12 MS Nurse International Workshop - EXCEMED - Excellence in Medical … · 2015. 10. 26. · Your Continuing Medical Education Partner 12 th MS Nurse International Workshop Go t

FINAL PROGRAM AND ABSTRACTS

Your Continuing Medical Education Partnerwww.seronosymposia.org

12th MS NurseInternational

Workshop

Gothenburg, Sweden

- Oct

ober

12,2

010

GENERAL INFORMATION

VENUEThe Workshop will take place at the:

Gothenburg Convention Centre, Sweden (GCC) Mässans Gata 20, SE-402 26 Gothenburg, Sweden

www.gcc.se

LANGUAGEThe official language of this Workshop will be English.

TRAVEL INFORMATIONGothenburg is the second largest city in Sweden. It is located on

the Swedish west coast. Gothenburg is home to many students, asthe city includes both the University of Gothenburg, one of the

largest universities in the Nordic countries, and Chalmers Universityof Technology. The sea, trade and industrial history of the city is

evident in its cultural life. Due to the Gothenburg's advantageouslocation in the centre of Scandinavia, trade and shipping have

always played a role in the city's economic history, and theycontinue to do so. Gothenburg port has come to be the largestharbour in the whole of Scandinavia. Gothenburg is a popular

destination for tourists on the Swedish west-coast, and offers anumber of cultural and architectural highlights. The first major

architecturally interesting period is the 18th century when the EastIndia Company made Gothenburg an important trade city. Imposingstone houses with a Classical look were erected around the canals.One example from this period is the East India House, which todayhouses Gothenburg’s City Museum. Other interesting buildings arethe Gothenburg Museum of Art, the city's theatre, the concert hall,

the Gothenburg Opera house and the Museum of World Culture.One of Gothenburg's most popular natural tourist attractions is the

Southern Gothenburg Archipelago, which is a set of manypicturesque islands that can be reached by ferry boat.

12th MS Nurse International Workshop

Serono Symposia International Foundation

12TH MS NURSE INTERNATIONAL WORKSHOPGothenburg, Sweden - October 12, 2010

AIM OF THE WORKSHOPThis is an educational program created to encourage the dissemination of scientific knowledge among nurses working in thefield of Multiple Sclerosis (MS). Disease management in research and clinical practice, with a special emphasis on the nurses’crucial role, will be reviewed. Management of main signs and symptoms of the disease, such as spasticity, pain, psychosocialdistress, cognitive impairment and genitourinary problems will be addressed both from the physician and nurse perspective.

LEARNING OBJECTIVESAt the conclusion of this Workshop, participants will: • Be updated on diagnostic tools used to define physical and psychological disorders related to MS • Be able to implement the most advanced tools in disease management in their practice • Have an updated knowledge of the management of experimental therapies and clinical trials in Multiple Sclerosis

TARGET AUDIENCENurses involved in the treatment of persons with Multiple Sclerosis.

ACCREDITATIONThis continuing education activity has been approved by the International Council of Nurses (ICN) for 6.45 InternationalContinuing Nursing Education Credits (ICNECs).

All Serono Symposia International Foundation programs are organized solely to promote the exchange and dissemination of scientific and medical information. No forms of promotionalactivities are permitted. There may be presentations discussing investigational uses of various products. These views are the responsibility of the named speakers, and do not represent anendorsement or recommendation on the part of Serono Symposia International Foundation. This program is made possible thanks to the unrestricted Educational grant received from: Centred’Esclerosi Multiple de Catalunya, Vall d'Hebron University Hospital, ComtecMed, Congrex Sweden, Congrex Switzerland, Cryo-Save, Datanalysis, Esaote, Fundación IVI, ISFP InternationalSociety for Fertility Preservation, ISMH International Society of Men’s Health, K.I.T.E., Merck Serono, Ministry of Health of the State of Israel, University of Catania.

SCIENTIFIC SECRETARIATSerono Symposia International FoundationSalita di San Nicola da Tolentino, 1/b00187 Rome, ItalyAssociate Project Manager: Serena Dell’AricciaTel.: +39-06-420 413 251Fax: +39-06-420 413 677E-mail: [email protected] Symposia International Foundation is a Swiss Foundation with headquarters in 14, rue du Rhône, 1204 Genève, Switzerland

ORGANIZING SECRETARIATMeridiano Congress International Via Mentana, 2/B - 00185 Rome - ItalyCongress Coordinator: Federica RussettiPhone: +39-06-88595 209Fax: +39-06-88595 234E-mail: [email protected]

SCIENTIFIC ORGANIZER

Giancarlo ComiDepartment of NeurologyInstitute of Experimental NeurologyVita-Salute San Raffaele UniversityMilan, Italy

