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Guest post: Part three of choosing a DMT: Understanding risk

DMTs carry a much higher degree of risk than nothing at all and the reality of MS means that attitudes towards risk need adjusting. It is fine to come into the scenario assessing things in a pre-diagnosis manner, that is understandable. A patient needs educating about the whole post-diagnosis cenario now. The lens through which risk,. Regarding treatments, has changed. From the risks of opting...

Reminder: your chance to influence preventive research!

Here is a reminder to book your place on next week’s preventive neurology discussion: your chance to influence the direction of research taken by the Preventive Neurology group. Here are the details if you missed the last post: The Preventive Neurology Unit are hosting an afternoon of informal conversations on the 30th April with people who have a particular interest in MS, Parkinson’s...

Re-vitalise your gut

Gut microbiome The lions share of the risk (~70%) for developing MS is attributable to environmental risk, while genetics explains bulk of the remaining risk. The environmental risk factors studied in MS have been manifold, ranging from the latitude effect, to viruses, and may well explain some of the heterogeneity that we observe. For some time now, researchers have been looking at an imbalance...

Oligodendrocytes do everything? They disrupt the blood brain Barrier

Aberrant oligodendroglial-vascular interactions disrupt the blood-brain barrier, triggering CNS inflammation.Niu J, Tsai HH, Hoi KK, Huang N, Yu G, Kim K, Baranzini SE, Xiao L, Chan JR, Fancy SPJ. Nat Neurosci. 2019 Apr 15. doi: 10.1038/s41593-019-0369-4. [Epub ahead of print]. Disruption of the blood-brain barrier (BBB) is critical to initiation and perpetuation of disease in multiple...

A moan…Doing trials to pat yourselves on the back for a paper and a job well-done is not what it’s about… Changing clinical practise is what it’s all about

A couple of years ago Dr Raj Kappoor and ProfG did a trial in optic neuritis and tested a sodium channel blocker to see if it could save nerves in the eye after optic neuritis. This was based on studies that MD1, 2, 3 & 4 had done in the beasties. The trial worked and it saved loss of nerves by about 30%, but then what?….Yep Nothing. I said to the neuros..”You have done a trial...

Foot drop

The study below tried to compare the clinical effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) and whether or not they were cost effective. The high drop-out rate (38%) made the study inconclusive. When we, at Barts-MS, did a clinical audit a few years ago we showed that the best predictor of falls was the need to use a walking aid; e.g. walking stick...

What, I don’t have MS?

In the study below approximately 1 in 5 people diagnosed with MS don’t have MS. This is so much higher than previous studies. I have always quoted the Danish post-mortem studies that sugget only 1 in 20 MSers are misdiagnosed. Maybe Danish neurologists are simply better at diagnosing MS compared to their American colleagues? There is no one test that can be done to diagnose MS. MS is...

Guest post: Part 2 of Choosing a DMT: the issues

Firstly, why the incredible hesitancy among some medics to flip the pyramid? Or at least break away from the Beta-interferons/Glatiramer Acetate as ‘safe’ fallback options, even when the research suggests that these days, the older first generation drugs give suboptimal outcomes compared to the modern crop. The MS neurologists that I spoke to all advocate versions of outlining the options...

Ocrelizumab’s known-unknowns

Below is the first case report of fulminant hepatitis owing to echovirus 25 in an MSers on ocrelizumab. Please note continuous anti-CD20 therapy takes out your B-cells and prevents you from forming germinal centres (where B-cells get educated to make antibodies, i.e. the B-cell’s Universities) in lymph nodes and the spleen. In other words, ocrelizumab treatment causes functional splenectomy...

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