Severity Grading in Multiple Sclerosis

Abstract

CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Appropriately apply information learned in this activity to assign a severity grade to MS patients Recognize the limitations of the severity grading scheme and be able to address those limitations in both treating and educating patients Accreditation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Consortium of Multiple Sclerosis Centers (CMSC), Nurse Practitioner Alternatives (NPA), and Delaware Media Group. The CMSC is accredited by the ACCME to provide continuing medical education for physicians. The CMSC designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Practitioner Alternatives (NPA) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. NPA designates this enduring material for 1.0 Continuing Nursing Education credit (none of these credits are in the area of pharmacology). Disclosures: Francois Bethoux, MD, Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed no relevant financial relationships. Robert Charlson, MD, has served on an advisory board for Teva Pharmaceuticals. Joshua Herbert, BA, has disclosed no relevant financial relationships. Ilya Kister, MD, has served as a consultant for Biogen Idec and Genentech. Dr. Kister has also performed contracted research for Bayer, Genzyme, and Biogen Idec. Laurie Scudder, DNP, NP, has served as Nurse Planner for this activity. She has disclosed no relevant financial relationships. The anonymous peer reviewers for the IJMSC have disclosed no relevant financial relationships. The staff at the CMSC, NPA, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Method of Participation: Release Date: October 1, 2016 Valid for Credit Through: October 1, 2017 In order to receive CME/CNE credit, participants must:Review the CME/CNE information, including learning objectives and author disclosures.Study the educational content.Complete the post-test and evaluation, which are available at http://www.cmscscholar.org. Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This CME/CNE activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC, NPA, and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC, NPA, or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

Expert consensus from the Arabian Gulf on selecting disease-modifying treatment for people with multiple sclerosis according to disease activity

“…A merit of the NHS and EMA approaches, in the opinion of the authors, is their avoidance of subjective terms such as 'mild' or 'moderate'. Such terms are often used in classifications of MS severity [45], but may have different leaning for different readers, and in the experience of the authors, it will often be difficult to classify patients into one category or the other in routine clinical practice. Accordingly, we propose the use of three categories of disease activity to guide therapy for a patient with RRMS, modified from the criteria described above:…”

A systematic review of oral health in people with multiple sclerosis

“…The earliest study was published in 1983, the most recent in 2018. The retrieved studies came from Europe (7), South America ( With respect to how people with multiple sclerosis were recruited, studies used a range of recruitment locations, including multiple sclerosis referral centres, neurology departments (at hospitals and medical schools) and databases. In one study, only participants treated with immunomodulatory drugs were considered eligible for inclusion.…”

“…Multiple sclerosis is classified according to type and severity and is characterized as an unpredictable disorder, between individuals and across time within the same individual . The symptoms presented are also dependent on which part of the nervous system is affected and to what degree .…”

“…5 The aetiology of multiple sclerosis is not fully understood, but it is believed that genetic and environmental factors both contribute to its pathogenesis. 6 Multiple sclerosis is classified according to type and severity 7 and is characterized as an unpredictable disorder, between individuals and across time within the same individual. 8 The symptoms presented are also dependent on which part of the nervous system is affected and to what degree.…”

Decreased plasma levels of 25(OH)D in multiple sclerosis patients. Correlation with disease severity expressed by EDSS, MSSS, progression index and Herbert´s scale severity grade

“…However, after getting to extracellulary milieu it has a strong proinfl ammatory activity and can be passively secreted by necrotic cells or actively produced by activated monocytes, macrophages and also microglia (31). Finally, the aim of our study was to fi nd an association between the evaluated plasma levels of 25(OH)D and MS, severity of MS defi ned by EDSS (expanded disability status scale) (32), MSSS (multiple sclerosis severity score) (33), PI (progression index) (34) and Herbert's six severity grades H1 -H6 (35).…”