WORKSHOP MODERATOR

Eija Luoto Masku Neurological Rehabilitation CentreMasku, FinlandPresident RIMS - Rehabiliation in MSEuropean network of MS Centres

Amy Perrin Ross Department of Neurosciences Loyola University Medical Center Oak Brook, Illinois, USAImmediate Past President IOMSN - International Organization of MS Nurses

MS NURSE WORKSHOP STEERING COMMITTEE

Sharalyn Anderson Department of NeurologyNorth East Lincolnshire Care TrustLondon, UK

Dawn CarleDepartment of NeurologyOttawa HospitalGeneral CampusOttawa, Ontario, Canada


Sara DishonThe MS Centre Carmel Medical Centre Haifa, Israel

Mark S. FreedmanThe Ottawa HospitalMS Research Unit Ottawa, Ontario, Canada

Barbara KieserNeurologische Klinik Kantonsspital Kuttingen, Switzerland

Dawn LangdonDepartment of PsychologyRoyal Holloway University of LondonLondon, UK

Eija LuotoMasku Neurological Rehabilitation CentreMasku, Finland

Roberta MottaItalian Multiple Sclerosis SocietyRehabilitation CentreGenoa, Italy

Amy Perrin RossDepartment of Neurosciences Loyola University Medical Center Oak Brook, Illinois, USA

Jürg KesselringDepartment of Neurology and NeurorehabilitationValens Clinic Rehabilitation CentreValens, Switzerland

Dawn LangdonDepartment of PsychologyRoyal Holloway University of LondonLondon, UK

Fred LublinCorinne Goldsmith Dickinson Center for MSMount Sinai School of MedicineNew York, NY, USA

Eija LuotoMasku Neurological Rehabilitation CentreMasku, Finland

Xavier MontalbanMultiple Sclerosis Center of Catalonia Unit of Clinical Neuroimmunology Vall d’Hebron University Hospital Barcelona, Spain

Roberta MottaItalian Multiple Sclerosis SocietyRehabilitation CentreGenoa, Italy

Amy Perrin RossDepartment of Neurosciences Loyola University Medical Center Oak Brook, Illinois, USA

Jaume Sastre-GarrigaMultiple Sclerosis Center of Catalonia Unit of Clinical Neuroimmunology Vall d’Hebron University Hospital Barcelona, Spain

LIST OF SPEAKERS AND CHAIRMEN

Maria Pia AmatoDepartment of Neurological and Psychiatric SciencesUniversity of FlorenceFlorence, Italy

Sharalyn Anderson Department of NeurologyNorth East Lincolnshire Care TrustLondon, UK


Monica FalautanoFunctional Unit of PsychologyDepartment of Neurology and Clinical NeurophisiologyIRCCS Fondazione San Raffaele del Monte Tabor Milan, Italy

Oscar FernándezNeuroscience Institute Service of Neurology University Regional Hospital “Carlos Haya” Malaga, Spain

Mark S. FreedmanThe Ottawa HospitalMS Research Unit Ottawa, Ontario, Canada

Urs N. GamperDepartment of TherapyValens Clinic Rehabilitation CenterValens, Switzerland

Claudio GasperiniDepartment of NeurosciencesSan Camillo Forlanini HospitalRome, Italy

