Hi. I’m RRMS, HSCT done in 2014 and relapsed in 2018 (probably due to the high stress factor). HSCT done a great job for me. EDSS dropped from 5,5 to 1,5 and I’m still doing well. Although new active liaisons has shown on my three latest MRIs (done every 6 months). What treatment would you recommend in my case? Thanks.
Professor G has mentioned that anticholinergic agents are to be avoided in MS. Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters? Is there any literature regarding which antidepressants tend to work well on MS patients? Thank you beforehand for your reply
Professor G has mentioned that anticholinergic agents are to be avoided in MS. Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters? Is there any literature regarding which antidepressants tend to work well on MS patients? Thank you beforehand for your reply
Re: “Is there any literature regarding which antidepressants tend to work well on MS patients?”
Anti-depressants are like horses for courses, i.e. some work well in some patients and not others. In relation to this question, I would suggest avoiding the so-called tricyclic anti-depressants as they have quite potent anticholinergic effects and are CNS penetrant. We don’t really use the tricyclics for depression anymore because they are so poorly tolerated at antidepressant doses.
If you have pain, which is common in pwMS who are depressed, duloxetine seems to work well.
Re: “Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters?”
Yes and no! As a general rule, you should try and avoid anticholinergics, particularly the older generation ones that are CNS penetrant and affect cognition. The newer generation ones are much better tolerated and are designed not to cross the blood-brain-barrier. However, these agents still have side effects in the periphery (dryness of the mouth, blurring of vision, constipation, reduced sweating, etc.). There is no harm in taking them for a short period of time to see how you do. The good news is that there is a new class of bladder drug that works on the adrenergic system and does have anticholinergic side effects.
is there any table/ diagram that can be used for patients on DMTs who are considering a switch to another for whatever reason… be it forced (I,e, on tysabri the patient becomes JCV+ with a risky tire level) or due to lifestyle reason (patient doesn’t want to have monthly infusions).
The visual/ chart, allows the patient to see what are options/ generic recommendations to move onto next.
if one does exist, then please could someone post a link?
Hi Profs & MS Community, following a recent shed load of blood tests, I have been given the thumbs up for the treatment ocrelizumab at the end of the month. My lymphocytes were low after a lengthy period on tecfidera. It has taken 15 months for my bloods to show that they have reached a steady ish time to enable me to have the ocrelizumab. I am of course nervous as my MS is daily active with pain, stiffness, spasticity, bathroom & diet problems along with numbness of my right foot. I’m not sure where I am in terms of progression and maybe that is a good thing! I’m told and have read that I also have gum disease (inflamed gums) – so along with tinnitus, burning pain in my neck and head, I feel awful daily & am now taking opoid patches to help me get through the day. I need to also understand how does ocrelizumab work on my immune system and not bring me back to where I was with the tecidera? Am I just buying myself a possible 1 year to 18 mths worth of no further systoms?
I read your article about Ocrevus patients developing Hypogammaglobulinemia.
I am diagnosed with Selective Antibody Disorder and Multiple Sclerosis and using Ocrevus as my DMT. I am prescribed Hizentra to treat the PI.
Does using Immune Globulin increase the risk of incomplete B-cell depletion or create an environment where B cells regenerate more quickly? Before each of my Ocrevus infusions, my B cells are higher than expected even on a 5.5 month dosing schedule (they are incrementally creeping up higher and higher at testing each infusion cycle.
Does the Hizentra raise my B cell count?
Thoughts on the risk/benefit scenario?
Anything else we should be tracking or investigating?
Fatigue/ lassitude in MS occurs often, but is not well understood. One theory is that it might be caused by an immune response.
In your opinion does fatigue completely resolve after successful (IRT)treatment?
Fatigue is one of the main complaints in MS, are there any studies that investigate the cause?
Yeah, i kinda guessed that was the case. One study actually found an increase in axonial degeneration when mice were administered NMN (small study with poor design). Prof David Sinclair is pushing this stuff as an anti-aging drug. However, NAD+ fuels tumour growth. So…….
Isn’t the theory of BBB not leaving lymphocytes to enter the brain becoming obsolete? We have several recent studies reporting that lympocytes do cross BBB in healthy people too, and for a good purpose (of course this is not the case for MS).
And most importantly, B cells again? Boring, with limited effectiveness and without imagination. This is why Pharma would be thrilled with such an idea.
Hi. I’m RRMS, HSCT done in 2014 and relapsed in 2018 (probably due to the high stress factor). HSCT done a great job for me. EDSS dropped from 5,5 to 1,5 and I’m still doing well. Although new active liaisons has shown on my three latest MRIs (done every 6 months). What treatment would you recommend in my case? Thanks.
This is one for MD2 and anyone else who’d like a profile pic / Avatar for this blog. Register your e-mail and chosen image here:
https://en.gravatar.com/
Finally got round to it!
Now I know what half a mouse looks like
Thought that was strange genitalia for a minute.
Professor G has mentioned that anticholinergic agents are to be avoided in MS. Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters? Is there any literature regarding which antidepressants tend to work well on MS patients? Thank you beforehand for your reply
Professor G has mentioned that anticholinergic agents are to be avoided in MS. Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters? Is there any literature regarding which antidepressants tend to work well on MS patients? Thank you beforehand for your reply
When can i please have an answer on this? Thank you 🙏🏼
Re: “Is there any literature regarding which antidepressants tend to work well on MS patients?”
