Pan-London Calman Neurology/Multiple Sclerosis SpR Training Programme

Wednesday 18th January 2017, Venue: Gilliat LT, Institute of Neurology,  London WC1N 3BG.

Time

Title

Tutor/Speaker 

09h30-10h15

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)

10h15-11h00

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)

11h00-11h30

Coffee & Tea

11h30-12h15

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)

12h15-13h00

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)

13h00-14h00

Lunch

14h00-14h45

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)

14h45-15h30

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)

15h30-16h00

Coffee & Tea

16h00-16h45

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)

16h45-17h15

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

17h15

End

Pre-reading

  1. Policy Document: Giovannoni et al. Brain health: time matters in multiple sclerosis. Mult Scler Relat Disord. 2016 Sep;9 Suppl 1:S5-S48.

  1. Pre-clinical models of MS: Kipp et al. Experimental in vivo and in vitro models of multiple sclerosis: EAE and beyond. Mult Scler Relat Disord. 2012 Jan;1(1):15-28. 

  1. NEDA: Giovannoni et al. Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Disord. 2015 Jul;4(4):329-33. 

  1. Brain atrophy: Vollmer et al. The natural history of brain volume loss among patients with multiple sclerosis: A systematic literature review and meta-analysis. J Neurol Sci. 2015 Jul 13. pii: S0022-510X(15)00435-9. 

  1. Anti-science and social media: Gafson & Giovannoni. CCSVI-A. A call to clinicians and scientists to vocalise in an Internet age. Mult Scler Relat Disord. 2014 Mar;3(2):143-6.