AuthorNeuro Doc Gnanapavan

Ponesimod in RRMS – long-term clinical trials

Ponesimod, like fingolimod and siponimod preceding it block the ability of lymphocytes to leave the lymph nodes, thereby lowering circulating lymphocytes. As such the clinical effect is similar in the broad sense to that of it’s parent compounds – this includes efficacy and side effects. Unlike fingolimod (2nd line for active RRMS in the UK) and siponimod (reserved for active SPMS in...

Does COVID19 affect your brain?

COVID-19 is pretty much a gift that keeps on giving. Couple of facts about COVID19 – immune response, particularly antibody response is not sustained (out goes the idea of establishing herd immunity), the brain is involved (headache and lack of smell being the commonest presentations), and long COVID exists. We’ve faffed about whether it affects MS adversely or not, an increase in...

Who would have guessed but DMDs improve survival

The number of times I’ve been asked whether DMTs have any impact in survival is countless. For those of you who are aware of the effect of MS on survival these study findings will be of great interest to you. It will also hopefully gets people who are still unsure about starting treatment off the fence. In a large review of administrative health databases in Canada amounting to 35,894 MS...

Should your neurologist take the lead?

I get it, it is all about shared decision making when it comes to selecting the right treatment for you in MS. But, this requires both individuals to be on the same page. When you’re dealing with a condition that affects the brain primarily it adds complexity and calls into question the validity of this process. A few months back, an MS patient informed me that I should have just told him...

EBV in Germany, is this the answer?

EBV, vitamin D and genetics are probably some of the most commonly reported risk factors for MS. All studies report these in terms of hazard ratios comparing occurrence in the exposed versus non-exposed individuals. Hazard ratio (HR) = (risk of outcome in one group)/ (risk of outcome in another group) An HR of 1 therefore means lack of association, a hazard ratio of greater than 1 suggests an...

Spot the mistake? A self-fulfilling hypothesis

En face this research seems straightforward, but upon reading the methodology of the manuscript my first thought was ‘huh’? Why the ‘huh’? Well, if you’re going to study on humoral immunity (i.e. antibody formation), the drug not to use is Ocrelizumab or any other anti-CD20 for that matter. The MOA (mode of action) of anti-CD20s is to target B-cell function and...

Does MS affect your baby?

There is little information out there on the effect of MS on a baby born to a mother with MS. Previous reports have noted a greater occurrence of pre-term delivery in mothers taking disease-modifying drugs (DMDs), as well as more C-sections and instrumental delivery. Anaemia and a greater occurrence of UTI has also been reported. In a review of 211 MS pregnancies in Italy comprising of foetal...

Domestic violence – a study reports from Iran

Domestic violence, often known as domestic abuse or intimate partner violence (IPV), is any pattern of behaviour aimed at establishing or maintaining dominance and authority over a partner. IPV is any kind of sexual, emotional, financial, or psychological harm or threat against another person. IPV is one of the most prevalent forms of violence against women worldwide [excerpt taken from this...

Does Teriflunomide as a DMT warrant discussion?

Speaking as a clinician who goes by the mantra ‘treat early, treat hard’, platform therapies as a whole receive less attention from me than highly-active treatments. However, I know that they have a place in the MS armamentarium and admittedly, I have a more than few patients on Teriflunomide. Some of whom have been stable on it for many years, whilst others I’ve had to transfer...

An EDSS of 0 – are you normal?

I hope many of you are a familiar with your EDSS score? If you attend an MS clinic, the score can be found in your clinic letter. It is used as a scale for defining the MS disease course focusing on disability levels; in particular your ability to walk. Rarely, an EDSS of 0 or “normal” is used when there are no objective signs of dysfunction in the different functional systems of the...

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