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CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000433303.85866.aa
Issue Overview

Issue Overview

Free Access

Continuum: Lifelong Learning in Neurology-Multiple Sclerosis, Volume 19, Issue 4, August 2013

Issue Overview

Multiple Sclerosis, August 2013;19(4)

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum Multiple Sclerosis issue, participants will be able to:

▸ Summarize the pathologic features of multiple sclerosis (MS) and other inflammatory demyelinating diseases

▸ Define the revised 2010 international criteria for diagnosis of MS

▸ Apply current clinical criteria to the clinical evaluation of acute disseminated encephalomyelitis, transverse myelitis, and neuromyelitis optica

▸ Discuss the indications and side effects of the current and most imminent therapies for MS

▸ Recognize the impact of transient events as a component of MS (eg, epilepsy, sleep disorders, paroxysmal tonic spasms)

▸ Explain recent developments regarding the impact, outcome measures, and management of gait disorders in MS

▸ Describe recent advances in the recognition, diagnosis, and management of monophasic and chronic demyelinating disorders in children

▸ Evaluate patients with MS for important comorbidities that may affect both general and MS-specific health

▸ Summarize current and emerging imaging techniques in the diagnosis and treatment of MS

▸ Discuss neuro-ophthalmologic issues in MS and related disorders

▸ Apply risk mitigation strategies to personalized disease management in MS

Core Competencies

The Continuum Multiple Sclerosis issue covers the following core competencies:

▸ Patient Care

▸ Medical Knowledge

▸ Practice-Based Learning and Improvement

▸ Interpersonal and Communication Skills

▸ Professionalism

▸ Systems-Based Practice

Disclosures

CONTRIBUTORS

Robert J. Fox, MD, FAAN, Guest Editor

Staff Neurologist, Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio

*Dr Fox serves as a consultant for Allozyne, Inc, Avanir Pharmaceuticals, Inc, Biogen Idec, Novartis, Questcor Pharmaceuticals, Inc, and Teva Neuroscience, and receives research support from Novartis.

Dr Fox discusses mitigation strategies for alemtuzumab, which is not currently US FDA-approved for the treatment of multiple sclerosis.

Alexander D. Rae-Grant, MD, FRCP(C), Guest Editor

Staff Neurologist, Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio

*Dr Rae-Grant has served as a speaker for Avanir Pharmaceuticals, Inc, Biogen Idec, Novartis, and Teva Neuroscience.

Dr Rae-Grant discusses the unlabeled use of carbamazepine, phenytoin, gabapentin, botulinum toxin injections, and thiamine for the treatment of multiple sclerosis symptoms.

Laura J. Balcer, MD, MSCE, FAAN

Professor and Vice Chair, Department of Neurology, New York University School of Medicine, New York, New York

*Dr Balcer serves as a consultant for Biogen Idec, Novartis, and Questcor Pharmaceuticals, Inc.

Dr Balcer reports no disclosure.

Robert A. Bermel, MD

Staff Neurologist and Assistant Professor of Neurology, Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio

*Dr Bermel serves as a consultant for Astellas Pharma Inc, Biogen Idec, Novartis, and Teva Neuroscience. Dr Bermel receives research support from Novartis, which funds an observational study on depression in MS, and from the National MS Society, which funds a study of imaging measures of repair and recovering in the visual pathway.

Dr Bermel reports no disclosure.

Francois Bethoux, MD

Director, Rehabilitation Services, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio

*Dr Bethoux has served as a speaker for Acorda Therapeutics, Allergan, Inc, Biogen Idec, and Medtronic, Inc and serves on scientific advisory boards for Acorda Therapeutics and Merz Pharma. Dr Bethoux serves on the editorial board of International Journal of MS Care, published by The Consortium of MS Centers. Dr Bethoux has received research support from Acorda Therapeutics for studies and clinical trials of dalfampridine; from Innovative Neurotronics, Inc, for a trial of the WalkAide device; and from Merz Pharma for a study of Xeomin.

Dr Bethoux discusses the unlabeled use of benzodiazepines, cannabinoids, and botulinum toxin injections for the treatment of lower extremity spasticity; antiepileptics and tricyclic antidepressants for neuropathic pain; and amantadine, modafinil, and armodafinil for fatigue related to multiple sclerosis.

