MULTIPLE SCLEROSIS Update 2020

The two-day webinar on MULTIPLE SCLEROSIS Update, held under the auspices of the Emirates Neurological Society (EMINS), was rich with the presence of experts and a lot of updates about MS. Dr. Suhail Abdulla Alrukn, president of Emirates Neurology Society and Consultant Neurologist at Rashid Hospital, UAE, has appointed Dr. Jihad Said Salim Inshasi and Dr. Mustafa Shakra to chair and moderate the two-day webinar. Despite the adverse conditions across the world, about 750 people attended each day. The main attraction of the webinar was the interactive question and answer session which helped the participants to clear their doubts and gain knowledge.

Day 1:

The webinar was conducted in a very useful and informative manner for people who suffer from Multiple Sclerosis the most and even disturb the balance of life. The meeting has received a great deal of acceptance as people suffering from various types of MS conditions are not able to go directly to the hospitals for treatment in the current pandemic situation.

Webinar Chairman Dr. Jihad Said Salim Inshasi, Consultant Neurologist and Professor of Neurology, Rashid Hospital, UAE, has welcomed Dr. Ahmed Shatila, Consultant Neurologist Sheikh Shakhbout Medical City, Abu Dhabi, Dr. Reem AlSuwaidi, Specialist Registrar, Rashid Hospital, Saudi Board in Neurology, and Dr. Areen Said Consultant Neurologist, American Hospital, UAE, to the webinar.

                Dr. Ahmed Shatila has focused on the topic of ‘Change the Conversation, Expand the Possibilities’ in relation to MS and discussed the progress in the diagnosis and treatments in MS. According to his studies, the majority of patients with MS have a relapsing–remitting onset followed by a clinical continuum to progression. He explained the characteristics of patients with RRMS, SPMS, and PPMS and said that most untreated patients with RRMS will transition to SPMS within 25 years of disease onset. Patients with SPMS have more unmet needs and a greater disease burden than patients with RRMS and this increase over time. Patients with SPMS reported greater disruption to their working and everyday lives than patients with RRMS. However, Diagnosis of SPMS has often been delayed in clinical practice. Physicians can be hesitant to diagnose SPMS due to difficulty identifying the transition, the associated psychological burden, and the historical lack of viable treatment options. No DMTs have been shown to consistently slow disability progression and cognitive impairment in patients with SPMS and the condition is driven by the CNS-resident inflammatory arm of the disease. Siponimod was the first and only DMT to have positive, clinically relevant data for a representative SPMS population. The safety profile of siponimod is generally similar to that of other drugs in the class.

                Dr. Reem AlSuwaidi centered on MS in the COVID-19 era and discussed case studies. According to her, COVID-19 may be with us for many months and potentially years. But, delaying treatment, de-escalating therapy by switching to immunomodulatory disease-modifying therapies, or interrupting dosing to wait for a vaccine will delay the adequate treatment of MS. National professional bodies like the Italian Society of Neurology and Association of British Neurologists and patient organizations like National MS Society, MS International Federation, UK MS Society, and MS Australia have responded rapidly by issuing guidelines for the COVID-19 pandemic, primarily focused on MS disease-modifying therapies. She detailed the COVID-19 cases among 8 patients with MS. Given the lack of knowledge or large data on the COVID-19 disease course in MS patients receiving DMTs, at present there is no recommendation to stop the different DMTs and therefore expose MS patients to the risk of MS exacerbations. There is increased infection-related health care utilization across all age groups in people with MS compared with the general population (include pneumonia and influenza) but not upper respiratory tract infections. These include social distancing, frequent hand washing with soap and water or an alcohol-based hand rub, and respiratory hygiene. Patients should be educated about the symptoms of COVID-19 infection, including fever, cough, and shortness of breath. People with MS and related disorders should be advised not to make changes to their MS treatment without discussion with their neurologist.

                Dr. Areen Said has discussed some Challenging Cases in Multiple Sclerosis with 10 different conditions. It includes the cases of Gliomatosis Cerebri, Adult-onset Leukoencephalopathy with neuroaxonal spheroids mimicking MS, Middle Cerebellar Peduncle Lesions, Multiple System Atrophy, Alexander disease, Solitary Sclerosis, Copper deficient Myeloneuropathy, Myelopathy due to dural thoracic spinal cord herniation, Neuromyelitis Optica Spectrum Disorder (NMOSD), and PPMS.

Day 2:

The second day was started with the opening remarks from webinar Chairman Dr. Mustafa Shakra, Neurology Consultant at Sheikh Khalifa Medical City, UAE.  He welcomed Dr. Suzan Ibrahim Noori, Senior Consultant Neurologist & Associate Professor, Medical College, University Hospital Sharjah, and Dr. Eslam Shosha, Assistant Professor of Neurology Consultant, Neuroimmunology, and MS McMaster University, Hamilton Health Sciences, Canada to the session.

Dr. Suzan Ibrahim Noori has emphasized Fertility issues in Multiple Sclerosis and its impacts. She has covered different parts such as factors potentially affecting fertility in MS, the impact of MS therapies on fertility, and Infertility Treatments. The role of pregnancy in MS has been exhaustively studied.  However, there has been less emphasis on the effects of MS on fertility.  The frequency of childlessness in the MS female population might be higher than in the general population, as suggested by the Swedish registry. Some patients of fertile age may also be concerned about the risk of transmitting a genetic susceptibility to MS to their children. Anti-Mullerian hormone (AMH) is a peptide hormone that is considered to be a marker of ovarian reserve, unrelated to the menstrual cycle. A recent study showed that men with MS have lower levels of endogenous testosterone, a potential marker for male infertility. Recent studies show a variable incidence of Sexual dysfunctions, ranging from 30% to 70% of patients. According to her findings, in both sexes, bladder and bowel incontinence, weakness, indwelling catheters, visual defects, and speech disturbance may also affect sexual activity, interfering with social relationships and with intimate behavior. MS patients are treated for a long time with immunomodulating drugs and, during treatment, female patients are recommended to maintain anti-conceptive behaviors. This implies, in clinical practice that the use of oral contraceptive (OC) by MS patients is frequent, peaking up to 86%. She suggested the infertility treatments Assisted Reproductive Technologies (ART), which include artificial actions such as in-vitro fertilization (IVF).

Eslam Shosha has introduced the highlights of ECTRIMS 2020, the world’s largest annual international conference devoted to basic and clinical research in multiple sclerosis. Webinar Chairman Dr. Jihad Said Salim Inshasi has taken a session on the ‘Mimics in MS’, which explained false attribution and interpretation of the disease. He shared clinical cases and explained the possible wring interpretations. Differences between small-vessel disease (SVD) and multiple sclerosis and the use of atypical symptoms and red flags to identify non-demyelinating disease were also included in his speech. According to him, Misdiagnosis of MS is still common and much higher for patients who are referred for radiological suspicion. The most common mimickers are non-specific MRI white matter lesions, NMO, psychogenic, migraine, and systemic autoimmune disorders. The strongest predictors of a final diagnosis of MS were younger age, presence of oligoclonal bands in the CSF, and periventricular, corpus callosum, spinal or enhancing lesions on MRI.

Webinar Chairman Dr. Jihad Said Salim Inshasi expressed his appreciation and sincere gratitude to the members for facilitating the webinar with so many participants over the holidays.

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