ArchiveApril 2019

Foot drop

The study below tried to compare the clinical effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) and whether or not they were cost effective. The high drop-out rate (38%) made the study inconclusive. When we, at Barts-MS, did a clinical audit a few years ago we showed that the best predictor of falls was the need to use a walking aid; e.g. walking stick...

What, I don’t have MS?

In the study below approximately 1 in 5 people diagnosed with MS don’t have MS. This is so much higher than previous studies. I have always quoted the Danish post-mortem studies that sugget only 1 in 20 MSers are misdiagnosed. Maybe Danish neurologists are simply better at diagnosing MS compared to their American colleagues? There is no one test that can be done to diagnose MS. MS is...

Guest post: Part 2 of Choosing a DMT: the issues

Firstly, why the incredible hesitancy among some medics to flip the pyramid? Or at least break away from the Beta-interferons/Glatiramer Acetate as ‘safe’ fallback options, even when the research suggests that these days, the older first generation drugs give suboptimal outcomes compared to the modern crop. The MS neurologists that I spoke to all advocate versions of outlining the options...

Ocrelizumab’s known-unknowns

Below is the first case report of fulminant hepatitis owing to echovirus 25 in an MSers on ocrelizumab. Please note continuous anti-CD20 therapy takes out your B-cells and prevents you from forming germinal centres (where B-cells get educated to make antibodies, i.e. the B-cell’s Universities) in lymph nodes and the spleen. In other words, ocrelizumab treatment causes functional splenectomy...

Predicting a relapse

The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated. But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it...

Teriflunomide is contraindicated in pregnancy

Abstract BACKGROUND: Teriflunomide is contraindicated in pregnancy. Some pregnancies have occurred despite guidance to use effective contraception. OBJECTIVES:To report outcomes of pregnancies occurring in teriflunomide clinical trials and the post-marketing setting. METHODS: Outcomes are summarized for pregnancies in teriflunomide monotherapy clinical trials and the post-marketing setting (data...

Hepatitis post-alemtuzumab

Another alemtuzumab-related post, this time in relation to alemtuzumab-associated liver injury, which has been also been included as a complication of alemtuzumab treatment in the EMA’s SmPC (summary of product characteristics). Liver or hepatic injury can occur as part of a drug-induced injury as seen in case 2 below or as a delayed, presumably autoimmune, condition as in case 1 below...

Haemophagocytic lymphohistiocytosis post-alemtuzumab

After yesterday’s post on alemtuzumab-related posts, many people are asking about haemophagocytic lymphohistiocytosis (HLH), which has been included as a complication of alemtuzumab treatment as is now in the SmPC (summary of product characteristics). HLH is a condition in which the body makes too many activated macrophages and lymphocytes. People with HLH usually develop systemic symptoms, which...

There is a reason why Neuros should not be comedians-Don’t change your appointments

Hello Peeps, for regular blog readers you know that I am the funny one, who can light up your day with a smile and a bit of light relief. For people attending ProfGs clinics who don’t want to read this look at the Red The neuros are the serious ones in grey suits who tell you how it is and dole our the good and bad news and sometimes tell you about their inner sensitive self. I woud say I...

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