ArchiveSeptember 2017

#ClinicSpeak & #ResearchSpeak: breast implants not associated with multiple sclerosis

Silicone breast implants not associated with a higher incidence of autoimmunity. #ClinicSpeak #ResearchSpeak Summary: A large study in over 55,000 women undergoing breast augmentation with saline and silicone implants demonstrates that breast implants are not associated with a higher risk of developing MS.  Theoretical ClinicSpeak scenario: A patient with MS asked me to write a letter to her...

Education: B cells are not a single subpoulation

Lehmann-Horn K, Kinzel S, Weber MS. Deciphering the Role of B Cells in Multiple Sclerosis-Towards Specific Targeting of Pathogenic Function.Int J Mol Sci. 2017 Sep 23;18(10). pii: E2048. doi: 10.3390/ijms18102048. B cells, plasma cells and antibodies may play a key role in the pathogenesis of multiple sclerosis (MS). This notion is supported by various immunological changes observed in MS...

#ClinicSpeak: how early is too early?

Cognitive impairment may begin before the first attack of MS. #ClinicSpeak #ResearchSpeak Summary: The following post makes the case to change the MS diagnostic criteria to include asymptomatic MS. This will allow us to identify high-risk patients for treatment at an earlier stage.  I was at a meeting early this week I voiced my disappointment that the new diagnostic criteria for MS will not...

#ClinicSpeak & #BrainHealth: poor sleep and increased mortality

Poor sleep is the Big Elephant in the room; we need to do something about it. #ClinicSpeak #BrainHealth Summary: We as a society are chronically sleep deprived. Sleep deprivation is associated with a large number of medical problems. Improving your sleep hygiene should reduce these problems and improve your quality of life.  One of my patients sent me the link to the Guardian article below...

Neutrophils lost after alemtuzumab

Marked neutropenia: significant but rare in people with multiple sclerosis after alemtuzumab treatment. David Baker, Gavin Giovannoni, Klaus Schmierer Mult Scler Rel Disord. 2017 . HIGHLIGHTS Neutropenia occurred in 20-25% of people in the 2 year phase III, pivotal trials of alemtuzumab. However, grade 3-4 neutropenia (neutrophils occurred in only 5/811 people with MS (0.6%) in the year following...

#GuestPost & #PoliticalSpeak: How Brexit made me even more uncertain about my MS

Can we really ignore the impact that Brexit will have on the NHS? #Brexit #GuestPost #PoliticalSpeak Summary: A perspective from someone with MS on Brexit and its potential impact on his/her life. The author is a professional journalist, who frequently visits our blog and volunteered this piece; it was not commissioned. For obvious reasons, he/she wants to remain anonymous and has penned this...

Should RIS (radiologically isolated syndrome) be treated?

Mult Scler. 2017 Sep 1:1352458517729462. doi: 10.1177/1352458517729462. [Epub ahead of print] Radiologically isolated syndrome should be treated with disease-modifying therapy-Yes. Okuda DT Radiologically isolated syndrome should be treated with disease-modifying therapy – No Andrés Labiano-Fontcuberta, Julián Benito-León First Published September 14, 2017 MS treatments are a caveat emptor...

#ThinkSpeak & #NewsSpeak: social medicine the great disruptor

We are in the process of ‘professionalising‘ the Barts-MS blog, by reducing the number of posts and improving the quality and relevance of each post for pwMS. As part of this transition, I will be moving all of my #ThinkSpeak posts, which are not directly relevant to MS onto Medium, a relatively new and evolving social media platform. Although the #ThinkSpeak post...

#NeuroSpeak: treating MS in patients with PML

Teriflunomide is the drug of choice for treating MS in patients recovering from PML. #NeuroSpeak #CharcotProject Summary: This post summarises the scientific principles for treating multiple sclerosis in patients who have PML as a complication of natalizumab treatment. I make the case for using DMTs that are not immunosuppressive and highlight the antiviral effects of Teriflunomide that make it...

Delayed Repopulation white cell population after stopping DMF

Bhupendra O. Khatri, Sergey S. Tarima, Benjamin Essig, Jean Sesing, Tayo Olapo. Delayed lymphocyte re-population following discontinuation of dimethyl fumarate and after switching to other disease modifying drug therapies MSARDS DOI: Background:Dimethyl fumarate (DMF) reduces absolute lymphocyte counts, CD4, and CD8 counts, without significantly affecting total white blood cell counts...

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