  3. Rowles WM, et al. Neurol Neuroimmunol Neuroinflamm. 2022;9:e1183.
  4. Das G, et al. Neurol Neuroimmunol Neuroinflamm. 2018;5:e453.
Question 2/5
Which of the following is true regarding paramagnetic rim lesion imaging in MS?

MS, multiple sclerosis.
Correct

Non-gadolinium-enhancing rim lesions indicating chronic active lesions may be identified using MRI. Paramagnetic rims have a potential future use as a diagnostic and prognostic marker.

Abbreviation

MRI, magnetic resonance imaging.

Reference

Ng Kee Kwong KC, et al. PLoS One. 2021;16:e0256845.

Question 3/5
When would you consider using a spinal cord MRI in your patient with MS?

MRI, magnetic resonance imaging; MS, multiple sclerosis.
Correct

The 2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of spinal cord MRI in patients with MS advise that spinal cord imaging should be used at diagnosis and, additionally, for monitoring patients on a case-by-case basis.

Abbreviations

CMSC, Consortium of Multiple Sclerosis Centres; MAGNIMS, Magnetic Resonance Imaging in Multiple Sclerosis; MRI, magnetic resonance imaging; MS, multiple sclerosis; NAIMS, North American Imaging in Multiple Sclerosis Cooperative.

Reference

Wattjes MP, et al. Lancet Neurol. 2021;20:653–70.

Question 4/5
The ultimate goal of shared decision making is to improve which of the following?
Correct

In a survey of patients with mild-to-moderate MS, patient-centred care and shared decision making were significantly associated with better adherence rates.

Abbreviation

MS, multiple sclerosis.

Reference

Ben-Zacharia A, et al. Int J MS Care. 2018;20:287–97.

Question 5/5
When taking a shared decision-making approach to treatment, which of the following topics would you discuss with your patient with MS?

MS, multiple sclerosis.
Correct

One of the key factors when following a shared decision-making approach is to take patient preference into account for factors such as the route of administration, which may optimize disease-modifying drug selection and adherence.

Reference

Ben-Zacharia A, et al. Int J MS Care. 2018;20:287–97.

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