Lisbon Declaration

Cahier Charcot -> Lisbon Declaration

EUROPEAN CHARCOT FOUNDATION

LISBON DECLARATION

European Charcot Foundation Symposium

"Treatment Strategies in Multiple Sclerosis. From pathophysiology to clinical practice"

17 - 19 November 2005

Results from a Round Table Discussion on Rules for individual patient care in MS.

J. Palace (chair), M. Amato, G. Comi, G. Edan

M. Friedrichs, O.R. Hommes

Introduction

All MS patients should receive the best available treatment, independent of country
Education of patients and physicians on MS should continue, supported by Health Care Systems and Pharmaceutical Industry
Clinical tools to monitor patients should improve
Post marketing, observational long term studies should investigate efficiency and compliance of treatment
Full patient information is a prerequisite
Patient's and doctor's freedom of choice concerning treatment should be preserved

Individual Patient Care

MS Health Care should shift its attention from disease orientation to care orientation
Quality of care should have monitoring tools
MS doctors should learn from daily practice
Learning relies on reliable information
Amount of structured information should increase through network of treating doctors, served by information technology (Blumhardt et al. 2000)
Improve clinical measurement tools
Improve MRI skills of MS doctors

Diagnosis

Careful exclusion of other diseases by CSF, immunology, neurophysiology
Make diagnosis as early as possible
Assess patient's condition
- use EDSS - Kurtzke FS - timed walked (TW)
- use Blumhardt Eight (BE)
- use Gad⁺MRI
Categorize individual patient's prognosis for progression
- use prognostic markers (Confavreux 2003)
- use educated guess risk assessment (Blumhardt 2000)
Categorize individual patient's treatment response
- use prognostic markers
- use educated guess treatment response (Blumhardt 2000)

Disease modifying treatment

Management

Results of Treatment

Blumhardt eight (BE)

Literature

Blumhardt et al.: A quality network model for the daily care of multiple sclerosis
Multiple Sclerosis (2000) 6, 231 - 236
Confavreux et al: Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process
Brain (2003) 126, 770-782
International Working Group for Treatment Optimization in MS: Treatment optimization in multiple sclerosis: report of an international consensus meeting
EJN (2004) 11:43-47
Heesen et al.: Decisional role preferences, risk knowledge and information interest in patients with multiple sclerosis
Multiple Sclerosis (2004) 10:1-8

Glossary