«State of the Art»

Introduction by Jürg Kesselring, Honorary President of the Swiss MS Society, who initiated the State of the Art Symposium in 1999.

Finding the Right Treatment for the Individual Patient
Christoph Lotter underlines the importance of research and thanks all participants and researchers for their fight against MS.

The «MS in the 21st Century» initiative was established with the purpose of (1) defining how multiple sclerosis (MS) treatment and standards of care should look in the 21st century; (2) developing a minimum standard of care across the globe; and (3) motivating the broad MS community to align standards of care and challenge the current treatment paradigm.

The aim was to develop a consensus statement to reach and influence the broader MS community. We constructed seven overall principles that support vision of «full access to personalized treatment, with reimbursement, to achieve freedom from disease». These principles include personalized care, patient engagement, commitment to research, regulatory body education and reimbursement issues, new endpoints in clinical trials, more therapy options, and MS centers of excellence.

Within a framework of regular meetings of both person with MS (PwMS) and health care providers (HCP) and intensive work flow on new initiatives we managed to publish several manuscripts in peer-reviewed journals, achieve high visibility at several international conferences, and presence in social media and webpages. This allowed us to reach an ever broader community and focus on the urgent need to improve communication tools for better standards of MS care: «myMS priorities» and «myMS commitments» are now available in several languages and can be used by PwMS to optimize consultations with HCP. A validation trial to test the usability of these tools in real world scenarios and future clinical trials is currently underway.

Peter Rieckmann, Bischofswiesen (DE)
Medical Park Loipl & University of ErlangenCentrum for Clinical Neuroplasticity

Neuropsychiatric disturbances (e.g. depression, anxiety) are reported in up to 60% of patients with multiple sclerosis (MS) and are among the main contributors to the morbidity and mortality associated with MS. Although these abnormalities generally present subsequent to neurological diagnosis, they may even herald a first clinical presentation of MS or may be concomitant to the neurological symptoms.

The spectrum of neuropsychiatric conditions encountered includes disorders of affect and behaviour, and psychotic and anxiety disorders. Although psychiatric comorbidity can be difficult to diagnose, it is generally responsive to treatment, conferring benefits in functional status, quality of life and overall disease burden.

In this talk I will discuss the most common neuropsychiatric syndromes that occur in MS, describe the clinical symptoms and management strategies for these conditions and speculate about their aetiology in light of recent neuropsychoimmunological findings.

The process of assisting a patient with MS starts with understanding chronicity from the patient’s perspective and its effect on the health care relationship. By learning the impact that chronic illness has on the individual and recognizing the factors involved with adapting to chronic illness, the health care professionals can reach this understanding. An appreciation of the coping strategies commonly used by patients with chronic illnesses helps in selecting the appropriate counseling methods to foster psychological health.

Pasquale Calabrese, Basel
University of Basel Neuropsychology and Behavioral Neurology Unit

Background — Multiple Sclerosis (MS) can lead to a wide range of neurological deficits and is often not diagnosed in time. However, since early therapy has an inhibitory effect on the progression of MS, timely diagnosis and treatment is important. In this context, a structured training of MS specialists is a significant part of the fight against MS.

Goals — MS specialists should be familiar with the detailed scientifically sound diagnosis or differential diagnosis in case of suspected chronic inflammatory diseases of the central nervous system (CNS) with a focus on MS. In addition, they should know the «state of the art management» of chronic inflammatory CNS diseases. This includes treatment measures and strategies for the individual patient as well as detailed and close monitoring of disease activity and disability. MS specialists should also be able to interpret scientific publications and clinical studies on chronic inflammatory CNS diseases and apply them in direct patient care.

Methods — A panel of experts developed a variety of modules focusing on basics, clinical and diagnostic aspects, studies and statistics, therapy and rehabilitation as well as monitoring and documentation of MS. In addition to the traditional transfer of knowledge through lectures and tutorials by experienced MS experts, the contents are to be conveyed with a particularly high practical share. For this purpose, preceptorships in specially selected centres, excursions and regular journal clubs as well as digital case conferences are intended to serve the direct practical implementation of the learned content on site.

Results — The master ́s program «Multiple Sclerosis Management» has been created. After the accreditation, it will start at the Dresden International University (DIU) in 2020 and will last four semesters. The program is mostly implemented digitally via adobe connect and will be held in German and English.

Conclusions — For the first time a single disease complex is topic of a master course. The program with a strong practical relevance offers an unprecedented, structured and practice-oriented training for different disciplines at the highest level. After the successful establishment of the program in Germany, it will also be offered internationally.

Tjalf Ziemssen, Dresden (DE)
University Clinic Carl Gustav Carus
DresdenCenter of Clinical Neuroscience

The treatment armamentarium for MS is steadily increasing, and also in the year 2020 will see novel substances for different phenotypes, including chronic progressive disease.

Despite postulated selective mechanisms of action on specific pathophysiological pathways, especially real life use of modern agents has revealed unanticipated, potentially severe adverse drug reactions. In addition to general safety considerations of classical immunosuppressants also more selective immune therapies may harbour adverse substance specific on- and off-target effects. This situation can further be complicated by multiple therapy switches, and for many substances long term effects are unknown. In addition, individual risk factors such as age and specific risks in vulnerable patient groups (children, pregnant women) add to complexity.

In this presentation, conceptual and practical considerations of treatment-related complications will be discussed. However, optimal choice for individual patients does not only depend on benefit-risk considerations of single substances but has to be integrated with practical considerations, e.g. risk perception, treatment adherence and monitoring requirements.

Andrew Chan, Bern
University Hospital Bern
Department of Neurology

The experience of stress symptoms has been gradually increasing in the last decades. This increase occurs most prominently after puberty. Chronic diseases such as MS represent the most distressing conditions in adult life.

This talk will describe factors and strategies to improve stress resiliency. Among them are strategies concerning the self, including self-efficacy expectations and self-determination, that are crucial for individuals with chronic medical conditions. In addition, I will explain the relevant aspects of social relationships that are associated with resiliency.

Finally, nutrition and a healthy gut are increasingly the focus of stress research. Some of the new findings are particularly important for patients with MS.

Gregor Hasler, Fribourg
University of Fribourg,
Freiburger Netzwerk für Psychische Gesundheit

«Finding the Right Treatment for the Individual Patient»
MS affects every person differently, and it is important to choose the right treatment with and for every patient. With the vast range of available medications, this has become a challenging task for the treating neurologists. In this podium discussion the speakers of the morning lectures will elaborate on the most important questions concerning on how to find the right treatment for the individual patient.

Participants: Andrew Chan, Bern; Tjalf Ziemssen, Dresden (DE); Pasquale Calabrese, Basel; Peter Rieckmann, Bischofswiesen (DE); Gregor Hasler, Fribourg.
Moderation: Sven Schippling, Zurich