Training the next generation of MSologists is one of my priorities.
I helped arrange and teach on the Pan-London Calman Specialist Registrar (SpR) teaching day yesterday. It was great to see so many young trainee neurologists attending; thank you. And to the speakers for giving up their time to teach and inspire the next generation of neurologists to become MSologists; thank you.
I hope you all enjoyed the day the following is the programme.
Neuro-Calman-MS-programme-16th-Jan-2019-gg3I was impressed by the level of engagement of the audience. I was particularly happy with an insight from one of the trainees who suggested we should be managing MS they way rheumatologists manage RA; i.e. early and aggressively. This was music to my ears. I have been pushing the treat-2-target RA paradigm for MS for several years now. The only difference is that our treatment targets have gradually become more ambitious as we have moved from NEDA-1 (relapses) to NEDA-3 (MRI activity) to preventing end-organ damage as measured with MRI (normalising the rate of brain volume loss or NEDA-4) and normalising CSF and blood neurofilament levels (NEDA-5) and beyond. What I mean by beyond is that our ultimate aim is to cure people of having MS and to allow them to get to old age with as much brain as possible. Is this too ambitious?
The following is my presentation from yesterday that can be downloaded from my slideshare site.
At the end of my session, we got into a lively debate about whether or not everyone with MS needs to be treated. Obviously not, based on my presentation only people with active MS are eligible for treatment. Those who have inactive MS cannot be treated under current NHS England guidelines and if they remain inactive they will hopefully end-up having benign MS. Surely the aim of our treatments is to convert everyone with MS into having inactive MS that will hopefully turn out to be benign MS after 25-30 years of follow-up. What we did not cover in this mini-debate is what is active MS? Should it include smouldering MS?
If any of the trainees are reading this post can I please recommend that you read the following posts I have recently done and to bookmark my MS-Selfie site that is still under development.
Posts of potential interest:
Thanks for sharing the slides. Very interesting presentation!
Next generation neurologists should see MS as a progressive disease, look to patients future and not be content to treat their relapses. Full stop.
Anon, as a Pw slow, slow PPMS, I fully agree.
100% agree anonymous.
It is becoming blatantly obvious that there is an uncoupling between relapses and progression. Neuroinflammatories will never be the complete answer.
This is highlighted with Dr. Burt’s HSCT trial with the most potent neuroinflammatory, cyclophosphamide, and a recent publication showing Tysabri causing no effect on BVL in grey matter (https://multiplesclerosisnewstoday.com/2019/01/17/brain-volume-loss-ms-gray-matter-atrophy-study/).