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1st World Congress on Controversies in Neurology: Berlin, Germany, 7-9 September 2007.

The first debate argued whether MS is a single nosologic entity due to an autoimmune mechanism or not. Hans-Peter Hartung (Germany) supported this, stating that the common features and pathology of MS described by neurologists since the time of Charcot suggest it is a single nosologic entity. MS disease course is variable, but disease phenotypes and outcomes are similar. MS pathology shows common features throughout and in every case, peripheral T-cells are able to cross the blood-brain barrier and damage axons. Israel Steiner (Israel) opposed, stating that MS is diagnosed by excluding other diseases and there is no single characteristic autoantigen. It was agreed that the efficacy of natalizumab indicates that MS has an incompletely-defined autoimmune aetiology, newer immunomodulatory treatments including alemtuzumab and daclizumab remain to be fully proven in clinical practice.

Per Sorensen (Denmark) supported the argument that the presence of neutralising antibodies (NAbs) necessitates a switch of therapy away from the interferon betas (IFNBs). He argued that NAbs persisted for several years, abolished biological effects and increased relapse rates similar to those of placebo-treated patients. Joel Oger (Canada) countered that the clinical significance of NAbs is still unclear, precise definitions of NAb positivity are still needed and there are large differences between US and European guidelines on NAbs. NAbs do not abolish all treatment effects and can diminish with time. It was agreed that more data are needed on NAbs, specifically on precise titres indicative of efficacy reduction.

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A strong theme at the congress was stem cell therapy for MS. Gianvito Martino (Italy) argued that this is a real option in the medium term. Stem cells could be used to replace damaged cells but would need to overcome brain defences. A human trial is a possibility within a few years, but procedures and endpoints for such studies need to be established. Michel Revel (Israel) however, argued that bioethical aspects of using human embryonic stem cells are still an issue. Although stem cells can be derived from various tissues, there remain hazards from pathogens and donor consent is required. In many countries, including the USA, stem cell research remains illegal.

In a further session, the issue of whether clinically isolated syndromes (CIS) should be treated or not was debated. Giancarlo Comi (Italy) stated that since 85% of placebo-treated patients with CIS developed MS (McDonald criteria) and because neurological damage occurs early in the disease process, treatment should start early. Aksel Siva (Turkey), however, argued that in some previous studies 55-62% of patients did not convert to clinically definite MS and patients with symptom-free courses of over 20 years have also been reported; this, he claimed, justified not hurrying to start treatment of CIS. In discussion however, it was agreed that CIS is a misleading term; if MS diagnosis is clear, it would be unacceptable not to treat.

In a further debate Xavier Montalban supported the contention that the IFNBs and glatiramer acetate (GA) provide a neuroprotective effect in MS. He argued that inflammation leads to axonal loss and that disease-modifying agents (DMTs) are antiinflammatory thereby preventing or limiting neurological damage. Cris Constantinescu (UK) countered that neuroprotection was a myth, DMTs do not act directly on the brain or stop disability progression and GA does not cross the blood-brain barrier. He asserted that the DMTs are therefore immunomodulatory, not neuroprotective.

Gavin Giovannoni (UK) discussed the weak points in MS diagnosis and K Selmaj emphasized the increasing importance of specific biomarkers in identifying MS. Vesna Brinar (Croatia) reported positive results with alemtuzumab compared with IFNB-la in a Phase II open-label study.

The CONy meeting brought together a range of neurologists and tackled a variety of current controversies in the field of MS and stimulated productive debate. The next CONy meeting is to be held in Athens, Greece, 23-26 October 2008.

Conflicts of Interest

No conflicts of interest were declared in relation to this article.

Bill Carroll

Perth, Western Australia
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Title Annotation:Meeting Report
Author:Carroll, Bill
Publication:The International MS Journal
Date:Mar 1, 2008
Words:650
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