June HalperCMSC/IOMSNHackensack, NJ, USA

SCIENTIFICPROGRAM

TUESDAY - OCTOBER 12, 2010

08.30 Serono Symposia International Foundation OpeningGiancarlo Comi, Italy

08.45 Workshop IntroductionEija Luoto, Finland - Amy Perrin Ross, USA

SESSION I

PRACTICAL ISSUES AND SOLUTIONS IN DMDs

Session Chair: Eija Luoto, Finland

09.00 L1: Immunomodulatory treatmentsFred Lublin, USA

09.20 L2: Fostering adherence to DMDsJaume Sastre-Garriga, Spain

09.40 L3: Fostering adherence to DMDs - The Nurse perspectiveSharalyn Anderson, UK

10.00 Discussion

10.10 L4: Nurses: key interface between patients and physiciansMark S. Freedman, Canada

10.30 L5: MS at home assistanceClaudio Gasperini, Italy

10.50 L6: MS at home assistance - The Nurse perspectiveAmy Perrin Ross, USA

11.10 Discussion

11.20 Coffee Break

SESSION II

COGNITIVE PROBLEMS IN MS


11.30 L7: Cognitive problems in MSMaria Pia Amato, Italy

11.50 L8: Cognitive rehabilitation in MSMonica Falautano, Italy

12.10 Discussion

SESSION III

MOTOR PROBLEMS AND REHABILITATION IN MS


12.20 L9: Motor problems and rehabilitation in MSJürg Kesselring, Switzerland

12.40 L10: Motor problems and rehabilitation in MS - The Physiotherapist perspectiveUrs N. Gamper, Switzerland

13.00 Discussion

13.10 Lunch

SESSION IV

EMOTIONAL PROBLEMS IN MS

Session Chair: Amy Perrin Ross, USA

14.30 L11: Affective and emotional problems in MSGiancarlo Comi, Italy

14.50 L12: Management of psychological problems in MSDawn Langdon, UK

15.10 Discussion

SESSION V

GENITO-URINARY PROBLEMS IN MS PATIENT


15.20 L13: Genito-Urinary problems in MS patientOscar Fernández, Spain

15.40 L14: Genito-Urinary deficiency in MS patient - The nurse perspectiveRoberta Motta, Italy

16.00 Discussion

16.10 Coffee break

SESSION VI

EXPERIMENTAL AND ROUTINE THERAPY MANAGEMENTIN MS RESEARCH CENTERS


16.30 L15: MS experimental therapiesXavier Montalban, Spain

16.50 L16: The role of nurses in the research center (The nurse perspective)June Halper, USA

17.10 Discussion and concluding remarks

17.30 End of the Workshop

Scientific Program

DISCLOSURE OF FACULTY RELATIONSHIPS

Serono Symposia International Foundation adheres to guidelines of the European Accreditation Council for Continuing Medical Education(EACCME) and all other professional organizations, as applicable, which state that programs awarding continuing education credits mustbe balanced, independent, objective, and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices,and other products (other than those uses indicated in approved product labeling/package insert for the product) may be presented in theprogram (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We ask allpresenters to provide participants with information about relationships with pharmaceutical or medical equipment companies that mayhave relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it is onlyintended to inform participants of any potential conflicts so participants may form their own judgments, based on full disclosure of thefacts. Further, all opinions and recommendations presented during the program and all program-related materials neither imply anendorsement, nor a recommendation, on the part of Serono Symposia International Foundation. All presentations solely represent theindependent views of the presenters/authors.

The following faculty provided information regarding significant commercial relationships and/or discussions of investigational or non-EMEA/FDA approved (off-label) uses of drugs:

Maria Pia Amato Declared receipt of grants and contracts from Bayer Schering, Aventis Pharma, Merk Serono, BiogenDompé; declared receipt of honoraria or consultation fees Bayer Schering, Aventis Pharma, Merck Serono,Biogen Dompé; declared to be member of a company advisory board, board of directors or other similargroup: Bayer Schering, Aventis Pharma, Merk Serono, Biogen Dompé.

Sharalyn Anderson Declared no potential conflict of interest.

Giancarlo Comi Declared receipt of grants and contracts from Novartis, Teva Pharmaceutical Industries Ltd., Sanofi-Aventis, Merck Serono, Bayer Schering, Biogen-Dompé.

Monica Falautano Declared no potential conflict of interest.

Oscar Fernández Declared no potential conflict of interest.

Mark S. Freedman Declared receipt of research or educational grants from BayerHealthcare, Genzyme, EMD Canada.Declared receipt of honoraria or consultation fees from BayerHealthcare, BiogenIdec, EMD Canada,Novartis, Sanofi-Aventis, Teva Canada Innovation. Declared to be member of a company advisory board,board of directors or other similar group: BayerHealthcare, Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis, Celgene.

Urs N. Gamper Declared no potential conflict of interest.

Claudio Gasperini Declared no potential conflict of interest.

June Halper Declared receipt of honoraria or consultation fees from Bayer healthcare, Biogen Idec, Acordatherapeutics.

Jurg Kesselring Declared no potential conflict of interest.

Dawn Langdon Declared receipt of grants and contracts: Bayer Healthcare,; declared member of a company advisoryboard, board of directors or other similar group of Bayer Healthcare, Novartis, declared participation in acompany sponsored speaker’s bureau of Bayer Healthcare, Merck-Serono, Sanofi-Aventis.

Fred Lublin Declared sources funding for research from Acorda therapeutics, Biogen Idec, Genentech, NovartisPharmaceuticals Corp, teva Neiroscience Inc, Genzyme, Sanofi Aventis, NIH, NMSS. Declared Consultingagreement/advisory boards/DSMB: Bayer Healthcare Pharmaceuticals, Biogen Idec, BioMS medical Corp,EMD Serono Inc, Genentech Inc, Novartis, Pfizer, Teva Neuroscience, Genmab, Medicinova, Actelion,Allozyne, Sanofi-Aventis, Questcor, Acorda, Avanir, Roche, Celgene, Abbott. Speakers Bureau/Honorariumagreement: EMD Serono, Pfizer, Teva Neuroscience. Declared financial interests/Stock ownership: CognitionPharmaceuticals Inc. The author declared that he may discuss unapproved agents that are in the MSdevelopmental pipeline without any recommendation on their use.

