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Current Congress

Teaching Courses Programme

Sep 14

Teaching Course 1
Disease modifying treatment

08:30 - 10:00

Chairs
R. Fox (Cleveland ,US)
L. Kappos (Basel ,CH)

New MS treatments and updates on established treatments

R. Fox (Cleveland ,US)

Assessing and mitigating risks: the right treatment for the right patient

S. Vukusic (Lyon ,FR)

Defining what is working: choosing a therapeutic strategy

L. Kappos (Basel ,CH)

Recent years has seen tremendous progress in the treatment of relapsing MS with disease modifying therapies. New therapies have become available, and new insights are being gained regarding the differential indication of established therapies. This course will review new and established therapies, with a focus on assessing and mitigating risks. From this foundation and using instructive cases, the course will then discuss therapeutic strategies, including how to define when therapies are working and when alternative therapies should be considered.

Teaching Course 2
MS during pregnancy and post-partum

08:30 - 10:00

Chairs
K. Hellwig (Bochum ,DE)
A.M. Langer-Gould (Pasadena ,US)

Family planning with MS general consideration/assisted reproductive techniques

M. Houtchens (Brookline ,US)

Pregnancy management: medications and lactation

K. Hellwig (Bochum ,DE)

MS and oral contraceptives: the effect on susceptibility and prognosis

A.M. Langer-Gould (Pasadena ,US)

In this workshop we will cover the most important updated management strategies for women with multiple sclerosis planning pregnancy, during pregnancy and the postpartum period. Rapid advances in MS treatments now allows women with previously highly active MS to have children but how to strike the optimal balance between the mother’s health and the potential risks to the infant are challenging. We will review the most up-to-date data on the safety of MS medication use during pregnancy and lactation, the risk of relapses during pregnancy and the postpartum period. Other emerging data on the risk of relapse following artificial reproductive techniques (ART) and the influence of oral contraceptives and other hormonal therapies on MS susceptibility and prognosis will also be addressed.

Teaching Course 3
Advanced MS genetics and immunology

08:30 - 10:00

Chairs
R. Liblau (Toulouse ,FR)
F. Zipp (Mainz ,DE)
L. Fugger (Oxford ,UK)

The MS genomic map: translating genetic architecture into a roadmap for dissecting neuroimmune mechanisms

L. Fugger (Oxford ,UK)

Immunology of MS: how the pathogenic adaptive immune response develops

R. Liblau (Toulouse ,FR)

Immunology of MS: innate and adaptive immune events within the CNS

F. Zipp (Mainz ,DE)

There has been major development in the unraveling of the genetic bases of MS and of the development of a deleterious immune response in MS. Moreover, therapeutic options have been increased and novel developments are ongoing. This teaching course at ECTRIMS is the ideal platform to discuss how normal variations of the genome impact on the function of the immune system and how innate and adaptive immune processes contribute to CNS tissue damage and repair. This knowledge has broad implications for the understanding of the pathophysiology and the immunotherapy of MS. The course provides an overview from genetic basis over immunopathology to therapy.

Teaching Course 4
Ms brain health

08:30 - 10:00

Chairs
G. Giovannoni (London ,UK)
R. Marrie (Winnipeg ,CA)

What is brain health?

G. Giovannoni (London ,UK)

Comorbidities in MS

R. Marrie (Winnipeg ,CA)

Lifestyle modification in MS

J. Saxton (Newcastle ,UK)

Although multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system numerous systemic and lifestyle factors affect MS outcomes. In summary Brain Health refers to a holistic approach to the management of multiple sclerosis that focuses on MS-specific, and MS non-specific, factors that are modifiable. An important aspect of brain health is the empowerment of people with the disease to make them understand that there is a lot they can do themselves to self-manage their own disease. The course will review the philosophical underpinnings of brain health and the shift to treating MS more actively and to a target. To optimise outcomes for people with MS we have to actively monitor the disease. An important part of brain health is the screening for, and the active management of, comorbidities, or other diseases, which have been shown to have a negative impact on MS disease outcomes. Examples include smoking, hypertension, metabolic syndrome and obesity. As part of managing MS, and comorbidities, people with the disease need to adopt a healthy lifestyle, including regular exercise, a healthy diet and good sleep hygiene. The lifestyle issues not only have the potential to improve MS outcomes, but may improve wellness of people with MS. At the end of the teaching course attendees will know about brain health and how to optimise MS outcomes. They will know how to screen for, diagnose and treat the common comorbidities and will know how important it is to address lifestyle issues when treating people with MS.

