Teaching Courses

In this programme, two experienced MS clinicians, from either side of the Atlantic Ocean, will engage the audience in an interactive programme that reviews several clinically important issues regarding the diagnosis and management of MS and related demyelinating disorders. Recently revised diagnostic criteria will be discussed, as well as the use of an increasing number of disease modifying therapies.
Strategies for drug selection that incorporate
risk-benefit analysis will be considered.

People with multiple sclerosis (MS) experience a wide variety of neurological symptoms. Over time, worsening of such symptoms increasingly compromises independence, economic productivity, and the ability to perform activities of daily living. The physical, psychological, social, and financial impact can be devastating for people with MS and their families. Although important advances with disease modifying therapies now diminish the likelihood of developing new lesions, in general, these do not benefit already existing symptoms. Mobility impairment is among the commonest and most disabling MS symptoms. Treatment of such symptoms remains an essential cornerstone of comprehensive care of patients with MS, and arguably, enhances quality of life as much as the disease-modifying medications. This course will update research findings and review strategies for management of mobility problems in patients with MS.

There is a strong interest in CSF biomarkers for multiple sclerosis, as these may serve as objective, relatively cheap, and dynamic aids in the diagnosis, prognosis and monitoring of disease progression in MS. CSF biomarker evaluation needs specific expertise and infrastructure. The BioMS-eu network provides a strong framework to gain this expertise, and a teaching course at ECTRIMS is the ideal platform to share and discuss this knowledge with any person with interest in CSF biomarker evaluation.

MRI plays a crucial role in the diagnosis of MS. The faculty of MAGNIMS and North-American experts will review the typical MRI features of the MS brain and spinal cord, will provide an update on the MRI diagnostic criteria for MS and will emphasize the clinical use of MRI indices for monitoring disease progression, treatment efficacy and safety in the individual patient. The importance of neurodegeneration from the earliest stages of the disease will also be discussed. Upon completion, participants will have updated knowledge of the usage of MRI in the clinical setting, for individual MS patient management.

The present teaching course will focus on the relationship between inflammation, neurodegeneration and repair in multiple sclerosis (MS). Nicole Schaeren-Wiemers will focus on molecular changes in the normal appearing white and grey matter of MS brains. Here, early molecular changes occur that may help identifying possible pathogenetic mechanisms of lesion development. The grey matter is substantially involved in the pathology of MS and reveals extensive demyelination, possibly from early disease on. Claudia Lucchinetti will in detail describe the quantity and quality of inflammation in cortical MS lesions and their role in the development of grey matter demyelination. Hans Lassmann will focus on the correlation between inflammation and neurodegeneration, especially axonal damage, in chronic MS lesions. He will clarify whether neurodegeneration is independent or dependent on inflammation within the lesions. Repair, especially remyelination, is limited in the MS brain. Wolfgang Brück will describe the extent of spontaneous remyelination in different disease stages and discuss the cause of remyelination failure in MS.

This course will introduce the concept of interaction from an epidemiological perspective and provide an updated review of gene-environment interactions in MS. Specific topics will include: the definition of interaction in biostatistics/epidemiology and its relation to biology; the importance of investigating gene-environment interactions in MS; the role of vitamin D and EBV infection as risk factors for MS; and potential interactions between vitamin D or EBV and the HLA-DR15 MS risk allele as well as other genetic polymorphisms.

In this course we will focus on somatic stem cell types whose therapeutic potential has been variably and reliably explored in pre-clinical model of multiple sclerosis (MS) or in patients with MS. These stem cells are haematopoietic stem cells, mesenchymal stem cells, and neural stem cells. Owing to the fact that regeneration of long tract axons and replacement of neurons by stem cell therapy has not been achieved so far neither in experimental nor in human MS, we will focus on the extent to which transplanted stem cells contribute either to immunomodulation or remyelination. As a consequence, stem cell-based therapies for MS patients should be regarded so far as an alternative tool to prevent damage and/or foster remyelination.

This ECTRIMS teaching course ’Diseasemodifying therapy in MS – current and emerging treatment’ will give the audience an overview of established DMTs including mode of action and recent comparative trials, on targeted immunotherapies defined by specific receptors or CD antigens, and on diverse immunosuppressive and cytotoxic drugs. Each lecturer will have 30 minutes including time for discussion to focus on the clinically most relevant targets and mode of actions, identified out of a plethora of possible mechanisms. Importantly also safety aspects will be addressed. Thus we will provide a comprehensive understanding of current and putative future immunotherapeutic approaches applied to different subtypes of MS.

Research in the pathogenesis of inflammatory demyelinating disease is developing rapidly due to the continuous development of novel technologies. The results obtained in animal models have resulted in the development of several MS therapies. This teaching course will cover the use of the animal model experimental autoimmune encephalomyelitis in MS research, and will address how in vivo imaging techniques give new insights into how effector cells enter the central nervous system and how they cause tissue damage. The course will also address how translational research using novel techniques for the study of immunological biomarkers is providing new insights into the pathogenesis and treatment of MS.

Advanced MRI techniques offer the possibility to study the pathology of MS in a quantitative fashion, going beyond the qualitative analysis used in a clinical setting. The faculty of MAGNIMS and North-American experts will discuss the benefits and limitations of various quantitative MR techniques that can be used to study damage in lesion and normal appearing
white and gray matter. We will also present
possibilities to study brain metabolism and
activation to understand disability and compensation.
Upon completion, the participants
should be able to understand the possibilities
and limitations of advanced MR techniques,
and be able to select the most appropriate
technique for their specific research questions.

Remyelination has been documented to occur in the central nervous system (CNS) in MS by histological and magnetic resonance based imaging criteria. Animal models using toxins to induce CNS demyelination indicate that oligodendrocyte progenitor cells (OPCs) can mediate robust subsequent remyelination. The purpose of this course is to present information regarding i) what the in vitro and in vivo animal models have taught us about the molecular mechanisms regulating remyelination ii) how we can use these models to understand the potential of human OPCs to carry out remyelination iii) how we can identify new mediators, receptors, or signaling pathways that if enhanced or inhibited would promote the remyelination process and iv) how we can relate imaging modalities to specific repair responses leading to translation of the basic studies into the clinic.

The genetics of MS has since long had its own agenda focused on finding genes associated to disease, because such genes would denote central pathogenic mechanisms, which in turn would be attractive as therapeutic targets and perhaps provide more selective therapeutic strategies than we have today. However, most efforts have been spent on finding the genes, but so far not to understand their function. In this teaching course efforts to understand the function of MS risk genes are discussed, both for the major MS risk genes in the HLA complex, and selected non-HLA genes.