Eija Luoto Declared no potential conflict of interest.

Xavier Montalban Declared receipt of grants and contracts: Bayer Schering, Biogen Idec, Novartis, Merck Serono, Teva SanofiAventis, Almirall.

Roberta Motta Declared no potential conflict of interest.

Amy Perrin Ross Declared no potential conflict of interest

Jaume Sastre-Garriga Declared to be member of a company advisory board, board of directors or other similar group: Novartis,Teva, Bayer. Declared the participation in a company sponsored speaker’s bureau: Sanofi-Aventis, Novartis,Almirall, Merck-Serono, Biogen.

All Serono Symposia International Foundation programs are organized solely to promote the exchange and dissemination of scientific and medical information. No forms of promotionalactivities are permitted. There may be presentations discussing investigational uses of various products. These views are the responsibility of the named speakers, and do not represent anendorsement or recommendation on the part of Serono Symposia International Foundation. This program is made possible thanks to the unrestricted Educational grant received from: Centred’Esclerosi Multiple de Catalunya, Vall d'Hebron University Hospital, ComtecMed, Congrex Sweden, Congrex Switzerland, Cryo-Save, Datanalysis, Esaote, Fundación IVI, ISFP InternationalSociety for Fertility Preservation, ISMH International Society of Men’s Health, K.I.T.E., Merck Serono, Ministry of Health of the State of Israel, University of Catania.

Disclosure of Faculty Relationships

ABSTRACTS (L1 – L16)

L1IMMUNOMODULATORY TREATMENTS

Fred LublinCorinne Goldsmith Dickinson Center for MS, Mount Sinai School of Medicine, New York, NY, USA

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Learning ObjectivesBy the end of the programme participants should appreciate: • International Variation in Assisted Reproduction Practice• Need to collect data to reflect practice• Value of e-Learning to facilitate best practice

IntroductionThe

MethodsThe

ResultsThe

ConclusionsThese results

Abstract not in hand at the time of going to press.

L2FOSTERING ADHERENCE TO DMDs

Jaume Sastre-GarrigaMultiple Sclerosis Center of Catalonia, Unit of Clinical Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain

Evidence coming from the pivotal clinical trials and from some other well-performed clinical trials has clearly demonstrated the benefit ofimmunomodulatory therapies in MS. It is also clear that present therapies are not without side effects and mode of administration is stillcumbersome for a number of patients; these factors impact on adherence to treatment, which may render the therapeutic efforts futile.Several studies have shown that most drop-outs occur in the early phases of therapy so special care needs to be taken when patients starttheir immunomodulating therapy in order to avoid treatment discontinuation. Available evidence suggests that individualized care is animportant factor to keep drop-out rates low; in this regard, management of side effects of therapies is crucial, as it is responsible for almosta half of all discontinuations. Another important factor related to treatment discontinuation seems to be lack of efficacy; therefore, closefollow-up of non-adherent patients is highly recommended to increase therapy efficacy and to achieve an early identification of patientswith poorer prognosis.

Side effects profile of IFNbeta preparations and GA are not entirely overlapping. In the case of IFNbeta preparations, it is especiallyimportant to manage flu-like symptoms at onset of therapy. Several strategies can be implemented to diminish patient discomfort, such asgradual dose increase and anti-inflammatory therapy administration schemes. Other side effects such as injection site reactions, flushingand laboratory abnormalities also need to be closely monitored. Nurse-led patient education at onset of therapy may be helpful to managepatients’ expectations from therapy and to anticipate and diminish the impact of side effects on adherence to treatment.

Finally, even though results from clinical trials are the keystone to our clinical practice, measuring efficacy of therapy in clinical practice inan appropriate manner is crucial to obtain the most from available therapies. Clinical daily practice individualized monitoring of treatmentresponse, treatment adherence, and side effects profile is therefore highly recommended if clinical trials efficacy results are to be met inour clinics.

ABSTRACTS

L3FOSTERING ADHERENCE TO DMDs - THE NURSE PERSPECTIVE

Sharalyn AndersonDepartment of Neurology, North East Lincolnshire Care Trust, London, UK

Multiple Sclerosis affects the whole family unit; it inflicts a heavy price on the patient, their families and the health care system. Quality oflife is sometimes impaired, unemployment is frequent due to sustained symptoms and further complications are common as the conditionenters into the chronic stage.

