Archive2019

Counting the cost, T2 lesions

Counting the cost and paying the price are not one and the same. For decades MRI has been the way by which all and sundry have monitored MS disease activity. But, what does it all mean? And, how good is it really? Recently, in a natural history evaluation of MS disease activity, the Barcelona group looked at MRI scans of those presenting to their centre on whom they had at least 10 years of...

Do you know what GROLDI means?

Several things often happen together for a reason and then make you sit up and think.  Firstly, I got a tragic email from a young woman, who lives in Los Angles, who was recently diagnosed with MS. Unfortunately, she is unable to get herself onto a DMT due to being uninsured. She describes having quite active MS and unless she is treated early and effectively will almost certainly be unable to...

A week too late to be the first, but more info on metformin and the remyelination story

Last week we had the suggestion that metforin can act as an anti-aging agent to make oligogendrocyte precursor cells to promote remyelination. This wasn’t the first time it had been suggested and it clearly was not the last. So this new study claims to be the first study to show metformin-induced AMPK ,could potentially accelerate regeneration . What a difference a week makes, becuase first...

Our prize winners

You may recall Barts-MS held a competition before ECTRIMS to see if any of you could guess the results of OPTIMUM and ASCLEPIOS trials, i.e. “Oral Ponesimod Versus Teriflunomide In Relapsing MUltiple Sclerosis (OPTIMUM)” and “Efficacy and Safety of Ofatumumab Compared to Teriflunomide in Patients With Relapsing Multiple Sclerosis (ASCLEPIOS I & II)”. We now have our...

Can you change your lifestyle?

I don’t know much about diet and multiple sclerosis, so we got ProfB to blag his way into the Houses of Parliment for a multiple sclerosis meeting on lifestyle and diet Chatting to the stars of the film can you guess who. It was the last time you will see that shirt The building reeks of history and it was pleasure to attend says ProfB. It was rather funny watching the Extinction Rebellion...

Inhibition of B cell survival factors does not inhibit MS

You know me, I love to write papers, pharma seem to hate it, so I say to them just give me the data and save yourself a few grand paying medical writers. OK, they can’t dictatate what I am going to write, but the data generally speaks for itself. They just don’t want to let the data out:-(. After the excitement of HSCT- thursday…. and friday, its back to reality. This post...

HSCT and fake news

I post to manage expectations and counteract fake news.  There is a group of pro-HSCTers going around and saying HSCT is a cure for MS even in MSers with more advanced disease, i.e. it halts and reverses their disability. This is simply not correct and we have no published, peer-reviewed, data to support their position.  The meta-analysis below from Paulo Muraro and colleagues clearly...

De novo PML on ocrelizumab

In my career as a neurologist, I have seen three patients who developed PML (progressive multifocal leukoencephalopathy) without any apparent risk factors apart from being old. They were all over 70. Prior to the HIV epidemic, about 1 in 10 patients with PML did not have an obvious underlying risk factor except for age or immunosenescence of the elderly.  Immunosenescence is the term...

My ‘Smouldering MS Clinic’

I finished yesterday emotionally burnt-out; “broken and useless, no longer working or effective” or “kaput” as the Germans would say. I did an all-day clinic with my registrar off sick; it was hard and brutal.  On my way home I wondered to myself if I should change the name of my MS clinic to the ‘Smouldering MS Clinic’. Virtually all of my patients had smouldering MS or as some of you would...

Telling signs

Despite advances in MRI, the diagnosis of MS is hard for the non-specialist. A Swiss study recently found that the delay in MS diagnosis is more than 2 years in 40% of PwMS. Surprised? You should be, because according to this study by 2016-2017 the delay in diagnosis had only improved by half as much since the year 2000! What is not surprising, however, is that in a majority of instances this...

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