Advances in MS
Module 1
Early Diagnosis of
Multiple Sclerosis
Module 2
Management of Side Effects of Treatments for Multiple Sclerosis
Module 3
Neutralizing Antibodies to Interferon Beta in the Treatment of Multiple Sclerosis
Module 4
Brain and Spinal Cord Atrophy

For more MS programs visit MSLeaders.org, which is not associated with Johns Hopkins

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CME Information
Faculty
Faculty Disclosures
Off-Label Discussion
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Brain and Spinal Cord Atrophy
Sponsored by The Johns Hopkins University School of Medicine

Program Overview
The role of MRI in the diagnosis and management of multiple sclerosis (MS) has depended upon assessment of discrete lesions. Over the past several years, the importance of whole brain measurement—atrophy—as one of the best predictors of clinical status in patients has been appreciated. Recent investigations have utilized brain atrophy measures for critical clinical evaluation of issues such as early diagnosis and the role of neutralizing antibodies. Advances in the use of MRI to include brain atrophy may soon become routine in the management of patients with MS.

Target Audience
Neurologists and other healthcare professionals involved in the management and treatment of patients with MS. There are no prerequisites for this program.

Educational Objectives
At the conclusion of this activity, participants should be better able to:

  • Describe the correlation between brain atrophy and other MRI findings
  • Describe the correlation between brain atrophy and usual sequellae of MS, such as relapses, disability, cognitive dysfunction and depression
  • Integrate estimates of brain atrophy by visual examination of the MRI scan into the clinical management of patients with MS
  • Understand ongoing research into computer-assisted techniques to quantify brain atrophy

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

CME Information

Accreditation
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

Date of Release and Expiration
This course was released on September 15, 2004 and will expire on September 15, 2005. CME credit cannot be awarded after this date. Estimated time to complete this educational activity: 1 hour.

Statement of Responsibility
The Johns Hopkins University School of Medicine takes responsibility for the content, quality and scientific integrity of this CME activity.

Privacy Statement
The Office of Continuing Medical Education (CME) at The Johns Hopkins University School of Medicine is committed to protecting the privacy of its members and customers. The Johns Hopkins University School of Medicine CME maintains its Internet site as an information resource and service for physicians, other health professionals and the public. Continuing Medical Education at The Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet-based program. Your information will never be given to anyone outside of The Johns Hopkins University School of Medicine's CME program. Continuing Medical Education collects only the information necessary to provide you with the services that you request.

Copyright 2004, The Johns Hopkins University School of Medicine. All rights reserved.

Faculty

Peter Calabresi, MD (Program Chair)
The Johns Hopkins University School of Medicine Director
The Johns Hopkins Multiple Sclerosis (MS) Center

Dr. Calabresi is an associate professor of neurology and director of The Johns Hopkins Multiple Sclerosis (MS) Center. He specializes in the diagnosis and management of MS. As director of the MS clinic, Dr. Calabresi is the principal investigator on several clinical trials and also oversees translational laboratory research projects. Dr. Calabresi has designed and directed several clinical trials investigating combination drug therapies in MS. He is on the advisory board for 3 national multicenter clinical trials. Dr. Calabresi's specific laboratory research interest lies in understanding the mechanisms of T lymphocyte migration into the brain and spinal cord. He has published numerous articles on the adhesion molecules and chemokine receptors responsible for T cell homing to the brain in MS. He recently reported on a novel potassium channel, Kv1.3, which is specifically and highly expressed on chronically activated immune cells in the blood and brains of people with MS. The availability of Kv1.3 blocking drugs makes this an attractive future therapeutic target in MS. Dr. Calabresi was also recently awarded a 5-year collaborative MS center grant from the National Multiple Sclerosis Society to study mechanisms of neurodegeneration and strategies for neuroprotection in MS.

Rohit Bakshi, MD

Associate Professor of Neurology
Brigham and Women’s Hospital
Harvard Medical School

Rohit Bakshi, MD, FAAN, is an associate professor of neurology at Harvard Medical School, neurologist and neuroimager at Brigham and Women's Hospital, director of clinical MRI/MS imaging at the Partners Multiple Sclerosis Center, and researcher at the Center for Neurological Imaging. A Buffalo native and graduate of Cornell University, he received his MD from the SUNY University at Buffalo. As an Alpha Omega Alpha scholar, he completed a one-year neuroscience research fellowship with Dr. Alan Faden at the University of California, San Francisco. He served a one-year internship at the Massachusetts General Hospital and Harvard Medical School followed by a neurology residency at UCLA, where he performed neuroimaging research with Dr. John Mazziotta. He then completed a one-year MRI/CT neuroimaging fellowship at the Dent Neurologic Institute followed by continuing training in functional imaging and brain mapping, including PET and SPECT.