Disease-modifying drugs have, over the last few years, made a significant difference in the management of the disease.

A diagnosis of Multiple Sclerosis in 2010 is not what anyone wants; however, to be diagnosed with the disease now offers far more choiceof treatment and help than if it were diagnosed ten years ago.

Patients have seen fewer symptoms and frequency of relapse reduced whilst on DMD therapies.

Recent new therapies have made significant impact on the slowing of the disability progression and quality of life.

The MS Specialist Nurse plays a major role in ensuring patience adherence and compliance in order to obtain optimal health outcomes forthe patients using DMD therapies.

The multidisciplinary teams continue to be the way forward where the Specialist Nurse plays a pivotal role in the monitoring of patientswith their chosen therapy.

However, we still need to ensure that measures are implemented to understand patient’s satisfaction and their understanding of thetherapy.

We need to ensure the therapies are explained and administered correctly to prevent inappropriate discontinuation.

L4NURSES: KEY INTERFACE BETWEEN PATIENTS AND PHYSICIANS

Mark S. FreedmanThe Ottawa Hospital, MS Research Unit, Ottawa, Ontario, Canada


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1. Adapting the ovarian stimulation protocol according to the patient’s individual profile and the experience from her previousstimulation cycles.

2. Reducing FSH and compensating with LH in the stimulation protocol to selectively stimulate the greatest follicles and prevent thegrowth of smaller ones.


IntroductionThe

MethodsThe

ResultsThe


References:1 - Chappel SC, Howles C 1991 Reevaluation of the roles of luteinizing hormone and follicle-stimulating hormone in the ovulatory process. Human

Reproduction 6 1206-1212. 2 - Filicori M, Cognigni GE, Pocognoli P et al. 2003 Current concepts and novel applications of LH activity in ovarian stimulation. Trends in Endocrinology

and Metabolism 14, 267-273.


ABSTRACTS

L5MS AT HOME ASSISTANCE

Claudio GasperiniDepartment of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy

Multiple sclerosis (MS) is associated with various symptoms and functional deficits resulting in a range of progressive impairments andhandicaps. Symptoms that contribute to loss of independence and restrictions in social activities produce continuing decline in quality oflife. Management of MS requires a multidisciplinary approach including drug therapy, psychological counselling, and physiotherapy.

Even if in recent years much progress has been made in therapeutic MS research, a concomitant advancement in the support of patientsin their daily activities improvement and in their assistance is not always so tangible.[1]

Patients in some countries (especially the UK) are not managed solely in hospitals [2]. There is evidence that most patients affected byprogressive forms of MS need major long-term support at home or in the community, rather than through hospital care. Specialised at-home care has had variable success as an alternative way to provide organised multidisciplinary care for various diseases [3, 4].

MS represents a high economic burden, with indirect costs greatly exceeding direct costs [5] and, for this reason, better understanding ofthe clinical effectiveness and costs of a supplementary home-assistance and home-exercise rehabilitation programme is needed.

In this lecture we will present our study regarding a possible home-based care model for MS patients.

References:1 - Freeman JA, Thompson AJ. Community services in multiple sclerosis: still a matter of chance. J Neurol Neurosurg Psychiatry 2000; 69: 728-322 - Shah E, Harwood R. Acute management: admission to hospital in stroke: epidemiology, evidence and clinical practice. 2nd ed. Oxford: Oxford University

Press, 19993 - Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home with in-patient hospital care I: three

months follow-up of health outcomes. BMJ 1998; 316: 1786–914 - Shepperd S, Iliffe S. Effectiveness of hospital at home compared to inpatient care. In: Cochrane Library. Oxford: Update Software, 19995 - Amato MP, Battaglia MA, Caputo D, Fattore G, Gerzeli S, Pitaro M, Reggio A, Trojano M; Mu. S. I. C. Study Group. The costs of multiple sclerosis: a cross-

sectional, multicenter cost-of-illness study in Italy. J Neurol. 2002; 249: 152-63

L6MS AT HOME ASSISTANCE - THE NURSE PERSPECTIVE

Amy Perrin RossDepartment of Neurosciences, Loyola University Medical Center, Oak Brook, Illinois, USA(Immediate Past President IOMSN - International Organization of MS Nurses)


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IntroductionThe

MethodsThe

ResultsThe


References:1 - Chappel SC, Howles C 1991 Reevaluation of the roles of luteinizing hormone and follicle-stimulating hormone in the ovulatory process. Human

Reproduction 6 1206-1212. 2 - Filicori M, Cognigni GE, Pocognoli P et al. 2003 Current concepts and novel applications of LH activity in ovarian stimulation. Trends in Endocrinology

and Metabolism 14, 267-273.


