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Clinical Dialogue
& eCase Challenge
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  "Addressing the Challenges of Diagnosing and Managing Pediatric Multiple Sclerosis"
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: March 19, 2019
Expiration Date: March 19, 2020
Estimated time to complete activity: 60 minutes for the which has been approved for a maximum of 1.0 (TM). 45 minutes for the which has been approved for a maximum of 0.75 (TM).
Acknowledgement of Commercial Support: Supported by an independent educational grant from Novartis Pharmaceuticals Corporation.
Learning Objectives
After participating in this activity, the participant will demonstrate the ability to:
  • Describe the possible presentations of multiple sclerosis (MS) in a child including vision, motor, sensory, and bowel/bladder related syndromes.
  • Identify the categories of diseases that can mimic pediatric MS including inflammatory, neoplastic, vascular, metabolic, genetic, and mitochondrial disorders.
  • Cite the types of disease-modifying therapies used in pediatric MS including the routes of administration, mechanisms of action, and efficacy/safety profiles of these agents.
  • Identify symptoms suggestive of new demyelinating episodes versus pseudoexacerbations and be familiar with management strategies for both.
  • Perform history-taking and counseling on areas most commonly impacted by pediatric MS, such as cognition, mood, fatigue, pain, and academic achievement.
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
It is estimated that 3-10% of individuals with multiple sclerosis (MS) develop symptoms in childhood and adolescence. While pediatric-onset MS is thought to represent the same disease process as adult onset forms of the disease, it poses unique challenges to the treating clinician. Diagnosing pediatric MS can be difficult due to the rarity of the disease in this age group and the existence of a broad array of disease mimics. Diagnosis may also be delayed due to a lack of recognition or dismissal of symptoms early in the course of the disease. Furthermore, pediatric providers are often unfamiliar with disease modifying treatments (DMT) for multiple sclerosis, as until recently, none were FDA licensed for use in children. The recent Food and Drug Administration (FDA) licensure of fingolimod as the first agent to treat pediatric MS is a significant event for the field, highlighting a growing recognition of pediatric-onset MS and the need for efficacy and safety data on DMTs used in children.
Intended Audience
This activity is intended to meet the educational needs of pediatricians and other clinicians treating pediatric patients with MS.
Contributors and Planners
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
Brenda L. Banwell, MD, FRCPC, FAAN
Professor of Neurology and Pediatrics
Chief of the Division of Neurology
Children’s Hospital of Philadelphia
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Cynthia Wang, MD
Assistant Professor
Neurology and Neurotherapeutics
UT Southwestern Medical Center
Dallas, Texas
Teri L. Schreiner, MD, MPH
Associate Professor and Associate Director
Residency Training Program
Department of Neurology
University of Colorado Hospital
Children’s Hospital
Aurora, Colorado
Benjamin M. Greenberg, MD, MHS
Research Activities: Chugai, Medday, MedImmune, Genentech
Consultant: Alexion, EMD Serono, Novartis
Brenda L. Banwell, MD, FRCPC, FAAN
Consultant: Novartis
Cynthia Wang, MD
No relevant financial relationships to disclose.
Teri L. Schreiner, MD, MPH
Applied Clinical Intelligence-Independent Adjudicator for TERIkids Clinical Trials.  Dr. Schreiner’s role was limited to the validation of study participants.  She had no other involvement in the operations of the clinical trial.
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 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
Drs. Banwell, Greenberg and Wang: alemtuzumab, dimethyl fumarate, glatiramer acetate, interferons, natalizumab, ocrelizumab, rituximab, teriflunomide
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 these enduring materials as follows: the has been approved for a maximum of 1.0 TM; the has been approved 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 Office of Continuing Medical Education and Public Education at UT Southwestern Medical Center 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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