Red Hot Debates

Today is World MS Day

Neuros love a good debate and contrary to what you may think there is not always a uniformity of ideas.

They have been having debates for years and sometimes these occur in print. 

Here is a list of examples that have occurred in the Multiple Sclerosis Journal over the past couple of years, with someone presenting the Yes over someone presenting the case for No.

  • Epstein-Barr virus is a necessary causative agent in the pathogenesis of multiple sclerosis: 
  • Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? 
  • Preventing brain atrophy should be the gold standard of effective therapy in MS 
  • Funding CCSVI research is/was a waste of valuable time, money and intellectual energy
  • We should abandon interferons and glatiramer acetate as first-line therapy for MS
  • Industrial pharmaceutical drug research has done more for the health of people with MS than academic neurologists
  • There is no such thing as a mild MS relapse. The mild relapse is an Anglo-Saxon delusion 
  • Epidemiology in multiple sclerosis has had its day: there are no more unanswered questions
  • Truly benign multiple sclerosis is rare: let’s stop fooling ourselves
  • Relapses do not matter in relation to long-term disability
  • The major cause of multiple sclerosis is environmental: genetics has a minor role

If you were to listen to heavy weight Neurologists having a live debate, What would be important for you to hear?

Please make some suggestions…….for subjects to debate

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  • How about 'Do we need to put any more funds into looking for anti inflammatory agents when the ones we have or are in the pipeline at the moment, do the job well. Maybe the money should be going into neuroprotection and remyelination now.

    • I know what you are getting at good question.

      Indeed the UK MS Society has not been supporting development of non-clinical immunosuppressives studies for over a decade and their research focus has been on neuroprotection and repair. Howeve, as I have an application
      to support anti-inflammatory without side effects…hope they are not too blinkered:-)

      …..however if you want neuroprotectives you may want anti-inflammatories, If the hot glia are a problem they may need sorting. Most current MS therapies have their actions outside of the brain. It depends what you need by anti-inflammatory

  • 1. Yes, and maybe other Viruses
    2. yes/no. It is a well established method to monitor the disease course.
    3. no. If you only look at MS.
    4. Yes in the field of MS, no if you also take biological functions into consideration
    5. yes, if there are better alternatives at hand (less side effect, better effectivness, cheaper etc.)
    6. yes/no, depends on the POV. Research is not limited to a certain disease. The things found can be used for other diseases as well.
    7. yes. And it is not limited to Anglo-Saxons…..
    8. No.
    9. Yes
    10. as long as the relation of relapses and progression is not fully understood, no.
    11. Yes/no

    • Thanks but I was hoping for some new topics, for each of the topics above there was a yes post and a no post and sometimes a commentary.

    • Ok, here you go:

      – is MS related to a poor / defective metabolism?
      – IL-6 is a strong driver towards getting MS
      – ppMS an rrMS are the same
      – thyroid hormones don't play a role in the development of OPC

  • Investigate the relationship between stress and relapses in greater details would be my pick.

    Also, the same with cholesterol and neurodegeneration in greater detail.

    Abandon GA and interferons – allow 'harder' meds as first-line (patients' choice)

    Viruses as cause of MS as well as bacteria.

    Preventing atrophy as golden standard (neurofilament levels as biomarker in routine practice & comparison of brain scans over time).

    Genetics has a minor role (and smoking is NOT causatively related to MS).

    Investigate further UV-rays effect on progression (not just Vit D levels).

    CCSVI is a waste of money.

    Relapses DO matter in disease progression!

    • There isn't the bona fide evidence to suggest relapses and progression are interrelated. If there was then PPMS will have delineated relapses in evidence, which it doesn't. Sorry.

    • Dear Anon
      Maybe read through the blog and you may find alternative views it is not just black and white as was mentioned there were yes and no responses, some people can make the alternative argument sorry:-)

  • There seems to be two camps in the pathogenesis of progression in ms. One camp believes microglia activation is directly responsible. The other camp thinks neurodegeneration is a consequence of early axonal damage leading to mitochondrial change which sets up a "virtual hypoxia" condition. I'm believe the latter is true, but this would be a great debate to hear all arguments.

  • The debate could focus on whether a paradigm shift is needed on treatments for ms, i.e. try a treatment to see if it works, not give a treatment if medics know why it works and it's politically and financially fashionable. (That the patient wants the treatment and knows what side effects could occur, is a given). Cases in point are fampridine, drugs already in use to treat muscular dystrophy, heart disease, epilepsy ….(sorry can't give chapter & verse). Thanks of course to Prof G for pointing out this eminently sensible point of view, as practiced by medics dealing with rheumatoid arthritis, with better outcomes than previously as a result.



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