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Inside the complex, surprising world of MS comorbidities
NASHVILLE, Tenn. – Recent research into comorbidities in multiple sclerosis – including head-scratching findings about lower cancer rates – is shedding light on the links between the disease and other illnesses, according to an epidemiologist specializing in MS.
“People should be mindful that if they look at having a positive impact on those comorbidities, they may have the ability to benefit patients in context of their MS,” Helen Tremlett, PhD, said in a video interview at the annual meeting of the Consortium of Multiple Sclerosis Centers. She is the Canada Research Chair in Neuroepidemiology and Multiple Sclerosis at the University of British Columbia, Vancouver.
In recent years, research into comorbidities in MS has risen dramatically. Dr. Tremlett found that the number of papers per year in PubMed that address MS and comorbidity has risen from roughly 30 in 2007 to about 80 in 2015, although the numbers dipped to about 50 and 60, respectively, in 2016 and 2017.
A 2015 systematic review of research into MS and comorbidities reported that while “findings were inconsistent overall,” studies suggested that “meningiomas and possibly urinary system cancers, inflammatory bowel disease, irritable bowel syndrome, epilepsy, depression, anxiety, bipolar disorder, early cataracts, and restless legs syndrome were more common than expected in the MS population.” (Mult Scler. 2015 Mar;21[3]:263-81).
Notably, most cancers are missing from this list. In fact, Dr. Tremlett cowrote a 2012 study that found lower risks of all cancers and several specific types of cancer – breast, lung, colorectal, prostate, and melanoma – in MS patients, compared with age- and gender-matched controls (Brain. 2012 Oct;135[Pt 10]:2973-9).
According to Dr. Tremlett, there are several theories about the apparent lower cancer risk in patients with MS. Perhaps their immune systems are hypervigilant, or maybe MS diagnoses inspire healthier lifestyles.
Researchers have been intrigued by another possibility – that cancer diagnoses are being delayed in patients with MS. Indeed, the 2012 study found that tumor sizes at diagnosis in patients with MS were larger than expected in breast, prostate, lung, and colorectal cancer (P = .04).
“We couldn’t record why that’s the case, but there may be some so-called ‘diagnostic neglect,’ ” she said. “You could imagine a scenario where a typical person with MS goes to see their physician and says, ‘I’m tired. I have fatigue,’ and the physician says, ‘Yes, you have MS, that’s what you should expect.’ Someone in the general population might get additional investigation, get blood work done, and their cancer might be found earlier.”
It’s also possible, she said, that cancer isn’t picked up earlier because it can be difficult to screen people with disabilities. “It’s only recently that physicians can offer the Pap smear to women in a wheelchair.”
On another front, there’s evidence linking comorbidities to worsening MS. A 2018 study coauthored by Dr. Tremlett found that patients with more comorbidities had more disability. Specifically, ischemic heart disease and epilepsy were associated with greater Expanded Disability Status Scale scores (Neurology. 2018 Jan 3. doi: 10.1212/WNL.0000000000004885).
Other research coauthored by Dr. Tremlett has linked comorbidities in MS – specifically, hyperlipidemia, migraine, and three or more comorbidities – to higher risk of MS relapse (Neurology. 2017 Dec 12;89[24]:2455-61).
Dr. Tremlett reported having no relevant disclosures.
NASHVILLE, Tenn. – Recent research into comorbidities in multiple sclerosis – including head-scratching findings about lower cancer rates – is shedding light on the links between the disease and other illnesses, according to an epidemiologist specializing in MS.
“People should be mindful that if they look at having a positive impact on those comorbidities, they may have the ability to benefit patients in context of their MS,” Helen Tremlett, PhD, said in a video interview at the annual meeting of the Consortium of Multiple Sclerosis Centers. She is the Canada Research Chair in Neuroepidemiology and Multiple Sclerosis at the University of British Columbia, Vancouver.
In recent years, research into comorbidities in MS has risen dramatically. Dr. Tremlett found that the number of papers per year in PubMed that address MS and comorbidity has risen from roughly 30 in 2007 to about 80 in 2015, although the numbers dipped to about 50 and 60, respectively, in 2016 and 2017.
A 2015 systematic review of research into MS and comorbidities reported that while “findings were inconsistent overall,” studies suggested that “meningiomas and possibly urinary system cancers, inflammatory bowel disease, irritable bowel syndrome, epilepsy, depression, anxiety, bipolar disorder, early cataracts, and restless legs syndrome were more common than expected in the MS population.” (Mult Scler. 2015 Mar;21[3]:263-81).
Notably, most cancers are missing from this list. In fact, Dr. Tremlett cowrote a 2012 study that found lower risks of all cancers and several specific types of cancer – breast, lung, colorectal, prostate, and melanoma – in MS patients, compared with age- and gender-matched controls (Brain. 2012 Oct;135[Pt 10]:2973-9).
According to Dr. Tremlett, there are several theories about the apparent lower cancer risk in patients with MS. Perhaps their immune systems are hypervigilant, or maybe MS diagnoses inspire healthier lifestyles.
Researchers have been intrigued by another possibility – that cancer diagnoses are being delayed in patients with MS. Indeed, the 2012 study found that tumor sizes at diagnosis in patients with MS were larger than expected in breast, prostate, lung, and colorectal cancer (P = .04).
“We couldn’t record why that’s the case, but there may be some so-called ‘diagnostic neglect,’ ” she said. “You could imagine a scenario where a typical person with MS goes to see their physician and says, ‘I’m tired. I have fatigue,’ and the physician says, ‘Yes, you have MS, that’s what you should expect.’ Someone in the general population might get additional investigation, get blood work done, and their cancer might be found earlier.”
