Repository Corticotropin Injection:  History, Mechanism of Action and Clinical Applications

Repository corticotropin injection is a natural product derived from a bovine or porcine source of the adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to secrete cortisol, corticosterone, aldosterone, and a number of other androgenic substances.  The release of ACTH is modulated by the nervous system via the corticotropin regulatory hormone released from the hypothalamus and by a negative corticosteroid feedback mechanism.  Elevated plasma cortisol levels suppress ACTH release.

Repository corticotropin injection was originally approved by the U.S. Food and Drug Administration (FDA) in 1952 and is currently approved for the treatment of acute exacerbations of multiple sclerosis after the patient has failed corticosteroid therapy including.  Recent clinical research provides findings of its use in multiple sclerosis. It is important to make neurologists and other healthcare professionals, who treat patients with multiple sclerosis aware of this treatment and clinical findings.

Epilepsy is a disorder with recurrent epileptic seizures. Corticosteroids have been used in the treatment of children with epilepsy and have significant adverse effects. Their efficacy and tolerability have not been not clearly established. The recent Cochrane review indicated that ACTH might have advantage for treatment of infantile spasms respect other steroid treatments or antiepileptic drugs. Up-to date information about corticotropin (ACTH) in the treatment of infantile spasms and evaluation of the long-term outcome was provided to answer questions about (1) the efficacy of doses of ACTH in comparison with other drugs, especially with vigabatrin, and the efficacy in patients with tuberous sclerosis; (2) tolerability; and (3) long-term outcome. The side effects of ACTH, unlike those of vigabatrin, are well known, treatable, and reversible.

Learning Objectives:

After participating in this activity, participant should be better able to:

• Discuss the history of the production, regulation, structure and function of adrenocorticotrpic hormone (ACTH)
• Describe the mechanism of action of ACTH and its application clinical practice
• Discuss use of repository corticotrophin injection in patients with multiple sclerosis and infantile spasms
• Explain the safety information about repository corticotrophin injection including adverse reactions and contraindications

Audience: The intended audiences for the program are neurologists, MS specialists, neurology residents, and MS nurse practitioners. Total linear seat time for the program will be approximately 1 hour.

Accreditation: This CME program is planned and implemented in accordance with the Essential Areas and Polices of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship with the State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Jacobs Neurological Institute. The University is accredited by the Accreditation Council for CME. This program awards 1.0 CME credit and was supported by an unrestricted educational grant from Questcor Pharmaceutical, Inc.

This CME program will become available soon.

Gray Matter Atrophy in Multiple Sclerosis

The measurement of gray matter pathology appears to be of growing clinical relevance as a biomarker of the multiple sclerosis (MS) disease process.  Concepts about the evaluation, pathogenesis and clinical relevance of gray matter pathology in multiple sclerosis (MS) continue to evolve.  A variety of imaging techniques that detect progressive gray matter pathology of the brain and spinal cord are now available.  These advanced nonconventional MRI techniques relate better to clinical impairment, disease progression, accumulation of disability, and have the potential to detect neuroprotective effects of treatment.

Learning Objectives:

After participating in this activity, participant should be better able to:

• Discuss GM-WM pathology as primary or secondary process in MS
• Identify MRI techniques for GM-WM atrophy and degeneration
• Discuss regional metrics (brain atrophy, lesions, magnetization transfer imaging (MTI), diffusion weighted imaging (DWI) as new MRI outcomes for improved assessment of neuropsychological status
• Assess the effects of disease-modifying treatments in brain atrophy

Audience: The intended audiences for the program are neurologists, MS specialists, neurology residents, and MS nurse practitioners. Total linear seat time for the program will be approximately 1 hour.

Accreditation: This CME program is planned and implemented in accordance with the Essential Areas and Polices of the Accreditation Council for Continuing Medical Education (ACCME) through joint sponsorship with the State University of New York at Buffalo School of Medicine and Biomedical Sciences and the Jacobs Neurological Institute. The University is accredited by the Accreditation Council for CME. This program awards 1.0 CME credit and was supported by an unrestricted educational grant from Biogen Idec, Inc.

This CME program will become available soon.