The Iceberg Effect: Subclinical Disease Activity in Multiple Sclerosis

RELEASE DATE: October 1, 2020

EXPIRATION DATE: September 30, 2021

The Iceberg Effect: Subclinical Disease Activity in Multiple Sclerosis

Continuing Education Supplement to the International Journal of MS Care

This activity is supported by an educational grant from Genentech.


In order to successfully complete this continuing education activity, the participant must complete the educational activity and complete the online Evaluation and Post-Test.

This activity is designed to meet the educational needs of physicians, nurses, advanced practice clinicians, and pharmacists who manage patients with multiple sclerosis (MS).


  1. Analyze clinical and diagnostic factors that guide the diagnosis of progressive multiple sclerosis (MS) across the spectrum of disease
  2. Discuss implications for treatment when a diagnosis of primary progressive MS is suspected
  3. Describe methods of assessment for subclinical or asymptomatic progression of MS including new biomarkers and investigative approaches
  4. Discuss the role of patient-centered outcomes in the assessment of clinical and subclinical progression in MS and appropriate strategies for patient education


Edward J. Fox, MD, PhD, FAAN
Director, Multiple Sclerosis Clinic of Central Texas
Round Rock, TX
Clinical Associate Professor of Neurology
University of Texas Dell Medical School
Austin TX

Sarah A. Morrow, MD, MS, FRCPC, FAAN
Associate Professor of Neurology
Department of Clinical Neurological Sciences
University of Western Ontario
London, Ontario, Canada

Scott Newsome, DO, MSCS, FAAN
Associate Professor of Neurology
Co-Director, Multiple Sclerosis Experimental Therapeutics Program
Co-Director, Johns Hopkins Neuroimmunology Clinical Fellowship Program
Johns Hopkins Hospital
Baltimore, MD

In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. CMSC 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.

The CMSC designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The CMSC designates this live activity for 1.0 continuing education nursing credit (1.0 in the area of pharmacology).

The Consortium of Multiple Sclerosis Centers (CMSC) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education and will award 1.0 contact hours (.1 CEUs) to pharmacists who (1) participant in the activity, and (2) complete the evaluation form. The Universal Activity Number (UAN) for this activity is JA4008165-9999-20-040-H01-P. This is a knowledge-based activity.

The CMSC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria.

The CMSC designates this live activity for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

A Certificate of Completion may be given upon completion of course requirements enabling you to register your credit with the appropriate licensing boards or associations. You may apply for other accreditations using the procedure established by the specific organization.


It is the policy of CMSC and Delaware Media Group to ensure balance, independence, objectivity, and scientific rigor in all educational activities. All faculty, activity planners, content reviewers, and staff participating in this activity have disclosed any relevant financial relationships they or their spouse/life partner have within the previous 12 months with manufacturers of any commercial products/devices and/or providers of commercial services included in this educational activity. The intent of this disclosure is not to prevent a person with a relevant financial relationship from participating in the activity, but rather to provide participants with information on which they can base their own judgments. All presentations were reviewed by an independent clinician with no relevant financial relationships for the purpose of resolution of any identified conflict of interest and a determination of evidence-base and fair balance.

Edward J. Fox has received consultant fees from Alexion, Biogen, Celgene – Bristol Myers Squibb, EMD Serono, Genentech Roche, Novartis, and TG Therapeutics; has served on speakers bureaus for Alexion, Biogen, EMD Serono, Genentech Roche, Novartis, and Sanofi-Genzyme; and has received research support from AbbVie, Biogen, Celgene – Bristol Myers Squibb, Chugai, EMD Serono, Genentech Roche, MedDay, Novartis, Sanofi Genzyme, and TG Therapeutics.

Sarah A. Morrow has received consultant fees from Biogen, Celgene, EMD Serono, Novartis, Roche, Sanofi Genzyme, and Teva; has served on speakers bureaus for Biogen, EMD Serono, Roche, and Sanofi Genzyme; and has received research funding from AbbVie, Biogen, EMD Serono, Roche, and Sanofi Genzyme.

Scott Newsome has received consultant fees for participation on scientific advisory boards from Biogen, Celgene, EMD Serono, and Genentech, serves as an advisor for Gerson Lehrman Group and BioIncept, and is a clinical adjudication committee member for a MedDay Pharmaceuticals clinical trial.

Laurie Scudder, DNP, NP has served as both a planner and reviewer for this activity and has disclosed no relevant financial relationships.

The following planners and managers have disclosed no relevant financial relationships: Joseph J. D’Onofrio, Frank Marino, Katherine Wandersee.

CMSC and Delaware Media Group require faculty to disclose to the attendees when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty in this activity may discuss information about pharmaceutical agents that is outside of US Food and Drug Administration approved labeling. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison
with recommendations of other authorities.

There is no fee to participate in this activity. To participate in the activity, go to To receive credit, participants must 1) read the activity front matter, 2) complete the educational activity online, and 3) complete the post-test and activity evaluation. Participants must receive a minimum score of 70% on the post-test.

If you have any questions about this CE activity, please contact the CMSC at [email protected] or 201-487-1050.