It’s also possible, she said, that cancer isn’t picked up earlier because it can be difficult to screen people with disabilities. “It’s only recently that physicians can offer the Pap smear to women in a wheelchair.”
On another front, there’s evidence linking comorbidities to worsening MS. A 2018 study coauthored by Dr. Tremlett found that patients with more comorbidities had more disability. Specifically, ischemic heart disease and epilepsy were associated with greater Expanded Disability Status Scale scores (Neurology. 2018 Jan 3. doi: 10.1212/WNL.0000000000004885).
Other research coauthored by Dr. Tremlett has linked comorbidities in MS – specifically, hyperlipidemia, migraine, and three or more comorbidities – to higher risk of MS relapse (Neurology. 2017 Dec 12;89[24]:2455-61).
Dr. Tremlett reported having no relevant disclosures.
NASHVILLE, Tenn. – Recent research into comorbidities in multiple sclerosis – including head-scratching findings about lower cancer rates – is shedding light on the links between the disease and other illnesses, according to an epidemiologist specializing in MS.
“People should be mindful that if they look at having a positive impact on those comorbidities, they may have the ability to benefit patients in context of their MS,” Helen Tremlett, PhD, said in a video interview at the annual meeting of the Consortium of Multiple Sclerosis Centers. She is the Canada Research Chair in Neuroepidemiology and Multiple Sclerosis at the University of British Columbia, Vancouver.
In recent years, research into comorbidities in MS has risen dramatically. Dr. Tremlett found that the number of papers per year in PubMed that address MS and comorbidity has risen from roughly 30 in 2007 to about 80 in 2015, although the numbers dipped to about 50 and 60, respectively, in 2016 and 2017.
A 2015 systematic review of research into MS and comorbidities reported that while “findings were inconsistent overall,” studies suggested that “meningiomas and possibly urinary system cancers, inflammatory bowel disease, irritable bowel syndrome, epilepsy, depression, anxiety, bipolar disorder, early cataracts, and restless legs syndrome were more common than expected in the MS population.” (Mult Scler. 2015 Mar;21[3]:263-81).
Notably, most cancers are missing from this list. In fact, Dr. Tremlett cowrote a 2012 study that found lower risks of all cancers and several specific types of cancer – breast, lung, colorectal, prostate, and melanoma – in MS patients, compared with age- and gender-matched controls (Brain. 2012 Oct;135[Pt 10]:2973-9).
According to Dr. Tremlett, there are several theories about the apparent lower cancer risk in patients with MS. Perhaps their immune systems are hypervigilant, or maybe MS diagnoses inspire healthier lifestyles.
Researchers have been intrigued by another possibility – that cancer diagnoses are being delayed in patients with MS. Indeed, the 2012 study found that tumor sizes at diagnosis in patients with MS were larger than expected in breast, prostate, lung, and colorectal cancer (P = .04).
“We couldn’t record why that’s the case, but there may be some so-called ‘diagnostic neglect,’ ” she said. “You could imagine a scenario where a typical person with MS goes to see their physician and says, ‘I’m tired. I have fatigue,’ and the physician says, ‘Yes, you have MS, that’s what you should expect.’ Someone in the general population might get additional investigation, get blood work done, and their cancer might be found earlier.”
It’s also possible, she said, that cancer isn’t picked up earlier because it can be difficult to screen people with disabilities. “It’s only recently that physicians can offer the Pap smear to women in a wheelchair.”
On another front, there’s evidence linking comorbidities to worsening MS. A 2018 study coauthored by Dr. Tremlett found that patients with more comorbidities had more disability. Specifically, ischemic heart disease and epilepsy were associated with greater Expanded Disability Status Scale scores (Neurology. 2018 Jan 3. doi: 10.1212/WNL.0000000000004885).
Other research coauthored by Dr. Tremlett has linked comorbidities in MS – specifically, hyperlipidemia, migraine, and three or more comorbidities – to higher risk of MS relapse (Neurology. 2017 Dec 12;89[24]:2455-61).
Dr. Tremlett reported having no relevant disclosures.
EXPERT ANALYSIS FROM THE CMSC ANNUAL MEETING
Value-based care spawns new challenges for MS physicians
NASHVILLE, TENN. – Jeffrey B. English, MD, of the MS Center of Atlanta, knows which quality measures physicians and their patients with multiple sclerosis think are important. After all, he and his colleagues have surveyed them about that very topic.
But he has little time to monitor these measures since he’s too busy with a more overwhelming task: keeping track of unrelated quality measures as required by the federal government.
“When they developed quality measures under the MACRA law, they were not thinking about MS people in general. They were very primary care based,” Dr. English said in an interview at the annual meeting of the Consortium of Multiple Sclerosis Centers.
In terms of MS, he said, “no one really knows what the correct outcome measures are.”
Dr. English knows more than most about quality measures preferred by neurologists and patients. At the annual CMSC meeting last year, he presented results from a survey of 11 physicians and 423 patients about the measures of care they consider most important. The patient survey asked about several measures recommended by the American Academy of Neurology plus other measures recommended by the physicians.
The two groups – physicians and patients – agreed on the top four measures: change observed via MRI, change observed via exam, quality of life, and fatigue. However, they disagreed on the ranking within the top four spots.
The least important measures for patients were exercise levels, depression, medication compliance, and relapses.
Dr. English wants to “be able to follow what the patients want me to follow.” However, he hasn’t been able to do so since “25% of my time with patients, in between patients and after hours, is spent trying to comply with outcome measures from the new health care system that are of no benefit to the patient,” he said.
