AuthorNeuro Doc Gnanapavan

Immunodeficiency after MS treatments, a rising concern

You can read the full text of this review article for free on the internet, but in a nutshell the article is about secondary immunodeficiency after immunosuppressive treatments. Immunoglobulins or antibodies are produced at a basal level in all of us to protect against infections. However, when you are low in antibodies you’re at an increased risk of infections. This ranges from a common...

Can you predict the next relapse? K-FLC in MS

I was recently in Vienna hearing about a relatively new biomarker, the kappa (k)-free light chains and their value in the diagnosis of MS. To date, biologically the oligoclonal bands in the cerebrospinal fluid (CSF) remain the gold standard for diagnosing MS. Oligoclonal bands in the CSF (also termed intrathecal restriction) represent the production of antibodies in the CNS that is unique to...

It’s in your eyes!

Human eye (image from familyhealthtale.com) I know what you’re thinking. You’re thinking that I’m going to write about optic neuritis since this is what everyone writes about. But, you will be wrong. This post is about the lesser well known portion of the eye – the conjunctiva. In a small cross-sectional study of MS patients and controls, a group of investigators from...

Multiple Sclerosis and being a woman

MS is commoner in women than men. In fact the incidence of MS is increasing all over the world but this seems to be preferentially in women. Now this new publication looking at cases and controls (through a process of enrichment from a large group of women with MS) is suggesting that there are marginal differences in non-natural menopause in MS females, with more cases observed in MS. Moreover...

A new spin on immune reconstitution

We’ve all heard of alemtuzumab induced thyroid autoimmunity; a side effect affecting roughly 30-48% of individuals receiving the treatment. It is believed to occur when immune cells, particularly autoreactive IgG+ memory B cells return early following depletion of the lymphocytes, leading to a breakdown in the immune tolerance towards the thyroid. But, according to this case report, an...

Serum neurofilament light chain falls short of the bar

Is having a blood test version of this test simply a pipe dream I wonder? Will we have to do lumbar punctures to really find out what’s going on in the brain with MS? These are questions I grapple with on a regular basis in this field, and what complicates matters is that is positive data and negative data on blood NfL predicting disability progression in MS. This recent publication shows...

COVID-19 vaccination and brain inflammation, fodder for anti-vaxxers?

The whole pandemic is like watching a slow-mo rendition of the ‘The Good, The Bad, and The Ugly’, where Eastwood keeps repeating the same lines over and over. Then enter those who are actually slow on the uptake, the wannabe anti-vaxxers who may use this article as evidence for their ideals. So, how can I portray the findings of this case series as no more than a rare occurrence and...

Is MS the new paraneoplastic disorder?

The most interesting of scientific discoveries are sometimes hidden in the most obscure of places. In this case an open access journal that I’d never heard of before, and a discussion from the authors that is close but no cigar. The authors report of a 39-year-old woman who presented with a demyelinating brain lesion, but on further search was found to also have a thymoma (a thyroid cancer)...

Bexarotene for remyelination, the full article is now available

This study is now finally published. The initial findings were presented virtually at the last ECTRIMS and although the study was negative (i.e. the primary outcome was not met) it is still interesting to read the whole caboodle in the final article. The road to remyelination has been a tough one, and this one in particular is underpinned by at least a decade of basic science preceding it...

SIZOMUS randomized clinical trial is on the roll

SIZOMUS anti-plasma cell RCT I’m happy to notify that SIZOMUS (Safety of IxaZOmib targeting plasma cells in Multiple Sclerosis) is re-commencing after MHRA approval. This follows a pre-planned interim safety analysis. MHRA stands for Medicines & Healthcare products Regulatory Agency and without their say so this trial would not have been able to proceed. The Medicines and...

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