ArchiveJuly 2019

Is DMF the new GA?

Glatiramer acetate has had more mechansims than most people have had hot dinners :-), without really asking the question how it works but does it work well enough? However, is dimethyl fumarate DMF moving in the same territory. Dimethyl fumarate was first described to be an anti-oxidant working via Nrf2. Work in Nrf2 knockout questioned this and then we had GPR105 and a CD8 dependent mechanisms...

Measles a known unknown

I was called to casualty to assess one of my patients with MS who was on natalizumab. She had been admitted with a temperature, confusion, seizures and a generalised skin rash. Within thirty minutes of seeing her, she went into status epilepticus and had to be sedated, intubated and admitted to ITU. Within 72 hours she was dead. At post-mortem, she had a measles pan-encephalitis. Four days before...

HSCT in MS, more a remission than a cure

In a prose to seduce the weary palate, the British neurologist, I recollect saying: “What should be the aims of HSCT treatment? At worst, remission. At best, a cure“. I may just have to eat my words… In a small study from Uppsala University (n=45), Larsson et al. report the effects of HSCT on neuronal damage (using neurofilament levels) and inflammation (IgG index and...

OXO Study

We want to build a sandwich to tackle the many facets of multiple sclerosis that result in neuroaxonal loss. At the base of treatment pyramid, we need an anti-inflammatory onto which we want to add a neuroprotectant, i.e. the combination therapy strategy. You need to protect damaged and vulnerable axons so that you can then remyelinate them or restore their function. We assume this makes sense...

OXO is not about gravy

If ProfG was in it for the money, he would have filed a patent before disclosing the combination of treatments:-(. However that could have meant the £96 a year extra cost to the NHS could have been substantially more. The OXO is not a well known Gravy Granule, it is a study aims to combine ocrelizumab with oxcarbazepine Why PPMS. Well many good reasons. In the NHS primary progressive MS can mean...

I’m wrong…it’s all T cells

A new study finds a another T cell subtype for MS This time the cell expresses Granulocycte macrophage growth factor and a chemokine recepter called CXCR4. There is a relatively new detection system and they have looked in the MS brain and found this one. Yes yes its T cells, It’s T cells I give up. They found a CD4 T cell is that surprising? So off we go and do a new set of EAE studies...

Double-whammy

Sleep glorious sleep! Walking, or sleeping, the talk. Over the last two years, I have tried to increase the duration and quality of my sleep. On reflection, it seems to be working for me. I feel so much better for it. It is now clear that shift work, reduced sleep and poor quality sleep are risk factors for developing dementia. We need to maximise my chances of not developing dementia. Sleep is...

ARRIVE- REVERSE & ARRIVE AGAIN. Animal Experiments

The ARRIVE guidelines are a set of reporting suggestions for reporting animal work. These follow on from the CONSORT guidelines about reporting clinical trials in humans. The aim was to improve the transparency of animal studies to help them be more reproducible and translatable. According to the authors the ARRIVE 2010 have not been fully adopted, will the 2019 revision improve this? I suspect...

Is too much Vitamin D Bad for you? Part II. If you are a Rodent Apparently Yes

High dose vitamin D exacerbates central nervous system autoimmunity by raising T-cell excitatory calcium. Häusler D, Torke S, Peelen E, Bertsch T, Djukic M, Nau R, Larochelle C, Zamvil SS, Brück W, Weber MS. Brain. 2019 Jul 13. pii: awz190. We have had a discussion on the merits of Vitamin D and making models of MS worse. We have said that the vitamin D council suggests that too much...

#ThinkCognition

If you have MS-related cognitive impairment would you want a treatment to improve your cognitive function?  The study below shows that dalfampridine, or fampridine, improves cognition in particular processing speed in MSers with cognitive impairment. Importantly the improvement on the SDMT (Symbol Digit Modalities Test) was greater than 4 points, which is considered clinically meaningful in that...

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