Podcasts about frcpc

Palliative care in multiple sclerosis spans the disease course, from early screening and support after diagnosis to symptom management and quality‑of‑life optimization in midstage disease, and end‑of‑life care in advanced MS. This episode outlines a staged approach to palliative care, highlights the roles of neurology and primary care teams, and discusses tools such as patient‑reported outcomes and symptom scales to support ongoing assessment of patients and care partners. In this episode, Katie Grouse, MD, FAAN, speaks with Penelope Smyth, MD, FRCPC and Janis M. Miyasaki, MD, MEd, FRCPC, coauthors of the article "Palliative Care in Multiple Sclerosis" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Smyth is the director of the Division of Neurology in the Department of Medicine at the University of Alberta in Edmonton, Alberta, Canada. Dr. Miyasaki is a professor in the Division of Neurology in the Department of Medicine at the University of Alberta and the zone clinical department head for Clinical Neurosciences at Alberta Health Services in Edmonton, Alberta, Canada. Additional Resources Read the article: Palliative Care in Multiple Sclerosis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Grouse: With the new treatments for MS, people might be saying palliative care is not relevant at all. It's about giving up hope and hopelessness. But this article covers why palliative care is important for your patients and families throughout their illness trajectory. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast, and please introduce yourselves to our audience.  Dr Smyth: Thank you, Katie. I'm Penny Smyth. I am a neurologist at the University of Alberta, a professor in neurology, and a clinical multiple sclerosis specialist.  Dr Miyasaki: Hi, Katie. Thanks for having us. I'm Janis Miyasaki. I am a movement disorder neurologist primarily who also provides neuropalliative care at the University of Alberta in Edmonton, Canada.  Dr Grouse: It's so great having you today to talk with us about your article. I thought this article was really a wonderful take on the topic. I learned a lot, and I'm really hoping all of our listeners will take advantage of this article and take advantage of all the learning they can get from reading about this topic. So, I wanted to start with a more general question, which is, what is the key message from this article that you're hoping your readers will take away?  Dr Smyth: In terms of key takeaways, I think it's our hope that neurologists will come away from reading this article with, really, an expanded understanding of what palliative care is and how that might be applicable to them in their care for their patients with MS along a continuum of treating people with MS, that there can be components of palliative care and strategies that can be integrated early after diagnosis in, really, anywhere along the continuum of caring for people with MS. We've called that kind of mid-stage. And then there are particular needs for people with MS and their care partners in late-stage or severe MS and end of life that might require different palliative care strategies. I think we kind of have maybe a bit of a bias sometimes in thinking of palliative care as more directed towards those that are near end-of-life. But in fact, it's a much expanded concept.  Dr Miyasaki: And I'll just add that we also discuss a palliative approach, that palliative care skills and philosophies can be used by generalists---in this case, neurologists who are providing care to people with MS---and that adopting certain skills and communication techniques can help us better address our patients' and their families' symptoms. And also to keep in mind that for most people with neurologic illness, the unit of care is not only the patient, but it's the patient and the family, however that family looks.  Dr Grouse: Now, Penny, I'm curious, how are early-stage and mid-stage multiple sclerosis palliative care strategies different from, say, a typical evaluation and counseling that a neurologist would give, say, an MS specialist or even a general neurologist?  Dr Smyth: Thank you, Katie. That's a great question, and something that actually I learned in writing this piece with Janice and from her as a neuropalliative care expert. I think in terms of early strategies around palliative care that can be helpful to the general neurologist in their office, palliative care is about holistic support for patients and their care providers spiritually, emotionally, physically. There are components of palliative care and symptom management and making sure that the patient is at the center of the care, as well as support for their care partners with their holistic approach of relief of suffering as well as offering hope. When I started this piece, I was thinking that many of us neurologists, I think, often informally utilize many of these components already when we're dealing with patients early on after diagnosis in terms of communication, counseling, and education; going through their fear of an uncertain future; spiritual well-being; and then connecting them with supports for adaptive coping strategies. And then as well in mid-stage, which is really around what we can do in symptom management and improving quality of life, with screening tools and patient-reported outcome measures. However, I have to say that there are many unmet needs for people with MS and their care partners that they identify that are clearly not being met by us neurologists in this day and age. So even though we may be incorporating some of these strategies, I don't think we're meeting the mark all the time and hitting the target, especially in our busy office practices, in various ways. Dr Grouse: Given that, at a high level, what are some important early-stage MS palliative care concepts that we should be keeping in mind when we are counseling patients in these stages of the disease? Dr Miyasaki: An important concept to keep in mind for neurologists dealing with early-stage MS patients is that for us, we feel successful that we have made a diagnosis. And yet for the patient, it is taking away that hope. Maybe it's not MS. Maybe I just have a numb hand and it's gonna go away. And for us to appreciate that while we make this diagnosis multiple times a week---or, for MS specialists multiple times a day---for this person, it is the first time, the first experience, and it shakes their entire foundation of who they are as a person, how they will perform all the tasks and roles that they have in society, in their professional lives, in their family structures, and in their close, intimate relationships. As physicians, we may be overwhelmed by acknowledging that. I feel that it's important for us to understand the needs that our patients have and to allow them to have their feelings. You know, feelings can feel messy and time-consuming, and yet when we fully see our patients, I feel that this is the best of medicine. And it certainly is, in terms of palliative care, the principle that we seek. We accept all of the patient, the joy and the sorrow, the anger and the frustration. We accept it all, and we try to determine what will serve this person who is suffering in front of us now.  Dr Smyth: There's another piece to this, which came up as Janice and I were writing together. We were talking about offering a prognosis to a patient as to how they would do, and this was something that I thought deeply about, because I said, we always communicate how uncertain the prognosis is and how we can't predict the future. And then she said to me, well, what about offering a roadmap to a person with MS soon after diagnosis as to how you're gonna determine how they do over the next couple of years? Which are really important years in terms of determining how patients are doing on their disease-modifying therapies, whether they're having progression or not, and things. It's a pivotal time. So, if you can offer a roadmap to a person with MS and say, look, this is when we will be following you up. This is how we will be following you with MRI and biomarkers if you have that available, and this is how we will determine how responsive you are and then how we move forward from there. Dr Grouse: Really important concepts. And the roadmap certainly makes a lot of sense to me and something that, apart from just being useful to the patient for so many reasons to help set expectations, you know, is useful for us to better partner with the patient so they understand this is sort of how we do things and everyone's sort of expectations are met. So, I think those sound like really great goals and things to keep in mind. Now, we talked about early-stage MS palliative care concepts. How does that change as you get into the mid-stage of the disease?  Dr Smyth: Yeah. So, this is reflecting the fact that the course of MS is so different and the experience of MS is so different person to person. And so, what do we do as neurologists when we follow these people long-term over years and decades of living with their MS as their needs evolve, as their symptoms evolve, and as their disability evolves? Well, really, this is about the time of getting into, what are the symptoms that they're struggling with, what are the causes of their suffering at various points? And then how do we identify that, maybe with use of patient-reported outcome measures, screening scales, things like that. And then how do we direct symptomatic management to the specific symptoms that are causing distress to the patient? As well as trying to improve their quality of life in various ways, treating their comorbidities, making sure to check on exercise, healthy living, and that kind of thing.  Dr Grouse: Now getting into, I think, topics that we're more used to thinking about when we think about palliative care: a lot of us, I think, are really unsure of the right time to discuss advanced care directives in the course of multiple sclerosis, and I think that's not helped by the fact that many of us are just, in general, not terribly comfortable talking about those types of things in general. What is your advice to questions like this?  Dr Smyth: And this is something that, again, Janice and I had to come together on, because there is no universal accepted time for when is the right time in multiple sclerosis to discuss advanced care directives and goals of care. And in fact, when they have looked at it in the literature, different things have come out. It has come out that neurologists can be uncomfortable discussing this. There's unique challenges to people with MS in that they have a diagnosis at a young age with an uncertain trajectory of how their course of disease is going to go. And many of these things lead care providers to be somewhat hesitant as to when is the right time, as well as, there were identified barriers within patients themselves as to when the right time might be to discuss. In that, you know, some of the coping strategies might be, as identified by some of the qualitative studies that have been done on this, around the fact that they would prefer to focus on the present rather than the future. In some studies expressed an ambivalence as to when they thought the right time might be, as well as some negative experiences that they might have had from providers trying to discuss these things in their previous experience. So, I went back to looking at the European guidelines for palliative care in MS, who suggested when a person might have severe MS---which they define as walking with bilateral aids for at least twenty meters or an EDSS of six or higher---or trigger-based, when there has been a change in the patient's status, when there's been a decline in some way or progression. Now, this is a little different, actually, than what we offer other people with neurologic diseases, and I don't know if that's the right answer. And this is where I'm going to turn it over to Janice, because I think we could learn something, as neurologists who treat people with MS, from our palliative care specialists.  