Effectively Navigating a Complex MS Diagnostic and Treatment Terrain: A Focus on the Primary Care Setting

Effectively Navigating a Complex MS Diagnostic and Treatment Terrain: A Focus on the Primary Care Setting

Presentation Points
This activity was developed in collaboration with Med-IQ and Stanford University School of Medicine

Med-IQ Stanford Medicine
Online Course | Specialties: Primary Care
Released: 4/19/2021
Expires: 4/18/2022
Max Credits: 0.75
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Lucas Kipp, MD
Clinical Assistant Professor, Neurology & Neurological Sciences
Director, MS/Clinical Neuroimmunology Fellowship Program
Director, Neurology Grand Rounds
Stanford University School of Medicine
Palo Alto, CA

Jeffrey Dunn, MD, FAAN
Clinical Professor, Neurology & Neurological Sciences
Chief, Division of Neuroimmunology
Stanford University School of Medicine
Palo Alto, CA

Elaine Su, MD
Fellow, MS/Clinical Neuroimmunology
Sylvia Lawry Fellow, National MS Society
Stanford University School of Medicine
Palo Alto, CA

Activity Planners
Amy Burdette, PhD
Manager, Educational Strategy & Content
Baltimore, MD

Laura Rafferty, ELS
Senior Managing Editor
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM
Associate Director, Education Quality and Compliance
East Lansing, MI

Sonia Vitorri
Compliance and Meeting Specialist
Stanford University School of Medicine
Stanford Center for Continuing Education
Palo Alto, CA

Jamie McDonald, MD
Stanford University School of Medicine
Stanford Center for Continuing Education
Palo Alto, CA

Learning Objectives
Upon completion, participants should be able to:

  • Identify MS symptomology in order to promptly initiate diagnostic investigations, start timely treatment, and rapidly refer patients to an MS specialist
  • Outline MS diagnostic criteria and features of an initial diagnostic workup
  • Understand the concept of neurologic reserve and encourage lifestyle changes among patients with MS while treating comorbidities to maximize neurologic reserve
  • Recognize the unique attributes and healthcare preferences of millennial patients as they relate to MS

Target Audience
This activity is intended for primary care providers.
Statement of Need
Multiple sclerosis (MS) is a chronic, highly debilitating, inflammatory neurologic disease. Although early diagnosis and intervention are crucial for improving patient outcomes, the identification and management of MS presents a variety of challenges, particularly among the millennial generation, who will represent the majority of MS diagnoses over the next 10 to 15 years.

Another challenge is the rapidly evolving MS treatment landscape. Clinicians must be prepared to apply current clinical data regarding the myriad of available treatment options to tailor therapy decisions. As our understanding of the disease biology increases as a result of advances in clinical, imaging, and pathologic techniques, clinicians must translate these data to inform the prompt diagnosis of MS, treatment selection, and prediction of disease progression.

Collaboration Statement
This activity was developed in collaboration with Med-IQ and Stanford University School of Medicine.

Med-IQ Stanford Medicine

Accreditation/Designation Statements
Joint Accreditation Statement In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Stanford Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Med-IQ is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This nursing activity has been approved for up to 0.75 contact hour.

Medium/Method of Participation
This CE activity consists of a 0.75-credit online Presentation Points. To receive credit, read the introductory CE material, read the Presentation Points, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: April 19, 2021
Expiration Date: April 18, 2022
Estimated Time to Complete This Activity: 45 minutes

Disclosure Policy
Stanford Medicine and Med-IQ require any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 24 months that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Stanford Medicine and Med-IQ have policies in place that will identify and resolve COIs prior to this educational activity. Stanford Medicine and Med-IQ also require faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Jeffrey Dunn, MD, FAAN
Consulting fees/advisory boards: Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb, Genentech, Novartis Pharmaceuticals Corporation, Progentec Diagnostics, Inc.

Lucas Kipp, MD
Contracted research: Biogen Idec, Sanofi-aventis U.S. Inc.

Elaine Su, MD, has indicated no real or apparent conflicts.
The peer reviewers and activity planners have no financial relationships to disclose.
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of CME. As an ACCME-accredited provider of CME, Stanford Medicine and Med-IQ have a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Stanford Medicine and Med-IQ are responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Stanford Medicine and Med-IQ are not liable for any decision made or action taken in reliance upon the information provided through this activity.

Contact Information
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For physician questions or comments related to physician accreditation, please contact The Stanford University School of Medicine. Call 650 497 8554 or email

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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This activity is available free of charge to participants.

Acknowledgment of Commercial Support
This activity is supported by an educational grant from Genentech.


Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • MS is a global disease; a new diagnosis is made every 5 minutes around the world
  • The US is disproportionately affected; according to a new prevalence study published in 2019, almost 1 million Americans are living with the disease, which is double our previous estimates and highlights the importance of recognizing this condition in clinical practice
  • MS affects people in the prime of their lives, typically between the ages of 20 and 40 years; thus, individuals in this age group who will present to primary care offices over the next decade will be from the millennial generation
  • Individuals in the millennial generation have unique health issues and distinct healthcare preferences, which significantly affect their disease course
  • An MS diagnosis must be based on the presence of a typical demyelinating syndrome supported by objective findings on neurologic exam and/or MRI
  • The 2017 RRMS McDonald criteria require evidence of central nervous system demyelination disseminated in both space and time
  • The rate of MS misdiagnosis may be as high as 10%, most commonly due to the presence of nonspecific neurologic symptoms and an overreliance on nonspecific T2 hyperintensities on MRI
  • Preserving neurologic reserve—the central nervous system’s finite capacity to compensate for injury and remodel itself—is key to minimizing long-term disability in MS
  • Every MS lesion causes irreversible axonal loss (not just demyelination), which is the main determinant of irreversible disability and is reflected by accelerated brain volume loss (a major component of neurologic reserve)
  • The trajectory of the disease course in the first few years is a significant predictor of long-term outcomes; substantial evidence shows that early treatment—particularly with highly effective therapies—portends a significantly better prognosis
  • Maximizing neurologic reserve by addressing modifiable risk factors and treating medical comorbidities also substantially affects disease course and quality of life
  • MS treatment should be individualized, with a low threshold to initiate high-efficacy disease-modifying therapy early if poor prognostic features are present
  • The goal of treatment should be no evidence of disease activity (NEDA), which is characterized by no new relapses, no increase in disability, no new MRI lesions, and slowing of brain atrophy into the normal range; this determination requires regular clinical and radiographic monitoring
  • MS therapy should be escalated to a higher-efficacy treatment at the earliest sign of disease breakthrough

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Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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