Dr. Bakshi is board-certified in neurology and certified in MRI-CT by the American Society of Neuroimaging. He previously served on the faculty at the University at Buffalo-SUNY, where he rose to the rank of Associate Professor of Neurology with Tenure and was Residency Program Director. He was the founding director of the Buffalo Neuroimaging Analysis Center (BNAC), neurologist and neuroimager, and multiple sclerosis specialist at the Dent Neurologic Institute, the Jacobs Neurological Institute, and Physicians Imaging Centers. In building his research program at the BNAC, he pursued studies of quantitative MRI in MS, funded by the National Institutes of Health, National Science Foundation, and National MS Society. He received the 1998 William H. Oldendorf Award for neuroimaging research. He is a member of the American Neurological Association, has achieved fellow status in the American Academy of Neurology, and is a grant reviewer for NIH. He serves on the editorial board of The Journal of Neuroimaging and as associate editor of NeuroRx. He is the president of the American Society of Neuroimaging. He has delivered more than 100 invited lectures and has authored more than 300 publications, including print and online articles and abstracts, more than 110 of which are peer reviewed articles. His work has appeared in a variety of journals such as The New England Journal of Medicine, The Journal of Neuroscience, Neurology, NeuroImage, AJNR: American Journal of Neuroadiology, Annals of Neurology, The Journal of Computer Assisted Tomography, NeuroReport, Multiple Sclerosis, Archives of Neurology, Brain Research, The Journal of Neurology Neurosurgery and Psychiatry, and Medscape.

Robert Zivadinov, MD, PhD
Associate Professor of Medicine
University at Buffalo School of Medicine and Biomedical Sciences

Robert Zivadinov, MD, PhD, is an associate professor of medicine at the University at Buffalo School of Medicine and Biomedical Sciences. He has staff privileges at The Jacobs Neurological Institute, Baird MS Research Center, Kaleida Health, Buffalo Neuroimaging Analysis Center and Physician Imaging Center.

Dr. Zivadinov received his medical degree from the University of Rijeka in Croatia, and he obtained a master's in neurology at the University of Rijeka. He served a one-year internship at the department of neurology at the University of Trieste in Italy, followed by a neurology residency at the same institute from 1995 to 1999, where he performed neuroimaging research with Professor Marino Zorzon. Under the supervision of Professor Giuseppe Cazzato, he performed training in MS care at the Center for Diagnosis and Treatment of Multiple Sclerosis in the department of clinical medicine and neurology at the University of Trieste. In 1999 he became the chief researcher on MS in the same institute. In 1998 he founded the Postimaging Analysis Center at Center for Diagnosis and Treatment of Multiple Sclerosis, in the department of clinical medicine and neurology at University of Trieste; he covered the role of its executive director from 1998 to 2002.

As a chief researcher, Dr. Zivadinov conducted and led significant and progressive research studies in the field of MS. Since 1999, he has also been an MS research consultant for several international pharmaceutical companies and foundations. Dr. Zivadinov has acquired extensive research experience in MS. His accomplishments in his field include: numerous awards from European and national neurological societies for his published articles, research studies and research fellowships.

Dr. Zivadinov obtained his PhD in neurology at the University of Rijeka. In 2003, he was appointed to associate professor of neurology at the University at Buffalo School of Medicine and Biomedical Sciences and to director of the Buffalo Neuroimaging Analysis Center.

He has authored more than 40 publications, including print and online articles and 85 abstracts. His work has appeared in journals such as Neurology; The Journal of Neurology, Neurosurgery and Psychiatry; Neuroimage; The Journal of Neurology; Multiple Sclerosis; and Neuroepidemiology.

Dr. Zivadinov is currently pursuing research studies of quantitative MRI findings in MS, therapeutic interventions including strategies towards assessing neuroprotective efforts in MS, but his current interests are also concentrated on genetic and neuroepidemiology fields of the same disease.

Faculty Disclosures

Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

Dr. Rohit Bakshi has received grant and research support as well as honoraria from Biogen Idec, Teva Neuroscience, Inc. and Serono, Inc.

Dr. Peter Calabresi has received grant and research support and served as a consultant with Biogen Idec, Berlex, Inc., Teva Neuroscience, Inc. and Serono, Inc.

Dr. Robert Zivadinov has no affiliations, financial interests or other related relationships to disclose.

Off-Label Discussion

No faculty member has indicated that their presentation will include information on off-label products.

This educational program is supported through an educational grant from Biogen Idec.
Copyright 2004, The Johns Hopkins University School of Medicine. All rights reserved.

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