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Credit Information |
Management of Multiple Sclerosis, Part 2 of 2: MRI Abnormalities - The Radiologically Isolated Syndrome
neuroscienceCME Journal Club
Premiere Date: Monday, February 1, 2010This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Nurses (CNE)
- Pharmacists (ACPE)
- Psychologists (APA)
- Social Workers (NASW)
- Certified Case Managers (CCMC)
Credit Expiration Date:
Tuesday, February 1, 2011
 | Aaron Miller, MD (Guest Host) Professor of Neurology Medical Director, Corinne Goldsmith Dickinson Center for Multiple Sclerosis Mount Sinai School of Medicine New York, NY |
 | Darin T. Okuda, MD (Featured Author) Assistant Clinical Professor of Neurology UCSF Multiple Sclerosis Center University of California, San Francisco San Francisco, CA |
| David H. Mattson, MD, PhD (Content/Peer Reviewer) Professor of Neurology Program Director, Neuroimmunology/Multiple Sclerosis Program Indiana University School of Medicine Bloomington, IN |
Multiple sclerosis (MS) affects 400,000 Americans and is the leading nontraumatic cause of neurological disability in young
adults.(1) Although MS is progressive, it is not fatal, and patients generally have a normal lifespan. However, progressive
disability imposes increasing limitations and reduced quality of life for these patients. Newly released consensus guidelines
offer neurologists and primary care physicians direction to improve the differential diagnosis and develop strategies to
facilitate early and accurate diagnosis of MS. A number of factors must be considered when selecting a treatment regimen
for patients with MS, including variations in clinical and MRI evidence of disease. The discovery and broad application of
MRI in medicine has led to an increased awareness of the number of patients with incidental white matter pathology in the CNS. The natural history or evolution of such individuals with respect to their risk of developing MS is unclear,(2) but a need for further studies on this subject and physician awareness is essential for progression of disease therapy in MS. In this two-part neuroscienceCME Journal Club series, the authors will translate their research and provide insights and application to clinical practice.
- Bermel RA, Rudick RA. Interferon-based treatment for multiple sclerosis. Neurotherapeutics 2007;4:633-646.
- Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology 2009;72:800-805.
Featured Article: Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology 2009;72:800-805.
View Abstract
Summary: The invention of MRI, together with technological advances in magnet field strengths and the increasing use of noninvasive structural neuro-imaging techniques in clinical and research practice, has led to the identification of incidental abnormalities in the central nervous system (CNS). Many of the detected abnormalities are nonspecific in etiology and are classified in medical parlance as unidentified bright objects or "UBOs", or are indicative of pathologies other than multiple sclerosis (MS). At times, the observed findings are highly suggestive of MS given their morphology and geographical location within the brain. Overall, the natural history or evolution of such individuals with respect to their risk of developing multiple sclerosis (MS) is unclear.
In this investigation, the authors aim to investigate the natural history of subjects who exhibit incidental imaging findings highly suggestive of MS through a retrospective analysis of such cases. They define this unique cohort - the radiologically isolated syndrome (RIS) - and propose diagnostic criteria, expanding upon the phenotype of at-risk individuals for demyelinating disease. Detailed clinical and radiological data were obtained from 41 female and 3 male asymptomatic subjects (median age = 38.5 years, range: 16.2-67.1). Clinical evaluations were performed in 44 patients at the time of initial imaging; longitudinal clinical follow-up occurred for 30 patients, and longitudinal MRI data was available in 41 subjects. The neurologic examinations at the time of the initial MRI scans were normal in nearly all cases. Radiologic progression was identified in 59% of cases and 33% (10/30) converted to clinically isolated syndrome (CIS) or clinically definite multiple sclerosis (CDMS) over a median time of 5.4 years (range: 1.1-9.8). The presence of contrast-enhancing lesions on the initial MRI was predictive of dissemination in time on repeat imaging of the brain (hazard ratio [HR] = 3.4, 95% confidence interval [1.3, 8.7], p = .01).
The authors conclude that individuals with MRI anomalies highly suggestive of demyelinating disease, not better accounted for by another disease process, are very likely to experience subsequent radiologic or clinical events related to MS. They also highlight that additional studies are necessary to fully define this risk.
To translate consensus recommendations on differential diagnosis into effective management of patients with MS, and to increase awareness surrounding the potential risk factor of white matter pathology for the development of MS.
