This was a course organised by the Multiple Sclerosis (MS) Academy, held over 2 days at the Halifax Hall in Sheffield. The course was conceptualised by neurologist Dr Riffat Tanveer who had undertaken research which showed that trainee neurologists largely feel unsupported in developing skills in the specialist area of MS. In response, there has been the creation of a MasterClass series to provide innovative, supportive and up to date courses to enhance trainee skills in MS. This was the third Basecamp course that was aimed at junior doctors in the earlier years of their neurology career journey, specifically doctors in the pre-registrar level. The course provided an invaluable resource of knowledge of the very common condition of MS as well as an opportunity to show evidence of commitment to neurology in preparation for registrar interview applications.
Prior to the course attendees were given comprehensive programmes as well as reading material which was very useful.
The layout of the conference room and the structure of lectures allowed for relaxed yet thought provoking discussion throughout. The lectures were interactive and informative, and the speakers were very engaging.
The first day of lectures included two lecture sessions held by MS neurology consultants based in Sheffield.
Dr Azza Ismail led the first session which was highly comprehensive. She spoke of the details of the diagnostic process of MS, including the application of the Macdonald Criteria, importance of history and examination and also the consideration of atypical presentations and taking care not to miss the “MS mimics.” She spoke of key clinical phenotypes and the red flags. She emphasised points through clinical cases which was very useful and relevant. Going through cases illustrated the difficulties that can arise in the diagnosis and also the decision for treatment. She also spoke of how to determine when and what treatment, including eligibility for disease modifying treatment and the process of “de-risking” DMTs.
The second lecture session was led by Dr Riffat Tanveer. This focused on how to confirm the diagnosis of MS and how to communicate this to a patient. The session was very useful to critique our own practice, and think about practicalities such as how to word clinic letters and the importance of including enough relevant information, as well as the need to digest the investigations and previous letters yourself prior to having a potentially life changing conversation with a patient – there is a need to “convince yourself” also.
He spoke of counselling required once the diagnosis of MS is confirmed, including pregnancy and family-planning.
Dr Tanveer also went through the classification of MS – in terms of active vs highly active, and how this impacts the treatment choice. He also spoke of prognostic tools which can be used to guide treatment as well as the maintenance escalation vs. immune reconstitution treatment strategies and how we might explain this to our patients.
The first session was lead by Consultant Neurologist Dr Rhian Raftopoulos, from King’s College in London. She spoke of the important components of an MS clinic – including how to record notes and construct letters, as well as the key aspects of MS care to focus on. This included a holistic approach to MS care – addressing the various symptoms that can arise, including cognitive difficulties, bladder and bowel incontinence as well as the very common symptom of fatigue. She went into more detail about “MS bladder issues” and the way to approach this, with conservative and medical/interventional means. She also spoke of fatigue in MS and the multidisciplinary approach to addressing this – involving therapists, neuropsychologists etc. This session really honed in on the importance of taking time to go through each symptom and trying to “unpick” what was really happening – how to try to tease out if a patient might be progressing, or if they might be having a relapse vs a pseudo-relapse, and importantly prompting the patient to highlight if they needed more support or attention to a specific symptom or concern.
This session was lead by the Consultant Neurologist Dr Kate Petheram who works in Sunderland where she is lead of the MS service. Her session focused on how to have difficult conversations with patients regarding explaining the cause of their MS. She spoke of the genetic vs environmental causes, and modifiable risk factors. She also spoke of the incidence of MS in families and how this is increased compared to risk in the general public. During the session she discussed the vast and expanding range of disease modifying therapies and also of the use of stem cells in MS which provides a promising new opportunity for improving patients’ long term outcomes and reduction in disability. She also discussed the current trials and importantly of the eligibility criteria and where to access more information to educate our patients.
Session 3 was a case based series led by Consultant Neurologist Dr David Paling, who practices in Sheffield and is the Strategic Director of the MS academy.
He went through 4 fascinating cases, each with different important learning points.
When discussing the cases he highlighted the need to take a detailed history and to prompt patients to discuss their symptoms, and importantly to highlight any change in their level of function as this could be a sign of disease progression. He also spoke of a case where there was physical decline which did not correlate with new lesions or radiological activity and the decisions regarding changing treatment vs continuing on efficacious therapy. He mentioned tumefactive MS, and how these cases often present as stroke calls and then respond to immunosuppression in the form of steroids in the acute phase. Dr Paling then spoke of the decisions involved in whether to start these patients on disease modifying therapy and the evidence behind this.
In summary… Each speaker was very engaging, passionate and evidently at a high level of expertise about their field of MS. This was inspiring for junior trainees like myself, and I feel like I have gained a good knowledge base which I aim to continue to expand on. This knowledge will benefit me both in my general medicine as well as in my neurology placements and future registrar years. I really enjoyed the course, and I found the MS Academy team to be professional yet friendly, efficient, and very well organised. I will definitely attend future courses and continue to engage with the MS community and use the learning resources in my clinical practice.