Q&A 2022 Jan 1.1.


If you have a question, this is the place for you.

I hope you have enjoyed the beautiful work of ANDRZEJ SZYMCZYK

Andrzej is a local artist with a studio in Bow

Syphinx cat

Andrejz has a piece in Leicester Square (Home of the London Cinemas)

A Statue of Harry Potter Playing Quidditch Is Bringing New Magic to London  | Travel + Leisure
Harry Potter in Leicester square.

Disclaimer: Please note that the opinions expressed here are those of the author and do not reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust or Queen Mary Univeristy of London.

This is the last one in this series. The Q&A will now move to a weekly post on mondays. This will make it easier to follow.

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  • Hi,

    why are Igm antibodies lower while on Ocrevus treatment? What is mechanism behind?
    Besides Plasma cells are Igm produced also by other B cells?

    Thank you

    • IgM is the first line of antibody defence…..B cells make this then switch to IgG it is expressed by memory cells and this drops by about 25% within first year of ocrelizumab

  • MD Could you explain why after 5 days covid suddenly crashes into a far worse infection for at least 12 days am on an immunocompromised ward and am not the worst by any means asthma sees v bad and where thank you

    • For the first 5-7 days the body is fighting the virus, if you win the virus goes, but during this time the virus is producing anti-interferon and if after 5-7 it wins then it inhibits your immune system and starts the lung problems big time, if you have asthma you have impaired lung function

  • Some people report an increase in spasticity post HSCT but nobody seems to understand why. Can you shed any light please?

    • hypothectical….if you are losing nerves as indicated by incrwase in release of neurofilament this could be pro spastic as spasticity relates to nerve loss

  • Happy New, everyone.

    At the risk of going wildly off-topic, I have a Corona question – which is, for the vast part of the planet that is vaccine-naive, will the Omicron takeover everyone everywhere is going to get be an effective vaccine (for those it doesn’t kill, of course, thanks to the first world’s budgeting problems)?

    Sorry if that’s bad taste, but I have been worried about the consequences of international indifference to those who can’t get hold of vaccine, and dreaming hopefully that Covid is shaping up as a respectable viral citizen sooner than we ever thought. Touches wood scientifically

    • The omicron is going everywhere and is even in Antartica and luckily it seems less deadly so it is going to give people some immunity in London about 1 in 20 people are infected and it is ripping through vaccinated individuals just as it willl rip through the un vaccinated and as you suggest may act like a vaccine..but i suspect less innocuous

  • I’ve heard differing opinions on stopping or continuing Mayzent, if the user tests positive for COVID. I recently heard from a few who said their Neurologists told them it was protective against severe covid disease. Can you share your thoughts?

    • Early on there was supposed be a fingolimod trial….never heard of the result. I am guessing it went nowhere

  • Would someone who is inbetween week 1 and week 2 of the first year of cladribine benefit from a booster? Would it also be safe to have it? Thank you beforehand for your reply

    • The data suggest that in the context of cladribine, immunisation (i) can happen at any time point and (ii) is likely to lead to a successful immune response (effective antibody level)

  • Happy New Year!
    A question on natalizumab washout and HSCT.
    Given the risk of rebound I wanted to ask what the purpose is of the washout period. Is there a problem with giving cyclophosphamide to someone who has had a dose of natalizumab 4/6 weeks earlier, there is no known interaction but do you know if there is a reason that cyclphosphamide would not have the desired effect on the natalizumab bound cells? If you are JC negative then the risk of PML would be low but the risk of rebound could potentially be high, just wondering what your thoughts are on this?
    Many thanks

    • I dont know but natalizumab influences migration of CD34 stem cells and cyclophosphamide is used to mobilize the stem cells into the blood, the nataluzumab could bind to them and stop them going into the bone marrow

    • Dr. Aaron Boster says that in order to prevent rebound he gives steroids for a few months after the last infusion to his patients who are stopping natalizumab. Might be worth bringing up with your neurologist if you are concerned.