Dr Miyasaki: I think of advanced care planning in a very different way. I think what a lot of the patients were expressing in the studies was that being asked about advanced care planning signaled to them in some way that they have reached this point in their illness where things aren't going so great and I anticipate that you may run into complications. Whereas in our movement disorder clinic, one of our fellows did a study looking at capacity for decision-making. And even in people who scored normally on the Montreal Cognitive Assessment, they had impairments in some of the domains of decision-making. And so, our philosophy in movement disorders at least---and some of our patients are quite young who have multiple system atrophy, they could be in their forties---we take the philosophy that everyone over the age of decision-making capacity, which is generally eighteen, should have some goals of care established. And how I introduce it in my clinic is, you know, for the young resident, you want the full-meal deal, because the likelihood of the resident surviving the ICU admission is very high. And then when we look at me, who… I am older, the likelihood of surviving an ICU admission is considerably lower. And so, the appropriate goals of care might be that I am willing to go to the ICU, and if things go well, then they can continue. But if things are not going well, they can have a discussion with my personal directive or power of attorney to talk about what the goals of care should be. And then the other aspect is sometimes having the conversation with family is really important because most of our families in hospital express an uncertainty. Am I doing the right thing? And they want to do the right thing for their loved ones. And most people actually say, if you ask them, I don't want to burden my family with making decisions that are going to tear at their hearts. So, then we can't actually make good informed decisions for our loved ones unless we have clear conversations. I think it does speak to our superstitious beliefs that if we talk about death, it's going to happen. But I hope the listeners will take my word for it, it really doesn't. And someone had a really good saying about the advanced directive. They're kind of like evening clothes. You should take them out every once in a while and make sure they still fit. And so, when you normalize it in this way, it helps people to just say, oh, yeah, it's once a year. Dr. Miyasaki is gonna ask me about how do I feel about those goals of care. And then it doesn't have this portent of, oh, I'm not doing well. Instead, it's just, this is what we should all be doing for our sake and for our family's sake.  Dr Smyth: Now, one thing that I have to add on to this is that it is important to try to establish advanced care directives before patients experience cognitive decline, because then that can make it a much more challenging conversation and brings nuances of challenge into the interactions, which, you know, are hard.  Dr Grouse: And Penny, I'm glad you brought that up, because I was really struck by that point too when reading this article, how easy it is to miss the subtle signs that cognitive changes are happening. I think it's just- it's a good kind of segue into that topic in general, but it is such an important link to, you know, making sure that you get those advanced directives at a time when the patient's really able to express and understand what they're talking to you about. Now, on the topic of the cognitive screenings, what's a good way to do this type of screening, and why is this type of screening so particularly important in the case of multiple sclerosis?  Dr Smyth: Yeah. Thank you, Katie. I think that it's important for our listeners to think about and recognize when we see our patients with MS because it is one of the invisible symptoms that people with MS can live with and may not be apparent on regular conversation in the office. So, it's important to deliberately ask about subjective challenges in cognition. Ask the partner about how they're doing in terms of their cognition in various ways. As well as asking them and exploring then, how are they doing in their professional roles if they're working or in their surroundings? How are they coping on a daily basis on a cognitive level in addition to a physical level? We know that cognitive issues are actually the biggest contributor for not working and are a huge driver of disability in MS in terms of functioning, even more than physical decline in many ways. So, it is important for us neurologists to keep top of mind and to think about and deliberately attend to. There are screening tests that we can do in the office. The easiest for us, which measures the verbal processing speed, is the SDMT test, which is a ninety-second test matching symbols and numbers. It's easy to do. You can train a MOA to do it before you see the patient and things like that, and it just gives you an idea as to where the patient is at. And usually they're having difficulties if they're greater than two standard deviations below the norm for their age, or if there's a significant drop of four or eight points, and that might signal to you that there might be more going on. You can explore it, and then if you do have this available, the ability to refer for neuropsychological testing if there's questions. But often we can't get it with the MoCA score, unfortunately.  Dr Grouse: Talking about all these concepts, I think they all sound great. I think a lot of us hearing this will naturally say, "Yes, these are absolutely things we should be incorporating in the care of these patients." What I wondered about was, certainly we're all very busy, it is really hard to find time for a lot of these things. We don't always have access to specialists who can help us with some of these conversations. How can we find time, and how can we work this into the care of our patients effectively and still make time for all the other things we have to talk about, and make sure that we're seeing all of our other patients and staying on time and all of those things?  Dr Miyasaki: Yes. I think that's the challenges of dealing with people who actually, over time, their care needs increase, is huge in neurology. I can't think of a single subspecialty where care actually gets easier. It's constantly getting harder. You know, having come from private practice, I completely understand my colleagues' challenges in the community. Some of the ways that other groups have managed this when they don't have government or university support in their center is actually to look at not-for-profits. There are a lot of not-for-profits that can help in terms of wayfinding for social services, explaining to the patients and the family what is available to them. And in fact, some of them can also provide some cognitive supports, as well as point them in the way of day programs. And many of them have very established caregiver support groups, as well as patient support groups for various stages of their illness. So, I think it requires for the individual or small or even a large group practice to be inventive, to look in your community and see what resources are available and free for your patients in order to establish that loose team without boundaries to help your patients. Of course, for those in academic centers, I know that times are tight for all of us, and if you haven't established a team, it is a challenge; and then learning how to write a business plan or a briefing note for your institution and to learn how to speak the love language of administrators, is really key to putting forward the needs of our patients. Which, compared to heart attack patients or hips and knees, they are very rare, and yet our patients can result in significant cost to the healthcare system. So, we do have an opportunity to make the case that putting a little bit of investment in the ambulatory setting can result in significant cost savings to the system when it comes to acute care hospitalization.  Dr Smyth: So, I was thinking, Janis, as you were talking about that, when you were talking about not-for-profit groups, it's really the MS societies in various countries that are very active in this and have a lot of resources available, especially for care partners.  Dr Grouse: Those are really great tips. Thank you for bringing those up as potential other resources we can take advantage of. I wanted to ask specifically about physician-assisted death and assisted suicide, which certainly does come up, especially in later-stage parts of the disease. How can palliative care specialists be helpful when patients do express interest in these types of interventions?  Dr Miyasaki: As you know, Katie, in Canada, we've had a legislative right to access to what we call medical assistance in dying. When the legislation passed, one of my other colleagues and I felt that these were the only conversations we were having with our patients. In all this experience, I have sort of developed in my mind a framework of people who are what we call MAID-curious. They want to know what their rights are and how it would look, when they feel the time is close, for them to exercise that right. And then there are those who are fearful of future suffering. And some of them may have a very unrealistic view of what the future will look like. And this may be in particular for multiple sclerosis because many of the public's view is based on what treatment was like thirty years ago. It may not be informed by more recent treatment where patients actually do quite well, and the majority never get to progressive MS. And so, to explore and be open to that request is the first thing that is important. And then if the person has unresolved symptoms that, traditionally, we can't care for, the palliative care specialist can be very helpful because they just have inventive ways of looking at things. They look at it outside the box, and they have a different toolkit available to them. I would not want all neurologists to just send all these patients requesting physician-assisted death to their palliative care colleagues. But I think for those who are having unaddressed symptoms, it can be very helpful. Certainly, if there is an acute event in the hospital, then this is a time of crisis. And often hospitals will have an in-hospital palliative care team who can come and speak to the patient about what is going on and address some of their needs. And I would also like to emphasize the importance of spiritual care, because for many of our patients, they are not just having the physical suffering, they are also having the spiritual suffering of hopelessness or of feeling that they are a burden or that they just are not seen because a lot of the symptoms in MS are invisible. To have that understanding by a spiritual care counselor is really helpful for the people to feel understood and to reduce some of that suffering.  Dr Grouse: That's a really great point, I think, to end on, and I think it really ties in a lot of the themes that we've been talking about today. Thank you so much for coming to talk with us today. It's been such a pleasure having you both here. Dr Smyth: Thank you. Dr Miyasaki: Thank you, Katie. Dr Grouse: Again, today I've been interviewing Drs Penelope Smyth and Janis Miyasaki about their article on palliative care in multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Irina Turchin, MD, FRCPC, DABD / Hélène Veillette, MD, FRCPC - On the Case: Practical Insights to Individualize Biologic Treatment in Moderate-to-Severe Hidradenitis Suppurativa