Tanuja Chitnis, MD

Associate Professor of Neurology, Harvard Medical School; Director, Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts

*Dr Chitnis serves as a consultant for Biogen Idec, Novartis, and Teva Neuroscience, and receives research support from Merck Serono and grants from the National Multiple Sclerosis Society.

Dr Chitnis discusses the unlabeled use of disease-modifying therapies for children with multiple sclerosis.

Mark S. Freedman, MSc, MD, FAAN, FRCP(C)

Professor of Neurology, University of Ottawa; Director, Multiple Sclerosis Research Unit, The Ottawa Hospital; Senior Scientist, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

*Dr Freedman has received honoraria from or serves as a consultant for Actelion Pharmaceuticals Ltd, Bayer HealthCare, Biogen Idec, Celegene Corporation, EMD Canada, Glycominds Ltd, Novartis, Sanofi-Aventis, and Teva Canada. Dr Freedman serves on the advisory boards or other similar boards of Actelion Pharmaceuticals Ltd, Bayer HealthCare, Biogen Idec, Celegene Corporation, Genzyme, Merck Serono, Novartis, Sanofi-Aventis, and Teva Canada Innovation. Dr Freedman receives research or educational grants from Bayer HealthCare and Genzyme Corporation.

Dr Freedman discusses the unlabeled use of laquinimod, alemtuzumab, and ocrelizumab for the treatment of multiple sclerosis.

Heather Hanwell, PhD

Postdoctoral Research Fellow, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

*Dr Hanwell serves as a speaker for the Multiple Sclerosis Society of Canada and Teva Neuroscience.

Dr Hanwell reports no disclosure.

Todd J. Janus, PhD, MD, FAAN

Attending Physician, Director, Iowa Health Systems Physicians and Clinics Center for Comprehensive MS Care (IHSP and CCFCMSC) (NMSS certified), Des Moines, Iowa

*Dr Janus has served as a consultant for Biogen Idec, holds 12,000 shares in NewLink Genetics Corporation, and receives research support for clinical trials from Acorda Therapeutics, Inc, Biogen Idec, and Genzyme Corporation.

Dr Janus reports no disclosure.

Ilana B. Katz Sand, MD

Assistant Professor and Associate Medical Director, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Medical Center, New York, New York

*Dr Katz Sand’s fellowship was supported in part by a Sylvia Lowry grant from the National Multiple Sclerosis Society. Dr Katz Sand has received research support from Acorda Therapeutics for an investigator-initiated study.

Dr Katz Sand reports no disclosure.

Eric C. Klawiter, MD, MSc

Assistant Professor of Neurology, Harvard Medical School; Assistant Neurologist, Massachusetts General Hospital, Boston, Massachusetts

*Dr Klawiter has received consulting fees from Genzyme Corporation and Teva Neuroscience and research support for clinical trials from Roche.

Dr Klawiter reports no disclosure.

Eran Klein, MD, PhD

Adjunct Assistant Professor, Oregon Health and Sciences University; Neurology Staff Physician, Portland VA Medical Center, Portland, Oregon

*†Dr Klein reports no disclosure.

Fred D. Lublin, MD, FAAN, FANA

Saunders Family Professor of Neurology and Director of Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai Medical Center, New York, New York

*Dr Lublin has consulting agreements with and/or serves on the advisory boards or data and safety monitoring boards of Acorda Therapeutics, Actelion Pharmaceuticals Ltd, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb Company, Celgene Corporation, Coronado Biosciences, EMD Serono, Inc, F. Hoffman-La Roche Ltd, Genentech, Inc, Genzyme Corporation, Johnson & Johnson Services, Inc, MedImmune, LLC, Novartis Corporation, Pfizer Inc, Questcor Pharmaceuticals, Inc, Revalesio Corporation, Sanofi-Aventis, and Teva Pharmaceuticals. Dr Lublin is the co-chief editor of Multiple Sclerosis and Related Diseases, owns stock in Cognition Pharmaceuticals, Inc, and reviews medicolegal issues. Dr Lublin receives research support from Acorda Therapeutics, Biogen Idec, Celgene Corporation, Genzyme Corporation, the National Multiple Sclerosis Society, the NIH, Novartis Corporation, Sanofi-Aventis, and Teva Pharmaceuticals.

Dr Lublin reports no disclosure.