ABSTRACTS

L7COGNITIVE PROBLEMS IN MS

Maria Pia AmatoDepartment of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy

Only during the past 20 years clinicians have become aware of the prevalence and functional impact of MS-related cognitive impairment.Cognitive dysfunction is highly variable and estimates of its frequency range from 43% to 65% of the cases. The domains most commonlyimpaired are episodic memory, complex attention and information processing speed, executive functions and verbal fluency. Language,semantic memory and attention span are less frequently involved.

Cognitive dysfunction can have a dramatic impact on several aspects of quality of life, independently by the degree of physical disability,and is one of the most important predictors of the patient work status. Attempt therapeutic approaches include the use of disease-modifying drugs, symptomatic drugs for fatigue and donepezil as well as different rehabilitative programs.

Due to the high prevalence and great functional impact of MS-related cognitive impairment, the search for effective therapeutic strategiesis an urgent priority for future research.

L8COGNITIVE REHABILITATION IN MS

Monica FalautanoFunctional Unit of Psychology, Department of Neurology and Clinical Neurophisiology, IRCCS Fondazione San Raffaele del Monte Tabor,Milan, Italy

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that commonly leads to inflammatory and atrophic brainpathology, often causing cognitive impairment. The different course of the disease, the time of the onset, the lesion burden, the age, thesocial and personological status of the subject and the “cognitive reserve” can all occur in the expression of the cognitive functions andin their possible alteration. Many studies have stressed the importance of neuropsychological evaluation in people with MS to characterizethe type of disease and to monitor the course of cognitive dysfunctions. The reported prevalence of cognitive impairments in people withMS ranges from 40-65% depending on study setting.

The functions most consistently affected are controlled attentional processing, speed of information processing, explicit anterogradememory, abstract reasoning and executive functions. This evidence introduces the query about the efficacy of the use of cognitiveinterventions in people with MS. In fact, the remediation of cognitive impairment is less well researched and understood. For the CochraneCollaboration Library the evidence of the effectiveness of intervention was inconclusive, partly because of the large number of outcomemeasures that are frequently used in this study, and partly because of small sample size. Further, the small number of studies actuallyconducted means that it is difficult to generalise about whether psychological approaches to treating cognitive impairment are helpful.Also the review by O’Brien et al. (2008) concludes that cognitive rehabilitation in MS is in its relative infancy and more methodologicallyrigorous research is needed to determine the effectiveness and efficacy of various cognitive rehabilitation interventions. These findingsshould provide motivation to assess randomised and double-blind trials focusing on the development of a gold standard forneuropsychological test measures and training tools.

Neuroplasticity is a fundamental issue that supports the scientific basis for treatment of acquired brain damage with goal-directedexperiential therapeutic programs in the context of rehabilitation approaches to the functional consequences of the damage. fMRI hasshown potential as a tool for visualization of cognitive training effects and even for verification of its efficacy. On the other hand it isnecessary to consider the rehabilitative training as a process involving different steps and people. In this way it is necessary, in the clinicalpractice, to assess an extensive neuropsychological evaluation, collect information about the personality features, the quality of life andthe motivation of the patient, plan and explain the intervention and then use specific tools to verify the efficacy at short and long term.

References:- Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for Multiple Sclerosis - The Cochrane Collaboration 2007, revised 2009.- Cicerone KD, Dahlberg C. Malec JF, et al. Evidence-based cognitive rehabilitation: Update review of the literature from 1998throught 2002. Arch PhysMed Rehabil. 2005; 86(8): 1681-1692.

- Amato MP, Zipoli V. Portaccio E. Multiple Sclerosis-related cognitive changes: A review of cross-sectional and longitudinal studies. J. of Neurol. Sc. 2006,245: 41-46.

- Wilson B.A. OBE. Cognitive Rehabilitation in the 21st Century. Neurorehab. and Neurall Repair Vol. 16 n°2 2002. - O’Brien AR, Chiaravalloti N., Goverover Y, DeLuca J. Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature.Arch Phys Med Rehabil, 2008, 89: 761-769.

