Source: Over the past decade, a lot of new MS disease-modifying treatments (DMTs) have entered the market leaving pwMS with a wide range of DMT options. Depending on the country, a treatment naive pwMS can nowadays choose between 15-20 different drugs,* which is an out-of-reach range for many other neurological diseases. At first glance, gratitude prevails. However, this expansion has...
Pain quotidien: lesion detection algorithms as an add-on treatment?
In the MS field, the equivalent of humanoid robots are computer algorithms aimed at replacing the expert eye of radiologists. To assess whether new lesions are present on a follow-up MRI, a radiologist needs to compare your previous brain scan with the current one ‘slice-by-slice’. This sounds more straightforward than it is. Especially if scans are not performed on the same scanner...
Haute CD20 couture: Swedish designer trials!
Many pwMS are currently treated with ocrelizumab (OCR, Ocrevus) which is an antibody targeting a surface protein named ‘CD20’ on B cells leading to longstanding depletion of this cell type. Some of you might wonder why we are not treating pwMS with OCR’s older, cheaper and more experienced brother: rituximab (RTX, Mabthera). RTX also targets ‘CD20’ resulting into profound B cell depletion. It was...
Project hindsight: Dutch aHSCT awakening!
Lately, there has been a lot of of debate about the position of aHSCT in the MS treatment field. Evolving insights fuelled by the actions of MS charities and the conclusions of the recent ECTRIMS focused workshop on aHSCT have triggered the Dutch Association of Neurologists to change their point of view on the matter, namely that there is no role for aHSCT in the context of MS treatment. In May...
Tripping over the red tape: Purple crocodiles in your pool?
One of the often unadressed consequences of an MS diagnosis is that you need to gain a new and unwanted expertise: you need to debug the services of your health care provider. Irrespective of whether you suffer from MS-related fatigue, walking difficulties or reduced vision, you will need referrals for rehabilitation services such as occupational, physical or vocational therapy or for adjusting...
Clinical-MRI paradox: Do you stop for groceries at night?
There are three ways of demonstrating disease activity in MS. First, pwMS can experience new neurological symptoms compatible with a relapse. Second, blood or CSF neurofilament levels can be elevated which indicates brain damage because of ongoing inflammation. Third, there can be new inflammatory lesions on a brain or spinal cord MRI. From a biological point of view, there is no hierarchy...
Zipping the DMT pyramid: What’s your sNfL Z-score?
Neurofilament light (NfL) levels are a promising biomarker of disease activity in MS. These brain proteins are released into the cerebrospinal fluid when neurons die and they tell us when MS-related focal inflammation is still damaging the brain or spinal cord. The biggest advantage of NfL over other techniques to measure brain volume loss such as brain MRI is that they can be measured in the...
AHSCT in pwMS: Not all squares are red
For many pwMS, autologous hematopoietic stem cell therapy (AHSCT) is considered as the holy grail to control MS disease activity. Based on the outcomes in people with very active disease, AHSCT is definitely more effective than any other DMT we currently have in our armamentarium, especially when used early. Comparative studies revealed that the proportion for whom no evidence of disease activity...
MS futuroscope: Are you a quitter?
Free your brain! Source: One of the burning matters in the MS community is how long we should advise pwMS to continue with immune suppressive therapies such as anti-CD20 monoclonal antibodies (mAb) (e.g. ocrelizumab). Current situation: At the moment, when you start with anti-CD20 there is no prefixed end date, implying you will continue years and potentially decades with the drug. As the...
Natalizumab’s airplane mode: PML vs. cessation relapses
The implementation of risk mitigation strategies in medicine is highly dependent on the context, and there is a thin line between an unwanted adverse event being considered as a medical error or an unfortunate portion of bad luck. Similar kinds of ambiguous risk assessments are implemented in our daily life. Many of our friends and colleagues have been injured by car accidents and almost never we...