AuthorProf G

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

#COVIDMS COVID-19 Q&A

I am getting a continuous stream of questions about MS and COVID-19 infection. The following is an example of the kind of questions that are being asked. Does MS increase my chance of getting COVID-19 infection?Does MS increase my chance of getting severe COVID-19 infection?Does COVID-19 cause MS to relapse?Should I self-isolate because I have MS?Should I stop my DMT if I become infected with...

#COVIDMS COVID-19 and Ondine’s curse

As a non-virologist, I have been relying on basic principles to make recommendations, and predictions, about what may happen to someone with MS who is infected with COVID-19. However, over time an observational evidence-base will emerge that will either confirm or refute some of these predictions.  One thing I would not have predicted is Twitter being the platform for some of the early...

NASA – Neurology Association of South Africa 2020

I am about to fly back from ZA (Zuid Afrika) as we have always referred to it in the past. I had a wonderful few days with my colleagues and old friends from University. Thank you for your kind, and as always incredible, hospitality. If the NASA meeting was to be held a week later it would have almost certainly have been cancelled. As South Africa goes into lockdown from the coronavirus epidemic...

#COVIDMS COVID-19 case study 2

I hope you enjoyed the first COVID-19 case study. The following is another case study that has just arisen in our unit. Case study: The patient has highly-active DMT having failed a trial of dimethyl fumarate (DMF). She had a brain-stem relapse and her MRI had shown several new lesions. She was switched to oral cladribine and had her first-cycle of 5 days of treatment two weeks ago. She is due...

#COVIDMS COVID-19 relevant case study

The following is a modified and anonymised email I received from a very concerned patient with MS. His treatment plan has been changed because of the COVID-19 epidemic. How would you advise him? Dear Prof GiovannoniI am a 51-year-old lady with active RRMS. I have only had MS for 3 years. I am due to have my first ocrelizumab infusion in 2 weeks time. My MS is active; I had a new lesion...

#COVIDMS Lessons from dengue fever for the COVID-19 epidemic

The immune system is a remarkable thing. It has mainly evolved to protect us from infections and has multiple intricate systems to detect and respond to novel infections. I used to warn my patients on the anti-trafficking DMTs, fingolimod and natalizumab, they should be hypervigilant of acquiring exotic new infections, particularly, neurotropic viruses. The theory was that if the virus got to the...

#COVIDMS DMT use during the COVID-19 epidemic needs to be more pragmatic

I saw several patients in clinic yesterday and had to speak to many on the phone about what to do about the next course of ocrelizumab and cladribine. It got me thinking. According to the Italian society of neurology or SIN (Società Italiana di Neurologia) recommendations on the management of patients with MS during the COVID-19 epidemic we should stop dosing. However, the SIN guidelines...

High-dose biotin disappoints

Disappointing news 🙁 Biotin MedDay has just announced the second Phase III trial, SPI2, of high-dose biotin (MD1003) is negative. I am sure many people with progressive MS will be disappointed. However, this trial supports why we need to blinded, randomised, controlled trials; i.e. to test hypotheses. Let’s hope some lessons will be learnt from the trial data that will inform future trial...

Temperature Sensitivity

Are you temperature sensitive?  In my experience the vast majority of pwMS are affected by changes in temperature; typically it is hot or cold temperature that triggers changes in central nerve conduction velocity that brings on old symptoms. One of my patients reports becoming paralysed if sits outdoors in the sunshine for as little as 30 minutes in the middle of summer. Other report worsening...

#COVIDMS Will COVID-19 mutate?

Human coronaviruses are predominantly associated with respiratory tract infections. This group of viruses includes viruses that cause severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and now the COVID-19 pandemic. One human coronavirus HCoV-OC43 is generally associated with mild upper respiratory tract infections, although it has been shown to have neuroinvasive...

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