Editor’s Note: On March 2, 2018, Biogen and AbbVie announced the voluntary withdrawal of daclizumab (Zinbryta) from the global market due to reports of inflammatory brain disorders associated with use of the drug in patients with MS. Readers should be aware of this development when reading the information provided in this activity, which was published before the announcement.
In recent years, the treatment options for multiple sclerosis (MS) have increased in number and in efficacy. These new therapies—coupled with our emerging understanding of the nature of the disease state itself—provide clinicians with more options to better control the inflammatory aspects of MS that are often associated with disability.
The benefit from disease-modifying therapies (DMTs) is likely greatest early in the disease course. However, before treatment can begin, a careful, accurate, and timely diagnosis must be made. Despite advances in our understanding of MS and in the tools available for identifying it, misdiagnosis of MS remains a problem.1-3
That challenges exist in the correct identification of MS is not surprising, given that fulfillment of the current (and still-evolving) criteria for the condition can be subjective.
Exclusion of alternative diagnoses
Imminent updates to the McDonald diagnostic criteria for MS are likely to refine the ways in which the aforementioned steps can be satisfied.5 The publication outlining those updates is in press at the time of this writing, in the fall of 2017. However, briefings at the October 2017 meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) indicate that the presence of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) can be substituted for demonstration of DIT to warrant diagnosis of MS in a patient who otherwise might be considered to have clinically isolated syndrome (CIS).5 While these and other refinements to the criteria will affect clinical practice, the principles that guide early, precise MS diagnosis and the continued emphasis on characteristic clinical symptoms of demyelinating disease will remain in place.
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Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via e-mail or you may print it out at that time.
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Stephen Krieger, MD
Andrew J. Solomon, MD
The recent approval and availability of a multitude of new options for MS management has led clinicians to reconsider their approach to the diagnosis of the disease, as well as the timing, approach, and aggressiveness of initial treatment. MS symptoms may often be subclinical or incorrectly attributed to another cause, potentially delaying treatment until the disease has already begun to progress. Earlier and more accurate diagnosis to guide treatment offers opportunities to improve patient outcomes and quality of life.
At the conclusion of this program, participants should be better able to:
- Discuss the role of radiologically isolated syndromes (RIS) and clinically isolated syndromes (CIS) in diagnosing and monitoring MS
- Describe recent updates to established MS disease phenotypes and discuss their application in clinical practice
- Recognize the importance of early diagnosis and treatment in reducing disability progression
- Identify important risk factors impacting the onset, severity, and progression of MS
- Understand and apply recent discoveries and emerging therapies in the management of patients with MS
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This activity is jointly provided by Global Education Group and Global Academy for Medical Education.
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This activity was released on December 1, 2017, and is valid for 1 year. Requests for credit must be made no later than December 31, 2018.
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The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME/CE activity:
Stephen Krieger, MD, FAAN: Consultant: Acorda, Bayer, Biogen, EMD Serono, Genentech, Genzyme, Mallinckrodt, MedDay, Novartis, Teva, TG Therapeutics. Speakers Bureau: Biogen
Andrew J. Solomon, MD: Consultant: Biogen, EMD Serono, Genentech. Grant/Research Support: Biogen
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Global Education Group (Global): The following planners and managers, Ashley Marostica, RN, MSN; Andrea Funk; Liddy Knight have nothing to disclose.
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