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Clinical Dialogue & eCase Challenge spacer Ask The Experts
  "Treatment Approaches and Therapies for Highly Active Multiple Sclerosis: Implementing Updated MS Guidelines"
Clinical Dialogue eCase Challenge

Clinical Dialogues are engaging, video-based roundtable discussions focusing on new guidelines, recent publications, and hot topics in patient management.  In tandem with the clinically-focused eCase Challenge, this educational activity creates a complete learning experience.

eCase Challenges are interactive, text-based case studies designed to integrate the educational objectives into day-to-day clinical practice.  The video "Clinical Pearl" summarizes key clinical aspects of this activity.

CME InfoHelp
Jointly Provided by: The University of Texas Southwestern Medical Center and Medical Logix, LLC
Release Date: November 28, 2018
Expiration Date: November 28, 2019
Estimated time to complete activity: 45 minutes for each of the two programs. Each part of this activity has been approved for a maximum of 0.75 TM.
Acknowledgement of Commercial Support: Supported by independent educational grants from EMD Serono and Sanofi Genzyme.
Learning Objectives
After participating in this activity, the participant will demonstrate the ability to:
  • Identify the characteristics of highly active multiple sclerosis (MS) and apply this knowledge to assessing MS severity in patients.
  • Describe the induction treatment approach and rationale for its use in highly active MS patients.
  • Explain the American Academy of Neurology (AAN) recommendations for therapies and other commonly utilized treatments in highly active MS.
  • Cite the potential serious adverse effects associated with drugs used in treating highly active MS and be familiar with the laboratory monitoring practices for these therapies.
  • Identify when MS patients are not sufficiently responding to a disease-modifying therapy (DMT) and consider options for switching therapies.
  • Recognize when a highly active MS patient has progressed to secondary progressive multiple sclerosis (SPMS) and may no longer benefit from treatments targeted at relapsing disease.
As an accredited provider, UT Southwestern Medical Center requires that the content of our activities are:
  • Independent, objective, scientifically rigorous, balanced and free of bias.
  • Based on scientific studies utilized or referenced from sources acceptable to the scientific and medical community.
  • Acceptable to the medical community as it relates to patient recommendations and do not recommend any unscientific modalities or those not supported by evidenced based sources.
Statement of Need
Highly active multiple sclerosis is a chronic, inflammatory and degenerative disorder that results in rapid and profound accrual of neurological disability. The 2018 American Academy of Neurology Practice Guideline: Disease-modifying Therapies for Adults with Multiple Sclerosis now suggests that specific agents be offered to individuals with highly active multiple sclerosis. Effective management of this challenging population relies on providers being skilled at identifying patient and disease characteristics that are associated with poor prognosis and offering high efficacy treatments to these individuals. Clinicians must have a thorough understanding of the efficacy and safety profiles of these therapies and be able to make recommendations based on a patient’s preferences and risk tolerance. In addition, ongoing surveillance for medication adherence, adverse events, relapses, and disability accumulation is essential. Now, more than ever before, clinicians have the ability to alter the natural history of highly active multiple sclerosis and preserve the long-term health and well-being of these individuals.
Intended Audience
This activity is intended for healthcare professionals, specifically, neurologists, internists, family practice physicians, nurse practitioners, physician assistants, nurses and other providers involved in the care of patients with multiple sclerosis.
Contributors and Planners
Joseph R. Berger, MD, FACP, FAAN, FANA
Professor of Neurology and Associate Chief of MS Division
Department of Neurology
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania
Benjamin M. Greenberg, MD, MHS
Vice Chair of Translational Research and Strategic Initiatives
Cain Denius Scholar of Mobility Disorders
Distinguished Teaching Professor
Department of Neurology and Neurotherapeutics
Department of Pediatrics
UT Southwestern Medical Center
Dallas, Texas
Olaf Stuve, MD, PhD
Department of Neurology and Neurotherapeutics
UT Southwestern Medical Center
Dallas, Texas
Neurology Section
VA North Texas Health Care System, Medical Service
Dallas VA Medical Center
Dallas, Texas
Cynthia Wang, MD
Assistant Professor
Neurology and Neurotherapeutics
UT Southwestern Medical Center
Dallas, Texas
Joseph R. Berger, MD, FACP, FAAN, FANA
Consultant: Amgen, Biogen, Genentech/Roche, Genzyme, Millennium/Takeda, Novartis
Research Activities: Biogen
Formal Advisor: Excision Bio, Inhibikase
Benjamin M. Greenberg, MD, MHS
Consultant: Alexion, EMD Serono, Novartis
Research Activities: Chugai, Medday, Medimmune
Olaf Stuve, MD, PhD
Consultant: EMD Serono, Merck, Sanofi/Genzyme
Research Activities: Sanofi/Genzyme
Cynthia Wang, MD
No relevant financial relationships to disclose
No other planners have indicated that they have any financial interests or relationships with a commercial entity.
The following Medical Logix, LLC planners/managers, Michael Speidel and John Gentile, and Nancy Baxter, Baxter Medical Communications, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
The following UT Southwestern employee, Ericka Harden-Dews, JD, CHCP, hereby states that she or her spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
Off-Label Discussion
Olaf Stuve, MD, PhD – azathioprine, cyclophosphamide, methotrexate
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of The University of Texas Southwestern Medical Center and Medical Logix LLC. The University of Texas Southwestern Medical Center is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation Statement
The University of Texas Southwestern Medical Center designates each of these enduring materials for a maximum of 0.75 TM. Participants should claim only the credit commensurate with the extent of their participation in the activity.
Format and Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the accreditation period, participants must read the learning objectives and faculty disclosures and review this internet-based activity. To take the post-test, please click on the post-test button below the slide window of the player. Complete the post-test and evaluation and attest to the amount of time spent in the activity. Upon receiving a score of 70% or above, print your CME certificate.
For CME questions, please contact the UTSW Office of CME at
Technical Requirements
Processor Speed:  1.4 GHz P3
Memory:  256 MB RAM (20MB available)
Operating Systems Supported: Windows 2000/XP, MAC
Browsers Supported:  Internet Explorer 5.5 or greater, Mozilla Firefox and Safari 3.525 or greater
Additional Requirements: Flash player 8.0 or greater, 800x600 Resolution or higher with 32-bit color
Connection Speed:  128 Kbps or better
Adobe Acrobat 6.0 or greater
Technical Questions:
Please click on the Help button within the online player, or email MS-Leaders at
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