Irina Turchin, MD, FRCPC, DABD / Hélène Veillette, MD, FRCPC - On the Case: Practical Insights to Individualize Biologic Treatment in Moderate-to-Severe Hidradenitis Suppurativa

Older adults consist of approximately half of the patients in the ICU, with that number expected to grow in the coming decades. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, and Lauren E. Ferrante, MD, MHS, to discusses new guidelines on caring for older adults in the ICU and the difficulties in finding research that focuses on those patients. The guidelines, “Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU,” will be published in an upcoming issue of Critical Care Medicine. The panel details the process and methodology behind the guidelines, the dearth of studies focusing on older patients in the ICU, and the difficulty of finding studies that enroll older adults who are on multiple medications. The guidelines offer two conditional recommendations and offer priorities for aging-friendly research topics to help provide stronger guidance in the future. Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, is an associate professor, intensivist, and researcher based at McMaster University in Hamilton, Ontario, Canada, who focuses on intravenous fluid use in sepsis, the role of corticosteroids in acute hypoxemic respiratory failure, and clinical practice guideline methodology. Lauren E. Ferrante, MD, MHS, is an associate professor of medicine in the section of pulmonary, critical care, and sleep medicine at the Yale School of Medicine; director of the operations core of the Yale Claude D. Pepper Older Americans Independence Center; and an attending physician in the medical intensive care unit at Yale-New Haven Hospital in New Haven, Connecticut, USA. Resources referenced in this podcast: Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU Compassionate and Evidence-Based Care (session from the 2026 Critical Care Congress) Congress Digital Geriatric Knowledge Education Group Thought Leader: Why the 4Ms Approach to Critical Care Improves Quality (session from the 2025 Critical Care Congress)

Please visit answersincme.com/YVT860 to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Michael Mak, MD, FRCPC, DRCPSC, FCPA, FAPA, FAASM; and Sabrina Kwon, BSc, MD. In this activity, experts in sleep and primary care discuss strategies for the screening, diagnosis, and treatment of adults with obesity and obstructive sleep apnea. Upon completion of this activity, participants should be better able to: Recognize key clinical and diagnostic challenges in identifying obstructive sleep apnea (OSA) in adults with obesity; Evaluate the role of weight management strategies, including incretin-based therapies, in the comprehensive management of OSA in adults with obesity; and Apply practical, patient-centered approaches to optimize obesity and OSA management across the care pathway.

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Mike Sharma, MD, MSc, FRCPC - Deepening the Dialogue on the Latest Data for Factor XIa Inhibition: Is It Time to Shift the Paradigm in Secondary Stroke Prevention?

Please visit answersincme.com/KAF860 to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Jill Trinacty, MD, FRCPC, ABOM. In this activity, an expert in endocrinology discusses incretin-based therapies for the management of cardiometabolic risk. Upon completion of this activity, participants should be better able to: Describe the role of incretin-based therapies in cardiovascular risk reduction; Compare cardiovascular outcomes evidence across incretin-based therapies to inform clinical discussions; and Recognize opportunities to identify and address cardiometabolic risk in a multidisciplinary team setting.

Join endocrine expert Vin Tangpricha, MD, PhD, as he moderates a discussion with members of the task force behind the updated 2026 AACE Consensus Statement: Algorithm for the Management of Adults with Type 2 Diabetes. AACE Past President and Chair Susan L. Samson, MD, PhD, FRCPC, FACE, is joined by Vice Chair Priyathama Vellanki, MD, along with Lawrence Blonde, MD, FACP, MACE, and Irl B. Hirsch, MD, MACP, to discuss key changes. Together, they explore how the new algorithm supports more individualized, complications-focused care and provides practical guidance clinicians can apply in everyday practice.

