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Multiple Sclerosis Program
Clinical Activities
The MS clinic at UBC hospital, with 3892 patient visits and 620 new patients in 2008, is one of the largest in Canada and provides a multi-disciplinary service, including psychiatric and genetic counseling, to all patients across the province via the British Columbia Multiple Sclerosis Clinic Network (BCMSCN). This network is one of the largest collaborative efforts in the world providing excellent multi-disciplinary services to MS patients. The clinical database at UBC includes up to 25 years of natural history data on the disease courses of over 8000 patients. This network provides an excellent resource for research, training, and education, and attracts national and international visitors ever year for clinical preceptorship or fellowship. For a list of MS clinics in BC click here.
The clinic maintains important interdepartmental collaborations to optimize care to affected patients and their family members as appropriate:
Genetic and Reproductive Counseling: Dr. A.D. Sadovnick and her team
Psychiatric Care: Dr. A. Jiwa and Dr. J. Tham
Sexual Medicine Care: Dr. S. Elliot
Neuro-urology: Dr. Fenster.
Specialized Services
The clinic coordinates (RN J. Geddes) new escalating immune therapy options for aggressive MS. The clinic also provides specialized care for patients with neuromyelitis optica (NMO), an aggressive form of optic nerve and spinal cord demyelination with special focus on the evolution of new phenotypes in the Asian immigrant population. The MS Clinic also has important collaborations with the Cell Separator Unit at VGH site with Dr. Traboulsee and Dr. Oger serving on the Neuroplex Committee. Currently, guidelines and pathways for rapid access to escalating therapies are established.
Outreach Clinics
As part of the commitment to the BCMSN, the UBC clinic provides outreach to 3 clinics in Victoria (1000 patients registered), Kelowna (700 patients), and Prince George (300 patients), as well as providing outreach care directly to patients in Comox. Collaborative projects have been established with the Burnaby Clinic and another outreach clinic is planned in Kamloops. The next step to improve the care for our patients is to provide interdisciplinary service as a provincial program.
MS Special Therapy Program
In collaboration with Pharmacare and with educational funding from the pharmaceutical industry, we were able to continue the MS Special Therapy program, which provides education to patients in their choice for Disease Modifying Therapies (DMT) and management of their potential side effects. There are over 2000 treated patients in this program.
Research Activities
Dr. Tremlett: Based on the excellent clinical database of the clinic, Dr H. Tremlett and her coworkers were able to further examine the natural history of secondary progressive MS, long-term adverse drug reactions, effects of sunlight exposure and infections on relapse rate as well as the timing of birth and disease progression.
Dr. Oger's Laboratory: In this laboratory, Dr. E. Gibbs has graduated with a PhD in experimental medicine. Using a new method of plasmon resonance, it was demonstrated that the immune response against recombinant interferon-beta injected by MS patients (neutralizing antibodies) switches from an IgG1-based response to an IgG4-based response and affinity increases. A Luciferase based assay to measure NABs against interferon-beta is now available as a standard test in the lab and together with the acetylcholine receptor antibody assay (for diagnosis of myasthenia gravis) has been approved by the laboratory medicine section of BCMA. Dr. Oger’s lab received over 1800 samples for tests in 2008.
Dr. Rieckmann's Laboratory:: After extensive renovations, finally, new wet laboratory space was created on the second floor of Koerner Pavilion and Dr. Rieckmann´s experimental research on functional aspects of the blood brain barrier and disease modifying genes in MS got on its way. Dr. J. Basivireddy started as a research coordinator together with one technician, one post-doc and 2 graduate students in the lab. This laboratory provides a centralized facility for DNA extraction from clinical sample and is currently used by the MS and the dementia programs (Dr. R. Hsiung).
Dr. V. Strehlau: A new interdisciplinary program on physical activity in MS patients, including functional and structural aspects of repair was initiated.
Dr. Sadovnick: This research on genetic susceptibility to MS has now entered its 5th phase and is continuously the most productive and successful part of the MS program. Her research team also significantly contributes to the success of the prospective study on epidemiology, pathobiology, and clinical outcome of Canadian children with clinically isolated demyelinating syndromes (CIS). Dr. Sadovnick has initiated a Multiple Sclerosis North American Pregnancy Program (MS-NAPP) in collaboration with the MS Society of Canada, National (US) MS Society and the Consortium of MS Clinics, which now includes cooperation partners in Argentina and Chile.
MRI Research Group: The MRI Research Group has further improved the clinical applicability of myelin water imaging (MWI), the only in vivo method to specifically quantify myelin content in the central nervous system. This important work has received ongoing grant support from the MS society and international acclaim. A serial study of MS subjects, monitoring the development and repair of new lesions over a 6-month period was completed. Based on these findings, this technique will be adapted for multicentre clinical trial use starting in 2009. A key component of this research has been the collaboration with Dr. Wayne Moore and Dr. Corre Laule who continue to work on pathologic validation of MRI techniques.
In addition to renewal of existing grants, MS/MRI Research Group received a new 2 year grant from the MS Society of Canada (PI: Tony Traboulsee) to investigate the effect of medications on brain hydration. Changes in brain size or atrophy (shrinkage) occur with most diseases of the central nervous system and they are often used to monitor for therapeutic benefit of new investigational drugs. Dr. Li and Dr. Traboulsee, in association with the Consortium of MS Centers, recently hosted an international panel of MS and MRI experts to revise a standardized MRI protocol and clinical guidelines for the use of MRI in MS care. This is an important translation of an evolving body of research and opinions into a clinically practical set of guidelines that will benefit patients and clinicians worldwide.
MS Clinical Trials Group: This group participated in 2 studies for clinical isolated syndromes (phase II and phase III), 9 studies for relapsing remitting MS (2 phase II, 5 phase III, 2 extension studies), 3 studies for PPMS (phase III). This latter group is particularly important as there are no treatment options for progressive MS. Both Dr. Rieckmann and Dr. Traboulsee serve on many steering committees and safety monitoring boards of international studies. We have a dedicated clinical trial staff including 4 nurse coordinators, 2 research technologists, and 1 research coordinator.
Researchers of the MS program participate in several national and international collaborative research networks and hold grants from CIHR, NSERC, European Union, MS Society of Canada, National MS Society of USA and MSFHR worth over $6 million. They have published in 2008 over 50 peer-reviewed articles.
Teaching Activities
Members of the MS Program actively recruit students for the neuroscience and experimental medicine graduate programs. In 2009, there are 12 students in this program. Members have lectured locally, in the region, nationally and on different international conferences on the important aspects of optimized MS treatment and care both for clinicians and also for MS patients. The MS Program offers research-training opportunities for students and residents, which has resulted in highly recognized publication. We recently organized a formal rotation of residents to all clinical neuroscience programs at UBC hospital. The UBC MS program offers clinical and research fellowships for neurologists who are interested in building a career as clinician scientists. In 2008, we hosted over 30 clinicians and researchers for short term or extended fellow- and preceptorships. Together with the University of Saskatoon, we successfully applied for Western Pacific Regional Research and Training Center, which will start in 2009 and will provide an optimal interdisciplinary environment to attract students, researchers and clinician scientist to MS research. The center is funded by the EndMS campaign of the Canadian MS society.
Participating Divisional Members
Neurologists
Dr. Traboulsee, DirectorClinical Research Fellows
J. Saeedi
R. Alroghani
Neuro-ophthalmologists
Dr. Anderson
Affiliated Non-Divisional Members
Dr. Elliot
Dr. O’Connor
Dr. Tham
MS Clinical Trial Group
Director: Dr. A. Traboulsee
Dr. H. Tremlett works as an epidemiologist in the group.