Anti-depressants are like horses for courses, i.e. some work well in some patients and not others. In relation to this question, I would suggest avoiding the so-called tricyclic anti-depressants as they have quite potent anticholinergic effects and are CNS penetrant. We don’t really use the tricyclics for depression anymore because they are so poorly tolerated at antidepressant doses.
If you have pain, which is common in pwMS who are depressed, duloxetine seems to work well.
Re: “Would you recommend that MS patients stir completely clear of all anticholinergic agents or the level of the anticholinergic effect matters?”
Yes and no! As a general rule, you should try and avoid anticholinergics, particularly the older generation ones that are CNS penetrant and affect cognition. The newer generation ones are much better tolerated and are designed not to cross the blood-brain-barrier. However, these agents still have side effects in the periphery (dryness of the mouth, blurring of vision, constipation, reduced sweating, etc.). There is no harm in taking them for a short period of time to see how you do. The good news is that there is a new class of bladder drug that works on the adrenergic system and does have anticholinergic side effects.
is there any table/ diagram that can be used for patients on DMTs who are considering a switch to another for whatever reason… be it forced (I,e, on tysabri the patient becomes JCV+ with a risky tire level) or due to lifestyle reason (patient doesn’t want to have monthly infusions).
The visual/ chart, allows the patient to see what are options/ generic recommendations to move onto next.
if one does exist, then please could someone post a link?
These slides from Prof G may help
https://multiple-sclerosis-research.org/2018/12/is-it-time-to-slay-the-gamblers-dilemma/
thanks for that. very useful
Hi Profs & MS Community, following a recent shed load of blood tests, I have been given the thumbs up for the treatment ocrelizumab at the end of the month. My lymphocytes were low after a lengthy period on tecfidera. It has taken 15 months for my bloods to show that they have reached a steady ish time to enable me to have the ocrelizumab. I am of course nervous as my MS is daily active with pain, stiffness, spasticity, bathroom & diet problems along with numbness of my right foot. I’m not sure where I am in terms of progression and maybe that is a good thing! I’m told and have read that I also have gum disease (inflamed gums) – so along with tinnitus, burning pain in my neck and head, I feel awful daily & am now taking opoid patches to help me get through the day. I need to also understand how does ocrelizumab work on my immune system and not bring me back to where I was with the tecidera? Am I just buying myself a possible 1 year to 18 mths worth of no further systoms?
Ocrevus and Hypogammaglobulinemia
I read your article about Ocrevus patients developing Hypogammaglobulinemia.
I am diagnosed with Selective Antibody Disorder and Multiple Sclerosis and using Ocrevus as my DMT. I am prescribed Hizentra to treat the PI.
Does using Immune Globulin increase the risk of incomplete B-cell depletion or create an environment where B cells regenerate more quickly? Before each of my Ocrevus infusions, my B cells are higher than expected even on a 5.5 month dosing schedule (they are incrementally creeping up higher and higher at testing each infusion cycle.
Does the Hizentra raise my B cell count?
Thoughts on the risk/benefit scenario?
Anything else we should be tracking or investigating?
Thanks.
Why myelinated mammalian nerves are fast and allow high frequency
https://medicalxpress.com/news/2019-11-myelinated-mammalian-nerves-fast-high.html
Fatigue/ lassitude in MS occurs often, but is not well understood. One theory is that it might be caused by an immune response.
In your opinion does fatigue completely resolve after successful (IRT)treatment?
Fatigue is one of the main complaints in MS, are there any studies that investigate the cause?
7 tesla
https://medicalxpress.com/news/2019-11-7t-mri-insights-multiple-sclerosis.html
Nicotinamide Mononucleotide – thoughts on utility for MS?
We looked at this about 5 years ago and so did another lab…our results were… don’t hold you breathe
Yeah, i kinda guessed that was the case. One study actually found an increase in axonial degeneration when mice were administered NMN (small study with poor design). Prof David Sinclair is pushing this stuff as an anti-aging drug. However, NAD+ fuels tumour growth. So…….
B cell time
https://medicalxpress.com/news/2019-11-multiple-sclerosis.html
Natalizumab b cell specific?
Isn’t the theory of BBB not leaving lymphocytes to enter the brain becoming obsolete? We have several recent studies reporting that lympocytes do cross BBB in healthy people too, and for a good purpose (of course this is not the case for MS).
And most importantly, B cells again? Boring, with limited effectiveness and without imagination. This is why Pharma would be thrilled with such an idea.
🙂
Single Dose of CD45-ADC Resets the Immune System, Delays the Onset of MS in Mice
Another irt
https://multiplesclerosisnewstoday.com/news-posts/2019/11/11/magenta-therapeutics-presents-first-immune-reset-results-with-antibody-drug-conjugate-across-multiple-autoimmune-diseases-at-acr/?utm_source=Multiple+Sclerosis&utm_campaign=f34e16b45a-RSS_NON-US_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b5fb7a3dae-f34e16b45a-71699829