He’s referring to the quality measures that many physicians are tracking to get reimbursed by Medicare and Medicaid.
Value-based care posts other challenges for MS physicians, he said, since MS care is especially expensive. Accountable Care Organizations are looking at cost savings in closed systems, he said, and that could spell trouble because patients with MS cost more.
As a 2015 report noted, first-generation disease-modifying therapies (DMTs) for MS cost about $60,000, and “costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. Newer DMTs commonly entered the market with a cost 25%-60% higher than existing DMTs” (Neurology. 2015 May 26;84[21]:2185-92).
“If I’m in an ACO, and I’m taking care of a lot of MS patients, I’ll already lose money for the accountable care system,” Dr. English said. “They may not necessarily want an MS center inside an ACO.”
What can doctors do? “Advocacy efforts are pretty difficult for physicians,” Dr. English said. “Our hope is that the CMSC will be a clearinghouse for doctors who have ideas and efforts and advocacy, and somehow channel that into the actual provision of care. You have people advocating for medications and for research and for patients, but there’s nobody advocating for the actual care that’s going on, the boots-on-the-ground care. That’s where CMSC should play a big role.”
Dr. English disclosed that he has served as a consultant for multiple pharmaceutical companies.
NASHVILLE, TENN. – Jeffrey B. English, MD, of the MS Center of Atlanta, knows which quality measures physicians and their patients with multiple sclerosis think are important. After all, he and his colleagues have surveyed them about that very topic.
But he has little time to monitor these measures since he’s too busy with a more overwhelming task: keeping track of unrelated quality measures as required by the federal government.
“When they developed quality measures under the MACRA law, they were not thinking about MS people in general. They were very primary care based,” Dr. English said in an interview at the annual meeting of the Consortium of Multiple Sclerosis Centers.
In terms of MS, he said, “no one really knows what the correct outcome measures are.”
Dr. English knows more than most about quality measures preferred by neurologists and patients. At the annual CMSC meeting last year, he presented results from a survey of 11 physicians and 423 patients about the measures of care they consider most important. The patient survey asked about several measures recommended by the American Academy of Neurology plus other measures recommended by the physicians.
The two groups – physicians and patients – agreed on the top four measures: change observed via MRI, change observed via exam, quality of life, and fatigue. However, they disagreed on the ranking within the top four spots.
The least important measures for patients were exercise levels, depression, medication compliance, and relapses.
Dr. English wants to “be able to follow what the patients want me to follow.” However, he hasn’t been able to do so since “25% of my time with patients, in between patients and after hours, is spent trying to comply with outcome measures from the new health care system that are of no benefit to the patient,” he said.
He’s referring to the quality measures that many physicians are tracking to get reimbursed by Medicare and Medicaid.
Value-based care posts other challenges for MS physicians, he said, since MS care is especially expensive. Accountable Care Organizations are looking at cost savings in closed systems, he said, and that could spell trouble because patients with MS cost more.
As a 2015 report noted, first-generation disease-modifying therapies (DMTs) for MS cost about $60,000, and “costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. Newer DMTs commonly entered the market with a cost 25%-60% higher than existing DMTs” (Neurology. 2015 May 26;84[21]:2185-92).
“If I’m in an ACO, and I’m taking care of a lot of MS patients, I’ll already lose money for the accountable care system,” Dr. English said. “They may not necessarily want an MS center inside an ACO.”
What can doctors do? “Advocacy efforts are pretty difficult for physicians,” Dr. English said. “Our hope is that the CMSC will be a clearinghouse for doctors who have ideas and efforts and advocacy, and somehow channel that into the actual provision of care. You have people advocating for medications and for research and for patients, but there’s nobody advocating for the actual care that’s going on, the boots-on-the-ground care. That’s where CMSC should play a big role.”
Dr. English disclosed that he has served as a consultant for multiple pharmaceutical companies.
NASHVILLE, TENN. – Jeffrey B. English, MD, of the MS Center of Atlanta, knows which quality measures physicians and their patients with multiple sclerosis think are important. After all, he and his colleagues have surveyed them about that very topic.
But he has little time to monitor these measures since he’s too busy with a more overwhelming task: keeping track of unrelated quality measures as required by the federal government.
“When they developed quality measures under the MACRA law, they were not thinking about MS people in general. They were very primary care based,” Dr. English said in an interview at the annual meeting of the Consortium of Multiple Sclerosis Centers.
In terms of MS, he said, “no one really knows what the correct outcome measures are.”
Dr. English knows more than most about quality measures preferred by neurologists and patients. At the annual CMSC meeting last year, he presented results from a survey of 11 physicians and 423 patients about the measures of care they consider most important. The patient survey asked about several measures recommended by the American Academy of Neurology plus other measures recommended by the physicians.
The two groups – physicians and patients – agreed on the top four measures: change observed via MRI, change observed via exam, quality of life, and fatigue. However, they disagreed on the ranking within the top four spots.
The least important measures for patients were exercise levels, depression, medication compliance, and relapses.
Dr. English wants to “be able to follow what the patients want me to follow.” However, he hasn’t been able to do so since “25% of my time with patients, in between patients and after hours, is spent trying to comply with outcome measures from the new health care system that are of no benefit to the patient,” he said.
He’s referring to the quality measures that many physicians are tracking to get reimbursed by Medicare and Medicaid.
Value-based care posts other challenges for MS physicians, he said, since MS care is especially expensive. Accountable Care Organizations are looking at cost savings in closed systems, he said, and that could spell trouble because patients with MS cost more.
