Pan-London Calman Neurology/Multiple Sclerosis SpR Training Programme
Wednesday 18th January 2017, Venue: Gilliat LT, Institute of Neurology, London WC1N 3BG.
Introduction and update
A 64-year patient with SPMS emails you asking you to explain to him why his MS has morphed from relapsing-remitting into secondary progressive disease. What are you going to tell him?
Gavin Giovannoni (Barts MS)
Is there a role for treating MS with off-label DMTs?
A 55-year old male patient with PPMS. He has had symptomatic disease ~15 years and is using a stick for outdoor mobility. He has a dropped left foot that gets worse when he is tired and as a result has had several falls. He has previously been part of the fingolimod in PPMS study, but doesn't feel fingolimod helped. His walking has continued to deteriorate. His latest MRI showed several spinal cord, cerebellar, pontine and brain lesions. There was gross spinal cord and cerebral atrophy. None of the lesions enhanced after the administration of gadolinium. A recent cerebrospinal fluid analysis showed OCBs and a raised CSF neurofilament light chain level (1050 ng/ml; ~ double the upper limit of normal for his age). What should you do for this patient?
Klaus Schmierer (Barts MS)
Coffee & Tea
Managing immunosuppression in MS
A 23-year medical student with rapidly-evolving severe MS has been on natalizumab for 18 months and is JC virus positive with an high antibody index (3.2). She is at high risk of developing PML and wants to be switched to another treatment. She is concerned about being immunosuppressed. She is keen to be treated with alemtuzumab (anti-CD52). What would you advise her and how would you switch her treatments?
Gavin Giovannoni (Barts MS)
DMT update; is there a common mode of action?
A 36-year old computer programmer is recently diagnosed patient with MS after presenting with optic neuritis and ataxia. He is confused by all the information on the internet about DMTs. He doesn’t understand why they all the DMTs have so many different modes of action; ‘surely MS is one disease and all these drugs should be working on a similar mechanism’. He is adamant that he is not keen to be treated with an immunosuppressive drug. He is interested in interferon-beta and daclizumab (anti-CD25) mainly because of their potential anti-viral properties. How would you counsel him?
David Baker (Barts MS)
Is there a role for HSCT in the management of MS?
A 34-year old high functioning business executive has been on dimethyl fumarate for 2 years and has recently had a disabling spinal cord relapse. She admits to be being poorly adherent to medication, missing 7-10 tablets per month. Her latest MRI shows 7 enhancing lesions. She is offered natalizumab or alemtuzumab by her treating neurologist, but has requested HSCT. If she is not offered it under the NHS her father is prepared to pay for her to travel to Moscow, or Mexico, for HSCT. What should I do?
Ben Turner (Barts MS)
Is there a role for repeat LPs in the management of MS?
43-year old male with RRMS has been stable on glatiramer acetate for the last 4 years with no relapses and no new MRI lesions. He is fully functional with no restrictions on mobility. He is a long-distance runner and has noticed that after 5-6 miles his left foot starts dropping. You perform a lumbar puncture on him and his CSF neurofilament light chain levels come back at 782 ng/mL, which are raised. How are you going to manage him?
Monica Marta (Barts MS)
Coffee & Tea
How to start a blog: PPI for the modern era
You have a very busy, and overbooked MS follow-up clinic, when the 8th patient in row comes in with a print-out from the BBC website about a recent Panorama programme describing a ‘miracle cure for MS’. This patient has numerous symptomatic issues that need dealing with in the 15 minute consultation. Discussing the BBC Panorama programme is a low priority. Is there anything you can do to save yourself from repeating the same information about the ‘miracle cure’ to this patient and subsequent patients?
Alison Thomson (Barts MS)
The active MS patient
I have MS and I want control over my own destiny. How I navigated the ‘quagmire of the NHS’ to get the treatment I wanted?
Person with MS