AuthorNeuro Doc Gnanapavan

COVID19 reality bites

Hats off to our Italian colleagues – I can only imagine what each day has brought into your lives. Last weekend, I held the notorious position as the last Consultant Neurologist on-call for Barts Health, one of the largest NHS Trusts England with 1,255 A&E patient attendances per day. Monday onward, every able bodied member of staff has been redeployed to a major incident rota, the...

The COVID19 brain

Letter by British Rhinological Society and Ear, Nose & Throat UK Although severe acute respiratory syndrome (SARS) has been the hallmark of severe COVID19 infection, anosmia (lack of smell) and hypogeusia (the reduced ability to taste), headaches/dizziness have also been reported. Is COVID19 neurotropic? We don’t have hard data to support/refute this beyond history from those so far...

#COVIDMS COVID-19 reinfection?

Coronovirus COVID-19 Global Cases The current UK strategy against COVID-19 is built solely around the development of herd immunity within the population (i.e. when sufficient numbers have immunity resisting the spread of the contagion). A risky strategy and relies on a number of suppositions: 1) infection results in immunity, 2) the virus doesn’t mutate resulting in a low chance of...

#COVIDMS Coronavirus COVID-19 – a new era?

Johns Hopkins (see below) have helpfully provided a world map of Coronavirus COVID-19 cases real-time () – join the dots… Despite the UN refusing to call it a PANDEMIC (defined as an epidemic occurring worldwide), scientists and health professionals agree it is just this. This concept of pandemic pandemonium caused by viruses is not new; in fact the record for the most number of...

The secret to drug approval

Each generation is built on trends. Different in it’s uniqueness, like a manifesto set apart from the one before. Popular trends only need to be mentioned once or twice before the herd mentality takes over. Like fashion, cars and the financial world, the scientific world is also susceptible to the whims of trends. So here is a piece of research announcing how trends have influenced FDA (US...

Cannabis use in MS is here to stay

Muscle spasms, stiffness (also known in medical speak as spasticity) and pain are major problem areas in MS. Most are on tablets for this, commonly baclofen, with fewer individuals receiving botox for focal areas of stffness or intrathecal (via lumbar puncture directly into the CSF) baclofen for severe lower limb stiffness. Many also use cannabis for this indication, but the exact usage is...

Pressure ulcer risk

As clinicians so much of our time nowadays is focused on MS DMTs that we lack the time or forget to ask questions about general health and well being during our consults; for example, cognition, employment, co-morbidities and in some instances the risk of pressure ulcers. According to this publication (see below for abstract) 4% of PwMS have pressure ulcers; sacral ulcers being the commonest...

MS-SMART outcomes in SPMS

MS-SMART was a multi-arm two year placebo (dummy tablet) controlled study looking at three putative neuroprotectants in secondary progressive MS (SPMS). The agents studied were amiloride, fluoxetine and riluzole, selected from previous successes at a smaller Phase II level. The scientific rationale is as follows:“Amiloride, widely used as a potassium-sparing diuretic, is an acid-sensing ion...

Cost effectiveness of cladribine vs fingolimod in Portugal

Firstly, this is not about money (I say this without a tell as my accountant taps away at their calculator nonchalantly). Really, this concept of cost-effectiveness is only obtrusive if you dislike politicking in any form or kind, or you’re British. The easiest way to understand cost-effectiveness models in healthcare in my view is to understand the principles of bartering. In bartering...

Clinical trials vs. real-world data in MS

We probably don’t really require a study to tell us that those participating in clinical trials are not exactly the same as the general population that may take a particular treatment – we already know this. However, when it comes to MS drugs it is worth noting what the differences between the two populations are. According to Rojas et al., upon reviewing 18 clinical trials and 73...

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