Novel MRI biomarkers, including cortical lesions, the central vein sign, and paramagnetic rim lesions, are highly specific for MS and can aid diagnosis in select clinical scenarios, particularly early in the disease course or in atypical presentations. When used with appropriate MRI sequences, these markers can improve diagnostic sensitivity while helping prevent misdiagnosis. In this episode, Casey Albin, MD, speaks with Jiwon Oh, MD, PhD, FRCPC, FAAN, author of the article "Diagnostic Neuroimaging Biomarkers for Multiple Sclerosis" in the Continuum® April 2026 Multiple Sclerosis and Related Disorders issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Oh is the medical director of the Barlo Multiple Sclerosis Program at St. Michael's Hospital and an associate professor at the University of Toronto in Toronto, Ontario, Canada. Additional Resources Read the article: Diagnostic Neuroimaging Biomarkers for Multiple Sclerosis Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr Albin: Spend any time in a neurology conference, and you are certain to hear about the new central vein sign, which, as I learn, is not actually all that new. But have you heard about cortical lesions or these paramagnetic rim lesions? Because today I have the privilege of talking to Dr Jiwon Oh about her article, and we're going to unpack all these new biomarkers in MS. Dr Jones: This is Dr Lyell Jones, editor in chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello, this is Dr Casey Albin. Today I'm interviewing Dr Jiwon Oh about her article on diagnostic neuroimaging biomarkers for Multiple Sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Welcome to the podcast. Thank you so much for being here. I'd love to start by having you introduce yourself to our listeners.  Dr Oh: Thanks, Casey. Hi, everybody. My name is Jiwon Oh and I'm a neurologist, mainly an MS specialist at Saint Michael's Hospital at the University of Toronto, and I'm the medical director of our MS program. Dr Albin: And you have written a really fantastic article that dives deep into some of the nitty gritty about these new diagnostic biomarkers that we find on the MRI that we're getting for our patients with multiple sclerosis. And I think we are going to get into a lot of that nitty gritty. How do we look for them? How do they improve our diagnostic specificity? This is really come a long way in shaping the advances for multiple sclerosis. And I'd kind of like to just start with the big picture. Like why do we need these more specific biomarkers?  Dr Oh: This set of diagnostic criteria in MS, it's actually a huge change in the field, and particularly for people like me who are really interested in developing new MRI measures, we're really, really excited because it's actually the first time since MRI was officially incorporated into the MS Diagnostic criteria, which was way back in 2001. It's the first time that we've actually been able to get newer, more advanced imaging measures beyond just simply detecting, new T2 lesions in the MS diagnostic criteria. So, it's a big moment in the field, and many of us are really excited about it in terms of why we need some of these newer, more specific imaging measures. Well, you know, diagnostic criteria always evolve over time for any disease state, and MS is one that we've recognized over the years. By the time someone actually presents with typical clinical symptoms and has diagnosed, whatever has been happening from a patho-biological standpoint has been happening probably for almost 5 to 10 years before that individual actually presents. And so, because of this recognition in the field and the fact that we're recognizing how important it is to first diagnose MS and then treat MS earlier and earlier, because we know that early treatment helps prevent more clinical outcomes. Diagnostic criteria over time have become much more permissive, meaning that we're doing everything that we can to try to facilitate a diagnosis of MS when we know that someone biologically has MS. But the problem with making diagnostic criteria more permissive, and it's obviously a good thing because you want to capture as many people with MS as early on as possible. The problem with making it permissive is there is this terrible risk of misdiagnosis. As clinicians, we all think we never make mistakes. But it turns out when you actually do studies, you do. And even at MS specialty centers, when studies have been done, 10% to 20% of people with MS are misdiagnosed. So, this is exactly why we need in diagnostic criteria that really help to facilitate a diagnosis. We need things that help us prevent misdiagnosis as well. And these are these specific imaging measures that have now been incorporated into the diagnostic criteria in many settings that will help to facilitate a diagnosis. But the really big perk is if you use them, you can help to prevent misdiagnosis as well.  Dr Albin: Yeah, that really shone through in your article that this was such a big step in towards being more specific about who were diagnosing. Also capturing more people, right? Trying to get those people that we, we don't want to miss because of all the things you say, you know, that allows them to accumulate more disability, have worse outcomes. Early diagnosis is so important. But I really did take away from your article just how critical these are and sharping our diagnostic acumen. And so just to jump right in, and you describe these three new biomarkers, these cortical lesions the central vein sign and paramagnetic rim lesions. And so just to kick things off let's start with cortical lesions I sort of conceptualize multiple sclerosis a disease of white matter. So, what's going on here?  Dr Oh: Yes. MS classically has always been described as a white matter disease. But it turns out when you look at brain and spinal cord tissue, as well as when you use kind of better sequences to actually look for lesions in the gray matter, it actually turns out there's a ton of lesions in the gray matter as well. And in fact, what's interesting is that regardless of whether it's the cortex or the deep gray matter, it's lesions within these areas that seem to have the highest relevance for clinical disability in MS. So, all this to say, of course, MS is a lesion that does affect white matter, but it also affects gray matter a lot. And maybe pathology within the gray matter is even more relevant to clinical disability. So, this is why we're really interested in being able to develop methods using MRI to more accurately visualize the gray matter, particularly the cortex, as well as deep gray matter structures like the thalamus. I should add the caveat that cortical lesions were actually included in the 2017 diagnostic criteria revisions, but they were included together with juxtacortical lesions, which are a typical area that MS lesions form. And so, this imaging measure, despite the fact that it is relatively novel and we consider it advanced, it hasn't been used that much only because it's not that easy to detect lesions within the cortex. And reasons for this include that you usually need higher field magnet platforms. And so, the typical clinical MRI scanners that are available kind of widely, regardless of whether you're at an academic center or a community center, are 1.5 Tesla magnets. And cortical lesions are actually really difficult to detect on those typical scanners. But when you get to like, say, three Tesla or seven Tesla, they're a lot easier to detect. But obviously that's a big hindrance to widespread use. And then you actually need very specialized sequences to adequately visualize cortical lesions. And these are not sequences that are usually collected for clinical purposes. So, it kind of requires convincing your radiologists that you need this additional sequence. And then it actually takes a lot of time and training to be able to adequately, accurately detect cortical lesions. So, despite the fact that it's actually very useful when you do have the appropriate MRI sequences and scanners to detect cortical lesions, even though they were incorporated into the 2017 criteria outside of specialty centers, they're not actually widely used. But when you do have the appropriate sequences, cortical lesions are actually pretty specific for MS. So, very helpful for a diagnosis in certain settings. But there's all these practical limitations that have really limited its widespread use. Dr Albin: That is a beautiful summary. So, it sounds like once we kind of get up to speed in terms of like the protocols for this, having the magnet strength for this, this will be really a game changer in terms of increasing the specificity and also maybe finding things that impact patient's clinical presentation and therefore quite meaningful. But it sounds like for most of us, this is probably not something that they're going to be adopting right away. Is that a fair assessment?  