AuthorGavin

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

Unassisted

Let’s talk about death, that is unassisted suicide.  The meta-analysis below, not surprisingly, shows that if you have MS your chances of suicide are about twice the background rate. The risk is particularly high at diagnosis compared to symptom onset. I suspect this latter is an artificial finding; if you commit suicide before you are diagnosed with MS the code ‘multiple sclerosis’ is...

Cubed

How do we colour in each block of this cube? Making a decision about which DMT to prescribe, or preferably to help your patients make a decision, many of my colleagues mix up their priorities. For example, some mix-up baseline prognostic profiling and disease activity, and then some of them throw disease-stage or disability progression into the mix. I think this occurs because these factors are...

Bandwagon

Our microbiomes are clearly very important, but they don’t come close to explaining why you get MS and whether or not one of our microbiomes is causal in MS. Yes, there are multiple microbiomes in and on our bodies. At the moment the attention is all focused on the gut microbiome, in particular, the distal colon. Why? Because it is easy to collect poo samples. But why the colonic microbiome in MS...

Black Swan?

Is this the black swan I have been looking for? We need to be able to explain smouldering MS and why pwMS get worse despite having no evident disease activity (NEDA) on DMTs. One of the hypotheses is that something is occurring within the brains and spinal cords of pwMS. I have referred to this in the past as the field hypothesis and have suggested that it could be due to an active virus within...

Taking flak for off-label prescribing

I was still wet behind the ears, in my 3-year as a neurology registrar in Johannesburg, when I first used an off-label DMT in MS. I manage to convince Vivian Fritz, my professor of neurology, to allow us to treat one of her patients with MS with mitoxantrone. This was shortly after the first case series had emerged from Germany. The patient concerned was a young woman with malignant MS who had...

Marmite on toast: the social crisis and MS

Recently one of my patients chastised me for telling her off for her poor diet, which consisted mainly of bread. She lives alone, which may explain why she eats so poorly. She has marmite or jam on toast for breakfast, a sandwich for lunch and if she feels hungry another piece of toast for dinner. Interestingly, my mother used to refer to her elderly stepmother as a tea-and-toast lady and I never...

Japan epicentre of an Asian MS epidemic

I am about to return from a short MS meeting in Tokyo. This was my first exposure to Japan and Japanese culture. It is everything and more than I expected. I am beginning to get a sense of what ikigai means. Ikigai translates ‘to a reason for being, encompassing joy, a sense of purpose and meaning and a feeling of well-being’. Ikigai derives from iki, meaning life and kai, meaning the realisation...

Does your neurologist walk the talk?

Thanks to Daniel Kahneman and Amos Tversky behavioural psychology and behavioural economics have become very sexy. Kahneman & Tversky have spawned an industry of nudge theorists; people who devise ways of getting populations of people to do things that are good for them. People with MS are no different from the general population when it comes to doing what they are told to do. We have major...

Reinventing the wheel or the 4×4

We were rightly criticised last year for holding a meeting that highlighted the problem of variance in the provision of MS services, in the NHS. without a plan and vision about how to change things. I hope we have listened to you. The follow on meeting that we are hosting next month (8th-9th July) has a more ambitious agenda; it will even come with a 3-year action plan. I have always made the...

What has getting old got to do with MS?

The brain and spinal cord were not necessarily designed by evolution to last longer than approximately 35 years. It is only relatively recently that as a species we have extended our lifespans. Once you go beyond approximately 35 years of age there is a gradual loss of nerve cells, axons and synapses. This explains why as we get older we notice the effects of ageing; reduced vision, loss of...

Translate

Categories

Recent Posts

Recent Comments

Archives