As I write this I am on the way back from an ‘atypical’ summer holiday with my family. We spent a week in the ‘Oude Land’, South Africa, celebrating my mother in law’s 80th Birthday and then a week in the subtropics for some warm sunshine. The internet access was dismal, which was a good thing that allowed me to switch-off, sleep, eat, exercise, think, relax and recharge my batteries. The...
I was called to casualty to assess one of my patients with MS who was on natalizumab. She had been admitted with a temperature, confusion, seizures and a generalised skin rash. Within thirty minutes of seeing her, she went into status epilepticus and had to be sedated, intubated and admitted to ITU. Within 72 hours she was dead. At post-mortem, she had a measles pan-encephalitis. Four days before...
We want to build a sandwich to tackle the many facets of multiple sclerosis that result in neuroaxonal loss. At the base of treatment pyramid, we need an anti-inflammatory onto which we want to add a neuroprotectant, i.e. the combination therapy strategy. You need to protect damaged and vulnerable axons so that you can then remyelinate them or restore their function. We assume this makes sense...
Sleep glorious sleep! Walking, or sleeping, the talk. Over the last two years, I have tried to increase the duration and quality of my sleep. On reflection, it seems to be working for me. I feel so much better for it. It is now clear that shift work, reduced sleep and poor quality sleep are risk factors for developing dementia. We need to maximise my chances of not developing dementia. Sleep is...
If you have MS-related cognitive impairment would you want a treatment to improve your cognitive function? The study below shows that dalfampridine, or fampridine, improves cognition in particular processing speed in MSers with cognitive impairment. Importantly the improvement on the SDMT (Symbol Digit Modalities Test) was greater than 4 points, which is considered clinically meaningful in that...
I had an interesting discussion with some like-minded colleagues recently about active and inactive MS. We seemed to agree on what active MS is, be it in the relapsing or progressive phases of MS. However, we couldn’t really agree on what inactive MS is. Take this following case scenario; many said he was inactive, but others felt he had active MS and should have his treatment switched. Would you...
We need to keep pushing the envelope and moving the goalposts in terms of our treatment targets in MS. As MS advances innate immune activation with microglial and astrocyte activation occurs. However, the latter may be adaptive in response to damage and hence a good thing, which is why I am sceptical about treatments aimed at targeting these cells in advanced MS. In comparison, B-cells and...
My recent blog post on food coma (14-Jan-2019) not only uncovered another hidden symptom in MSers but has led us to start exploring this phenomenon in our patients and, hopefully, to some evidence-based advice on how to manage the problem. In our short web survey on food coma, I was surprised to find that 86% of MSers report this phenomenon with 28 of the 81 respondents (35%) reporting their...
I have just received the following information from Roche, which is reassuring in that As of July 3rd 2019, the Roche can confirm there have been no new carry-over cases of PML in MS patients treated with ocrelizumab since their last update in April 2019. The seventh case was reported in March 2019.As of April 2019, over 100,000 people have been treated with ocrelizumab globally, within a...
At our second MS Services Variance meeting, ‘Raising the Bar’, in Birmingham last week my colleague Helen Ford and I co-chaired the workstream on the social determinants of health (SDoH). What are the SDoH? The SDoH are life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education and health care, whose distribution across populations...