AuthorIde Smets

Improving MS outcomes: The smoke in our eyes!

Many of you will have registered themselves on the UK MS registry. This is an online registry that aims to monitor the motor, mood and treatment status of pwMS based on what we call patient-reported outcomes or PRO’s. This means that pwMS voluntarily fill out simplified MS questionnaires every 6 months after being prompted by MS email spam of the most honourable kind. Based on the responses of...

Is your mind ready for a derisky business?

Over the past years, anti-CD20 treatments such as Ocrevus have quickly superseded other DMTs on the first and second line treatment shelf. This is good news, because Ocrevus has a high efficacy in controlling MS-related inflammation. The MRI results are very impressive, and pwMS treated early with this drug will definitely do better in the long run. However, the most logical outcome of solving...

DMT tool vs. The Flawed Milky Way

Urbanisation is by and large a good thing, and I wouldn’t want to miss the buzzing environment of people, culture and, last but not least, cuisine for a second. However, it comes with an annoying side effect: more dangerous city streets. Last week, I had to experience this the hard way. Decennia of intelligent road design couldn’t protect me from being hit by a car while going out for a run. How...

Advanced pwMS skills: Reading between the lesions!

For many pwMS, the annual MRI scanning has become an anxiety-provoking routine. The goal is to compare the most recent MRI with the previous one. Similar to a sepia or black-and-white filter on your camera, we use different MRI filters to improve visualisation of certain brain structures. A T2-sequence is the MRI filter we use to visualise (new) MS lesions. If new lesions appear between scanning...

Booming the babies: ‘DMT-free’ family action!

The mean age of women in the European Union on giving birth to their first child has gradually increased from 28.8 years in 2013 to 29.3 years in 2018. Importantly, it has increased in all EU countries over this period. As the majority of female pwMS develop the disease in their early thirties, it’s therefore not acceptable to take decisions on DMTs without discussing the implications for family...

Invisible MS aging: Grey pride movement kick-off!

There are currently several ongoing clinical trials that examine whether disease-modifying treatments (DMTs) can be stopped in pwMS with stable disease or above 50 years old. They will evaluate whether clinical relapses and new MRI lesions are more frequent upon discontinuation vs. continuing therapy. Ironically, they coincide with the registration of siponimod as a DMT in secondary progressive...

New DMT species: An efficacy sheep in wolf’s clothing

In MS, there is a distinction between first- and second-line disease-modifying therapies (DMTs). Newly-diagnosed pwMS often start with a so called ‘first-line’ drug. These drugs balance low to medium efficacy with a favourable long-term safety profile. This is a potentially interesting DMT choice when it’s not entirely clear yet how ‘active’ an individual’s MS will be. Protagonists are Tecfidera...

Does true patient consent exists? – NO

In a recent MS Journal Club, my colleague Heather Mah  presented an article about patient involvement in research. This then prompted the discussion about research bureaucracy, patient information sheets, and the standard of consent. Patient information sheets (PIS) are often long, text heavy documents that are impossible to understand. They are intended to provide all the information about...

Why I’m no longer talking to pwMS about wheelchairs

When newly diagnosed pwMS enter a clinic room, they have read up about MS and are often focused on the daunting idea of ending up in a wheelchair or having to use a zimmer frame. From natural history cohorts before disease-modifying treatments (DMTs) were introduced, we know that for an untreated pwMS it takes a median 11.4 years to reach EDSS 4/not being able to walk unrestricted anymore, 23...

Back to school: Does one new MRI lesion matter?

Although neurologists love to brag about their ‘fingerspitzengefühl’, pwMS will have experienced that the clinical examination is only a smokescreen for what really determines clinical management: brain imaging. Especially during the COVID-19 pandemic, MRI was our germ-free way into an MS brain. The goal of requesting an MRI is to compare the number and volume of MS lesions with the previous scan...

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