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Understanding Multiple Sclerosis Better in 2014 –
Environmental Factors, Remyelination, Diagnostic Techniques,
Treatment Decisions and the Future Focus of Multiple Sclerosis Treatment
Report of the MS Days Meeting Held in Istanbul, Turkey, Friday 31 October to Sunday 2 November 2014
Expert review by: Hüsnü Efendi, 1 Rana Karabudak, 2 Orhun Kantarci 3 and Aksel Siva 4
1. Kocaeli University, School of Medicine, Kocaeli, Turkey; 2. Hacettepe University, School of Medicine, Ankara, Turkey; 3. Department of Neurology,
Mayo Clinic and Foundation, Rochester, Minnesota, US; 4. Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
Abstract Epidemiological factors, such as vitamin D, Epstein–Barr virus, smoking and adolescent obesity, are associated with multiple sclerosis (MS)
susceptibility and may be involved in MS aetiology. There is also evidence of gene–environment interactions. Both validated predictive
biomarkers and gene-expression data will play a crucial role in future diagnosis of MS and prognosis facilitating early treatment and improving
management. Understanding the mode of action of disease-modifying therapies (DMTs) should also enhance MS management by identifying
the best treatment for different stages of the disease course. Magnetic resonance imaging (MRI) plays a significant role in both diagnosis
and monitoring of patients and is likely to become part of the daily MS practice using standardised protocols and software to increase
reproducibility. A future goal of MS treatment is to facilitate neuron repair and remyelination. In this respect, animal models of remyelination
could be useful in identifying potential therapies. Diagnosis of radiological syndrome is now simpler, but its management is controversial and
it does not always convert to MS. In addition, treatment for progressive MS is problematic as current DMTs are indicated only for relapsing-
remitting MS. Symptomatic treatment is a neglected aspect of MS management, which is often the main concern of both patients and
neurologists. Neurologists need to collaborate in trials and consider repurposed drugs that could provide treatment for these symptoms.
The second MS Days meeting provided a valuable platform for these critical topics to be discussed and novel solutions to be considered.
Keywords Epidemiological factors, gene/environment interactions, radiological isolated syndrome, MRI, remyelination, progressive MS, diagnosis
Disclosure: Hüsnü Efendi has received travel funding and/or speaker honoraria from Bayer Schering, Biogen, Genzyme, Merc Serono, Novartis and Teva. Rana Karabudak
has received honorary fees and grants for consultation and educational presentations and manuscripts from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey,
Teva, Bayer-Schering and Genzyme, and travel grants for annual ECTRIMS and AAN meetings from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey, Teva,
Bayer-Schering and Genzyme. Orhun Kantarci receives research support from the European Regional Development Fund (FNUSA-ICRC CZ.1.05/1.1.00/02.0123) and the
National Multiple Sclerosis Society and has given scientific presentations at meetings supported by Teva and Novartis Pharmaceuticals, but has received no personal fees
or personal compensation for this activity (all compensation for consulting activities paid directly to Mayo Clinic). Aksel Siva’s department has received research grants
from The Scientific and Technological Research Council Of Turkey – Health Sciences Research Grants numbers: 109S070 and 112S052; and also unrestricted/unconditional
research grants from Merck-Serono to his Clinical Neuroimmunology Unit. Aksel Siva has received honoraria for giving educational presentations and consultation fees and
travel and registration coverage for attending several national or international congresses or symposia, from Merck Serono, Novartis, Biogen Idec/Gen Pharma of Turkey,
Teva, Genzyme and Excemed.
Acknowledgement: Medical writing support was provided by Ray Ashton, Touch Medical Media, funded by Novartis Pharmaceuticals. This article reports the proceedings
of a sponsored satellite symposium and as such has not been subject to the journal’s usual peer-review process.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation
and reproduction provided the original author(s) and source are given appropriate credit.
Received: 13 October 2015 Published Online: 10 November 2015 Citation: European Neurological Review, 2015;10(2):148–56
Correspondence: Hüsnü Efendi, Kocaeli University faculty of Medicine, 41380 Kocaeli, Turkey. E: firstname.lastname@example.org.
Support: The publication of this article was supported by Novartis Pharmaceuticals. The views and opinions expressed in the article are those of the authors and not
necessarily those of Novartis Pharmaceuticals.
Understanding MS Better in 2014
Contribution of Epidemiological factors
Multiple sclerosis (MS) is considered to be an immune-mediated
neuro-inflammatory and neurodegenerative disease of the central
nervous system (CNS) with heterogeneous clinical presentation and
course, neuroimaging and pathological findings. Several genetic
and environmental factors have been shown to show some association
148 with MS; gene–environment interactions are hypothesised to have
a stronger effect and the interplay between these factors might be
due to common pathogenic mechanisms. Epidemiological factors are
involved in the causality of MS and affect the disease course. Several
well-validated environmental factors have been identified that are
associated with MS susceptibility including vitamin D, viral infections
(especially Epstein Bar virus [EBV]), smoking and adolescent obesity.
TOU C H ME D ICA L ME D IA