Benjamin M. Segal, MD

“A big issue that we addressed in this meeting that I think is going to continue being a subject of discussion is: during the beginning stages of MS, how aggressive should you be in disease-modifying therapy?”

One of the leading topics of conversation in the multiple sclerosis (MS) community has been the induction versus escalation therapeutic approach. On one hand, induction: the thought that high-efficacy therapy should be started as soon as possible; and on the other, escalation: the thought that efficacy can be escalated to meet the needs of the patient along their disease progression and activity.

At this year’s joint ECTRIMS-ACTRIMS meeting, MS Virtual 2020, this conversation continued. Benjamin M. Segal, MD, chair, Department of Neurology, and director, Neuroscience Research Institute, The Ohio State University, offered 

 an overview of this debate in a recent interview. He discussed some of the pros and cons of each side of the conversation, and some anecdotal experience he’s had in treating patients.

Segal, who was the co-chair of the scientific program committee for MS Virtual 2020 and is the co-director of the Neurological Institute and The Stanley D. and Joan H. Ross Chair in Neuromodulation at Ohio State, also offered some insight into the literature that has been published comparing these philosophies, and what those findings suggest.

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The chair of the department of neurology at The Ohio State University spoke to the ongoing conversation in MS about how aggressive to be with treatment early on.

Benjamin M. Segal, MD: Escalation Versus Induction in MS

“There is this growing body of literature indicating that before people are actually diagnosed with definite MS, there is this period of time which can span quite a few years in which they are actually utilizing health services more frequently.”

At this year’s joint ECTRIMS-ACTRIMS meeting, MS Virtual 2020, the opening plenary address was given by Helen Tremlett, PhD, professor, and Canada Research Chair in Neuroepidemiology and Multiple Sclerosis, University of British Columbia. She discussed the novel idea of the multiple sclerosis (MS) prodrome, a period of time in which patients experience an increased usage of health care, as well as lifestyle changes, which she noted are recognizable 5 to 10 years prior the clinical recognition of MS.

This myriad of prodromal features, however, are nonspecific to MS, but they offer a potentially great insight into what may be the first signs of disease. As Benjamin M. Segal, MD, chair, Department of Neurology, and director, Neuroscience Research Institute, The Ohio State University, noted to 

, there has long been the knowledge that the ongoing damage is undetectable early on. This new data, though, suggest it might be identifiable with further research.

Segal, who was the co-chair of the scientific program committee for MS Virtual 2020 and is the co-director of the Neurological Institute and The Stanley D. and Joan H. Ross Chair in Neuromodulation at Ohio State, provided a recap of this plenary talk and what his takeaways were. He also spoke to what he believes may happen as this MS prodrome is elucidated further.

The chair of the department of neurology at The Ohio State University discussed the idea of the multiple sclerosis prodrome, presented in a plenary address at the MS Virtual 2020 meeting.

Benjamin M. Segal, MD: The Multiple Sclerosis Prodrome

“These parallel sessions, really, were designed so that someone that has a particular research or clinical interest, or background, would be able to stay on that same track and not have competing talks that they had to bounce around from.”

This year, as was the case for many a medical organization meeting, the joint ECTRIMS-ACTRIMS meeting was forced into a virtual format, and thus aptly named MS Virtual 2020. The new format, however, did offer attendees a unique opportunity to perhaps more freely attend sessions of interest in spite of the challenges of shifting the conference to this new format.

One adjustment was to develop a number of “tracks” to group together presentations of similar type, in light of the scope of the meeting being one of the largest in multiple sclerosis (MS). Benjamin M. Segal, MD, chair, Department of Neurology, and director, Neuroscience Research Institute, The Ohio State University, who was the co-chair of the scientific program committee, believes that this design helped allow for attendees a smoother time in getting to the sessions that they’d like.

Segal, who is also the co-director of the Neurological Institute and The Stanley D. and Joan H. Ross Chair in Neuromodulation at Ohio State, recently offered a recap of this year’s meeting in a conversation with NeurologyLive. He also spoke to some of the takeaways from the meeting, including the themes that joint congresses attempted to put on display and the ongoing conversations that the meeting highlighted.

The chair of the department of neurology at The Ohio State University discussed some of the main themes and takeaways from the MS Virtual 2020 meeting.

Benjamin M. Segal, MD

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