ArchiveNovember 2019

Heart features of fingolimod

As we gear up for the mod wars as a number of S1P1 inhibitors arrive including siponimod and ozanimod, it will be interesting to see how fingolimod fairs. Fngolimod binds to S1P1, S1P3, S1P4 and S1P5 but the new variant bind to S1P1 and S1P5 and so avoid S1P3. This is in part the reason why fingolimod has heart issues and needs to be monitored. This risk is relatively low but needs to be checked...

A treatment for NMO

Not that long ago neuromyelitis optica was called Devics MS but it was split because it seems to have a different pathology and responds to MS drugs differently. It also more commonly presents itself East Asia. One of the features of NMO in some people is the production of an antibody to Aquaporin 4 a water channel on astrocytes. Many years ago I stained brain tissue with an antibody to...

What’s in a name?

The Barts-MS team are in the final stages of preparing a UK MS Society grant application to tackle the ‘real MS’ that lives inside you. Our focus is on studying or defining what is smouldering MS. This is a massive unmet need and refers to what we currently call inactive SPMS and PPMS. This is likely to affect a lot of you; at present, you remain in the so-called untreated MS camp. Ocrelizumab...

The cost of treating MS

One of my patients recently asked if they could return their tablets back to stock as they had decided not to make the swap as initially planned. Of course, the tablets could not be returned, and it’s a couple of hundreds of pounds down the tube. The patient was not to blame for this. Why should a tablet be worth more than the currency of gold? In fact, unanimously high cost drugs top all...

Time is Brain

So what has the UK’s poor performance in relation to cancer survival has to do with MS? A lot. These cancer statistics are collected as part of a national audit and are a bellwether for NHS services in general. If we had national MS statistics they would indicate similar problems, i.e. delays, delays, more delays and poorer outcomes. This is why we wrote a policy document ‘MS Brain Health: Time...

A lymph gland biopsy, Do you think you would do this? It tells us the blood is different

Recently I have had to sit through some dreary EAE studies, where the animal studies were justified by saying it was impossible to know what happens in lymph nodes and bone marrow. in humans I would say do some reading and you will find that the animal studies added nothing to what we know happens in humans. Learning from other autoimmunities to understand targeting of B cells to control multiple...

Adios Mexico

A big thank you to my Mexican friends and hosts for such a wonderful experience at the annual meeting of the Mexican Academy of Neurology. Your hospitality and friendship were truly special, not to mention the food, tequila, weather and the Pacific ocean. As promised I have uploaded my presentations onto my SlideShare site for you to download and use. Talk 1 – Case studies Talk 2 –...

Pregnancy and Iv Ig

Intravenous immunoglobulins for the prevention of postpartum relapses in multiple sclerosis. Horvat Ledinek A, Brecl Jakob G, Jerše J, Ruška B, Pavičić T, Gabelić T, Barun B, Adamec I, Rot U, Šega Jazbec S, Krbot Skorić M, Habek M. Mult Scler Relat Disord. 2019;38:101519.  OBJECTIVES:To evaluate the effect of intravenous immunoglobulins (IVIG) on prevention of postpartum relapses in women with...

Brave dreams, or not

A blast from the past. Just when we thought CCSVI had died a quiet death the Brave Dreams trial is reported. It is clear that venoplasty in pwMS with “CCSVI”, a non-disease, are not cured of having MS.  However, it appears that venoplasty may have some weak antiinflammatory effects.  A secondary assessment in subjects with favourable venograms had a significantly higher probability of...

We don’t know how CD20 antibodies works…but it is depletion of myelin CD8 T cells?

How does B cell depletion work. The Charcot meeting has given us nothing concrete. Is it the production of regulatory B cells or something else? So to keep on the Charcot theme of B cell therapy Some people say that it is because ocrelizumab/rituximab attacks T cells. In this new study, they look at CD8 T cells and notably myelin reactive T cells. CD8 T cells express more CD20 than other T cells...

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