Teaching Course 5
Examination of blood and CSF in clinical practise

08:30 - 10:00

Chairs
F. Sellebjerg (Copenhagen ,DK)
M. Comabella (Barcelona ,ES)

Biomarkers in blood

F. Sellebjerg (Copenhagen ,DK)

Current biomarkers in cerebrospinal fluid

M. Comabella (Barcelona ,ES)

Emerging biomarkers

C. Teunissen (Amsterdam ,NL)

The analysis of blood and cerebrospinal fluid (CSF) is becoming increasingly important in the management of MS treatment. The analysis of antibodies associated with neuromyelitis optica, vitamin D measurements and anti-virus antibodies associated with risk of infectious complications is already established. In contrast, pharmacogenetic or other biomarkers for predicting response to treatment, with the exception of anti-drug antibodies, have not been definitely identified. New predictive CSF biomarkers are emerging, which may be useful not only in research but also in daily clinical practice. This course covers established and emerging blood and CSF biomarkers and their use in MS treatment.

Teaching Course 6
Controversy in management

10:30 - 12:00

Chairs
A.E. Miller (New York ,US)
X. Montalban (Barcelona ,ES)

Case 1 - Relapsing MS

A.E. Miller (New York ,US)

Case 2 - Progressive MS

X. Montalban (Barcelona ,ES)

Case 3 - Neuromyelitis optica spectrum disorder

D. Wingerchuk ( ,Scottsdale, US)

Three expert faculty members will use a case-based approach to highlight and discuss controversial issues in the diagnosis and management of relapsing MS, progressive MS, and neuromyelitis optica spectrum disorder. Use of an interactive audience response system will enable participants to compare their responses with those of their peers and the faculty and will also prompt the faculty to focus on areas of particular controversy and concern. Cases will involve discussion related to current diagnostic considerations, therapeutic decision-making, and other potentially vexing management problems that confront clinicians who care for people with MS.

Teaching Course 7
Symptomatic therapy

10:30 - 12:00

Chairs
T. Berger (Innsbruck ,AT)
A. Feinstein (Toronto ,CA)

Lower urinary tract dysfunction in multiple sclerosis: pitfalls and challenges

M. Pakzad (London ,UK)

Treatment of spasticity and walking impairment

T. Berger (Innsbruck ,AT)

Prevalence, diagnosis and treatment of psychiatric disorders in MS patients

A. Feinstein (Toronto ,CA)

The merits and benefits of multiple sclerosis (MS) disease modifying therapies are well known, however patients are often left with significant symptoms as a result of MS. These symptoms contribute substantially to disease-related burden, however is still a neglected domain in the holistic MS caregiving concept. MS patients perceive walking impairment, bladder dysfunction and mood disorders as their most disabling symptoms, and these have an enormous impact on their health-related quality of life, social activities, work performance, and economic status. It is therefore important to address this area, and to provide advice about conservative measures for managing symptoms. This teaching course aims to provide participants with basic knowledge on the recognition of MS-related symptoms, their assessment and also a multidisciplinary approach to diagnosis and management. In this interactive course, participants will have the opportunity to enhance their practical knowledge about neuro-rehabilitative and drug treatments for spasticity and weakness related walking impairment, neurogenic bladder dysfunction and mood/psychiatric disorders. It is intended that this course will raise awarenss amongst participants about early recognition, diagnosis and multimodal treatment of MS related symptoms.