  • I have PPMS. The “end stage”, as I can see it in all my Drs eyes. I have been on this journey, bogging Everchangingms.blogspot.com of this journey.
    Everything has been additive, to the thick blood, and h63D genes mutated causing iron overload, to fenofibrate causing chronic kidney disease stage 4, to the years saying I was out of breath.
    This led from endocrinologist, to cancer center, to plumanologist. My lung size is so small, thank you MS nerves, that there is not a repair.
    A bandage of oxygen. A bipap was considered, but that’s back to mechanical ventilation.
    What studies does MS done when the major nervous stays tom fails.
    Like Copd, just in reverse of getting air, co2 out. Lungs shrank to much.. Iron deficient for two years. Would love science, or a student or even you professor to look at my chronic hypoxia, secondary-polycythemia, Erythoctosis,
    Am I fighting a uphill battle? On copaxone. Ocrevus out of plans due to lung issues and pandemic.

    • JoeY, we can’t provide individual medical advice here; depending on where you are based, you can always request referral for a 2nd opinion, it’s in the NHS Constitution.

      • Profk,
        I have seen how small my lung capacity has became. They can not fix the nerves that control this. So just opposite of copd. Researching this, its a common problem with ppms, for them to become hard at breathing. No way to expand lungs, not candidate for surgery.
        Just thought you may have more articles of when MS hits lungs, chronic hypoxia, secondary-polycythemia, Erythoctosis, or MS and the lungs, that would enhance doctors, MS neurologist, on this. I am in usa.

  • If you cannot access Evusheld, are on Ocrevus and test positive for Covid, should you push for Paxlovid or Sotrovimab?

  • What are your thoughts on the epsilon neuro toxin being a potential trigger for ms and is there any research being carried out with it ? If so what is the best place to read it ?

      • cluded from further analysis outlined below.
        We found that 23% of the CDMS patients’ sera had
        antibodies to epsilon toxin while the matched control
        group for this cohort showed reactivity in 8% of sam-
        ples (Table 1 and Figure 2). The proportion of patients
        diagnosed with CIS/MS, relapsing-remitting multiple
        sclerosis (RRMS), secondary progressive multiple
        sclerosis (SPMS) and showing reactivity with epsilon
        toxin was broadly similar (31%, 21% and 18%,
        respectively). None of the primary progressive multi-
        ple sclerosis (PPMS) samples we tested were reactive
        though the number tested (n=5) may be too low to be
        representative of this group.

        Maybe im misunderstanding this but is that not a correlation with point of disease course to percentage of antibody reaction found ? As in the peecentage falls as the people tested are further along in the disease ?

    • I know there is interest in this within the group, but I’m not convinced this is a universal trigger. However I am there to be proved wrong

    • I am sure it is…..if it is stopping focal inflammation it is neuroprotective…..ProfG would spout on about B cell treatment not being neuroprotective, with I believe to be wrong , the study is now in motion so lets see

      • Excellent definition of neuroprotective.
        Any thoughts on anti-epileptics? I have been thinking specifically about lamotrigine, which is not exactly a first-line treatment in the UK. The NHS is required to stick to NICE guidelines, which can be counterproductive in many circumstances, to say the least.

        • Phase II studies have been done; there is a need to do phase III, but who does them? Question is, (i) will they be done and (ii) will they be done as add-on studies, i.e. added on to DMT?

        • Loads of thoughts of anti- epileptics. Lamotrigine is licenced for epilepsy it.is not licenced for neuroprotection

  • Hi, result of IgM blood test represents only released immunoglobulins IgM, or also IgM memory B cells are taken into an account (or other b cells types which express IgM, if there are any)?


  • Selma Blair famously got HSCt. She just posted on instagram today that she is getting IVIG. What is that for?

  • IviG does it really work. Is it a six hour infusion?
    Looking for links to understand this protein, from donor’s in usa. Blood is given, and protein ivig taken out, but what to expect?

    • It depend what the reason. If you are long term treated with some ms treatment such anti CD20 you get this as it may give you immunity that you are lacking. Ivig is made from the blood of many different people

      • Thank you. Muscle that regulates chest breathing attacked. On o2. Bipap looking at, ms Dr sends me to top plumanologist, who sends me back to MS Dr.
        Bandage approach. Also looked at Acthar

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