AuthorIde Smets

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...

Black vs. White pwMS: Mirror, mirror on the wall?

Healthcare is a reflection of how a society cares for its most vulnerable individuals. It is a well-known fact that the U.S. spends more money on healthcare than any other country. Yet among wealthy nations, they have the lowest life expectancy. This illustrates the fact that delivery of medical care is only a minor element in the well-being of a society. Services like maternity leave, housing...

Rebranding the MS prodrome: Missed MS?

A prodrome is an early symptom or set of symptoms that indicates the onset of a disease before more diagnostically specific signs develop. One of the most typical examples is a migrainous aura (i.e. flickerings in your visual field) half an hour before you develop a throbbing migrainous headache. However, very often prodromal symptoms are very unspecific. Clouds could be a prodrome of a storm...

The art of switching!

Natalizumab blocks the lymphocyte migration over the blood-brain barrier and is one of our more potent disease-modifying therapies (DMT). In the phase 3 trial, it reduced the annual relapse rate with 68% compared to placebo and it is typically given as a first/second line therapy to pwMS tagged with the unenviable label of ‘highly active’ disease. However, this is as far as the fairy tale...

Die Wende: Extending the anti-CD20 overdose

It’s a bittersweet fact that wars spark big leaps in science, and this has unfortunately also been true for our fight against the COVID-19 pandemic. When it comes to treating MS, susceptibility to common infections and ability to mount vaccine responses have become important themes among neurologists. Furthermore, pwMS prefer drugs that do not require regular hospital or phlebotomist visits. One...

To all MS earthlings: the DMT tool is ready for take-off!

Elon Musk has not been able to reach Mars yet but we have been able to officially launch the ‘DMT tool’ on the clinicspeak website! On April 29th, we invited all readers of The MS blog to share their opinions about our ‘DMT tool’. This online web tool was designed to help pwMS select a disease-modifying treatment that matches with their lifestyle and is fit for the literal and figurative long run...

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