NeuroSpeak: CaseStudy 1 or CS1

Learn how to practice MSology. #NeuroSpeak #CaseStudy #MSBlog

“On my recent trip to New York I was asked why do I contribute to an MS Blog. The reasons are multiple and one important one is education. We are therefore launching a new series of posts in the New Year called ‘NeuroSpeak: Case Studies’ as a platform to demonstrate to trainee healthcare professionals (HCPs) how to manage MS. The format will be a short case scenario with several questions. The latter will take about 5-10 minutes to complete. This will then be followed-up in ~2 weeks time by a short webinar (10-15 mins) to discuss the questions and to report the survey results. Based on the response of the readers of this blog we have decided not to do these case studies behind a firewall so that people with MS (pwMS) or MSers can also participate. I feel strongly about this as this will demonstrate to you how the ‘art of neurology’ is practiced and give you some insight into the neurological decision making process. These case studies are part of the evolution of the practice of medicine and will go a long way to helping you self-manage your MS.”

“The following is the first case study in the series:

Questions you need to consider before the Jan-2016 webinar:

  1. What type of MS does this patient now have (Dec 2015)? 
  2. What was his baseline prognostic profile in Feb-2005?
  3. Would you have managed his MS differently?
    • In Feb-2005?
    • Between Oct-2006 to May-2012?
    • Between May-2012 to Dec-2015?
  4. Would you stop his glatiramer acetate (Dec-2015)?
  5. Does knowing his EDSS profile help you clinically?
  6. Excluding symptomatic treatments how would you manage his MS in 2016?”

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Very interesting! As someone with MS I am grateful for the opportunity to take part. I look forward to seeing how my ideas stack up against clinicians.

  • Case study 1 slide 2 doesn't include when the patient became unemployed, if he smoked, did he exercise, did he get mental health help? I'm sure even with his cognitive impairment he would remember that. I've had loads of discussions with medical students, but sometimes they ask more pertinent questions about my life than the "experts". They should be allowed to think outside the box.

  • I assumed all the above. Neurologist thinks its GP to take care of any side effects from meds or MS. GP thinks Neurologist should be doing care.

    • This is exactly what I get! What are the MS nurses doing exactly? Aren't they supposedly there to help and organise care?

  • I think those first 6 years since starting therapy should have been monitored closely. I see my neuro even 6 months and have an annual MRI. I don't know if this is the case in England but if it was he should have been escalated to a 2nd line DMD.

    But I guess this could be a case of hindsight is 20/20.

  • Congratulations on "we have decided not to do these case studies behind a firewall so that people with MS (pwMS) or MSers can also participate". How wonderful to be sharing like this, and not perpetuating the "me doctor, you patient" ethos which unfortunately is still far too common. Another step forward from Barts towards empowering PwMS to gain knowledge and understand what far too many clinicians would prefer us not to know.

  • I also appreciate this : I suffer with PPMS – I live in Croydon which has no specialist MS nurse. My GP has nothing to do with ongoing treatment. My diagnosis only came from my attending the British School of Osteopathy (I was worried about my spine curvature from reliance on walking stick for unknown reason). They recommended me to be referred to a Neurologist and so MRI, diagnosis. My Neurologist prescribed the Baclofen which is my only medication beyond high dosage Vitamin D available. I also use Gingko Biloba for beneficial memory. This sort of transparency in research is rewarding and helps negate stresses. Thank you.

  • After 10 years of MS, CS1 is depressed, anxious, unemployed, living alone and not seeing his daughter. Really? You know how to talk to MSers and cheer them up!

    Full of hopes for 2016, we are going to beat it depressing blog or not.

By Prof G



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