Teaching Course 8
MRI as predictor of treatment response

10:30 - 12:00

Chairs
C. Gasperini (Rome ,IT)
M. Tintoré (Barcelona ,ESP)

Predictive model of treatment response in MS

M.P. Sormani (Genoa ,IT)

Predicting treatment response

M. Tintoré (Barcelona ,ESP)

Scoring treatment response

C. Gasperini (Rome ,IT)

The advent of a large number of new therapies for multiple sclerosis (MS) warrants the development of tools to select the best treatment for each patient, and to identify factors that can predict whether that patient will respond to the selected therapy. At present, although personalized therapy is highly desirable, genetic or molecular biomarkers are still scarce. Clinical and MRI parameters are in fact, the main tools used in clinical practice, to establish therapeutic decisions. Response to a given treatment could be defined as a benefit that would not have happened without the treatment. However, the detection of early markers of response to any treatment is very challenging in MS, possibly due to the variability of the disease, the fact that therapies are only partially effective and the difficulties in measuring disease progression. In this course we will try to distinguish 3 different concepts that play a key role in a correct definition of response to treatment: prognostic markers, treatment effect modifiers and surrogate endpoints. We will also discuss the different scores that integrate clinical and MRI parameters as well as emerging concepts such as NEDA (no evidence of disease activity). The changes in NEDA definition as new metrics are adopted into clinical practice (e.g,T25FW, SDMT, brain atrophy, etc.) will also be presented. Because NEDA is difficult to sustain in the long term, the tolerance of some degree of activity (MEDA: minimal degree of disease activity) will also be discussed. Controversies between MEDA and NEDA will be highlighted.

Teaching Course 9
Cognition

10:30 - 12:00

Chairs
M.P. Amato (Florence ,IT)
J. DeLuca (New Orange ,US)

Epidemiology of cognitive impairment in MS: an update

M.P. Amato (Florence ,IT)

Assessment: Pros and cons of available tools

D. Langdon (Egham ,UK)

Current approaches to management

J. DeLuca (New Orange ,US)

The subtle and often insidious changes in cognition, unspoken of for years and seen in all subgroups of Multiple Sclerosis (MS) irrespective of age or disease pattern, are finally being given the profile and importance their impact warrants. Cognitive impairments have been reported in 40% of population-based studies and >65% of clinically- based studies. They are not exclusively a late phenomenon in the disease course and can be identified in patients who are at the beginning of their disease, although they tend to progress in the long-term and are usually prominent in the progressive phases of the disease. The neuropsychological profile is characterized by defects of information processing speed, working memory, long-term visual-spatial and verbal memory, and aspects of executive functioning, whereas language and general intelligence are usually spared. The last decade in particular has seen a stream of high quality studies addressing some of the key issues pertaining to this area: (1) documenting the frequency and neuropsychological pattern of cognitive impairment in different disease phenotypes and its evolution over time; (2) identifying and developing appropriate clinical measures with which to assess the impact on the patients, their family and society; (3) as a direct consequence, assessing the potential for therapeutic intervention, be it medication, training or rehabilitation. However, this research field is still in its infancy, and much more needs to be done if we are to make a real difference to the impact on our patient patients’ lives.

Teaching Course 10
Myelin regeneration and neuroprotection

10:30 - 12:00

Chairs
C. Lubetzki (Paris ,FR)
B. Stankoff (Paris ,FR)

Models of myelination and remyelination to identify potential therapeutic cues

C. Lubetzki (Paris ,FR)

In vivo analysis of neuronal damage

M. Kerschensteiner (Munich ,DE)

Molecular imaging to quantity tissue damage and repair

B. Stankoff (Paris ,FR)

The course is focused on the myelin/axon unit in multiple sclerosis and experimental models. It will first give a comprehensive review of the different and complementary models used to decipher the mechanisms of central nervous system myelination and remyelination and to identify therapeutic cues. The neuronal consequence of inflammation and demyelination, which crucially impacts disability progression in multiple sclerosis will then be addressed through the use of innovative in vivo “real time” imaging techniques. Finally the course will review the different methods of molecular imaging allowing to quantify, in MS patients, tissue damage and repair, and to assess the potential efficacy of therapeutic strategies of remyelination and/or neuroprotection.