As a 2015 report noted, first-generation disease-modifying therapies (DMTs) for MS cost about $60,000, and “costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. Newer DMTs commonly entered the market with a cost 25%-60% higher than existing DMTs” (Neurology. 2015 May 26;84[21]:2185-92).
“If I’m in an ACO, and I’m taking care of a lot of MS patients, I’ll already lose money for the accountable care system,” Dr. English said. “They may not necessarily want an MS center inside an ACO.”
What can doctors do? “Advocacy efforts are pretty difficult for physicians,” Dr. English said. “Our hope is that the CMSC will be a clearinghouse for doctors who have ideas and efforts and advocacy, and somehow channel that into the actual provision of care. You have people advocating for medications and for research and for patients, but there’s nobody advocating for the actual care that’s going on, the boots-on-the-ground care. That’s where CMSC should play a big role.”
Dr. English disclosed that he has served as a consultant for multiple pharmaceutical companies.
REPORTING FROM THE CMSC ANNUAL MEETING
iPad app puts cognitive screening in the hands of MS patients
NASHVILLE, TENN. – A new computer tablet application puts cognitive screening literally in the hands of patients with multiple sclerosis.
The Multiple Sclerosis Performance Test (MSPT), created specifically for iPad, presents patients with four assessments that they can complete in a short time before any clinic visit, according to Stephen M. Rao, PhD, who helped develop the tool. After patients complete the test battery, the program translates their results into adjusted normative data and feeds them directly into the individual electronic medical record. When the clinic visit begins, everything is ready for the physician and patient to review together. The program not only provides a solid baseline assessment, but can also, over time, create a longitudinal profile of a patient’s cognitive status, and help to guide management decisions, Dr. Rao said at the annual meeting of the Consortium of Multiple Sclerosis Centers.
“About half of people with MS do have cognitive problems, which, above and beyond the physical problems, can result in major challenges with work, the ability to engage in social activities, and the need for personal assistance,” said Dr. Rao, who is the Ralph and Luci Schey Chair and director of the Schey Center for Cognitive Neuroimaging at the Cleveland Clinic. “But despite that, even comprehensive MS care centers rarely screen for cognitive dysfunction using objective neuropsychological tests.”
Time is the issue for most clinics, he said. Although the paper-and-pencil screening tools out there take only 10 minutes or so, most centers don’t have the luxury of carving out those extra moments or dedicating a staff member to administer the test and handle the data.
The MSPT attempts to sidestep the problem of time and manpower. In Dr. Rao’s center and the other 10 in the United States and Europe that now use the tool, patients simply arrive a bit early for their appointment and complete the three components: a structured patient history; the Neurological Quality of Life assessment; and an electronic adaptation of the MS Functional Composite.
It assesses cognition with a processing speed test based on the Symbol Digit Modalities Test, which has long been validated for MS patients. A contrast sensitivity test assesses visual acuity. A simple manual-dexterity test, in which patients move peg symbols into “holes,” tests upper extremity function, and a video-recorded walking speed test assesses lower extremity function.
The system was validated in 165 patients with MS and 217 healthy controls. It correlated well with the paper-and-pencil Symbol Digits Modalities Test, and correlated more highly than that test with cerebral T2 lesion load (MS Journal. 2017;23:1929-37).
The MSPT is part of a Biogen-sponsored project that Dr. Rao and colleagues unveiled at the American Academy of Neurology annual meeting in April, called the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS). It will gather longitudinal data on 11,000 patients using the MSPT program, and correlate it to multiple clinical and socioeconomic outcomes, Dr. Rao said.
The processing speed test portion of MS PATHS isn’t only available to PATHS centers, he added. Any clinician can obtain it by simply registering with Biogen and downloading the standalone version, which is called CogEval.
After downloading, the clinician must register with Biogen, which then will email a code to unlock the program. CogEval can be used on any iPad system that runs iOS 11 or higher. Results don’t get uploaded automatically into an EHR, but they can be entered manually or printed.
Dr. Rao disclosed that he received financial support from Biogen for the research and development of the MSPT program.
SOURCE: Rao SM et al. CMSC 2018. doi: 10.1177/1352458516688955
NASHVILLE, TENN. – A new computer tablet application puts cognitive screening literally in the hands of patients with multiple sclerosis.
The Multiple Sclerosis Performance Test (MSPT), created specifically for iPad, presents patients with four assessments that they can complete in a short time before any clinic visit, according to Stephen M. Rao, PhD, who helped develop the tool. After patients complete the test battery, the program translates their results into adjusted normative data and feeds them directly into the individual electronic medical record. When the clinic visit begins, everything is ready for the physician and patient to review together. The program not only provides a solid baseline assessment, but can also, over time, create a longitudinal profile of a patient’s cognitive status, and help to guide management decisions, Dr. Rao said at the annual meeting of the Consortium of Multiple Sclerosis Centers.
“About half of people with MS do have cognitive problems, which, above and beyond the physical problems, can result in major challenges with work, the ability to engage in social activities, and the need for personal assistance,” said Dr. Rao, who is the Ralph and Luci Schey Chair and director of the Schey Center for Cognitive Neuroimaging at the Cleveland Clinic. “But despite that, even comprehensive MS care centers rarely screen for cognitive dysfunction using objective neuropsychological tests.”
Time is the issue for most clinics, he said. Although the paper-and-pencil screening tools out there take only 10 minutes or so, most centers don’t have the luxury of carving out those extra moments or dedicating a staff member to administer the test and handle the data.