At the end of this CE activity, participants should be able to:
- Identify the objectives and methods of the clinical study.
- List the diagnostic criteria for Radiologically Isolated Syndrome (RIS).
- Evaluate the results of the study and consider the implications in clinical practice.
Physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers, certified case managers, pharmacists, and other healthcare professionals interested in the management of multiple sclerosis.
This activity is supported by an unrestricted educational grant from Pfizer Inc.
CME Credit (Physicians):
Indiana University School of Medicine
is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians.
Indiana University School of Medicine designated this educational
activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™
Physicians should only claim credit commensurate with the extent
of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.
CNE Credit (Nurses):
(Live activity) This continuing nursing education activity was approved by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.
It has been assigned approval code 7ZDQ2B-10. 1.0 contact hours will be awarded upon successful
completion.
(Archive activity) This continuing nursing education
activity was approved by the New York State Nurses
Association, an accredited approver by the American Nurses
Credentialing Center’s Commission on Accreditation.
It has been assigned approval code 7ZDQGL-10. 1.0 contact
hours will be awarded upon successful completion.
CEP Credit (Psychologists):
CME Outfitters is approved by
the American Psychological Association to sponsor continuing
education for psychologists. CME Outfitters maintains
responsibility for this program and its content. (1.0 CE credits)
NASW Credit (Social Workers):
This program was approved by
the National Association of Social Workers (provider #886407722)
for 1 continuing education contact hour.
CCMC Credit (Certified Case Managers):
This program has
been approved for 1 hour by the Commission for Case Manager
Certification (CCMC).
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by
the Accreditation Council for Pharmacy Education as a
provider of continuing pharmacy education.
1.0 contact hours (0.1 CEUs)
Universal Program Number:
376-999-10-004-L01-P (Live)
376-999-10-004-H01-P (Recorded)
Activity type: Knowledge-based
Post-tests, credit request forms, and activity evaluations can be
completed online at www.neuroscienceCME.com (click on the
Testing/Certification link under the Activities tab—requires free account
activation), and participants can print their certificate or statement
of credit immediately (80% pass rate required). This website supports
all browsers except Internet Explorer for Mac. For complete technical
requirements and privacy policy, visit www.neuroscienceCME.com/technical.asp.
This continuing education activity is co-sponsored by Indiana University School of Medicine and by CME Outfitters, LLC.
Disclosure Declaration
In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, educational programs sponsored by Indiana University School of Medicine (IUSM) and CME Outfitters, LLC, (CMEO) must demonstrate balance, independence, objectivity, and scientific rigor. All faculty, authors, editors, and planning committee members participating in activities sponsored by IUSM and CMEO are required to disclose any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an educational activity.
Note: While it offers CME credits, this activity is not intended to provide extensive training or certification in the field.
Dr. Miller has disclosed that he receives grants/research support from Acorda Therapeutics, Genentech, Inc., Genzyme Corporation, Novartis Pharmaceuticals Corporation, Sanofi-aventis, and Teva Pharmaceuticals. He serves as a consultant to Acorda Therapeutics, Biogen Idec, Daiichi Sankyo, EMD Serono, Inc., GlaxoSmithKline, Merk Serono, Novartis Pharmaceuticals Corporation, Ono pharmaceutical Co., Ltd, Sanofi-aventis, and Teva Pharmaceuticals. He serves on the speakers bureaus of Biogen Idec, EMD Serono, Inc., Pfizer Inc., and Teva Pharmaceuticals.
Dr. Okuda has disclosed that he receives grants/research support from EMD Serono, Inc., and Pfizer Inc. He serves as a consultant to Pfizer Inc. He has received honoraria/speakers fees from Teva Neuroscience, Inc.
Dr. Mattson has disclosed that he receives grants/research support from Acorda Therapeutics Inc., Berlex Laboratories, Biogen Idec, Genentech, Inc., Genzyme Corporation, Lilly USA, LLC, Novartis Pharmaceuticals Corporation, Pfizer Inc., sanofi-aventis, and Teva Pharmaceuticals USA. He serves on the speakers bureaus of Biogen Idec, Merck Serono, Pfizer Inc., and Teva Pharmaceuticals USA. He serves as a consultant to Lilly USA, LLC.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
Indiana University School of Medicine, CME Outfitters, LLC, the faculty, and Pfizer Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
JC-015-020110-02
