AuthorGavin

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

Foot drop

The study below tried to compare the clinical effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) and whether or not they were cost effective. The high drop-out rate (38%) made the study inconclusive. When we, at Barts-MS, did a clinical audit a few years ago we showed that the best predictor of falls was the need to use a walking aid; e.g. walking stick...

What, I don’t have MS?

In the study below approximately 1 in 5 people diagnosed with MS don’t have MS. This is so much higher than previous studies. I have always quoted the Danish post-mortem studies that sugget only 1 in 20 MSers are misdiagnosed. Maybe Danish neurologists are simply better at diagnosing MS compared to their American colleagues? There is no one test that can be done to diagnose MS. MS is...

Ocrelizumab’s known-unknowns

Below is the first case report of fulminant hepatitis owing to echovirus 25 in an MSers on ocrelizumab. Please note continuous anti-CD20 therapy takes out your B-cells and prevents you from forming germinal centres (where B-cells get educated to make antibodies, i.e. the B-cell’s Universities) in lymph nodes and the spleen. In other words, ocrelizumab treatment causes functional splenectomy...

Hepatitis post-alemtuzumab

Another alemtuzumab-related post, this time in relation to alemtuzumab-associated liver injury, which has been also been included as a complication of alemtuzumab treatment in the EMA’s SmPC (summary of product characteristics). Liver or hepatic injury can occur as part of a drug-induced injury as seen in case 2 below or as a delayed, presumably autoimmune, condition as in case 1 below...

Cry, the Beloved Country

This post has been moved to Medium. From now on Prof G will do all personal postings on Medium. He will continue to post on this platform but will be limiting his posts on the Barts-MS blog to factual content, no random personal musings and no off-beat MS topics.

Why is everyone drinking anti-CD20 kool-aid?

Prof G will ocrelizumab and rituximab prevent SPMS? Just back from the COMBAT-MS stakeholders meeting in Pasadena with the Kaiser (Kaiser Foundation Research Institute) and Swedish (Karolinska Institute) trial teams, PCORI (Patient-Centered Outcomes Research Institute) and many brave an wonderful people with MS and their families. The COMBAT-MS study (NCT03193866) is recruiting well and is on...

1st-line HSCT

If push came to shove would you really choose HSCT as a first-line treatment to treat your MS? When asked on the blog yesterday which DMT would I choose if I had MS, I chose HSCT. One of my patients, who I have been looking after for over a decade, sent me an email stating how upset she was that I had never offered her HSCT. I clearly need to explain my position so as not to upset anyone else...

Calling all vegans

As a vegan what supplements do I need to take? I am in the process of researching the dietary landscape for people with MS and will not be ready to make any firm recommendations for some time, but I can make a recommendation of what diets to avoid. The first is a strict vegan diet without supplements. My index patient was an Asian woman, in her mid-20s, with RRMS who referred for a second opinion...

COMBAT-MS: have your say

What are the most important outstanding research questions for people with MS? Depending on how long you have been following this blog you may or may not be aware of the COMBAT-MS study. This is a study that is funded by the US government as part of  the Patient-Centered Outcomes Research Institute (PCORI). COMBAT-MS is a US-Swedish initiative for a hybrid study between a traditional...

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