Welcome to MS Project ECHO A collaborative project funded ...echo.msrrtc.washington.edu/sites/echo/files/files... · MS Diagnosis, Disease and Symptom Management app – Diagnostic

Welcome to MS Project ECHO A collaborative project funded by a grant to the

National Multiple Sclerosis Society from the Medtronic Foundation

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Introductions • National MS Society • ECHO team • Participants

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Introduction to ECHO Projects John Scott, MD

• Originated in New Mexico (Sanjeev Arora MD) • University of Washington

– Hepatitis C at UW – HIV/AIDS at UW – Other

• MS pilot

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MS ECHO: pilot • Goal: To improve the capacity of healthcare

providers in rural communities to serve people with MS

• Desired Outcomes: – Increased in MS knowledge – Increased confidence in treating people with MS – Enhanced patient connections to resources of the

National Multiple Sclerosis Society

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MS ECHO • 12 weekly video conferences: 11:30AM – 12:30PM

starting 1/28/2015-4/15/2015, may continue beyond this date

• Format: – 15 minutes didactic – Collaborative consultations on participant-

presented cases

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CME Information

• University Of Washington School Of Medicine-designated live activity for a maximum of 36.0 AMA PRA Category 1 Credits (1.5 credits per session)

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MS ECHO Session 1: Disease Overview January 28, 2015

Gary Stobbe, MD Medical Director, MS Project ECHO Clinical Assistant Professor, Neurology

Conflict of Interest:

• Dr. Stobbe has no conflicts of interest to disclose

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Educational Objectives • Define MS • Outline diagnostic criteria (including CIS) and

differential diagnosis • Emphasize importance of early and ongoing

comprehensive MS care: – Disease modification – Relapse management – Symptom management – psychosocial interventions

• Highlight resources for you and your patients 9

Areas of Management

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Case A - Overview • 19 yo female • no prior hx/family hx • Intermittent paresthesias R arm – 2 weeks later,

tingling in BUE when washing hair – 1 week later, continuous numbness in L ulnar

• 1 month later – tingling in pelvis/perineum with neck flexion (atypical Lhermitte's)

• ROS – fatigue, balance complaints, headache • Exam – L hand intrinsic weakness; L C8T1

numbness

Diagnosing MS

• Signs and symptoms • Dissemination in time • Dissemination in space • No other explanation for clinical and para-

clinical findings

National MS Society 12

Differential Diagnosis Mnemonic (VITAMINS)

• V – Vascular • I – Infectious • T – Traumatic • A – Autoimmune • M – Metabolic/Toxic • I – Idiopathic/Genetic • N – Neoplastic • S – Psychiatric

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Case A – Work up • Brain MRI - multiple non-enhancing foci

involving the corpus callosum/pericallosal white matter/periventricular white matter

• T/C Spine MRI – lesions at C3-4 (enhancing), C5, and T7

• CSF – positive OCBs, elevated IgG index • Serology – positive ANA

Corpus callosum and brainstem lesions

Periventricular lesions

C3-4, C5 lesions

C3-4 enhancing lesion

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Most Common Symptoms • Fatigue 75 – 90% • Cognitive changes 40 – 65% • Pain 80% • Depression 50 + % • Vision 14 – 23% • Bowel/bladder 75% • Sexual function 40 – 50% • Mobility ≈60% remain able to walk

(many with mobility aids) • Spasticity 40 – 60%

Managing MS

• A complex, variable and unpredictable disease requires a comprehensive, interdisciplinary approach: – Disease Modification – Relapse Management – Symptom Management – Psychosocial Interventions

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Resources • MS Diagnosis, Disease and Symptom Management app

– Diagnostic criteria, algorithm, differential diagnosis, red flags – Disease courses – Comprehensive care – MS symptoms

• National MS Society Flash Drive – Clinical Bulletin: Overview of MS, Primary Care in MS – Difficult Topics: Communicating the Diagnosis

• Professional Resource Center: – www.NationalMSSociety.org/PRC – Clinical consultation: email [email protected]

• UW MEDCON (WWAMI): 1-800-326-5300 • For your Patients: MS Navigator Program: 1-800-344-4867 (1-800 FIGHT MS)

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Epidemiology of MS Overview

• 400,000 people in the US with physician-diagnosed MS (2.3 million worldwide)

• Incidence higher in women (2-3:1) • Onset usually between 20 and 50 years of age • Occurs in all ethnic groups (most common in

Caucasians of Eastern European descent)