The Hidden Side of Multiple Sclerosis: Harnessing Key Pathologies to Improve Outcomes Across the Multiple Sclerosis Spectrum

Program Description

The understanding of MS pathophysiology has rapidly advanced in recent years, prompting reevaluation of concepts that were once considered understood. It is now recognized that the hallmark insidious worsening of progressive disease and related pathologies are not limited to classically progressive phenotypes and in fact often begin early in relapsing disease. This program – originally delivered as a live symposium in conjunction with the Consortium of MS Centers (CMSC) Annual meeting – dives into the questions of what really is the pathophysiological process of MS progression, how clinicians can better capture resulting subclinical disease changes, and what current therapeutic strategies, if any, can be employed today to address this challenging phenomenon. It also explores the latest evidence with Bruton tyrosine kinase inhibitors (BTKis), the insight it provides into this class, and its implications for the trajectory of MS management.

Target Audience

The target audience for this CME initiative includes neurodegenerative disease specialists, general neurologists, advanced practice neurology professionals, registered nurses, and other healthcare professionals involved in the diagnosis and long-term management of patients with MS.

Learning Objectives

Upon completion of the educational activity, participants should be able to:

  • Describe early peripherally-initiated (e.g., gadolinium enhancing lesions) and central (e.g., slowly expanding lesions [SELs]) MS pathologies to raise early suspicion of MS and improve prognostication
  • Employ modern disease frameworks (e.g., progression independent of relapses [PIRA]) and assessment strategies (e.g., timed 25-foot walk [T25FW], nine-hole peg test [9-HPT]) to more effectively capture and monitor subclinical disease worsening 
  • Assess the impact of available disease-modifying therapies (DMTs) on MS progression to determine for which patients these may be optimal strategies
  • Evaluate the mechanisms of action, clinical profiles, and phase 2/3 data with BTKis in MS to determine their utility in potential future management
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC
  • 1.00 Attendance
Course opens: 
Course expires: 
   Jiwon Oh, MD, PhD, FRCPC, FAAN (Moderator)
   Medical Director, Barlo MS Program
   St. Michael’s Hospital
   Scientist, Keenan Research Centre Li Ka Shing Knowledge Institute
   Associate Professor of Medicine
   University of Toronto, Canada




   Stephen Krieger, MD, FAAN
   Professor of Neurology
   Corinne Goldsmith Dickinson Center for MS
   Icahn School of Medicine at Mount Sinai
   New York, NY




   Darin Okuda, MD, FAAN, FANA
   Professor of Neurology
   Director, Neuroinnovation Program
   Director, Multiple Sclerosis & Neuroimmunology Imaging Program
   Department of Neurology
   The University of Texas Southwestern Medical Center at Dallas
   Peter O’Donnell Jr. Brain Institute
   Dallas, TX


This activity is jointly provided by Medical Education Resources (MER) and Efficient LLC and was originally conducted in conjunction with the 2024 Annual Meeting of the CMSC.

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Joint Accreditation Statement


In support of improving patient care, this activity has been planned and implemented by Medical Education Resources (MER) and Efficient LLC. MER is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Designation Statement

Medical Education Resources designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medical Education Resources designates this enduring material for a maximum of 1.0 ANCC nursing contact hours Nurses will be awarded contact hours upon successful completion of the activity.
A Certificate of Participation will be given upon completion of the enduring activity enabling participants to register their credit with the appropriate licensing boards or associations.

Disclosure of Relevant Financial Relationships

Medical Education Resources ensures balance, independence, objectivity, and scientific rigor in all our educational activities. In accordance with this policy, MER identifies relevant financial relationships with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Reported relevant financial relationships are mitigated by MER to ensure that all scientific research referred to, reported, or used in an accredited continuing education activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing learners with high-quality accredited continuing education activities that promote improvements or quality in health care and not the business interest of an ineligible company.

Staff Disclosures

Efficient LLC and Medical Education Resources' planners and managers have no financial relationships to disclose.

Faculty Disclosures

Dr Oh reported the following financial relationships:

  • Consulting Fees: Biogen-Idec, EMD Serono, Horizon Therapeutics, Eli-Lilly, Novartis, Roche, and Sanofi-Genzyme
  • Grants/Research Support: Biogen-Idec and Roche

Dr. Krieger reported the following financial relationships:

  • Consulting Fees: Baim Institute, Biogen, Cleveland Clinic, Cycle, EMD Serono, Genentech, Novartis, Octave, Genzyme/Sanofi, TG Therapeutics
  • Grants/Research Support: Biogen, BMS, Novartis, Sanofi 
  • Speakers’ Bureau: Non-promotional speaking with Biogen, EMD Serono, Genentech, and TG Therapeutics. 

Dr. Okuda reported the following relationships: 

  • Consulting Fees: Biogen, Eisai, EMD Serono, Genentech, Genzyme/Sanofi, Moderna, RVL Pharmaceuticals, Inc.
  • Grants/Research Support: EMD Serono/Merck, Novartis
  • Royalty/Patent Owner: D.T.O. has issued national and international patents along with pending patents related to other developed technologies. D.T.O. received royalties for intellectual property licensed by The Board of Regents of the University of Texas System

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources, Efficient LLC, and/or Sanofi. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. Before prescribing any medicine, primary references and full prescribing information should be consulted. 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 on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.

Commercial Support

This activity is supported by educational grant from Sanofi.

Method of Participation

There are no fees for participating in and receiving credit for this activity. During the period June 30 2024 through June 30, 2025, participants must: 1) review the learning objectives and faculty disclosures; 2) watch the educational activity; 3) complete the posttest by recording the best answer to each question; and 4) complete the evaluation form.



Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 ANCC
  • 1.00 Attendance


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