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T cells and cortical Lesions is Siponimod the next thing to sort out cog fog?

What causes demyelination of the cortex creating grey matter lesions. Well in this study there is no difference to what causes demyelination in the spinal cord…It’s T cells, T cells, T cells. Cortical lesions have been associated with cog fog and so if you get rid of them surely that is great for progression. Siponimod is the new mod on the block and now we get data suggesting it...

Killjoys peddle fake news

For all the killjoys out there DMTs do work, i..e. they modify the course of MS and prevent you from reaching all disability milestones including the time to diagnosis of SPMS and EDSS 10.0 or death. Please don’t listen to the zealots who are trying to spin fake news that the only treatment to prevent the development of progressive MS is HSCT; they are wrong. There are other options; the study...

Inflammation in the brain is a bad thing.

This study says that inflammatory events in the CNS are important for progression, I say NSS! Enhanced B cell products in the CSF of MS Intrathecal, Not Systemic Inflammation Is Correlated With Multiple Sclerosis Severity, Especially in Progressive Multiple Sclerosis. Milstein JL, Barbour CR, Jackson K, Kosa P, Bielekova B. Front Neurol. 2019 Nov 22;10:1232. doi: 10.3389/fneur.2019.01232...

Will the real MS say hello?

The difference between religion, a belief system, and science, an experimental system, is that you can falsify the latter, but not the former. So when KoL (key opinion leaders) say they believe something they don’t really mean it literally. What they are really stating is a hypothesis that needs to be interrogated.  So when I say that relapses and focal MRI activity are not MS, but are...

Shoehorning man into mice is going to take us down the garden path.

A distinct mouse model of multiple sclerosis was used to examine factors involved in ectopic lymphoid tissue formation during central nervous system autoimmunity and eveals that infiltration and aggregation of B cells within the meninges is dependent upon B cell expression of VLA-4 and is preceded by neutrophil migration. This finding establishes the early mechanisms involved in the establishment...

Looking for autoimmunity, is it flogging a dead horse

On saturday I talked about a Jan Klein moment and today I am wondering if we need another one. Should we say…Schtop…you are all wasting your time! One, reader thought the story written on my phone on the tube, was written like a “soap”. But is it Sainsbury’s own brand, Imperial leather or is it not soap but a bit of “head and shoulders” Hope you enjoy...

Time-poor

I want to apologise to my patients for running late in clinic yesterday. Since reducing my NHS, or clinic time, from 50% to 20% of my work week and moving onto a yearly job plan I stopped cancelling clinics. I now move them to ‘ad hoc’ slots at a different time of the week. This may increase my workload, but it also means that I don’t have to overbook clinics, which I used to do in the past...

Neutropenia with ocrelizumab

If you buy into the mantra that a B cell therapy only works on B cells, then think again. Like a debutante three years shy of their first season, successful targeted therapies in the immune world are disappointing to say the least, and most definitely fall short of initial expectations. B cell ontogeny Ocrelizumab a humanized monoclonal antibody targeting CD 20 on the surface of B cells during...

Post-partum relapses after alemtuzumab

One of the problems of immune reconstitution therapies (IRTs), such as HSCT, alemtuzumab and cladribine, is nagging worry that at some time in the future your MS will reactivate. Some people with MS (pwMS) try and avoid potential triggers of disease activity, for example, vaccinations and pregnancy, particularly the post-partum state. Unfortunately, there is some evidence the latter may trigger...

Do you take your pills

Risk Factors for Suboptimal Medication Adherence in Persons with Multiple Sclerosis: Development of an Electronic Health Record-Based Explanatory Model for Disease-Modifying Therapy Use.Gromisch ES, Turner AP, Leipertz SL, Beauvais J, Haselkorn JK. Arch Phys Med Rehabil. 2019 Dec 3. pii: S0003-9993(19)31430-3. OBJECTIVE:To determine which factors are associated with suboptimal disease-modifying...

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