Claudia F. Lucchinetti, MD, FAAN

Professor of Neurology, Mayo Clinic, Rochester, Minnesota

*Dr Lucchinetti holds a patent for aquaporin-4–associated antibodies for the diagnosis of neuromyelitis optica; receives royalties from Elsevier for the publication of Blue Books of Neurology: Multiple Sclerosis; and receives research support from Guthy-Jackson Charitable Foundation, the National Multiple Sclerosis Society, and the NIH.

Dr Lucchinetti reports no disclosure.

Ruth Ann Marrie, MD, PhD

Associate Professor, Departments of Internal Medicine Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

*Dr Marrie receives research funding from Sanofi-Aventis for a clinical trial and peer-reviewed research grants from Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, and Public Health Agency of Canada.

Dr Marrie reports no disclosure.

Daniel Ontaneda, MD, MS

Staff Neurologist, Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio

*Dr Ontaneda has served as a consultant or speaker for Acorda Therapeutics, Biogen Idec, and Novartis, and receives research support from the National Multiple Sclerosis Society and the NIH.

Dr Ontaneda discusses mitigation strategies for alemtuzumab, which is not currently approved for the treatment of multiple sclerosis.

Istvan Pirko, MD, FAAN

Associate Professor of Neurology, Mayo Clinic, Rochester, Minnesota

*Dr Pirko serves as the clinical editor of Nanomedicine: Nanotechnology, Biology and Medicine and receives research support from the NIH.

Dr Pirko reports no disclosure.

Bogdan F. Gh. Popescu, MD, PhD

Assistant Professor and Canada Research Chair Tier II in Multiple Sclerosis Research, Department of Anatomy and Cell Biology, Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

*Dr Popescu has served as a speaker for Teva Canada Innovation and receives research support from the Canada Research Chairs program and the Saskatchewan Health Research Foundation

Dr Popescu reports no disclosure.

Andrew J. Solomon, MD

Assistant Professor of Neurology, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont

*†Dr Solomon reports no disclosure.

Brian G. Weinshenker, MD, FRCP(C), FAAN

Professor of Neurology, Mayo Clinic, Rochester, Minnesota

*Dr Weinshenker serves on the data and safety monitoring board of Biogen Idec and Novartis and serves as a consultant regarding neuromyelitis optica therapeutics for Asahi Kasei Medical Co, Ltd, Elan Corporation, and Novartis. Dr Weinshenker receives royalties for licensed technology for the diagnosis of neuromyelitis optica from RSR Limited, and receives research funding from Guthy-Jackson Charitable Foundation.

Dr Weinshenker discusses the unlabeled uses of corticosteroids and plasma exchange for the treatment of acute disseminated encephalomyelitis, transverse myelitis, and neuromyelitis optica; IV immunoglobulin for acute disseminated encephalomyelitis; and azathioprine, mycophenolate mofetil, rituximab, mitoxantrone, methotrexate, and eculizumab for neuromyelitis optica.

Dean M. Wingerchuk, MD, MSc, FRCP(C), FAAN

Professor of Neurology, Vice-Chair for Clinical Research, Mayo Clinic, Scottsdale, Arizona

*Dr Wingerchuk receives research support from Alexion, Genentech, Genzyme Corporation, Guthy-Jackson Charitable Foundation, and Terumo BCT, Inc.

Dr Wingerchuk discusses the unlabeled uses of corticosteroids and plasma exchange for the treatment of acute disseminated encephalomyelitis, transverse myelitis, and neuromyelitis optica; IV immunoglobulin for acute disseminated encephalomyelitis; and azathioprine, mycophenolate mofetil, rituximab, mitoxantrone, methotrexate, and eculizumab for neuromyelitis optica.

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MULTIPLE-CHOICE QUESTION WRITERS

Eduardo E. Benarroch, MD, DSci, FAAN

Professor of Neurology, Mayo Clinic, Rochester, Minnesota

*Dr Benarroch serves as a section editor for Neurology.

Dr Benarroch reports no disclosure.

Joseph E. Safdieh, MD

Associate Professor of Neurology (Education), Weill Cornell Medical College, New York, New York.

*Dr Safdieh serves as a consultant for Pfizer Inc.

Dr Safdieh reports no disclosure.

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Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information and comprehensive CME and self-assessment offerings, including a self-assessment pretest, multiple-choice questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

Copyright © 2013 by the American Academy of Neurology.

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