2014 Joint ACTRIMS-ECTRIMS Meeting


Access the Teaching Courses Full Program Description (PDF format)

Accreditation Statement and Credit Designation for Physicians (PDF format)

Teaching Courses
Wednesday, 10 September 2014

Participants must sign up for one of the Meeting registration packages or the Wednesday Day Card in order to purchase a teaching course.
Course materials will be emailed to learner by 1 September 2014.
Limited capacity. First come, first served.


Teaching Course Committee

Jerry Wolinsky (USA), chair
Per Soelberg Sørensen (Denmark), co-chair
Amit Bar-Or (Canada), member
Roland Liblau (France), member
Catherine Lubetzki (France), member
Samuel Ludwin (Canada), member
Aaron Miller (USA), member
David Miller (United Kingdom), member



08:00 – 09:30

Teaching Course 1
Current Controversy in Management: Interactive Case Discussion

Chair: Aaron Miller (New York, US)
Xavier Montalban (Barcelona, ES)

Faculty from both sides of the Atlantic will use a series of interactive cases to highlight current controversy in the management of MS. The course will emphasize real-world decision-making regarding disease-modifying therapy selection as well as other critical issues that arise in MS clinical practice. The use of an audience response system will enable participants to compare their own decisions with those of the faculty and their fellow registrants.

08:00 – 09:30

Teaching Course 2
How do I choose the correct disease-modifying treatment?

Chair: Robert Fox (Cleveland, US)
Bernd Kiesier (Dusseldorf, DE)
Alexandra Goodyear (Stanford, US)

This course will explore the pros and cons of initiating therapies in clinically isolated syndrome and early relapsing MS, how to choose the correct therapy for an individual patient, and when and how treatment should be switched or escalated under various circumstances.

08:00 – 09:30

Teaching Course 3
Symptom management

Chair: Andrew Goodman (Rochester, US)
Alan Thompson (London, UK)
Ulrik Dalgas (Arhus, DK)

This year’s course will concentrate on the theme of symptom management and therapy of motor function – focusing on weakness and spasticity, and discussing the contribution exercise can make.

08:00 – 09:30

Teaching Course 4
Management during pregnancy

Chair: Maria Houtchens (Boston, US)
Kerstin Hellwig (Bochum, DE)

As a disease predominantly affecting women of childbearing age, issues of conception, pregnancy, delivery and breastfeeding are major concerns for MS patients and treating physicians. The risks and benefits of ongoing therapies for the health of the mother and the fetus must be considered. This course reviews the modulatory effects on pregnancy in relapsing MS and its long-term disease course. The risks and benefits of disease-modifying treatments around conception and during pregnancy, relapse management during pregnancy, and questions related to breastfeeding will be addressed.

08:00 – 09:30

Teaching Course 5
Clinically isolated syndromes (CIS)

Chair: Mar Tintoré (Barcelona, ES)
Darin Okuda (Dallas, US)
Olga Ciccarelli (London, UK)

CIS is the first manifestation of MS in the majority of adults and children. This course reviews the challenges of diagnosis, prediction of outcome and clinical management of patients with CIS. Similarities and differences of clinical characteristics of CIS between children and adults, and risk factors used in clinical practice to predict the evolution from CIS to MS are considered. Treatments that delay the clinical onset of MS and those currently under testing in clinical trials are reviewed. Where radiologically isolated syndrome (RIS) fits in the spectrum of early MS is debated.

08:00 – 09:30

Teaching Course 6
Neuromyelitis optica (NMO)

Chair: Jackie Palace (Oxford, UK)
Brian Weinshenker (Rochester, US)
Kazuo Fujihara (Sendai, JP)

The diagnostic criteria for NMO are under rapid evolution and refinement – approaches based on the most current iteration will be considered in depth. The differential diagnosis of NMO can be difficult and how to approach optico-spinal MS and AQP4 antibody-negative NMOSD (including MOG antibody-positive cases) will be covered. Considerations for treatment in clinical practice and controversy surrounding trial designs to explore new approaches will provide very practical yet highly topical information for clinicians.

08:00 – 09:30

Teaching Course 7
Imaging small parts of the nervous system (MAGNIMS)

Chair: Maria Rocca (Milan, IT)
Daniel Reich (Bethesda, US)
Ahmed Toosy (London, UK)

Accurate imaging of small parts of the central nervous system (CNS) such as the spinal cord, optic nerve and deep grey matter is relevant for a better understanding of the underlying pathology in MS. Imaging these demanding structures can provide new outcome measures useful for clinical studies and drug trials. However, advanced imaging is challenging and must overcome several technical limitations. This course will review recent technical developments in the field of advanced imaging that enable quantitative imaging of difficult regions of CNS, and discuss the advantages of using these techniques in both clinical setting and patient studies.

10:00 – 11:30

Teaching Course 8
Update in pediatric MS

Chair: Brenda Banwell (Philadelphia, US)
Cheryl Hemingway (London, UK)
Tanuja Chitnis (Boston, US)

This year’s update will focus on the diagnosis of MS and acute demyelinating disorders in children, emerging therapies and clinical trials in pediatric MS, and the role of MRI in the assessment of disease activity and its impact in patients with childhood onset MS.