The MSPT attempts to sidestep the problem of time and manpower. In Dr. Rao’s center and the other 10 in the United States and Europe that now use the tool, patients simply arrive a bit early for their appointment and complete the three components: a structured patient history; the Neurological Quality of Life assessment; and an electronic adaptation of the MS Functional Composite.
It assesses cognition with a processing speed test based on the Symbol Digit Modalities Test, which has long been validated for MS patients. A contrast sensitivity test assesses visual acuity. A simple manual-dexterity test, in which patients move peg symbols into “holes,” tests upper extremity function, and a video-recorded walking speed test assesses lower extremity function.
The system was validated in 165 patients with MS and 217 healthy controls. It correlated well with the paper-and-pencil Symbol Digits Modalities Test, and correlated more highly than that test with cerebral T2 lesion load (MS Journal. 2017;23:1929-37).
The MSPT is part of a Biogen-sponsored project that Dr. Rao and colleagues unveiled at the American Academy of Neurology annual meeting in April, called the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS). It will gather longitudinal data on 11,000 patients using the MSPT program, and correlate it to multiple clinical and socioeconomic outcomes, Dr. Rao said.
The processing speed test portion of MS PATHS isn’t only available to PATHS centers, he added. Any clinician can obtain it by simply registering with Biogen and downloading the standalone version, which is called CogEval.
After downloading, the clinician must register with Biogen, which then will email a code to unlock the program. CogEval can be used on any iPad system that runs iOS 11 or higher. Results don’t get uploaded automatically into an EHR, but they can be entered manually or printed.
Dr. Rao disclosed that he received financial support from Biogen for the research and development of the MSPT program.
SOURCE: Rao SM et al. CMSC 2018. doi: 10.1177/1352458516688955
NASHVILLE, TENN. – A new computer tablet application puts cognitive screening literally in the hands of patients with multiple sclerosis.
The Multiple Sclerosis Performance Test (MSPT), created specifically for iPad, presents patients with four assessments that they can complete in a short time before any clinic visit, according to Stephen M. Rao, PhD, who helped develop the tool. After patients complete the test battery, the program translates their results into adjusted normative data and feeds them directly into the individual electronic medical record. When the clinic visit begins, everything is ready for the physician and patient to review together. The program not only provides a solid baseline assessment, but can also, over time, create a longitudinal profile of a patient’s cognitive status, and help to guide management decisions, Dr. Rao said at the annual meeting of the Consortium of Multiple Sclerosis Centers.
“About half of people with MS do have cognitive problems, which, above and beyond the physical problems, can result in major challenges with work, the ability to engage in social activities, and the need for personal assistance,” said Dr. Rao, who is the Ralph and Luci Schey Chair and director of the Schey Center for Cognitive Neuroimaging at the Cleveland Clinic. “But despite that, even comprehensive MS care centers rarely screen for cognitive dysfunction using objective neuropsychological tests.”
Time is the issue for most clinics, he said. Although the paper-and-pencil screening tools out there take only 10 minutes or so, most centers don’t have the luxury of carving out those extra moments or dedicating a staff member to administer the test and handle the data.
The MSPT attempts to sidestep the problem of time and manpower. In Dr. Rao’s center and the other 10 in the United States and Europe that now use the tool, patients simply arrive a bit early for their appointment and complete the three components: a structured patient history; the Neurological Quality of Life assessment; and an electronic adaptation of the MS Functional Composite.
It assesses cognition with a processing speed test based on the Symbol Digit Modalities Test, which has long been validated for MS patients. A contrast sensitivity test assesses visual acuity. A simple manual-dexterity test, in which patients move peg symbols into “holes,” tests upper extremity function, and a video-recorded walking speed test assesses lower extremity function.
The system was validated in 165 patients with MS and 217 healthy controls. It correlated well with the paper-and-pencil Symbol Digits Modalities Test, and correlated more highly than that test with cerebral T2 lesion load (MS Journal. 2017;23:1929-37).
The MSPT is part of a Biogen-sponsored project that Dr. Rao and colleagues unveiled at the American Academy of Neurology annual meeting in April, called the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS). It will gather longitudinal data on 11,000 patients using the MSPT program, and correlate it to multiple clinical and socioeconomic outcomes, Dr. Rao said.
The processing speed test portion of MS PATHS isn’t only available to PATHS centers, he added. Any clinician can obtain it by simply registering with Biogen and downloading the standalone version, which is called CogEval.
After downloading, the clinician must register with Biogen, which then will email a code to unlock the program. CogEval can be used on any iPad system that runs iOS 11 or higher. Results don’t get uploaded automatically into an EHR, but they can be entered manually or printed.
Dr. Rao disclosed that he received financial support from Biogen for the research and development of the MSPT program.
SOURCE: Rao SM et al. CMSC 2018. doi: 10.1177/1352458516688955
REPORTING FROM THE CMSC ANNUAL MEETING
CMSC looks to increase advocacy efforts to address looming concerns
As patients with multiple sclerosis and their caregivers face various challenges in the American health care system, the Consortium of Multiple Sclerosis Centers (CMSC) is re-energizing its focus on advocacy. The 2018 annual meeting in Nashville, Tenn., will feature programming designed to teach MS professionals and researchers how to speak up and let their voices be heard.
“CMSC has re-engaged in advocacy, in a more focused and energized way, because of mounting concerns that there is inadequate advocacy pressure on some of the critical issues negatively impacting the quality and comprehensive nature of MS care required of people living with MS,” said Lisa Taylor Skutnik, a physical therapist and chief operating officer of the CMSC. “Both people living with MS and the clinicians dedicated to treating them are increasingly frustrated and powerless in attempts to facilitate the right care and resources for people living with MS. Our members are facing significant barriers and obstacles to ensure timely and seamless comprehensive care.”
