Multiple sclerosis (MS) affects nearly 400,000 people in the United States. Its presentation and course are highly variable and often unpredictable, and the diagnostic criteria for MS continue to evolve, reflecting ongoing advances in neuroimaging and neuroimmunology. Recent findings have demonstrated that disease pathology is present long before patients develop any symptoms, and that MS involves the gray matter of the brain and not just the white matter, as had been previously believed. In addition, even normal-appearing white matter seems to be affected. These findings underscore the importance of early diagnosis of and aggressive therapy for MS, and suggest that multiple pathologic processes may be involved. These findings also open the door for diverse treatment strategies and the use of combination therapies. The development of novel medications has brought previously unseen challenges and controversies, and much work remains to be done in terms of monitoring drug efficacy and individualizing therapeutic regimens. Treatment-related decisions have, therefore, become increasingly complex.

Through a series of interactive case studies, this program will examine the challenges of treating MS, from patients with a clinically isolated syndrome to those with long-standing disease. The specific challenges inherent to monitoring therapeutic efficacy, balancing the risk of adverse events with the benefits of aggressive treatment, and choosing among the numerous available therapeutic agents will be examined, with specific attention to communicating these complex issues to patients and guiding them to make informed treatment decisions.

At the conclusion of this activity, participants should be able to:

• Assess the data supporting treatment initiation in patients with a clinically isolated demyelinating syndrome
• Discuss the risks and benefits of available therapeutic options in patients with progressive disease despite interferon treatment
• Identify and implement successful strategies to ensure adherence with prescribed MS therapy
• Evaluate the therapeutic implications of radiographically progressive disease in patients who appear clinically stable

Benjamin Greenberg, MD, MHS (Co-Chair)
Assistant Professor
Johns Hopkins School of Medicine
Department of Neurology
Co-Director, Johns Hopkins Transverse Myelitis Center
Johns Hopkins Hospital
Baltimore, MD

Frederick Munschauer, MD (Co-Chair)
Smith Professor and Chair, Neurology
SUNY Buffalo
Chief, The Jacobs Neurological Institute
Buffalo General Hospital
Buffalo, NY

Steven L. Galetta, MD
Van Meter Professor of Neurology
Hospital of the University of Pennsylvania
Philadelphia, PA

Aaron Miller, MD
Professor of Neurology
Mount Sinai School of Medicine
New York, NY

Marie Namey, RN, MSN, MSCN
Advanced Practice Nurse
Mellen Center for Multiple Sclerosis Treatment and Research
The Cleveland Clinic
Cleveland, OH

Intended Audience
Neurologists, MS nurses, neuropathologists, neuroradiologists, and other healthcare professionals involved in the treatment of MS. There are no prerequisites for attendees.

Statement of Responsibility
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This 2 contact hour Educational Activity (Provider Directed/Learner Paced) is provided by The Institute for Johns Hopkins Nursing. Each participant should claim only those contact hours that he/she actually spent in the activity.

Policy on Faculty and Provider Disclosure
It is the policy of the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing that the faculty and provider disclose real or apparent conflicts of interest relating to the topics of this educational activity, and also disclose discussions of unlabeled/unapproved uses of drugs or devices during their presentation(s). Johns Hopkins University School of Medicine OCME and The Institute for Johns Hopkins Nursing has established policies in place that will identify and resolve all conflicts of interest prior to this educational activity.Detailed disclosure will be made in the course handout materials.

Americans With Disabilities Act
The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing fully comply with the legal requirements of the ADA and the rules and regulations thereof.Please notify us if you have any special needs.