Dr Oh: Yes. And you know, they were included in the last diagnostic criteria revisions. And it really hasn't changed things very much, only because of these difficulties with, you know, requiring higher field magnet strengths and these specialized sequences and then needing training to kind of figure out how you can adequately detect cortical lesions. Dr Albin: Totally. So, the other thing we've heard a lot about, and I have to say, I was in the AAN fall conference not too long ago, and this came up quite a bit, was the central vein sign and the fascination with that, because it tells us a lot about the MS pathophysiology and again, increasing that specificity. And it seems like maybe this is one that we can more easily adopt in clinical practice. So, tell our listeners about what that is, how they detect it. How many do you need to find?  Dr Oh: Sure. And so, this is one of the imaging measures I'm really excited about. So, the central vein sign heard about it recently. And probably in the last ten years particularly in the MS field we're talking about it all the time. But just wanted to emphasize that the central vein sign is not something that is new. Even back in the 1800s, when Charcot described MS lesions in these ancient textbooks, he actually very clearly described that MS lesions form around the central vein. And that makes sense, because we know that these waves of peripherally mediated inflammation somehow get through the blood-brain barrier and cause this cascade of events leading to inflammation in the brain and spinal cord, which is what MS is. But we know that B cells in T cells require veins to get into the central nervous system. And so, it's no surprise, really, that MS lesions form around veins. And so, this is something that's been known pathologically. But the reason we're so excited about it now is because we actually have good enough iron-sensitive MRI sequences that allow us to see a central vein when it is present within a white matter lesion. As a neurologist, we know that there's probably hundreds and hundreds of different things that can cause white matter lesions in the brain. But when you use an appropriate iron-sensitive sequence and you see that many of them, if not most of them, actually have visible central veins, that tells you that this person very likely has MS. And so that's why we're so excited about it, because there have been many studies done in the last ten years. In fact, so much evidence generated in the last ten years that there have been I think it's now four systematic reviews and meta analyzes. Looking at the diagnostic properties of the central vein sign. And, you know, it turns out that when you look at people with MS, most of them have a pretty high proportion of white matter lesions that have visible central veins. And there's a lot of questions about, you know, how to best use the central vein sign. But when 40% or more of the white matter lesions that you see have visible central veins, then the likelihood of a diagnosis of MS is very high. So, this is why we're so excited about it in the MS field because it's a really useful diagnostic tool. You know, again when you have appropriate ion sensitive sequences, if you see someone with white matter lesions and you see that 40% or more of them have visible central veins, this tells you that this person very likely has MS.  Dr Albin: So, Dr Oh, I hear you say, you know, 40% of the lesions. Does that mean the neuro radiologist needs to look at every single lesion and then count how many have the central veins, or is there an easier way to do this? Dr Oh: Great question. Casey, there is definitely an easier way because our neuro radiologists would not be our friends anymore if we made them look at every white matter lesion and make sure that 40% of them had the central vein sign. So, because it's so time-consuming to use that 40% threshold, there's an easier criterion that has actually made it into the diagnostic criteria. And it's called Select Six. And what this means is when you have more than ten lesions, as long as you show that six of them have a visible central vein, you just have to count six with the central vein. Then you're done. So that means you're Select Six positive or central veins nine positive. However, if you have ten or fewer lesions, as long as you show that more than 50% of them show a visible central vein, then you are select six positive, and then you're done. So, as you can see, it's a much simpler criterion to apply, and it seems to perform almost as well as that 40% threshold, which is why that is the criterion that's made it into the new diagnostic criteria.  Dr Albin: Perfect. I love that we definitely do not want to make enemies with our neuro radiology colleagues, but yet they do so much for us. So perfect. I'm glad that we can, make their jobs a little easier without losing any specificity there, or just losing a touch of specificity there. All right. If I am working with a, you know, in a center that maybe doesn't do this all the time, am I just getting a run of the mill SWI sequence? Do I need to ask my radiologist for a special sequence? Or is this just, you know, you can get it from the typical array of what our patients are getting.  Dr Oh: You know, SWI is a widely available commercial sequence that's iron-sensitive, the ones that are typically commercially available, they can detect central veins, but there actually are little tweaks that you can do to make it a little more optimal. With the recent diagnostic criteria publication, which was, led by Xavier Montalban and recently published in Lancet Neurology. There's actually a companion MRI paper that was led by Frederick Barkov and Danny Wright. And the reason I'm specifically citing those papers is in that companion MRI paper, there's a table that has kind of optimal sequence parameters that you can use even with a conventional SWI sequence, to try to best detect the central vein sign. And then there's a wide range of different iron-sensitive sequences, and SWI is one of them, but the one that seems to have emerged as most sensitive to detect the central vein sign is something called the 3D T2*-EPI sequence. But the bottom line is there's a whole bunch of different iron-sensitive sequences that you can use, little tweaks that you can do to make them optimal, to be able to visualize central veins when they're present within white matter lesions. Dr Albin: Incredible. So like partner with your neuro radiologist, there is a great sounds like a field guide almost to this. So, it makes it easy to pick up in your standard of care so that you can make sure that you are detecting them at the optimal level to see that more specific diagnostic biomarker.  