Teaching Course 11
Differential diagnoses

12:30 - 14:00

Chairs
S. Fredrikson (Stockholm ,SE)
A. Siva (Istanbul ,TR)

Diagnostic and differential diagnostic aspects in MS

S. Fredrikson (Stockholm ,SE)

MRI - diagnostic possibilities and pitfalls

A. Siva (Istanbul ,TR)

Blood and CSF biomarkers in the diagnostic process

F. Sellebjerg (Copenhagen ,DK)

An accurate and rapid diagnosis of multiple sclerosis (MS) is essential for the management of patients with the disease. There are several MS-mimics that have to be excluded in the diagnostic process. A cornerstone in the diagnosis of MS is still the clinical evaluation, that should be evaluated together with results from paraclinical tools, like magnetic resonance imaging (MRI). As a consequence of improved MRI techniques, the diagnostic criteria for MS have been changed three times over the latest 15 years. In this teaching course we will describe diagnostic criteria and how to exclude differential diagnoses. MRI is essential in the diagnosis of MS, but the MRI scans are not always easy to interpret. Potential diagnostic pitfalls of MRI scans will be described. During recent years the search for diagnostic biomarkers has been intensified. There are now several blood and CSF tests that can be of help in the differential diagnostic procedure. These markers will be described and evaluated.

Teaching Course 12
Neuromyelitis optica spectrum disorders

12:30 - 14:00

Chairs
D.M. Wingerchuk (Scottsdale ,US)
K. Fujihara (Sendai ,JP)

Benefits and challenges of the new diagnostic criteria (2015)

D.M. Wingerchuk (Scottsdale ,US)

Pathomechanisms of AQP4-IgG-, MOG-IgG- and seronegative diseases

K. Fujihara (Sendai ,JP)

Management of typical, gray-zone and pregnant patients

A. Jacob (Liverpool ,UK)

The investigation of neuromyelitis optica spectrum disorders (NMOSD) has progressed significantly during the past decade. Clinical, neuroimaging, laboratory, pathological, and therapeutic features of NMOSD distinct from multiple sclerosis have been clarified, and the new international consensus diagnostic criteria were published last year. This course aims to provide basic and updated information of diagnosis, pathogenesis and treatment of NMOSD. In addition to aquaporin 4 (AQP4)-IgG-positive disease, we will review seronegative NMOSD including myelin oligodendrocyte glycoprotein (MOG)-IgG-positive cases. We will also present case vignettes on diagnostic challenges in seronegative cases and practical management of typical, gray-zone and pregnant patients. To enhance an interactive approach, we encourage registrants to send us their questions in advance. We will try to address them in the course.

Teaching Course 13
Improving the differential diagnosis of MS using MRI

12:30 - 14:00

Chairs
J. Palace (Oxford ,UK)
F. Barkhof (Amsterdam ,NL)

Aging and vascular diseases

F. Barkhof (Amsterdam ,NL)

Neuromyelitis spectrum disorders

J. Palace (Oxford ,UK)

MS mimics

A. Rovira (Barcelona ,Spain)

Magnetic resonance imaging (MRI) is a crucial tool in diagnosing multiple sclerosis (MS) as it detects clinically silent lesions and allows for an early diagnosis and treatment. To avoid a false-positive diagnosis of MS, it is crucial to identify the features that are characteristic of MS and differentiate MS from other neurological disorders. This course focusses on the distinguishing imaging features of MS from other diseases that are associated with white matter lesions (WML). Although the emphasis will be on conventional imaging, useful quantitative and non-conventional techniques that are likely to become available in the near future will also be discussed. The first session focusses on the commonest WML condition; aging and vascular disease. In clinical practice differentiating vascular WML from MS lesions is a subjective process but there are useful features that aid their distinction. This session will include the pathological features that drive the distinctive features and will also cover related conditions such as migraine. The second session covers the neuromyelitis spectrum disorders (NMOSD) which can mimic MS both clinically and in its imaging features. Because the NMOSD are heterogeneous and include relapsing and monophasic conditions, patients with AQP4 or MOG antibodies and sero-negative patients, the outline classification along with an update on imaging distinguishers will be reviewed. The last session will review the remaining WML disorders such as vasculitis and other inflammatory disorders of the brain and spinal cord that most commonly mimic MS radiologically and clinically and identify useful ways to differentiate between the diseases. These sessions will incorporate audience participation in diagnosing cases and answering questions covering key messages in order to assess the learning objective of the course.

