Per Soelberg Sørensen, Professor of Neurology at the University of Copenhagen, discusses the optimization and potential beneficial impacts of the MS care unit on patient management.
We know that the MS care differs a lot between various countries but in fact we don’t know how much, so the first thing we are going to look at is do a worldwide survey to see how the MS care is in various countries. And, of course we know that some countries already have what we call the MS care unit, which basically is a number of neurologists working together with other disciplines. And so, you could say you have the whole care in one place.
We know that not all MS patients can be seen in multidisciplinary MS care units, but we want to make it possible for any patients, when there is a demand for it, to be referred to a multidisciplinary unit. So, it’s not a place where all patients should stay but if there are problems with the monitoring, problems with treatment decisions, you could refer the patients to this unit and there should be MS specialists, both MS neurologist and MS nurses, and this unit should be able to provide any disease modifying drug that the patient needs.
The core of the MS unit is the MS neurologist and the MS expert nurses. And then you can build on that and to call it an MS care unit, you would at least need to have a physiotherapist and MS psychologist and preferably a psychologist. And then if you have the fully developed MS unit, then you have a number of specialists that work within the unit, MS urologists, rehabilitation persons and so forth. Whereas in the small unit you would have to collaborate with external experts.
There are always challenges and, of course, we know that there might be one fully developed MS care unit in each region of a country. And, of course, most patients will still be seen by either non-academic MS centres or by a practicing neurologist and in some countries even the general practitioner. And the challenge is, of course, to help get the collaboration with these so that they will refer those patients to the MS care units that need to go there and also there will be a collaboration in treatment between those so patients can go back when there has been treatment been initiated.
In most places the nurse will have the key role because there is a shortage of MS neurologists, which means that some of the tasks that maybe today is done by an MS neurologist will have to be done about by MS nurse or a physiotherapist – scoring patients on different scales and giving advice about medicine and adverse effects and so forth. This will be collected by the MS nurse. And then if there’s a need the patients will be seen by the MS neurologist.
We are now moving from looking at relapses, now looking at the whole spectrum of activity or including MRI and maybe some biomarkers and what we are aiming at today is to see if we can provide what we call no evidence of disease activity or NEDA; knowing that this goal cannot be achieved in all patients. But this is what we thrive at. And so there is definite change in the goal of the treatment to a more effective treatment and to get real stable disease.
This is of course one of the things that we are going to measure – what is being achieved by the MS care unit and, of course, we hope that the goal is to prevent the disability, the long term disability, and treat patients to the target – meaning that we would delay or even prevent patients going from the relapsing phase into the progressive phase. So the goal is to prevent disability in the long term.