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Under&Over: we need your help

Since being hit by a motorbike travelling at high speed and nearly losing my life or independence I now have personal experience of the value of physical neurorehabilitation. When I say #UseItOrLoseIt I really mean it. So if you have more advanced MS and are using a walking stick (EDSS 6.0) we want you to enrol in a #CitizenScience type study in which we are testing a new hand and arm activity...

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#MSCOVID19. Learning from arthritis….Anti-CD20 antibodies block vaccine responses

We have seen one paper in MS…this is going to be repeated…Why because they use anti-CD20 (rituximab) in MS. In arthritis they are seeing blunting too. Spiera et al. Rituximab, but not other antirheumatic therapies, is associated with impaired serological response to SARS- CoV-2 vaccination in patients with rheumatic diseases . There is a paucity of data on the effect of...

Watchful waiting 2

Barts-MS rose-tinted-odometer: zero-★s (still seeing red) Did you know that MS disease activity defines if you are eligible for therapy and which therapy? The following is a list of definitions that are generally applied to MS in England.  Inactive: Patients with MS with no relapses or imaging features of disease activity in the last 2 years.  Active: Patients with active disease are defined...

Bad cop behaviour: Pushing NEDA over the RIM!

Over the last years, it has become apparent that some MS brain lesions are more detrimental than others. One MS lesion subtype that is specifically attracting attention is the “iron rim containing lesion” or IRL. A ‘normal’ MS lesion represents inflamed brain tissue. Over time, the ‘normal’ MS lesion is likely to shrink a little bit because of the resolution of inflammation-induced swelling and...

Saving nerves from damage. Protect the cell’s power houses.

Mention New York and you get a picture of the Brooklyn bridge By Suiseiseki – Own work, CC BY-SA 3.0, Mention Neurodegeneration and you get the brooklyn bridge of neurodegeneration. It is this picture showing axonal blebbing (green balloon) where the contents of the nerve escapes, because it has been cut. In the centre of an active MS lesion you can get over 10,000 blebs per square...

#MSCOVID19 Green Book update

For those who have not been vaccinated yet you may be interested in the Vaccine Green Book update. There is info on Pfizer Astrazeneca and Moderna vaccines Click to access Greenbook_chapter_14a_7May2021.pdf Individuals with immunosuppression may not make a full immune response to vaccination.As there is no evidence on response in immunosuppressed individuals there is also noevidence upon which to...

To switch or not to switch that is the question

Barts-MS rose-tinted-odometer: ★★★ The one good thing about thinking aloud is that your colleagues’ chip in and provide feedback. Case 2 from my ‘ethical quandary post‘ is generating an important debate about whether to support this patient’s decision to switch therapy or not. As a reminder, this is the 40-year old woman who started natalizumab as a first-line therapy 11...

Guest post: the medical student view

Sita is a final year medical student who has just successfully completed all of her exams and will be starting as an F1 doctor in August. Before starting work, she is spending a month with the neurology and MS team, learning more about both how we diagnose and MS in the hospital, and aspects of the clinical research that we are doing. She’s written a blog post reflecting on what she’s...

What you can’t pick in MS

“Whatever choice you make makes you. Choose wisely” – Roy T Bennett, The Light in the Heart. Unfortunately, you can’t pick your race or whether you get MS, nor whether you have to deal with both. Racial differences in treatment response for health conditions is not a novel concept. When I was a trainee I was taught that it was harder to control blood pressures in African...

Natalizumab biopsies, is the T cell hypothesis all wrong?

Natalizumab, a recombinant humanized monoclonal antibody directed against the α4 subunit of the integrins α4ß1 and α4ß7, has been approved for the treatment of active relapsing-remitting MS. It has been suggested to work by blocking T and B cells and perhaps monocyte entry into the central nervous system. This inhibits relapsing disease but the side effect seems to expose people to the risk of...

Framing

Barts-MS rose-tinted-odometer: zero-★’s – still seeing red When the EMA doubted its wisdom and ran scared on alemtuzumab, after an Article 20 review of its benefits and risks, I was inundated with emails and queries. “Gavin, didn’t you see this coming? Surely, alemtuzumab should never have been licensed as a 1st-line treatment for active MS? Clearly, the FDA got this right and the EMA made...

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