The development of quality measures in MS is also a “huge concern,” she said, referring to the federal government’s efforts to develop new ways to measure whether health professionals are providing high-quality care. Physicians have expressed widespread concern about the measures, which are being linked to reimbursement from Medicare and Medicaid.
Among the highlights of the CMSC meeting will be an educational session that “will focus on the available resources within the MS community for MS professionals and researchers to access advocacy efforts and get involved,” Ms. Skutnik said.
Another educational session “will focus on helping MS clinicians and researchers to understand all of the various stakeholders and their respective perspectives related to access to comprehensive care services for those living with MS,” such as pharmacy benefit managers and insurers, she said.
As patients with multiple sclerosis and their caregivers face various challenges in the American health care system, the Consortium of Multiple Sclerosis Centers (CMSC) is re-energizing its focus on advocacy. The 2018 annual meeting in Nashville, Tenn., will feature programming designed to teach MS professionals and researchers how to speak up and let their voices be heard.
“CMSC has re-engaged in advocacy, in a more focused and energized way, because of mounting concerns that there is inadequate advocacy pressure on some of the critical issues negatively impacting the quality and comprehensive nature of MS care required of people living with MS,” said Lisa Taylor Skutnik, a physical therapist and chief operating officer of the CMSC. “Both people living with MS and the clinicians dedicated to treating them are increasingly frustrated and powerless in attempts to facilitate the right care and resources for people living with MS. Our members are facing significant barriers and obstacles to ensure timely and seamless comprehensive care.”
The development of quality measures in MS is also a “huge concern,” she said, referring to the federal government’s efforts to develop new ways to measure whether health professionals are providing high-quality care. Physicians have expressed widespread concern about the measures, which are being linked to reimbursement from Medicare and Medicaid.
Among the highlights of the CMSC meeting will be an educational session that “will focus on the available resources within the MS community for MS professionals and researchers to access advocacy efforts and get involved,” Ms. Skutnik said.
Another educational session “will focus on helping MS clinicians and researchers to understand all of the various stakeholders and their respective perspectives related to access to comprehensive care services for those living with MS,” such as pharmacy benefit managers and insurers, she said.
As patients with multiple sclerosis and their caregivers face various challenges in the American health care system, the Consortium of Multiple Sclerosis Centers (CMSC) is re-energizing its focus on advocacy. The 2018 annual meeting in Nashville, Tenn., will feature programming designed to teach MS professionals and researchers how to speak up and let their voices be heard.
“CMSC has re-engaged in advocacy, in a more focused and energized way, because of mounting concerns that there is inadequate advocacy pressure on some of the critical issues negatively impacting the quality and comprehensive nature of MS care required of people living with MS,” said Lisa Taylor Skutnik, a physical therapist and chief operating officer of the CMSC. “Both people living with MS and the clinicians dedicated to treating them are increasingly frustrated and powerless in attempts to facilitate the right care and resources for people living with MS. Our members are facing significant barriers and obstacles to ensure timely and seamless comprehensive care.”
The development of quality measures in MS is also a “huge concern,” she said, referring to the federal government’s efforts to develop new ways to measure whether health professionals are providing high-quality care. Physicians have expressed widespread concern about the measures, which are being linked to reimbursement from Medicare and Medicaid.
Among the highlights of the CMSC meeting will be an educational session that “will focus on the available resources within the MS community for MS professionals and researchers to access advocacy efforts and get involved,” Ms. Skutnik said.
Another educational session “will focus on helping MS clinicians and researchers to understand all of the various stakeholders and their respective perspectives related to access to comprehensive care services for those living with MS,” such as pharmacy benefit managers and insurers, she said.
Rehabilitation in MS is hot topic at CMSC 2018
This year’s annual meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tenn., will feature an intense focus on rehabilitation in MS. The topic is often a priority for patients but not necessarily at top of mind for health care providers, said rehabilitation therapist Patty Bobryk, secretary of the CMSC.
“This year, some of the Rehab Track topics include addressing respiratory issues in MS, exploring the impact of visual impairments on rehab, and recommending the proper orthotics, as well as discussing treatments that focus on mind-body understanding,” said Ms. Bobryk of MS Comprehensive Care Center of Central Florida, Orlando. She serves as cochair of the International Organization of MS Rehabilitation Therapists.
Rehabilitation in MS is a controversial topic. Two years ago, the CMSC endorsed a statement criticizing a 2015 report by the American Academy of Neurology that found limited evidence supporting MS rehabilitation (Neurology. 2015 Nov 24;85[21]:1896-903). The statement, also supported by the International Organization of MS Nurses and International Organization of MS Rehabilitation Therapists, declared that the AAN report “presents an incomplete review of the evidence published” (Neurol Clin Pract. 2016 Dec;6[6]:475-9).
However, the statement acknowledged that “larger studies with better research methodologies and higher-quality evidence are needed in rehabilitation.”
More recently, a 2017 systematic review of systematic reviews of rehabilitation in MS found that “strong” evidence only exists “for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue.” The review of reviews also found there’s “ ‘moderate’ evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge” (Arch Phys Med Rehabil. 2017 Feb;98[2]:353-67).
In an interview, Ms. Bobryk said the MS rehabilitation community is evolving toward “a better understanding of neuroplasticity and the impact that rehab can have on maintaining and improving functional skills.”
