A new survey shows that seven in 10 U.S. neurologists who treat multiple sclerosis believe the current definitions used to classify MS patients -- from the least to the most severe -- fail to adequately address the diagnosis and management of patients in each of the disease categories.
Results of the national survey, conducted by Louis Harris & Associates,were presented at a recent University of Maryland-sponsored consensus conference of neurologists and other MS experts designed to reassess and redefine the natural history -- or classification -- of the various stages of the debilitating disease.
Of those physicians surveyed, 36 percent said the definitions used to classify MS patients, based on symptoms and progression of disease, were too vague. As a result, many people with MS may not be diagnosed or treated appropriately, and risk progressing more rapidly to a more serious disease state.
"MS specialists and opinion leaders need to take more of a leading role in guiding the community-based neurologists to ensure that everyone treating MS is up-to-date with the current science," said Kenneth P. Johnson, MD, professor and chairman of Neurology, at the University of Maryland Medical Center, and director, Maryland Center for Multiple Sclerosis. "Neurologists need to better understand the present research trends, specifically as they relate to classifying, diagnosing and treating MS patients.
"A better understanding of the classifications of MS subgroups, and refinement of methods for measuring disease activity, will enable us to have a more objective and accurate assessment of the disease, and help us tailor treatment to a patient's disease course."
While 98 percent of all neurologists surveyed consider themselves "very" familiar with the clinical aspects of diagnosing MS, somewhat fewer are as familiar with managing the symptoms (84 percent), tracking MS disease progression (77 percent), or treating the actual disease, as opposed to just the symptoms of the disease (76 percent).
"It is imperative that all neurologists understand how best to classify MS patients," said Patricia Coyle, MD, Department of Neurology and MS Comprehensive Care Center, State University of New York at Stony Brook, and conference presenter. "Increased clarity in our MS disease state classification system will help us improve our ability to diagnose, and ultimately treat, patients more effectively."
Experts have begun to study a segment of MS patients that are converting -- or transitioning -- from relapsing-remitting MS (RRMS), a category that accounts for 40 percent of all MS patients, to secondary-progressive MS (SPMS), which is marked by ever increasing severity of irreversible disability. These patients in transition from RRMS to SPMS have a generally more aggressive state of disease and may be less likely to respond to currently available therapies.
By expanding the classification system to include these patients in transition, and by developing specific treatment regimens for this group, experts believe they can give practicing clinicians the tools they need to help to treat these patients and slow their progression of disease.
According to the survey, 40 percent of neurologists believe that there is a distinct phase between RRMS and SPMS. However, only two percent were able to characterize patients as being in a transitional stage when presented with the description of a patient whose symptoms and medical history might suggest a transition from RRMS to SPMS. Therefore, regardless of what this "middle category" is labeled, neurologists are beginning to recognize this phase of the disease as being distinct.
The University of Maryland-sponsored, consensus conference, where these survey findings were presented, brought some of the world's leading MS experts together to reassess the various classifications of MS, including the need for new distinctions between disease subtypes. The conference was designed to foster discussion and debate among key MS thought leaders and researchers.
The University of Maryland will make the outcome of the meeting available to 3,000 MS specialists through a monograph which will offer recommendations on how emerging data affects current treatment practices and new treatment regimens.
"It is with great interest to know the results of this survey coincided with this meeting of the world's leading MS experts," said Humphrey Taylor, Chief Executive Officer, Louis Harris & Associates, Inc., one of the nation's leading research and opinion groups, and senior counselor on this MS survey. "I am confident that the findings of the survey added a critical context -- demonstrating the need for greater clarity -- and thus, brought value to the conference discussions. This, coupled with the important dialogue by the participants at the conference, will ideally help advance the science of MS."
"We are encouraged by our dialogue and look forward to this conference helping us all to be better practitioners for our patients, because they deserve no less," added Dr. Johnson.
The survey was done on behalf of Serono Laboratories and was based on interviews with a representative sample of 100 neurologists who treat MS patients.
The University of Maryland Medical Center includes the 747-bed University of Maryland Hospital, the Maryland Center for MS, the Greenebaum Cancer Center, and the R Adams Cowley Shock Trauma Center.