AuthorNeuro Doc Gnanapavan

Brain volume loss in MS

Cognition (thinking, memory and learning) is known to be affected in MS. This is more so in progressive MS. In a study last year, it was found that those with more structural damage to the brain at baseline were more likely to have cognitive issues. And more likely that not cognitive issues were encountered if the brain cortex was involved (the area comprised of the surface of the brain where...

Shrinking MS lesions – anything to take note of?

Are you surprised that some MS lesions shrink in size? It has nothing to do with quantum mechanics – Planck’s constant or Pym particles. However, it has been noted for a while now that in some individuals their MS lesions could shrink. The prevailing hypothesis is that shrinking lesions represent resolution of the underlying inflammation or even possibly repair. Others believe, like...

JCV index and the effect of DMTs

JCV STRATIFY (anti-JCV antibody) test has been utilized for more than decade to de-risk natalizumab treatment and other DMTs for risk of PML (Progressive Multifocal Leukoencephalopathy). Cases of PML have occurred predominantly in natalizumab, but less commonly with fingolimod (Gilenya), dimethylfumerate (Tecfidera) and rituximab. A high JCV antibody index value indicates that the risk of...

All for one and one for all

“All for one and one for all”- The Musketeers FACTS Fact 1 – Siponimod (Novartis Pharmaceuticals) trialed for SPMS, but the FDA label sits as Clinically isolated syndrome (the first clinical episode), Relapsing-remitting MS, and active Secondary progressive MS. Fact 2 – Ocrelizumab (Genentech, Roche Pharmaceuticals) trialed for RRMS/PPMS; the latter has been shown to be...

ECTRIMS 2019: Biomarkers

ECTRIMS, Stockholm Biomarkers session Finally in the ECTRIMS mood! Hundred Unbelievable that an year has passed already since the last one, but before I get maudlin, lets get some focus back in. I’ll be co-chairing a session this Friday with Dr Salzer, from Umea University, Sweden (Rituximab man). You can see all the topics of discussion in the program above, but for those of you who...

Is telemedicine the future?

Medical care without leaving your home – has an attractive ring to it; but, one that has been a reality for many parts of the world where ease of access to healthcare has been an issue. For example, in Scotland, ‘Telestroke‘ was developed to allow acute stroke patients to be evaluated by a stroke specialist within the 4.5h thrombolysis window, remotely. Increasingly telemedicine...

The central vein sign in MS

Multiple Sclerosis (From Reich et al NEJM 2018) Last week, I blogged on smoldering lesions visualized on MRI as a marker of progressive MS. Today, I will discuss the central vein sign. This publication in JAMA by the MAGNIMS group (a group of MRI bods from the world over) is therefore, timely. If you haven’t heard of the central vein sign, it is the presence of a vein within an MS lesion...

Chronic lesion activity in MS as seen on MRI

If you’d asked an year ago on whether I though MRI had a role beyond diagnosis in MS? My answer would have been an emphatic ‘NO’. The Achilles heel of MRI has always been the difficulty of standardizing scanning techniques to a large scale population level and adapting these accurately to work seamlessly during the day-to-day shortcomings of clinical imaging facilities within...

Thyroid disease with Alemtuzumab – risk mitigation

There is a popular old saying in English – “forewarned is forearmed”. Prior knowledge that something is going to happen offers tactical advantage, whether you’re at war or simply everyday life. The difficulty, however, is that more often than not we are transfixed by the detail of the matter, resulting in numerous avenues of investigation in the process, some of which are...

Is cholesterol truly bad for you?

Low-density lipoprotein particle, apolipoprotein B (blue) is surrounded by various forms of cholesterol (orange and yellow) and other lipids. JUAN GAERTNER/SCIENCE PHOTO LIBRARY Scientists have known for a long time that cholesterol like other basic food components forms an essential component in a healthy human body. It forms the cell membrane architecture (or the cell wall), helps produce the...

Translate

Categories

Recent Posts

Recent Comments

Archives