ArchiveJuly 2022

Low Antibody levels

Hypogammaglobulinemia and Multiple Sclerosis – An Overlooked Correlation?].Diem L, Hoepner R.Ther Umsch. 2022;79(6):285-288. doi: 10.1024/0040-5930/a001362. Hypogammaglobulinemias occur in people with multiple sclerosis (MS) without immunotherapy in 8.1% of patients and with immunotherapy (not drug-specific) in up to 26.4% of affected individuals. This is thus significantly higher than the...

Switching from cladribine

Background: Patients with relapsing-remitting multiple sclerosis commonly switch between disease-modifying therapies (DMTs). Identifying predictors of relapse when switching could improve outcomes. Objective: To determine predictors of relapse hazard when switching to cladribine. Methods: Data of patients who switched to cladribine, grouped by prior disease-modifying therapy (pDMT;...

Microglia- The Good, the Bad and Will it Get Ugly

Wong VW. Microglia in multiple sclerosis: Protectors turn destroyers Microglia are implicated in all stages of multiple sclerosis (MS). Microglia alterations are detected by positron emission tomography in people living with MS (with the previso that this could be microglia but improtantly astrocytes, microglia, nerves expressing the marker) prior to the formation of structural lesions determined...

Predicting MS

This study looked at factors involved in moving from a first attack to a diagnosis of MS. The biggest single factor detected was MRI…which is good as it is part of the clinical work-up. There were others such as age and the expression of some genes and some environmental factors, but remember if the 95% confidence interval goes through one…the real result may be no influence. The...

B cells and how it works

I don’t normally comment on reviews, but this one is open source and provides a rather different view to the one we have been presenting for a few years. It is good to have alternative ideas Baker D, Pryce G, Amor S, Giovannoni G, Schmierer K. Learning from other autoimmunities to understand targeting of B cells to control multiple sclerosis. Brain. 2018;141:2834-2847. doi: 10...

Does Teriflunomide as a DMT warrant discussion?

Speaking as a clinician who goes by the mantra ‘treat early, treat hard’, platform therapies as a whole receive less attention from me than highly-active treatments. However, I know that they have a place in the MS armamentarium and admittedly, I have a more than few patients on Teriflunomide. Some of whom have been stable on it for many years, whilst others I’ve had to transfer...

Inflammation associated with nerve loss

If you have been a reader of the blog for some time, you will note that ProfG has been infering that the “real MS” is not the inflammatory response but some intrinsic pathological process occurring in the brain . So us researchers have been chastised by you for working on the inflammatory response and progressive MS and not the “real MS”, which is often portrayed as some...

Natalizumab and pregnancy

If you are using nataizumab and fall pregnant you may be interested in this post. Remember I am not a neuro and not giving any clinical advice but it is something you could discuss. If you are in the UK you can read the Neurologists guidelines Dobson et al. UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines Highly active MS (HAMS) have a poorer...

Monitoring Nerve Damage. Is it different from Aging?

Neurofilament detection in biological fluids is largely a measure of inflammation induced neurodegeneration as neurofilament is an internal nerve protein and it is released when a nerve is damaged. We know that “time is brain” meaning that if you don’t get on top of the disease, nerve damage occurs. However, “time is brain” because as you become an old fart like me...

A positive trial on Ashworth Scale in Spasticity

Spasticity is a common problem in multiple Sclerosis and is caused by muscle contraction due to over excited nerves. Baclofen stimulates inhibitory nerves and so is sedative and causes muscle relaxation, cannabis blocks nerve excitation and so is sedative and may cause muscle relaxation. Why do I say “may”…well it is because it is not been proven to the standards that the US...

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