ABSTRACTS

L9-L10MOTOR PROBLEMS AND REHABILITATION IN MS

Jurg Kesselring and Urs N. GamperDepartment of Neurology and Neurorehabilitation, Valens Clinic Rehabilitation Centre, Valens, Switzerland

Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairmentsand handicap. The symptoms, which contribute to loss of independence and restrictions to participate in social activities, are oftenresponsible for a continuing decline in quality of life. The main objective of rehabilitation is, therefore, to ease the burden of symptoms byimproving self-performance and independence. Compensation of functional deficits, adaptation and reconditioning, together withmanagement of symptoms, impairment, emotional coping and self-estimation, are all important long-term objectives. There are specifictreatment recommendations for patients with spastic disorders, sensory loss and ataxia. Although rehabilitation has no direct influence ondisease progression, recent studies indicate that this form of intervention improves personal activities and participation in social activities,thereby improving quality of life. The improvements often outlast the treatment period by several months. These findings suggest thatquality of life is determined by disability and handicap more than by functional deficit and disease progression.

L11AFFECTIVE AND EMOTIONAL PROBLEMS IN MS

Giancarlo ComiDepartment of Neurology, Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy

Multiple sclerosis (MS) has major impacts on emotions: changes of mood and behaviour include anxiety, depression, grief, euphoria andemotional lability. Each patient may suffer from one or more of these phenomena during his life and all these mood changes may havegreat influences on the quality of life and on the working activity, even more than physical disturbances.

The pathophysiology of these disturbances is far from being clarified, with combined influences of nervous damage and reactions to achronic disabling disease.

Depression is the most frequent emotional disorder. Metanalysis revealed significantly higher scores for depression in MS patientscompared to control groups. Depression symptoms may characterize the disease onset in some cases. Interestingly enough, in isolatedsyndromes depression is not observed, however at follow up patients who developed clinically definite MS resulted significantly depressedcompared to patients who did not develop MS and to normal controls. In the early phases of the disease mood changes may be mostlyexplained by an adaptation to the disease. Depression prevalence tends to increase again in the more advanced phases of the disease asa reaction to the irreversible accumulation of disability. The frequency of suicide is increased by 7 times in MS population compared to thegeneral population.

If the depression is caused by the nervous damage we should expect some association with the measures of brain damage. The amountof lesions in periventricular areas, temporal and frontal lobes, as revealed by magnetic resonance imaging, resulted significantly correlatedto the presence of depression in some small studies. The small dimension of the examined samples and some methodological problemslimit the value of these observations.

Immunological factors may also play a role in mood changes. An increased risk of depression has been observed in patients undergoingnew attacks and it has been explained as a reaction to the increased impairment or to an adverse effect of steroid treatment. However thepossibility of psychoneuroimmunologic dysfunction should also be considered (abnormal response to dexametasone suppressor test). Somemedications, like steroids, anticonvulsivants, antispastics, etc. may also contribute to the depression. The negative impact of interferon betatreatment on mood reported in the Interferon beta-1b North American clinical trials has not been confirmed by subsequent studies withthe same drug or other interferons.

Emotional lability is also frequently observed in MS, as in other chronic diseases. Patients may exhibit sudden and unmotivated changesof the mood with periods of anger, irritability and aggressiveness lasting a few minutes. Euphoria has been for a long time considered veryfrequent in MS; more recent controlled studies indicate that it is present in not more than 10% of the patients. It is frequently associatedto executive dysfunctions indicating the key role of frontal lobes. Affective release, emotional crescendo, behavioural abnormalities mayalso be observed in MS, but probably not more frequent than in the general population.

Pharmacotherapy works in MS as in the general population, however the physician should consider the safety profile of the prescribeddrugs because of the possible interference with other problems of the person with MS. Psychotherapy is of the outmost importance in orderto help patients to adapt to affective and physical problems; it must be integrated with the involvement of the family and care givers. Thecorrection of affective problems not only increase the quality of life but also allow a better compliance of etiologic treatments.

ABSTRACTS

L12MANAGEMENT OF PSYCHOLOGICAL PROBLEMS IN MS

Dawn LangdonDepartment of Psychology, Royal Holloway University of London, London, UK

People with multiple sclerosis (MS) endure significant emotional distress, in the context of their disabling physical symptoms. Emotionaldistress is in evidence during the process of diagnosis and throughout the variable and progressive course of the disease. Once a personis diagnosed with MS, they have a lifetime risk of 50% of experiencing a significant depressive episode. The increased suicide risk linkedto MS is related to depression. At the less severe end of the scale, people with MS can also display a flattened affect that does not qualifyfor a depression diagnosis, but nevertheless signals a chronic sadness. Anxiety is also a feature of MS, often linked to disease progressionor pain. Emotional distress is linked to a person’s understanding of MS, their illness representation. This can mediate coping strategies.Emotional distress and coping strategies both impact on disease management generally. Understanding patterns of emotional distress andcoping responses can guide clinical management and support.

References:- Beckner V, Howard I, Vella L, Mohr DC. Telephone-administered psychotherapy for depression in MS patients: moderating role of social support. J BehavMed. 2010 Feb;33(1):47-59.