Teaching Course 14
Patient empowerment and coping

12:30 - 14:00

Chairs
A. Solari (Milan ,IT)
C. Heesen (Hamburg ,DE)

Self-management interventions

R. Moss Morris (London ,UK)

Evidence-based patient information

C. Heesen (Hamburg ,DE)

Coping with severe MS

A. Solari (Milan ,IT)

The teaching course focuses on strategies to help MS patients cope with their disease, and has two referral models, shared decision-making and evidence-based medicine. We will consider three all-important themes: symptoms, patient information, and advanced disease. Symptoms: we will discuss the up to date scientific evidence on patient self-management of common MS symptoms, such as depression and fatigue. Patient information: strategies to improve patient knowledge and facilitate informed choices since diagnosis communication will be presented. Advanced disease: integrated care approaches tailored to the requirements of people with severe MS and their families, and to support treatment decisions in this disease phase will be discussed.

Teaching Course 15
Paediatric MS

12:30 - 14:00

Chairs
B. Banwell (Philadelphia ,US)
C. Hemingway (London ,UK)

Diagnosis of MS and related disorders

C. Hemingway (London ,UK)

MRI features of MS in children

B. Banwell (Philadelphia ,US)

Genetic and environmental risk factors for pediatric MS

E. Waubant (San Francisco ,US)

The Pediatric MS course will focus on several key areas of active interest: We will review the diagnosis and differential diagnoses for pediatric MS. The MRI features of MS in children, including evidence of a neurodegenerative and inflammatory component present from onset, even in the youngest patients will be presented. We will then present epidemiological and genetic features of pediatric-onset MS.

Teaching Course 16
OCT in clinical practise: a hands on teaching course

10:30 - 12:00
Moorfields Eye Hospital

Chair
A. Petzold (London ,UK)

OCT in clinical practise: a hands on teaching course

A. Petzold (London ,UK)

This teaching course will give hands-on experience of performing optical coherence tomography (OCT). The course will take place at Moorfields Eye Hospital which is equipped with state-of-the-art OCT devices from all major suppliers. The course is limited to 20 participants. The course will start with a pragmatic introduction to the OCT technology. This will be followed by a first round of “see one”, “do one”, “teach one” OCT acquisitions with participants acting as OCT examiner and subject. The OCT images will be reviewed in the group with the aim to discuss and learn from the “seven deadly sins” that may occur. The aim is to acquire the skills and knowledge for recognising true signs of neurodegeneration and pathology which makes the eye such a valuable “window to the brain”. Participants will receive a 102 page training manual summarising the knitting bitty details and illustrative OCT images and clinical cases in 60 Figures.

Teaching Course 17
OCT in clinical practise: a hands on teaching course

12:30 - 14:00
Moorfields Eye Hospital

Chair
A. Petzold (London ,UK)

OCT in clinical practise: a hands on teaching course

A. Petzold (London ,UK)

This teaching course will give hands-on experience of performing optical coherence tomography (OCT). The course will take place at Moorfields Eye Hospital which is equipped with state-of-the-art OCT devices from all major suppliers. The course is limited to 20 participants. The course will start with a pragmatic introduction to the OCT technology. This will be followed by a first round of “see one”, “do one”, “teach one” OCT acquisitions with participants acting as OCT examiner and subject. The OCT images will be reviewed in the group with the aim to discuss and learn from the “seven deadly sins” that may occur. The aim is to acquire the skills and knowledge for recognising true signs of neurodegeneration and pathology which makes the eye such a valuable “window to the brain”. Participants will receive a 102 page training manual summarising the knitting bitty details and illustrative OCT images and clinical cases in 60 Figures.