10:00 – 11:30

Teaching Course 9
Differential diagnoses and diagnostic dilemmas

Chair: Patrick Vermersch (Lille, FR)
Steven Galetta, US (New York, US)
Emmanuelle Waubant (San Francisco, US)

Diagnostic approach to multiple sclerosis (MS) includes clinical and paraclinical assessments emphasizing the need to demonstrate dissemination in time and dissemination in space and to exclude alternative diagnoses. Although, the diagnosis can be made on clinical grounds alone, MRI can support, implement or even replace some clinical criteria. Diagnostic approaches have identified some clinical and paraclinical red flags that should signal particular caution. Many metabolic, vascular or inflammatory diseases can mimic MS. A few biomarkers, as NMO-IgG targeting aquaporin-4, or other antibodies directed against central nervous system targets now define specific entities. Differentiation of acute disseminated encephalomyelitis remains problematic. Those attending this course will come away with a better approach to diagnostic precision.

10:00 – 11:30

Teaching Course 10
Neuroimmunology in relation to MS pathophysiology and immunotherapy

Chair: Roland Liblau (Toulouse, FR)
Amit Bar-Or (Montreal, CA)
May Han (Stanford, US)

This session provides basic principles on how the immune system can go awry and promote CNS tissue damage in MS. We discuss how an inadequate activation of the adaptive immune response takes place in the periphery. The possible impact of genetic and environmental factors is presented with new data that begins to identify the antigenic targets of this deleterious response. How blood-CNS barriers control the migration of different immune cell subsets into the CNS is also explored to illustrate the pathways used by immune cells to enter the CNS and introduce the molecules involved. An integrated view on the mechanisms by which immune cells induce demyelination and axonal damage, suggests number of promising therapeutic targets.

10:00 – 11:30

Teaching Course 11
MRI issues in clinical practice (MAGNIMS)

Chair: Nicola De Stefano (Siena, IT)
Elizabeth Fisher (Cleveland, US)
Daniel Pelletier (New Haven, US)

Brain and spinal cord MRI are recognized as the most important paraclinical tool for the diagnosis and management of MS. Understanding how pathology evolves in patients with MS, is essential as it leads to neurological deficits and clinical progression. Imaging is an important tool that allows detecting the dynamic changes in the pathological processes. It provides biomarkers that can be used in clinical trials to test the efficacy of new medications and that enable monitoring of patients in the clinical setting. This course will review and discuss the imaging biomarkers currently used for clinical studies. It is focused on the macroscopic pathological changes by summarizing what is known for each of them, and describing the insights provided by imaging. Established biomarkers and new, emerging and biomarkers, will be discussed.

10:00 – 11:30

Teaching Course 12
Neuro-ophthalmology update

Chair: Fiona Costello (Calgary, CA)
Jérôme de Seze (Strasbourg, FR)
Laura Balcer (New York, US)

This course implements a case-based format to provide participants with a practical understanding of how the afferent and efferent visual systems can be used to localize clinical symptoms and measure disease activity in MS and related disorders. Emerging ocular imaging and ophthalmic testing techniques are discussed. At the conclusion of the course, participants will be able to distinguish visual pathway manifestation of MS from neuromyelitis optica (NMO), identify visual manifestations that can help diagnose NMO spectrum disorder, and recognize the evolving role of visual outcomes in MS clinical trials.

10:00 – 11:30

Teaching Course 13
Assessing the drug efficacy: Challenges in study design

Chair: Maria Pia Sormani (Genoa, IT)
Gary Cutter (Birmingham, US)
Fred Lublin (New York, US)

This offering is focused on methodological issues related to the assessment of treatment efficacy in MS. After an introduction about the current state of the art of trial designs in MS and the challenges in the design of future trials in an era when many drugs are available, problems related to the long-term assessment of treatment efficacy in observational studies will be reviewed. Finally, the issue of spontaneous versus sponsored trials will be discussed.

10:00 – 11:30

Teaching Course 14
Neuropsychiatric manifestations and cognitive impairment

Chair: Anthony Feinstein (Toronto, CA)
Maria Pia Amato (Florence, IT)
Ralph Benedict (Buffalo, US)

Behavioral changes are common in MS patients and are frequently overlooked. This does patients a considerable disservice for effective treatments are now available for an array of disorders. This course will focus on cognitive dysfunction and disorders of mood (depression, bipolar affective disorder) and affect (euphoria, pseudobulbar affect (PBA), also called pathological laughing and crying). The nature of cognitive dysfunction in MS will be defined and the methods of detection explained. Participants will learn how to detect depression and distinguish mania, euphoria and PBA while avoiding the diagnostic pitfalls that such conditions can present. Recent advances in treatment will be described. Case illustrations are used as examples of how effective treatments can substantially reduce the morbidity associated with MS while boosting quality of life.




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