AuthorIde Smets

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...

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...

Translate

Categories

Recent Posts

Recent Comments

Archives