Sponsored by A Continuing Education Company N PAPA w w w . c m e A I M S . o r g AIMS ADVANCES IN MULTIPLE SCLEROSIS ADVANCES IN MULTIPLE SCLEROSIS PRIMER AUTHORS Guy J. Buckle, MD, MPH June Halper, MSN, APN-C, MSCN, FAAN David J. Rintell, EdD Supported by educational grants from Genzyme, a Sanofi company, Novartis, and Teva. A PRACTICAL GUIDE TO IDIOPATHIC ADVANCESPRIMER IN MULTIPLE SCLEROSIS TABLE OF CONTENTS CME/CNE Information ...........................................................................................2 Chapter 1: What is MS?...........................................................................................5 Epidemiology and Demographics.................................................................................7 Disease Course .............................................................................................................8 Impact on Quality of Life and Economic Burden of MS .............................................9 Pathophysiology .........................................................................................................10 Diagnosis....................................................................................................................12 Chapter 2: Treatment of MS ..................................................................................23 Disease Modifying Therapies • Current Therapies ..................................................................................................25 • Emerging Therapies................................................................................................33 • Treatment of Progressive Forms of MS ..................................................................36 Relapse Management .................................................................................................37 Symptom Management..............................................................................................38 Rehabilitation.............................................................................................................42 Chapter 3: Comprehensive Care............................................................................49 Psychosocial Issues .....................................................................................................51 Cognitive Dysfunction in MS ....................................................................................54 Family Issues ..............................................................................................................58 Psychosocial Adaptation to MS..................................................................................60 Optimizing Treatment Adherence..............................................................................62 Multidisciplinary, Collaborative Care........................................................................65 Chapter 4: Patient Education, Tools, and Resources...............................................67 References..............................................................................................................71 Evaluation and Attestation Form............................................................................78 Table of Contents 1 AIMS A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS CME/CNE INFORMATION SPONSOR ACCREDITATION/DESIGNATION This activity is sponsored through an educational STATEMENT collaboration by the CMSC, NPA, and The France This activity has been planned and implemented Foundation. in accordance with the Essential Areas and policies of the Accreditation Council for TARGET AUDIENCE Continuing Medical Education through the joint This activity is intended for neurologists, nurse sponsorship of the Consortium of Multiple practitioners, physician assistants, nurses, and Sclerosis Centers (CMSC), Nurse Practitioner other health care providers involved in the Alternatives (NPA), and The France Foundation. management of MS. The Consortium of Multiple Sclerosis Centers STATEMENT OF NEED (CMSC) is accredited by the Accreditation This education is designed to support optimal Council for Continuing Medical Education diagnosis, treatment, and management of patients (ACCME) to provide continuing medical with multiple sclerosis. education for physicians. EDUCATIONAL ACTIVITY LEARNING CMSC designates this enduring activity for a OBJECTIVES maximum of 3.0 AMA PRA Category 1 Credits™. Upon completion of this course, the participants Physicians should claim only the credit should be able to: commensurate with the extent of their • Discuss how new information on the participation in the activity. immunopathology of MS affects understanding Nurse Practitioner Alternatives is accredited as a of the disease process provider of continuing nursing education by the • Employ current information on the use of MRI American Nurses Credentialing Center's to improve diagnosis, treatment, and Commission on Accreditation. monitoring of patients with MS • Apply information on new and emerging Awarded 3.0 contact hour(s) of continuing therapies to the development of individualized nursing education for RNs and APRNs. management strategies for patients with MS Laurie Scudder DNP, NP, has served as Nurse • Examine the safety, efficacy, and tolerability of Planner for this activity. new and emerging therapies for the treatment of MS At the time of publishing this primer, the • Implement strategies for the identification of application status for AAPA Category 1 CME barriers to patient adherence and develop Credit was pending. To find out the latest status management strategies that incorporate patient of AAPA credit, visit www.cmeaims.org/primer. and family education to address these barriers and improve adherence Co-provided through an educational collaboration • Discuss strategies to address common adverse by the CMSC, NPA, and The France Foundation. events and injection-related concerns associated with disease modifying therapies in Release Date: December 2013 order to improve patient adherence Expiration Date: December 31, 2014 Estimated Time to Complete Activity: 180 minutes 2 CME/CNE Information A PRACTICAL GUIDE TO IDIOPATHIC ADVANCESPRIMER IN MULTIPLE SCLEROSIS METHOD OF PARTICIPATION/ DISCLOSURES HOW TO RECEIVE CREDIT It is the policy of CMSC, NPA, and The France 1. There are no fees for participating in and Foundation to ensure balance, independence, receiving credit for this activity. objectivity, and scientific rigor in all its sponsored 2. Review the activity objectives and CME/CNE educational activities. All faculty, activity planners, information. content reviewers, and staff participating in this 3. Complete the CME/CNE activity. activity have disclosed to the participants any 4. Go to www.cmeaims.org/primer and complete significant financial interest or other relationship the posttest. A score of at least 75% is required with manufacturer(s) of any commercial to successfully complete this activity. The product(s)/device(s) and/or provider(s) of participant has five attempts to successfully commercial services included in this educational pass. activity. The intent of this disclosure is not to 5. Complete the CME/CNE evaluation/attestation prevent a person with a relevant financial or other form at www.cmeaims.org/primer, which relationship from participating in the activity, but provides each participant with the opportunity rather to provide participants with information on to comment on how participating in the which they can base their own judgments. CMSC, activity will affect their professional practice; NPA, and The France Foundation have identified the quality of the instructional process; the and resolved any and all conflicts of interest prior perception of enhanced professional to the release of this activity. effectiveness; the perception of commercial bias; and his/her views on future educational Activity Staff Disclosures needs. The planners, reviewers, editors, staff, continuing 6. Your CME/CNE certificate will be available for professional education committee, or other download. members at the Consortium of Multiple Sclerosis Centers who control content have disclosed no FACULTY relevant financial relationships. Guy J. Buckle, MD Assistant Professor in Neurology The planners, reviewers, and staff at the Nurse Harvard Medical School Practitioner Alternatives who control content have Director of Clinical Care disclosed no relevant financial relationships. Brigham & Women’s Hospital Boston, Massachusetts The planners, reviewers, editors, staff, CME committee, or other members at The France David J. Rintell, EdD Foundation who control content have no relevant Clinical Instructor in Psychiatry financial relationships to disclose. Harvard Medical School Adjunct Professor of the Practice Faculty Disclosures Brandeis University The following faculty have indicated they have Boston, Massachusetts relationships with industry to disclose relative to the content of this CME/CNE activity: June Halper, MSN, APN-C, MSCN, FAAN • Guy J. Buckle, MD, has served as a consultant Chief Executive Officer for Acorda, Bayer, Biogen Idec, EMD Serono, Consortium of Multiple Sclerosis Centers and Genzyme, Novartis, and Teva the International Organization of Multiple Sclerosis Nurses Hackensack, New Jersey CME/CNE Information 3 AIMS A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS • David J. Rintell, EdD, has received COMMERCIAL SUPPORT ACKNOWLEDGMENT grants/research support from Biogen Idec and This activity is supported by educational grants Serono Pharmaceuticals. He has served