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Rotation Director: Dr. Andrew Romeo

Clinic days: Monday-Friday, 8:00AM-5:00PM

Resident continuity clinic: Wednesdays PM

Days off: Thursday PM, Friday PM, weekends, holidays

MA: Kim Duval (completing forms, setting up labs/tests/resources for patients)


Rotation components: 

  1. Clinic attendance
  2. Neuroimmunology Case Conference
  3. Wednesday Conferences
  4. Journal Club
    • 3rd Wednesday of Month (ask for specifics)
  5. Chalk Talks
    • Wednesday mornings (schedule with Romeo) 

Patient Resources: News, disease/treatment information brochures, support groups, financial aid/patient assistance programs

My MSToolkit

Disease-Modifying Therapies for MS (patient information packet)

National Multiple Sclerosis Society

Multiple Sclerosis Association of America


Clinic Schedule:

  • MiChart clinical context: "TC NEU MULTIPLE SCLEROSIS 02"
  • after patient arrives, right-click patient name and select "Change provider to me" (don't do this before arrival, otherwise schedulers will see open blocks and schedule patients into those time slots)

AMPM
Monday

Taubman MS Clinic

Attending: Braley

Taubman MS Clinic

Attending: Romeo

Tuesday

Taubman MS Clinic

Attending: Irani

Taubman MS Clinic

Attending: Irani/Mao-Draayer

Wednesday

Wednesday morning conferences

Teaching Romeo

Resident continuity clinic
Thursday

AAVA MS Clinic

Attendings: Braley, Romeo

Reading time

Friday

Taubman MS Clinic

Attending: Romeo

Reading time


Clinical Resources:


How to send JC virus antibody in MiChart:

    • Miscellaneous Send-out: type in serum JC virus ab stratify 91665; source=serum; diagnosis=MS
    • Send out lab is Quest Diagnostics
    • Lab location: 1947 Technology Drive, Troy, MI 48108 - (866)697-8378

 

News/Updates:

March 2019: FDA approves cladribine (Mavenclad) for adults with relapsing-remitting multiple sclerosis and active secondary progressive disease (FDA)

March 2019: FDA approves siponimod (Mayzent) for relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis (FDA)

March 2019: Imaging outcome measures of neuroprotection and repair in MS (NAIM consensus statement)

November 2018: FDA warns about rare but serious risks of stroke and blood vessel wall tears with multiple sclerosis drug Lemtrada (alemtuzumab) (FDA)

November 2018: Gilenya (fingolimod): Drug Safety Communication - Severe Worsening of Multiple Sclerosis After Stopping the Medicine (FDA)

October 2018: Results Reported from Innovative “MS-SMART” Clinical Trial in Secondary Progressive MS Presented at ECTRIMS (National MS Society)

October 2018: Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis (JAMA)

May 2018: FDA expands approval of Gilenya to treat multiple sclerosis in pediatric patients (FDA); see also PARADIGMS: Trial of Fingolimod versus Interferon Beta-1a in Pediatric Multiple Sclerosis (NEJM)

April 2018: Durable Clinical Efficacy of Alemtuzumab in Patients With Active RRMS in the Absence of Continuous Treatment: 7-Year Follow-up of CARE-MS I Patients (TOPAZ Study) (P6.376) (AAN); Durable Clinical Outcomes With Alemtuzumab in Patients With Active RRMS in the Absence of Continuous Treatment: 7-Year Follow-up of CARE-MS II Patients (TOPAZ Study) (P6.369) (AAN)

March 2018: Biogen and Abbvie announce voluntary withdrawal of ZINBRYTA (Daclizumab) (Biogen)

March 2018: Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study (Lancet)



UPDATED 2017 McDonald Criteria for the Diagnosis of Multiple Sclerosis (Lancet Neurol 17:162-173)

(Click to enlarge)


Summary of Treatments in Multiple Sclerosissee Multiple Sclerosis wiki page


Guidelines/Practice Parameters:

April 2018: Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis (AAN)

February 2018: Guideline on the pharmacological treatment of people with multiple sclerosis (ECTRIMS/EAN)

March 2017: The use of disease-modifying therapies in multiple sclerosis: principles and current evidence (MS Coalition)

January 2014: Assessment and management of psychiatric disorders in individuals with MS (AAN)

March 2014: Complementary and alternative medicine in multiple sclerosis (AAN)

December 2011: Clinical evaluation and treatment of transverse myelitis (AAN)

March 2007: Neutralizing antibodies to Interferon-beta (AAN)

May 2000: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected MS (AAN)


Clinical Trials and Systemic Reviews/Meta-Analyses for MS Treatments

    • DMT - Oral Agents

Dimethyl fumarate for multiple sclerosis (April 2015)

Teriflunomide for multiple sclerosis (March 2016)

Fingolimod for relapsing-remitting multiple sclerosis (April 2016)


    • DMT - Injections

Glatiramer acetate for multiple sclerosis (May 2010)

Interferon in relapsing-remitting multiple sclerosis (October 2001)

Inferferons-beta versus glatiramer acetate (November 2016)

Interferon beta or glatiramer acetate for delaying conversion of CIS to MS (April 2008)

Interferon beta for primary progressive multiple sclerosis (January 2010)

Interferon beta for secondary progressive multiple sclerosis (January 2012)

Daclizumab for relapsing remitting multiple sclerosis (December 2013)


    • DMT- Infusions

Ocrelizumab versus interferon beta-1a in relapsing multiple sclerosis (OPERA I and II, NEJM 2017)

Ocrelizumab versus placebo in primary progressive multiple sclerosis (ORATORIO, NEJM 2017)

Rituximab for relapsing-remitting multiple sclerosis (December 2013)

B-cell depletion with rituximab in RRMS (NEJM 2008)

Natalizumab for relapsing remitting multiple sclerosis (October 2011)

Alemtuzumab for multiple sclerosis (April 2016)

Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in RRMS (Lancet 2017)

Mitoxantrone for in multiple sclerosis (May 2013)


    • Corticosteroids

Oral versus intravenous steroids for treatment of relapses in multiple sclerosis (December 2012)





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