AuthorProf G

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

Beyond the B-cell: cognitive dissonance

I continue to be amazed when I hear senior MS neurologists make the claim they have never prescribed alemtuzumab or referred any of their patients for HSCT and don’t intend to do so either. These same neurologists seem to be happy with natalizumab and ocrelizumab as their #1 high-efficacy go to DMTs. When I challenge them with the exceptional longterm outcomes for pwMS treated early with...

#T4TD colour vision

When your neurologist looks in your eyes with an ophthalmoscope he/she is looking for the telltale signs of previous damage to the optic nerve. The sign we look for is optic disc pallor. The optic disc is made up of nerve fibres from the retina, which then pass out of the back of the eye to form the optic nerve. If you have had optic neuritis in the past and have lost nerve fibres this can be...

#ThinkSpeak: Rachel Horne

An interview with Rachel Horne who wrote the extraordinary blog post “The Kingdom of the Sick” (14th July 2020), which in my opinion is almost certainly the most well written and insightful piece on this blog.

CoI: nothing relevant in relation to this blog post

#MSCOVID19: the storm

I have been asked many times about how COVID-19 is affecting our MS research programme. The short answer is massively and its true impact is yet to be realised because we are a far way off from anything that feels and looks like normal. We are still paralysed by the threat of a second wave of COVID-19; the social distancing requirements within the NHS means everything is going to be at half-mast...

#T4TD Anticholinergics

Are you taking anticholinergics?  It is clear that centrally acting anticholinergic drugs, which block so-called muscarinic receptors, are being used by many people with multiple sclerosis as DIY agents to promote remyelination. The scientific rationale for this practice is based on preclinical work in cell culture systems and animal models and one proof-of-concept study of clemastine in pwMS...

Parallel Universes

I attended an online meeting yesterday and gave my usual talk on why the MS community needs to change its worldview from MS being a “clinico-radiological” entity to being a “biological disease”. There are many reasons for doing this but an alternative MS worldview will allow us to (1) diagnose MS earlier, (2) start treatment earlier, (3) define prevention strategies targeting very early MS or the...

#T4TD onychogryphosis

When last did you cut your toenails?  In patients who I  think are vulnerable, I always try to take the time to look at their feet. Unfortunately, because of COVID-19-induced NHS service changes, this is very difficult using telemedicine. Poor foot hygiene and uncut toenails are in my experience an integrator of neglect. As the feet are generally hidden from view people with MS often...

#MSCOVID19: vaccine readiness

Will Prof G have to eat his proverbial hat? I have been telling people that an effective SARS-CoV-2 vaccine is a long way away and that we shouldn’t expect a commercially available vaccine for another 12-18 months. Maybe I am wrong. The Moderna phase 1 results were published by the NEJM yesterday and are more impressive than I expected. These results are so important because the vaccine is...

#T4TD Infected

Did you know that a third of relapses are triggered by infections, typically non-specific viral infections?  The observation that a relapse is more likely to occur in the so-called ‘at risk’ period, typically 5-6 weeks after infection than at other times predates the disease-modifying therapy era of MS. The mechanism is thought to be that infection boosts the immune system non-specifically, which...

#T4TD Driving at night

Did you know that more than half of people with established multiple sclerosis (pwMS) have had an episode of optic neuritis (an MS lesion in the optic nerve)? Not all episodes of optic neuritis cause symptoms and can be subclinical. We detect the latter using visual evoked potentials that show slowed conduction in a particular optic nerve.  When optic neuritis recovers the conduction speed of...

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