ArchiveOctober 2016

#ClinicSpeak & #NeuroSpeak: alemtuzumab and opportunistic infections

Calling all alemtuzumabers please be extra-vigilant about infections when your lymphocyte counts are low. #ClinicSpeak #NeuroSpeak #MSBlog I was at a meeting on Friday and heard about a patient who had died of Listeria meningitis after receiving alemtuzumab. Listeria is an opportunistic infection and tends to occur more often in people who are immuno-compromised. Nocardia is another opportunistic...

#GuestPost & #MSChampion: exercise as driver of recovery

Exercise is not only important for Brain Health, it helps recovery of function. #BrainHealth #MSChampion #MSBlog I met Olga Bobrovnikva, at an MS event, almost 10 years years ago and we have been in contact ever since. She is a MS Champion and an inspiration to many. If you get a chance please read her book ‘Playing the Pathways of My Brain‘; I have a signed copy if anyone wants to...

#BrainHealth: on how-not to do it

Are you a Brain Health yo-yoer? Brain Health should be about consistency. #BrainHealth #MSBlog I taught on the 2nd annual specialist-neurology-registrar (SpR) master course on Friday. One topic I covered was brain health and the holistic management of MS. We go onto the subject of MSer-activation and making them responsible for their own care. One topic of discussion was exercise and...

B cells as antigen presenting cells.

Fraussen J, Claes N, Van Wijmeersch B, van Horssen J, Stinissen P, Hupperts R, Somers V. B cells of multiple sclerosis patients induce autoreactive proinflammatory T cell responses. Clin Immunol. 2016 . pii: S1521-6616(16)30163-2 Antibody-independent B cell functions play an important role in multiple sclerosis (MS) pathogenesis. In this study, B cell antigen presentation and costimulation in MS...

#PoliticalSpeak & #OffLabel: stand-up and shout

Why are neurologist’s so reluctant to prescribe off-label DMTs? #PoliticalSpeak #OffLabel #MSBlog It is wonderful to see some momentum behind the off-label use of DMTs for treating MS. Since the Swedish experience with rituximab was published a few weeks ago the position paper on reducing the cost of MS treatments below came to my attention with an accompanying blog post, ‘Stand...

Do nothing Lose teeth….Do Nothing Lose Brain..I can get falsies

Neurology is an odd subject because there are lots of conditions and not many treatments.  Therefore you can have a bright bod that can diagnose you…but then they can say “sorry we can’t do anything about it” In the bad old days this is what happened.  But this should not be the case with MS. This is because there are an increasing number of treatments that may offer benefit..at least...

Better reported trials

Rikos D, Dardiotis E, Tsivgoulis G, Zintzaras E, Hadjigeorgiou GM.Reporting quality of randomized-controlled trials in multiple sclerosis from 2000 to 2015, based on CONSORT statement.Mult Scler Relat Disord. 2016 Sep;9:135-139.BACKGROUND: Randomized controlled trials (RCTs) are the best tool to evaluate the effectiveness of clinical interventions. The CONSORT (Consolidated Standards of Reporting...

Needles, haystacks, and primary progressive MS: big data debunks big headlines

Our understanding of how genes influence disease is better than ever, and increasing at an incredible rate. While some diseases like Huntington’s disease are caused by mutations in a single gene, most diseases are influenced by a huge number of variants across the genome. Multiple sclerosis, diabetes, and cardiovascular disease are examples of conditions which are not caused by a single gene...

Exercise can’t be associated with reduced risk

Dorans KS, Massa J, Chitnis T, Ascherio A, Munger KL.Physical activity and the incidence of multiple sclerosis. Neurology. 2016 Sep 28. pii: 10.1212/WNL.0000000000003260. [Epub ahead of print] OBJECTIVE:To study whether physical activity during adulthood or early life is associated with multiple sclerosis (MS) incidence in 2 prospective cohorts of women.METHODS:Women in the Nurses’...

#ClinicSpeak: What about PPMS?

Do you have PPMS? This post is for you. #MSBlog #ClinicSpeakPrimary progressive MS (PPMS) = relapse-onset MS = MS  A lot of assumptions about PPMS have crept into the field and have become entrenched; we call these dogmas. We need to challenge the dogma; in particular that (1) PPMS in non-inflammatory, (2) PPMSers don’t have relapses and (3) PPMS is a different disease to relapse-onset...

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