ArchiveMarch 2021

How much dimethyl fumarate gets in the brain

A couple of weeks ago someone asked about the penetration of dimethyl fumarate into the central nervous system. The active breakdown product of DMF is monmethyl fumarate. T Max is the time to the maximal concentration Edwards KR, Kamath A, Button J, Kamath V, Mendoza JP, Zhu B, Plavina T, Woodward C, Penner N. A pharmacokinetic and biomarker study of delayed-release dimethyl fumarate in subjects...

MS Octupus is hatching

The octupus is an incredibly intelligent mollusc and starts life as an egg. If you want to see an amazing film watch “My Octupus Teacher” its on Netflix (See trailer.) set in South Africa. Maybe it will be the last time you will eat one! I have seen the birth of this octupus (see below) It is a massive (90 x 60cm) bronze made in the East End of London by an amazing artist. I first saw...

Mind matters

New research from Brazil suggests that the act of walking when you have MS uses up greater cortical resources than if you don’t have MS; especially in the frontal and parietal cortical areas. Their hypothesis is that this increased activity is a compensatory response for the subcortical damage that occurs with MS. This is a plausible as majority of MS lesions occur in a periventricular...

Can’t Neuros just flipping Read!

This is one of those posts where I bring our profession into disrepute. The neuros are gods when they do something that works and yes I am not worthy when it comes to licking the bosses boots, but eventually you have to crack. I have been reporting year after year as a stocking filler for when ProfG or some other neuros posts something of interest. Therefore I have read a lot and you see this...

Please help I am getting worse

Barts-MS rose-tinted-odometer: ★ After my clinic last week I was emotionally drained and probably more than usual. Patient after patient was telling me the same story and asking the same questions. “Since lockdown last year things have gotten worse, what can I do about it?” My superficial interpretation is that most of these patients had gotten worse because of relative physical and...

Like a Good Wine, MS DMT efficacy takes time

Determinants of therapeutic lag in multiple sclerosis. Roos I et al. Mult Scler 2021 PubMedhttps://doi.org/10.1177/1352458520981300 Article information  A good wine takes time……and you accept this but this is also true for MS disease modifying treatments. ProfG brought the idea of the length dependent axonopathy (Long nerve tracks take on damage more quickly) and therapeutic lag...

#MSCOVID19 MDs Saturday COVID lunch

Wow what a week Vaccinations Work…If your DMT lets them Shah et al. Effect of vaccination on transmission of COVID-19: an observational study in healthcare workers and their households. MedRXiv doi:  A national study determined documented COVID-19 cases and hospitalizations in unvaccinated household members of vaccinated and unvaccinated healthcare workers. The cohort comprised of...

Why does fingolimod affect antibody responses?

Barts-MS rose-tinted-odometer:  ★ The Twittersphere is abuzz with the preliminary seroconversion rates in Israelis patients with MS on various DMTs in response to the Pfizer-BionTech COVID-19 vaccine (see below). As expected the antibody seroconversion rates in response to anti-CD20 therapies and S1P modulators are blunted and in most cases inhibited. The backstory or biology around anti...

Progressive MS is a T cell Problem?

Kaufmann M, Evans H, Schaupp AL, Engler JB, Kaur G, Willing A, Kursawe N, Schubert C, Attfield KE, Fugger L, Friese MA. Identifying CNS-colonizing T cells as potential therapeutic targets to prevent progression of multiple sclerosis. Med (N Y). 2021 Mar 12;2(3):296-312.e8. Multimodal single-cell profiling of blood and spatial RNA sequencing of brain tissueVLA4 blockage mobilizes CD161+/LTB+...

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