- Ghaffar, O., Feinstein, A. The neuropsychiatry of multiple sclerosis: a review of recent developments. Curr Opin Psychiatry. 2007. 20 (3). 278-85.- Isaksson, A. K., Gunnarsson, L. G., Ahlstrom, G. The presence and meaning of chronic sorrow in patients with multiple sclerosis. J Clin Nurs. 2008. 16(11C). 315-24.

L13GENITO-URINARY PROBLEMS IN MS PATIENT

Oscar FernándezNeuroscience Institute, Service of Neurology, University Regional Hospital “Carlos Haya”, Malaga, Spain

Multiple sclerosis (MS) is a frequent chronic neurologic disease in young persons. Cause is still unknown. Both genetic susceptibility plusenvironmental factors have been involved as needed for the development of the disease, Treatment to modify pathogenesis is only partiallyefficacious

MS produces multiple lesions along the neuraxis, all neurological systems are affected. A low percent of patients present initially withurologic complaints, alone or associated with other neurologic symptoms, There may be evidence of urologic dysfunction in clinically silentMS patients, During the course of the disease the majority of patients develop urinary symptoms (urgency, frequency, urge/incontinence,hesitancy, retention). The severity of bladder symptoms is unrelated to the duration of the disease, but parallels the severity of otherneurologic symptoms, particularly those due to pyramidal tract involvement. For the majority of MS patients the bladder symptoms are troublesome rather than life threatening. Renal failure attributable to neurogenic bladder dysfunction is uncommon.

Genital alterations are also infrequent as an onset symptom, but are frequent along the course of the disease around 70% will suffer fromerectile dysfunction, reduced libido, delayed or loss of ejaculation, reduced genital sensation in males. In females reduced libido, orgasmicdysfunction and reduced vaginal lubrication and sensation are common) causing a negative impact on the quality of life of patients.

Many of these problems have symptomatic treatment. The treatment is directed to prevent further complications. Consequently an increaseof QoL is obtained. Adequate workup and individualised treatment are paramount in the case of genitor-urinary alterations.

Nowadays, the majority of the symptoms can be treated or alleviated with conservative treatments. Consultation with urological orgynaecological experts should be used only if more aggressive diagnostic or therapeutic measures are needed.

ABSTRACTS

L14GENITO-URINARY DEFICIENCY IN MS PATIENT - THE NURSE PERSPECTIVE

Roberta MottaItalian Multiple Sclerosis Society, Rehabilitation Centre, Genoa, Italy

It is estimated that as high as 90% of people with multiple sclerosis (MS) experiences some type of urinary problem over the course of thedisease. The importance of an interdisciplinary approach becomes significant, particularly with a symptom that requires the involvementof different professionals, each with specific knowledge of evaluation and treatment. The MS nurse is perhaps the professional most likelyto be in a position to initiate the process of identifying urological dysfunction. Starting the evaluation with a review of symptoms recordedin the patient’s medical records over time, the use of a urinary diary and a check of the patient’s post void residual at the time of eachvisit, aids the MS nurse in recognizing which urinary dysfunction could be affecting the patient. The MS nurse can also have an importantrole in teaching the patient behavior strategies that aid in both evaluating and treating urinary dysfunction. Finally, the MS nurse can bethe primary instructor of techniques related to the intermittent catheterization procedures.

L15MS EXPERIMENTAL THERAPIES

Xavier MontalbanMultiple Sclerosis Center of Catalonia, Unit of Clinical Neuroimmunology, Vall d’Hebron University Hospital, Barcelona, Spain



ABSTRACTS

L16THE ROLE OF NURSES IN THE RESEARCH CENTER (THE NURSE PERSPECTIVE)

June HalperCMSC/IOMSN, Hackensack, NJ, USA

During the past three decades, multiple sclerosis nursing care has broadened its reach to extend beyond clinical practice to include clinicaltrials. While the role of the MS nurse clearly emphasizes day-to-day management of patients and families, there is an increased need towork collaboratively with the research team in important clinical trials that have made a huge difference in the lives of all those affectedby MS.

The nursing profession lends itself to this work because the task involved patient care, coordination, documentation, and ensuring thatpatients remain safe and healthy during their participation in a clinical trial. Nurses are in a unique position to perform these roles due totheir knowledge, skills, and competencies. For patients, participation in clinical trials brings a sense of participation and empowerment asthey contribute to the great good in healthcare. For nurses, there is an opportunity to use their administrative and creative skills to helppatients successfully participate in activities that impact current and future care and research in multiple sclerosis.

NOTES

NOTES

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