Dr Oh: Yes. And you know, in contrast to what we were talking about with cortical lesions, you can actually detect central veins when you use these iron-sensitive sequences at any field magnet. So even at 1.5 Tesla, particularly when you use contrast, which is often given with the diagnostic scan anyway, you can very easily detect a central vein. So that's a huge benefit because it allows for widespread use. As long as you work with your radiologist to get the right iron-sensitive sequences in.  Dr Albin: Yeah, that's incredible. I mean, I think that it really will be practice-changing. And then the last one that I think was honestly new to me, I feel like I had heard a lot about the central vein sign, but the whole new to me term was this paramagnetic rim lesion. So, what does that tell us about the underlying biology of MS? And are there any other things that might also have this finding that we should sort of be aware of? And how specific is it?  Dr Oh: You know, the central vein sign is kind of the main, really new imaging measure that's made it into every part of the MS diagnostic criteria. And then together with that paramagnetic rim lesions or we call them PRL or pearls for short, they've made it as well, but in a much more limited way only because there's not as much evidence that has accumulated over time to support the diagnostic utility of pearls. But first of all, what are pearls? So, people in the MS field are really excited about pearls, because we know that they capture a subset of what we call chronic active lesions. So, MS lesions will form acutely and over time, some of them will become inactive. And then some of them are chronic active lesions, meaning that they have this rim of activated microglia around them. Over time, they continue to slowly expand. And it's almost like this slow burn. And the reason why we focus a lot on chronic active lesions is because we know that they're a driver of progressive disease biology and MS, meaning that in people who have progressive MS or who have pretty severe disability, global disability or cognitive disability, we know that they have a high burden of pearls. And so that's why there's so much excitement in MS about being able to image chronic active lesions. It's because we're always looking for an imaging measure that allows us to accurately predict progression or to, measure progression over time. So that's why there's so much excitement in MS about pearls. But as kind of an added bonus, it turns out pearls are also really specific for MS. And so, when you use the same iron-sensitive sequences, by the way, that's used to detect the central vein sign when you use appropriate iron‑sensitive sequence. And if you see that someone has a pearl, the likelihood of a diagnosis of MS is very high. The one exception to that is Susac syndrome, where pearls have been observed. But other than that, with many other white matter diseases like neuro rheumatology disease, NMOSD, MOGAD, you really don't see pearls. And so, this is why it's made it into the new diagnostic criteria. In contrast to the central vein sign, though, not everybody with MS has a pearl, so the sensitivity isn't as high. However, it's really, really specific in the range of, you know, 90 to 95%. So, this is why it's been added as, an imaging measure in certain settings. It can help facilitate a diagnosis. But the real utility, again, is when you use it, it helps you to prevent misdiagnosis.  Dr Albin: It's fantastic. And hearing you talk about that, this one stands out to me as a biomarker that not only helps increase our diagnostic specificity, but also may really inform if the patient has having progression despite the treatment they're on, that this could play a role in helping you say, look, there probably is something that we need to switch because we can still see this ongoing progression. Dr Oh: Yes. And especially in this new era of treatment in MS. I think, you know, MS as a field, we've been so fortunate to have so many treatments emerge over the years that mainly target relapsing disease. But we hopefully, in the next little while, in short order, I hope we'll have treatments that target these progressive disease biologies. And so, not only is it helpful as a diagnostic marker, but there's a lot of evidence accumulating, showing that it may have a lot of prognostic value and will also help guide treatment decisions, exactly as you said.  Dr Albin: It truly does sound like it's a great time to be an MS doctor there. So, so many new advances in the field. There is so much more that we can do for these patients in our limited time left. I'd love to ask you, what is it that you're most excited about now with the change in the biomarkers, the change in the treatment, what makes you really excited to be a doctor specializing in MS right now? Dr Oh: I feel like we're on the brink of a new era of treatment. I think, you know, in the last two decades, MS care has changed so dramatically. I remember, you know, way back when, as a medical student, when I did my first neurology elective, this was when the first treatments for MS were emerging. And the prognosis that we were talking to patients about at that time is like night and day compared to what we talk to them about now. But we're going to do even better in the next couple of years. And so, there's a number of new treatments that hopefully will be approved soon that, for the first time, have shown an effect in clinical trials where it seems to be decreasing progression that is independent of relapsing activity. And that's really the greatest unmet treatment need that we have. And it seems like we might have some therapies on the horizon that can actually target that aspect of progression. It's really exciting, and even more that we're going to be able to do for our patients to completely change the way, we look at and the way we treat MS in the years to come.  Dr Albin: Dr Oh, this has just been fantastic. To all of our listeners, I really want to point you to the article because obviously, as an imaging biomarker article, there are so many beautiful images. There are great examples. There are some fantastic cases that show how applying these new biomarkers can help get you to the right diagnosis. This is truly a tour de force of how imaging has really shifted the care that we provide patients with MS, and so please go and check it out. It is one that you do not want to miss. And again, today I've been interviewing Dr Jiwon Oh about her article on diagnostic neuroimaging biomarkers for multiple sclerosis, which appears in the April 2026 Continuum issue on multiple sclerosis. Thank you again, Dr Oh, this has just been such a delight.  Dr Oh: Thank you for having me on the show, Casey, and look forward to people reading the article. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO, chief medical officer with the International Myeloma Foundation and professor in the Applied Cancer Research and Drug Discovery Division of the Translational Genomics Research Institute, has spent more than 25 years advancing the treatment of multiple myeloma. In this episode, he breaks down how improved survival, evolving frailty assessments, and the rise of therapies like CAR T and bispecific antibodies are reshaping care for an aging population, and he highlights the growing emphasis on quality of life, caregiver support, and expanding clinical trial access.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/UHR865. CME/AAPA credit will be available until March 24, 2027.Neuroinflammation in Focus: Interpreting the Latest Evidence for BTK Inhibition in Multiple Sclerosis In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis independent Satellite Symposium is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

