Columbia University Clinical Care MS Center Personnel Support
Columbia University Multiple Sclerosis Clinical Care Center
Dr. Mark Tullman
1 year grant, $100,000
This grant is for salary support for Jennifer Smrtka MSN, ANP-BC, M.S.C.N, and Claire Riley, MD.
Multiple sclerosis affects approximately 400,000 people in the United States and 2.5 million worldwide. Just 15 years ago, MS was not considered a treatable neurologic illness. Fortunately, MS patient care has been has been revolutionized over the past decade. We now have a much better understanding of the immunopathogenesis of MS and there are currently six U.S. Food and Drug Administration-approved therapies that alter the course of the disease. However, these therapies are only partially effective; two of them are associated with very serious side effects, and they have no effect on preexisting neurological deficits and symptoms. Tremendous efforts are being undertaken to improve upon these therapies and it is conceivable that by 2012, the number of MS disease-modifying drugs could double and we could begin early phase testing of therapies to repair damaged tissue and restore function in people afflicted by this illness. While we have seen major advances in MS over the past decade, there is a dearth of fellowship-trained MS experts, as the overwhelming majority of neurology residents enter directly into private practice or pursue fellowship training in neuromuscular disease, epilepsy, electromyography, and stroke. There is a critical need to train the next generation of MS specialists; continued progress in the understanding and treatment of MS will require health care providers to have even greater expertise.
A neurology resident was chosen in July 2008 by the National Multiple Sclerosis Society to become a Clinical MS Fellow. She began a two year MS fellowship at the Columbia University MS Clinical Care Center in July, 2008. This grant will help support funding for the first year of this fellowship.
The catchment area of the MS Center includes the Washington Heights area of northern Manhattan, mainly populated by low-income Hispanics and African Americans. These demographics will result in Dr. Riley, the MS Fellow, being exposed to a diverse MS patient population with all forms of the disease. During her fellowship, Dr. Riley will spend most of her time in direct patient care. This will provide an opportunity for her to gain expertise in the diagnosis and treatment of MS. Under supervision from a senior clinician, she will:
- evaluate patients and learn how to diagnose MS
- learn when and how to treat MS exacerbations
- learn to choose an initial disease modifying therapy
- monitor response to treatment and make necessary changes when necessary
- become a skilled symptom manager
- follow patients on a regular basis and gradually work with less supervision as she moves toward becoming a MS primary care physician
The MS Center is currently involved in numerous phase 3 immunomodulatory therapy clinical trials for both relapsing and progressive forms of MS; in addition, the Center is working on novel immunomodulatory agents and treatment strategies to alter the course of MS as well as symptomatic therapies to improve functioning and quality of life in MS patients. Experience with these studies will provide Dr. Riley with experience in the intricacies of clinical trials, participate in numerous studies and become proficient in analyzing the Kurtzke Expanded Disability Status Scale and and the Multiple Sclerosis Functional Composite. Upon completion of the Master of Science in Biostatistics/Multi-Disciplinary Patient Oriented Research Track that Dr. Riley is pursuing and her fellowship, she will have the necessary skills to conduct MS Clinical trials. The MS Center has assembled a multidisciplinary team of health care providers with specific areas of expertise. During her fellowship, Dr. Riley will spend time working with members of the team to gain the knowledge and expertise necessary to care for MS patients. In addition, she will work with neuro-opthamologists and neuro-audiologists in order to develop an understanding of ocular coherence tomography and recently developed MRI techniques such as functional MRI, magnetization transfer, diffusion tensor and spectroscopy. This will be an asset as the MS Center moves toward development of neuroprotective strategies and therapies to repair damaged tissue and restore function in MS patients. Dr. Lauren Krupp, a world renowned expert in pediatric MS and director of the National Pediatric MS Center at Stony Brook, recently initiated a monthly pediatric MS clinic at Columbia. Our pediatric MS patients now undergo a comprehensive evaluation by Dr. Krupp and now Dr. Riley will attend the pediatric clinic for the duration of her fellowship.
Jennifer Smrtka is a skilled Multiple Sclerosis Certified Nurse, a co-investigator for all of our clinical trials, and a tremendous asset to the MS Center. In addition to seeing new and follow-up patients and providing routine MS care, Ms. Smrtka spends an enormous amount of time with many of the patients that are seen at the center. She helps devise a treatment plan to meet their individual needs, optimizes symptomatic therapy (e.g. treatment of bowel, bladder, and/or sexual dysfunction), and provides extensive counseling and education to patients and their families. She is also responsible for treating patients that require intravenous infusions with corticosteroids or Tysabri®. She is currently working on a paper to be presented at the World Congress on Treatment and Research in Multiple Sclerosis in Montreal in September and is helping develop a research protocol using functional magnetic resonance imaging in patients treated with fampridine. In addition, Ms. Smrtka is pursuing a doctoral degree in clinical nursing at the Columbia University School of Nursing. Salary support from MS Hope for a Cure will enable Ms. Smrtka to continue to provide superior patient care, actively participate in clinical research, and pursue her doctoral degree.
The success of this proposal will ultimately be determined by the contributions that Dr. Riley and Ms. Smrtka make to the field of MS. It is fully expected that upon completion of her fellowship, Dr. Riley will have a successful career as an MS clinician who provides comprehensive patient care and becomes a true asset to the entire MS community. Ms. Smrtka will also continue with her tireless efforts to optimize patient care and will serve as an example for other MS nurses.