In addition, she said, “more emphasis is being placed on early intervention and preventing the secondary effects of the disease versus providing only compensatory strategies.”
Highlights of this year’s rehab sessions at the CMSC conference include a 3-hour course on imbalance in MS that will “provide an intensive review of the anatomy of the balance system and educate the audience on evaluation and treatment interventions specific to retraining the balance system,” Ms. Bobryk said.
Another highlight: A half-day course that will “provide the rationale for including rehabilitation in a comprehensive model of care for people with severe MS,” she said. “Unique interventions such as the use of functional electrical stimulation cycling and body weight-supported treadmill training will be discussed.”
In the big picture, “clinicians who are working in the field of MS realize the benefits of rehab, but more education is needed to spread the word to the broader scope of health care providers,” Ms. Bobryk said. “Patients are often the ones that bring up rehab to their physicians to initiate a referral.”
This year’s annual meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tenn., will feature an intense focus on rehabilitation in MS. The topic is often a priority for patients but not necessarily at top of mind for health care providers, said rehabilitation therapist Patty Bobryk, secretary of the CMSC.
“This year, some of the Rehab Track topics include addressing respiratory issues in MS, exploring the impact of visual impairments on rehab, and recommending the proper orthotics, as well as discussing treatments that focus on mind-body understanding,” said Ms. Bobryk of MS Comprehensive Care Center of Central Florida, Orlando. She serves as cochair of the International Organization of MS Rehabilitation Therapists.
Rehabilitation in MS is a controversial topic. Two years ago, the CMSC endorsed a statement criticizing a 2015 report by the American Academy of Neurology that found limited evidence supporting MS rehabilitation (Neurology. 2015 Nov 24;85[21]:1896-903). The statement, also supported by the International Organization of MS Nurses and International Organization of MS Rehabilitation Therapists, declared that the AAN report “presents an incomplete review of the evidence published” (Neurol Clin Pract. 2016 Dec;6[6]:475-9).
However, the statement acknowledged that “larger studies with better research methodologies and higher-quality evidence are needed in rehabilitation.”
More recently, a 2017 systematic review of systematic reviews of rehabilitation in MS found that “strong” evidence only exists “for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue.” The review of reviews also found there’s “ ‘moderate’ evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge” (Arch Phys Med Rehabil. 2017 Feb;98[2]:353-67).
In an interview, Ms. Bobryk said the MS rehabilitation community is evolving toward “a better understanding of neuroplasticity and the impact that rehab can have on maintaining and improving functional skills.”
In addition, she said, “more emphasis is being placed on early intervention and preventing the secondary effects of the disease versus providing only compensatory strategies.”
Highlights of this year’s rehab sessions at the CMSC conference include a 3-hour course on imbalance in MS that will “provide an intensive review of the anatomy of the balance system and educate the audience on evaluation and treatment interventions specific to retraining the balance system,” Ms. Bobryk said.
Another highlight: A half-day course that will “provide the rationale for including rehabilitation in a comprehensive model of care for people with severe MS,” she said. “Unique interventions such as the use of functional electrical stimulation cycling and body weight-supported treadmill training will be discussed.”
In the big picture, “clinicians who are working in the field of MS realize the benefits of rehab, but more education is needed to spread the word to the broader scope of health care providers,” Ms. Bobryk said. “Patients are often the ones that bring up rehab to their physicians to initiate a referral.”
This year’s annual meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tenn., will feature an intense focus on rehabilitation in MS. The topic is often a priority for patients but not necessarily at top of mind for health care providers, said rehabilitation therapist Patty Bobryk, secretary of the CMSC.
“This year, some of the Rehab Track topics include addressing respiratory issues in MS, exploring the impact of visual impairments on rehab, and recommending the proper orthotics, as well as discussing treatments that focus on mind-body understanding,” said Ms. Bobryk of MS Comprehensive Care Center of Central Florida, Orlando. She serves as cochair of the International Organization of MS Rehabilitation Therapists.
Rehabilitation in MS is a controversial topic. Two years ago, the CMSC endorsed a statement criticizing a 2015 report by the American Academy of Neurology that found limited evidence supporting MS rehabilitation (Neurology. 2015 Nov 24;85[21]:1896-903). The statement, also supported by the International Organization of MS Nurses and International Organization of MS Rehabilitation Therapists, declared that the AAN report “presents an incomplete review of the evidence published” (Neurol Clin Pract. 2016 Dec;6[6]:475-9).
However, the statement acknowledged that “larger studies with better research methodologies and higher-quality evidence are needed in rehabilitation.”
More recently, a 2017 systematic review of systematic reviews of rehabilitation in MS found that “strong” evidence only exists “for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue.” The review of reviews also found there’s “ ‘moderate’ evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge” (Arch Phys Med Rehabil. 2017 Feb;98[2]:353-67).
In an interview, Ms. Bobryk said the MS rehabilitation community is evolving toward “a better understanding of neuroplasticity and the impact that rehab can have on maintaining and improving functional skills.”
In addition, she said, “more emphasis is being placed on early intervention and preventing the secondary effects of the disease versus providing only compensatory strategies.”
Highlights of this year’s rehab sessions at the CMSC conference include a 3-hour course on imbalance in MS that will “provide an intensive review of the anatomy of the balance system and educate the audience on evaluation and treatment interventions specific to retraining the balance system,” Ms. Bobryk said.
Another highlight: A half-day course that will “provide the rationale for including rehabilitation in a comprehensive model of care for people with severe MS,” she said. “Unique interventions such as the use of functional electrical stimulation cycling and body weight-supported treadmill training will be discussed.”