Please visit answersincme.com/860/240201375-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by James Michael Ramsahai, BSc, MD, PhD, FRCPC and Nan Zhao, BSc, MD, FRCPC. In this activity, experts in managing severe eosinophilic asthma discuss evidence-based strategies for personalizing biologic therapy, reducing steroid burden, and optimizing treatment in the setting of overlapping eosinophilic diseases. Upon completion of this activity, participants should be better able to: Identify strategies to individualize the selection of biologic therapies for patients with severe eosinophilic asthma based on the latest clinical and real-world evidence; Evaluate the implications of real-world data on biologic therapies for addressing airway remodeling and airway plugging; Develop steroid-sparing treatment plans and monitoring strategies for patients with severe eosinophilic asthma; and Formulate treatment plans to adjust the use of biologic therapies in patients with severe eosinophilic asthma and overlapping eosinophilic comorbidities.

Please visit answersincme.com/860/240201375-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by James Michael Ramsahai, BSc, MD, PhD, FRCPC and Nan Zhao, BSc, MD, FRCPC. In this activity, experts in managing severe eosinophilic asthma discuss evidence-based strategies for personalizing biologic therapy, reducing steroid burden, and optimizing treatment in the setting of overlapping eosinophilic diseases. Upon completion of this activity, participants should be better able to: Identify strategies to individualize the selection of biologic therapies for patients with severe eosinophilic asthma based on the latest clinical and real-world evidence; Evaluate the implications of real-world data on biologic therapies for addressing airway remodeling and airway plugging; Develop steroid-sparing treatment plans and monitoring strategies for patients with severe eosinophilic asthma; and Formulate treatment plans to adjust the use of biologic therapies in patients with severe eosinophilic asthma and overlapping eosinophilic comorbidities.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/TPK865. CME credit will be available until March 11, 2027.Disease and Disability Progression in Relapsing MS: Unpacking Efficacy Data to Advance Treatment DecisionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The University of Cincinnati and PVI, PeerView Institute for Medical Education, are both accredited by the ACCME to provide continuing medical education for physicians and have collaborated to design and execute this activity. For accreditation purposes, the University of Cincinnati is responsible for certification and documentation of attendance for this activity.SupportThis independent Satellite Symposium is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

Ashkan Shoamanesh, MD, FRCPC - Turning Pathophysiologic Promise Into Evidence-Based Potential: Are Factor XIa Inhibitors Ready for Prime Time in Secondary Stroke Prevention?

Please visit answersincme.com/860/240201356-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Sue D. Pedersen, MD, FRCPC, DABOM; Leon Waye, MD; and Basel Bari, MD, MCFP. In this activity, experts in obesity discuss treatment management with a focus on the role of incretin-based therapies. Upon completion of this activity, participants should be better able to: Explain the rationale for managing obesity as a chronic, treatable disease; Discuss the latest evidence for incretin-based therapies in the management of obesity, including clinical outcomes and safety profiles; and Identify patients who might benefit from incretin-based therapies as part of a comprehensive treatment plan for obesity.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

Please visit answersincme.com/860/240201321-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Neda Amiri, MD, MHSc, FRCPC, ABIM; Dharini Mahendira, MD, FRCPC, MScCH and Eleftherios Soleas, PhD. In this activity, experts in rheumatology discuss evidence-based strategies to facilitate the selection and optimization of biologic therapies in women with inflammatory arthritis who are of childbearing potential. Upon completion of this activity, participants should be better able to: Describe how patient-specific factors, including fertility status, pregnancy, and lactation, inform personalized biological therapy selection in inflammatory arthritis; Evaluate the efficacy and safety profiles of approved biologics in women of childbearing potential across inflammatory arthritis indications; and Apply strategies to optimize management decisions in reproductive-age women with inflammatory arthritis.

