ArchiveJanuary 2019

NEDADI or ‘Nee Daddy’ another treatment target beyond NEDA

Prof G do you think disability improvement is a reasonable treatment goal? NEDADI = no evident disease activity and disability improvement Two weeks ago one of my patients with PPMS, who we treated with off-label subcutaneous cladribine, came for her annual follow-up appointment. Despite being treated with cladribine over 2 years ago she has unfortunately progressed from EDSS 5.5 to 6.5. Her...

Guest post: My annual visit

Just recently I had my annual appointment with the MS consultant. He said it could only last 15 minutes. He did apologise for such a brief slot. Even so I couldn’t help but feel short changed. I could only discuss my 3 worst symptoms. Here is my own version of events at the MS review. He started “Has it got worse”? I thought to myself “This is a bit of a stupid question to ask anybody with...

Not All Data is Created Equal. Brain Atrophy

ProfG has put an interesting question about whether DMT are all born equal. Whilst the influence on relapse rates is much clearer in terms of the hierarchy, the effects on brain atrophy has led ProfG to ask a sensible question. It was suggested that HSCT and alemtuzumab are up there at the top of the pile in the atrophy states, leaving the B cell therapies in their wake. B cell therapies are...

MS in a snapshot: Global Burden of Disease study 2016

Trying to understand disease, especially rare disorders, at a global level is a Herculean task; not only from a resources perspective, but also from the cost and logistics involved. Before, the Global Burden of Disease study presented here, there was the Multiple Sclerosis International Federation that provided up to date figures on the global epidemiology of MS back in 2008. So, almost a decade...

The Learner

Do we need to include cognition as a treatment target in multiple sclerosis? In every clinic, I do patients with MS complain of cognitive symptoms. Either it is increasing forgetfulness, difficult multi-tasking, the inability to learn and use a new technology or cognitive fatigue. Case study: One of my high functioning patients, who worked in a large City law firm, simply could not keep up and...

Blood cells clearing up the myelin damage..

Zhou T, Zheng Y, Sun L, Badea SR, Jin Y, Liu Y, Rolfe AJ, Sun H, Wang X, Cheng Z, Huang Z, Zhao N, Sun X, Li J, Fan J, Lee C, Megraw TL, Wu W, Wang G, Ren Y. Microvascular endothelial cells engulf myelin debris and promote macrophage recruitment and fibrosis after neural injury. Nat Neurosci. 2019 Jan 21. doi: 10.1038/s41593-018-0324-9. [Epub ahead of print] The clearance of damaged...

Beyond NEDA

Prof G are we being lulled into a false sense of security by being told that we have no evident disease activity (NEDA)? A patient of mine, who I have been looking after now for over 11 years, asked me in clinic a few weeks ago why despite being NEDA for 6 years, on a highly effective maintenance DMT (fingolimod), has she gone from being able to run 5-10 km to needing a stick and barely managing...

Making new myelin, have animal studies been sending us in the wrong direction?

You all know that you can assess how old a tree is by counting the growth rings. You all have heard on carbon-dating, whereby you can assess the age of living things that have died. This works because living things are made of carbon containing molecules. Carbon comes in a radio-active form called carbon fourteen (related to the number of atoms and electrons in the molecule). This is decaying to...

Supporting the NHS & social medicine

Why don’t you support private prescribing and HSCT abroad? The social media response to yesterday’s Barts-MS Hangout on HSCT has been rather mixed. A lot of commentators are being critical of us for creating too many hurdles regarding the access to HSCT and that we shouldn’t stop our patients going abroad for treatment. From my perspective, going abroad or to private units in the UK for...

Lumbar Puncture Headache…The answer is not age and sex…It’s your needle!

We have been talking about dinosaur neurologists and asking can they learn and change pratice? Prof G and DrRuth will be tearing their hair out with dispare on reading this. It will be disappointing that we are not listening and learning. Post-lumbar puncture headache: an adverse effect in multiple sclerosis work-up. Vecchio D, Naldi P, Ferro V, Comi C, Leone MA, Cantello R.Neurol Sci...

Translate

Categories

Recent Posts

Recent Comments

Archives