AuthorNeuro Doc Gnanapavan

Sepsis in MS patients and Intensive care admissions

Sepsis (or blood infection) is a dangerous thing. I remember first realising this as a Junior doctor in respiratory medicine, when an audit of pneumonia admissions revealed a mortality of 60%. Sadly, this has not improved by much even with the latest antibiotics. As I rotated through, transplant medicine, haem-oncology, and finally into ICU, I found myself forever pre-occupied with watching the...

How to recover from an MS relapse

A relapse is one scary experience. The tendency of traditional medicine in the past was to advocate bed rest and the patient to adopt a ‘sick role’. The lack of research in this area meant that doctors were left to adopt beliefs that were outdated by modern standards; they truly believed that bed rest during an MS relapse helped with the recovery process. This would make sense if in...

Pain in optic neuritis – the importance of careful history taking

Optic neuritis (source: Quora) I was recently the on-call Neurologist for The Royal London Hospital, which over the weekend can have an immense catchment area extending as far as Southend Hospital. It was during said on call that I was contacted by the on-call registrar. The story was of a pregnant lady experiencing unilateral eye pain and profound visual loss. Their working diagnosis was...

Rebound after switching with fingolimod

Rebound in MS disease activity occurs when coming off highly-active drugs. It refers to a return in MS activity that is more than before. The drugs most likely to demonstrate this are the highly-active treatments that are given on a regular basis (i.e. maintenance treatments, such as natalizumab and fingolimod – it is too early to say with ocrelizumab) that create a gating system for the...

Real-world figures on the efficacy of anti-CD20 in PPMS

In the UK ocrelizumab, an anti-CD20, is licensed for the treatment of Primary Progressive MS (PPMS) and Relapsing Remitting MS (RRMS). Rituximab, although not licensed for use in MS in the UK is also an anti-CD20 therapy with immunosuppressive properties. The two are matched in their efficacy in terms of reduction in disease progression (see Figure below) and serum neurofilament (sNfL) in PPMS...

Psoriasis as a side effect of Ocrelizumab

I would be interested to know how many of you have experienced this with ocrelizumab (Ocrevus)? Is it a rare event or more or less uncommon (see Figure below). How to classify the likelihood of side effects Case 1 in this publication is a 40y old female with PPMS (Primary Progressive MS) who developed after the first half year of treatment, pustules, loss of skin, redness of her palms and soles...

My predictions for 2022 foresee choppy waters for Clemastine

Figure: Myelin formation (source: Jackman et al. Physiology (Bethesda). 2009 October ; 24: 290–297. doi:10.1152/physiol.00016.2009) Clemastine is a first generation anti-histamine used to relieve the signs and symptoms of hay fever. However, it is its purported remyelination properties have garnered great interest in the MS community. No fairy tale run smoothly as you can see from this recent...

Brain inflammation in MS, ongoing activity leads to axonal breakdown

In so far as your immune cells are concerned there is a vast difference between the brain and the rest of the body . In fact, the only resident immune population in your brain are the microglia and the perivascular (surrounding blood vessels) macrophages. These immune sentinels change their baseline identity depending on the disease (see the two figures below). This segregated state also means...

A study from Norway finds that a good BCG vaccine response reduces MS risk

Figure: BCG vaccination and its many effects on the adaptive and innate immune system (source: Frontiers) We don’t really know what triggers MS. Genetics, EBV/other viruses, vitamin D and pathological levels of stress have all been associated with the onset of MS. In a recent study, investigators have now also found an association with Tuberculosis (TB) – namely it’s vaccination...

What your personality says about you?

Oddly enough Freud’s Theory on Personality still applies to this day and age. The array of competing forces between the ‘Id, Ego and Superego’ describe one’s personality to tee. But, psychoanalytics aside, I would like to mention for those researching/designing MS treatment programmes, structuring them in accordance with a persons underlying subconscious personality can...

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