Kick off 2026 with the January episode of RAPM Focus, where RAPM Social Media Editor Alopi Patel, MD, converses with Josh Gleicher, MD, MSc, FRCPC, and Hermann dos Santos Fernandes, MD, PhD, following the September 2025 publication of their original research paper, “Outpatient continuous adductor canal block (CACB) for total knee arthroplasty: a double-blinded randomized placebo-controlled trial.” Dr. Gleicher is a staff anesthesiologist and regional anesthesia expert at Mount Sinai Hospital in Toronto, Canada. He completed his anesthesiology training and fellowship in regional anesthesia at the University of Toronto and holds a master's degree in quality improvement and patient safety. Dr. Gleicher has extensive experience leading clinical trials in acute postoperative pain, with multiple funded studies and recognized expertise in anesthesia research. He is also a co-developer of the ISAFE technique for adductor canal catheter placement. In his spare time, he enjoys skiing and spending time with his wife and three kids. Dr. dos Santos Fernandes is a specialist in anesthesiology and pain management, trained at University of São Paulo, where he also achieved his PhD and completed a post-doctorate program. He has fellowship training in regional anesthesia and medical education at Mount Sinai Hospital, University of Toronto, and holds multiple certifications, including the superior title in anesthesiology and European diploma in anesthesiology and intensive care. Currently, he is an assistant professor at the University of Toronto and a staff anesthesiologist at Mount Sinai Hospital, with research and clinical focus on regional anesthesia. A retired basketball player and aspiring tennis player, he likes to travel with the family in his free time. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Please visit answersincme.com/RND860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, experts in hypophosphatasia (HPP) discuss its multisystem burden and diagnostic challenges, and the importance of early referral for timely treatment. Upon completion of this activity, participants should be better able to: Describe the clinical burden and multisystem manifestations of HPP across the lifespan; Recognize key diagnostic challenges in HPP through practical screening strategies, including interpretation of alkaline phosphatase (ALP) and pyridoxal 5′-phosphate (PLP) levels; and Outline the importance of early referral and diagnostic confirmation to enable timely treatment initiation, including the role of genetic testing and family screening.

Please visit answersincme.com/RND860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, experts in hypophosphatasia (HPP) discuss its multisystem burden and diagnostic challenges, and the importance of early referral for timely treatment. Upon completion of this activity, participants should be better able to: Describe the clinical burden and multisystem manifestations of HPP across the lifespan; Recognize key diagnostic challenges in HPP through practical screening strategies, including interpretation of alkaline phosphatase (ALP) and pyridoxal 5′-phosphate (PLP) levels; and Outline the importance of early referral and diagnostic confirmation to enable timely treatment initiation, including the role of genetic testing and family screening.

Join Drs. Andy Cutler and Roger McIntyre as they discuss the most significant advancements in psychopharmacology over the past year. Their conversation highlights groundbreaking developments and innovations in the field of psychiatry.   Roger McIntyre, MD, FRCPC, is a globally recognized psychiatrist and psychopharmacologist who holds pivotal roles in academia, research, and leadership. His research primarily focuses on the phenomenology, neurobiology, and development of novel therapeutics for mood disorders. Dr. McIntyre is currently a Professor of Psychiatry and Pharmacology at the University of Toronto.   Andrew J. Cutler, MD, is a distinguished psychiatrist and researcher with extensive experience in clinical trials and psychopharmacology. He currently serves as the Chief Medical Officer of Neuroscience Education Institute and holds the position of Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York.  Resources  Thanarajah ES et al. Soft drink consumption and depression mediated by gut microbiome alterations. JAMA Psychiatry 2025;82(11):1095–1102. doi:10.1001/jamapsychiatry.2025.2579  Durgam S et al. Lumateperone as adjunctive therapy in patients with major depressive disorder: results from a randomized, double-blind, phase 3 trial. J Clin Psychiatry 2025;86(4):25m15848. doi: 10.4088/JCP.25m15848  Hendershot CS et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry 2025;82(4):395–405. doi: 10.1001/jamapsychiatry.2024.4789  Aron L et al. Lithium deficiency and the onset of Alzheimer's disease. Nature 2025;645:712–21. doi: 10.1038/s41586-025-09335-x  Never miss an episode!

Please visit answersincme.com/NEH860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, an expert in rheumatology discusses strategies for the use of biologics, including IL-17 inhibitors, in the management of patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA). Upon completion of this activity, participants should be better able to: Recognize the rationale for IL-17 inhibition in the treatment of psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA); Select appropriate biologic therapies for PsA and axSpA using current guidelines and patient-specific factors; and Outline patient-centered strategies for optimizing the management of PsA and axSpA.

Please visit answersincme.com/NHE860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, an expert in rheumatology discusses strategies for the use of biologics, including IL-17 inhibitors, in the management of patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA). Upon completion of this activity, participants should be better able to: Recognize the rationale for IL-17 inhibition in the treatment of psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA); Select appropriate biologic therapies for PsA and axSpA using current guidelines and patient-specific factors; and Outline patient-centered strategies for optimizing the management of PsA and axSpA.

Please visit answersincme.com/NHE860 to participate, download slides and supporting materials, complete the post test, and get a certificate. In this activity, an expert in rheumatology discusses strategies for the use of biologics, including IL-17 inhibitors, in the management of patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA). Upon completion of this activity, participants should be better able to: Recognize the rationale for IL-17 inhibition in the treatment of psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA); Select appropriate biologic therapies for PsA and axSpA using current guidelines and patient-specific factors; and Outline patient-centered strategies for optimizing the management of PsA and axSpA.

John Abramson, M.D., and Jim Wright, M.D., Ph.D., FRCPC, expose how pharmaceutical industry influence distorts clinical trial outcomes. Gain crucial insights to help you critically evaluate medical evidence and make informed healthcare decisions. #ClinicalTrials #MedicalEthics #PharmaTransparency