AuthorIde Smets

Pack your DMT tools for the long run!

Over the past year, I was privileged to counsel many people when starting an MS disease-modifying treatment (DMT), and reviewed even more pwMS whom had been on a DMT for a considerable amount of time. This has given me valuable insights in which drug-related characteristics matter in the long run, both literally and figuratively. First, there is no doubt about the fact that some drugs are more...

Happy dominos are the prettiest!

The prevalence of MS is not equally spread around the world, and is associated with latitude. Apart from some exceptions such as Sardinia, people living more closely to the equator are less likely to develop MS. Strikingly, when an individual moves before the age of 15 years old from for example Kenia (low MS prevalence) to the UK (medium MS prevalence), it will acquire the MS risk of his new...

Vaccine Trumpism for President!

A pneumonia might not sound like something you necessarily want to avoid in life, or not something that ‘coughs’ you awake. However, outcome data on pneumonia in non-hospitalised individuals do indicate it’s not a benign condition. A large study in Germany showed a 30-day mortality of 6.3%. Obviously, this was mainly driven by age (mortality was 2.2% below 65 years old) and nursing home status...

Minimalism in MS: More is Less!

Our eyes are a very promising window into the brain. By looking into the eye with a technique called optical coherence tomography (OCT), we are able to visualise the retina’s ganglion cell layer that consists of naked, unmyelinated neurons. When MS’s inflammatory lightning affects the myelin sheet of the optic nerve (which is the case in 99 % of pwMS), this ultimately leads to dying back of...

“Only your eyes can show the suffering” dixit Fausto Coppi

Once upon a time, there were cyclists as Fausto Coppi. He was the kind of guy that attacked 5 km after the start of the race (Milan San-Remo 1946), and then dropped the rest of the lead group with 14 minutes on the ‘Passo del Turchino’ or ‘who-wins-on-the-Turchino-wins-the-race’. He not only won the Tour de France twice, he did it with a ‘martian’ dominance. In 1949, there was a 14’ difference...

Becoming an MS outlier: the manual

MS outliers are pwMS that are different from all other people diagnosed with the disease. Being an outlier could go both ways. Some pwMS develop significant disability very short after being diagnosed while others live with the disease for decades and are still out and about. The problem is we cannot reliably predict the disability trajectory of pwMS at diagnosis. Observations in big groups of...

Are you ready for the “dørstokkmila”?

One of the things that has struck me during this COVID-19 pandemic is how little many pwMS move. Very often I speak to young pwMS that have low levels of disability but hardly reach 2000 steps a day, which corresponds to 1.5 K or 1 mile. Similarly, also people with advanced MS told me that lockdown has been detrimental to their levels of physical fitness and report an increase in spasms and...

The blinding lights of ‘Mesenchymal Stem Cell Transplantation’

Recently, the first phase II double-blinded trial of mesenchymal stem cell (MSC) transplantation in MS was published. MSC reside mainly in the bone marrow compartment. These stem cells can differentiate into a variety of cell types, including osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat tissue). They do not evolve into immune cells. To...

Ibudilast in Progressive MS: Hope with the size of a peanut

Neuroprotection has been a tough nut to crack in MS, and essentially we are still eagerly waiting for the first drug that improves neuronal survival without impacting on inflammation (such as our beloved CD20 antibodies or siponimod). Ibudilast is one of the latest molecules that has tried to influence progression in pwMS… In the 2018, Ibudilast (n=129) was compared with placebo (n=126) in...

What Einstein forgot: Multiple Sclerosis curbs “spacetime”

We all know that time is relentless and cruel. However, do you believe it ticks at the same imperturbable pace for all of Earth’s inhabitants?  This has been a controversial topic among scientists, and one of Einsteins biggest mindboggles. Newton believed time was absolute “true time”. If the universe was to be frozen, time would tick on regardless (lockdown has taught us this is definitely...

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