Highlights From the 2014 Joint Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS)-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

Abstract

The 2014 Joint ACTRIMS-ECTRIMS meeting was held in Boston, Massachusetts, at the John B. Hynes Veterans Memorial Convention Center, September 10–13, 2014. With an impressive 8806 registered participants representing 92 countries in attendance, this was the largest joint meeting of multiple sclerosis (MS) specialists ever held in North America. Notably, NANOS was well represented at the event, with several of our own members included among the 147 faculty representatives. Dr Steve Galetta (New York, USA) delivered a sizzling talk, “Red flags in MS: Zebras or horses?” in the highly popular Differential Diagnoses and Diagnostic Dilemmas teaching course chaired by Dr Patrick Vermersch (Lille, France). Together with Dr Emmanuelle Waubant (San Francisco, USA), Drs Galetta and Vermersch used a case-based format to apply the recently revised McDonald criteria and demonstrate how magnetic resonance imaging (MRI) measures can support, implement, or even replace some clinical parameters in the diagnosis of MS. The course also highlighted the utility of new MRI protocols, including double-inversion recovery sequences, which can be used to detect small cortical lesions in MS patients. High-field MRI studies were also used to illustrate how penetrating veins can be detected in most MS lesions using T2 or susceptibility-weighted MRI. The Neuro-Ophthalmology Update was chaired by Dr Fiona Costello (Calgary, Canada) and featured Dr Je[Combining Acute Accent]rôme de Seze (Strasbourg, France), and Dr Laura Balcer (New York, USA) as speakers. Dr Costello kicked off the session with a talk entitled, “Visual Manifestations of CNS Demyelinating Disorders.” This primer outlined the approach to clinical localization of common visual manifestations in MS and related syndromes. Dr Costello also introduced the concept of the afferent visual pathway as a clinical model of MS, which was expanded upon in the talks that followed. Dr. de Seze reviewed new diagnostic criteria that enlarge the spectrum of the neuromyelitis optica spectrum disorders, and proposed therapeutic strategies to help interpret AQP-4 antibody results in a presentation called, “Neuromyelitis Optica: New Diagnostic Criteria Enlarge the Spectrum.” Dr Laura Balcer closed the session with a panoramic summary entitled “The Role of Visual Outcomes in MS Clinical Trials”, with specific emphasis on the role of low-contrast letter acuity, visual evoked potential testing, and optical coherence tomography (OCT). Course participants identified several key learning points, which they planned to implement in their day-to-day clinical practice based on the course content, including the role of OCT testing and the value of more detailed visual assessments for their patients. The 2014 Joint ACTRIMS-ECTRIMS meeting showcased cutting edge-research in the field of MS. A record-breaking 1724 abstracts were submitted for consideration: 94 were selected for platform presentations, and an additional 981 were selected as posters. There were numerous abstract topics presented that would be of potential interest to neuro-ophthalmologists including diagnosis and differential diagnosis, clinical trials, disease biomarkers, OCT, experimental models, neuromyelitis optica, neurophysiology, neuroprotection, and repair. A novel feature of the 2014 Joint ACTRIMS-ECTRIMS meeting was the effort made to critically examine how factors including the “expert patient”, news media, social media, and health policy affect the relationships between MS patients' health care providers, and researchers. Certainly, the importance of issues such as patient advocacy and social media-engagement would also resonate with neuro-ophthalmologists. The potential value of the 2014 Joint ACTRIMS-ECTRIMS meeting was aptly summarized by Dr Steve Galetta: “This provides a large-scale opportunity to view the advances for the treatment of multiple sclerosis and optic neuritis. Vision has become one of the key outcome measures for many of the latest clinical trials and the data is usually presented first in this forum”. The annual ACTRIMS and ECTRIMS meetings, whether held jointly or as separate events, introduce new agents emerging from the therapeutic pipeline and highlight early clinical trial findings related to MS and vision. The next joint meeting has yet to be announced, but future ACTRIMS and ECTRIMS (2015, Barcelona, Spain) meetings could be of considerable interest to neuro-ophthalmologists who wish to keep abreast of novel clinical and research developments in MS.