In the big picture, “clinicians who are working in the field of MS realize the benefits of rehab, but more education is needed to spread the word to the broader scope of health care providers,” Ms. Bobryk said. “Patients are often the ones that bring up rehab to their physicians to initiate a referral.”
Wide variety of MS topics on tap at CMSC 2018
More than 2,000 members of the multiple sclerosis care, advocacy, research, and patient communities will gather in Nashville, Tenn., May 30–June 2 for the annual meeting of the Consortium of Multiple Sclerosis Centers.
Dozens of topics will be discussed, ranging from complementary/alternative therapies, ethics, and neuropsychiatry to neuroimmunology and disease models, relapse management, and self-care. Clinicians also will tackle sensitive topics such as suicide, depression, and cognitive impairment.
“Accredited continuing education will be offered for MDs, registered nurses, pharmacists, occupational therapists, physical therapists, social workers, and psychologists,” said Gary Cutter, PhD, president of the CMSC. “Our offerings include beginner courses, advanced science sessions, rehab and mental health tracks, platform and poster sessions, and roundtables.”
“We’ll discuss meds for progressive forms of MS as well as targeted therapies based on new information from genetics,” Dr. Cutter said. Participants will also gain insight from registries and other data sources, he added.
Lecture topics will include the use of computerized screening for cognitive dysfunction in the MS clinic and new research into MS pathology.
Other sessions will explore the use of cannabis, infusion therapies, respiratory enhancement, and a new class of medications for blocking lipid metabolism. Rehabilitation will also be a major focus.
One session will examine MS in patients before conception, during pregnancy, and in the postpartum period. Another session will explore suicide in MS and discuss how clinics can identify and help patients at risk.
The annual CMSC conference stands apart because it’s a “relatively unique meeting where the entire MS treatment team, researchers, and persons with MS can interact and discuss the complex issues in MS care,” Dr. Cutter said. “Much of this takes place outside of the formal program but can still have major impact on all of us. The enthusiasm of the young attendees is always amazing. They are supported, involved, and encouraged.”
More than 2,000 members of the multiple sclerosis care, advocacy, research, and patient communities will gather in Nashville, Tenn., May 30–June 2 for the annual meeting of the Consortium of Multiple Sclerosis Centers.
Dozens of topics will be discussed, ranging from complementary/alternative therapies, ethics, and neuropsychiatry to neuroimmunology and disease models, relapse management, and self-care. Clinicians also will tackle sensitive topics such as suicide, depression, and cognitive impairment.
“Accredited continuing education will be offered for MDs, registered nurses, pharmacists, occupational therapists, physical therapists, social workers, and psychologists,” said Gary Cutter, PhD, president of the CMSC. “Our offerings include beginner courses, advanced science sessions, rehab and mental health tracks, platform and poster sessions, and roundtables.”
“We’ll discuss meds for progressive forms of MS as well as targeted therapies based on new information from genetics,” Dr. Cutter said. Participants will also gain insight from registries and other data sources, he added.
Lecture topics will include the use of computerized screening for cognitive dysfunction in the MS clinic and new research into MS pathology.
Other sessions will explore the use of cannabis, infusion therapies, respiratory enhancement, and a new class of medications for blocking lipid metabolism. Rehabilitation will also be a major focus.
One session will examine MS in patients before conception, during pregnancy, and in the postpartum period. Another session will explore suicide in MS and discuss how clinics can identify and help patients at risk.
The annual CMSC conference stands apart because it’s a “relatively unique meeting where the entire MS treatment team, researchers, and persons with MS can interact and discuss the complex issues in MS care,” Dr. Cutter said. “Much of this takes place outside of the formal program but can still have major impact on all of us. The enthusiasm of the young attendees is always amazing. They are supported, involved, and encouraged.”
More than 2,000 members of the multiple sclerosis care, advocacy, research, and patient communities will gather in Nashville, Tenn., May 30–June 2 for the annual meeting of the Consortium of Multiple Sclerosis Centers.
Dozens of topics will be discussed, ranging from complementary/alternative therapies, ethics, and neuropsychiatry to neuroimmunology and disease models, relapse management, and self-care. Clinicians also will tackle sensitive topics such as suicide, depression, and cognitive impairment.
“Accredited continuing education will be offered for MDs, registered nurses, pharmacists, occupational therapists, physical therapists, social workers, and psychologists,” said Gary Cutter, PhD, president of the CMSC. “Our offerings include beginner courses, advanced science sessions, rehab and mental health tracks, platform and poster sessions, and roundtables.”
“We’ll discuss meds for progressive forms of MS as well as targeted therapies based on new information from genetics,” Dr. Cutter said. Participants will also gain insight from registries and other data sources, he added.
Lecture topics will include the use of computerized screening for cognitive dysfunction in the MS clinic and new research into MS pathology.
Other sessions will explore the use of cannabis, infusion therapies, respiratory enhancement, and a new class of medications for blocking lipid metabolism. Rehabilitation will also be a major focus.
One session will examine MS in patients before conception, during pregnancy, and in the postpartum period. Another session will explore suicide in MS and discuss how clinics can identify and help patients at risk.
The annual CMSC conference stands apart because it’s a “relatively unique meeting where the entire MS treatment team, researchers, and persons with MS can interact and discuss the complex issues in MS care,” Dr. Cutter said. “Much of this takes place outside of the formal program but can still have major impact on all of us. The enthusiasm of the young attendees is always amazing. They are supported, involved, and encouraged.”