AuthorNeuro Doc Gnanapavan

Spanner in the works for intrathecal rituximab

Figure: To-and-fro bi-directionality of CSF flow in the brainBy © Nevit Dilmen, CC BY-SA 3.0 I get a sinking feeling in the pit of my stomach when I read this article. Starting out in science, one is considered smart when following the trends of the populist. As a seasoned scientist, when one continues to work in this way, one is just not being too clever. I am not being disparaging of those who...

We sincerely apologize, but you don’t have MS

The rate of misdiagnosis of MS around the globe is roughly a quarter. We are so focused in making an early diagnosis in MS that before we know it, it’s a runaway train. Sometimes, even the best of us need to eat our words, and admit to having a made a mistake. The diagnosis of MS is not easy; how many of you have googled non-specific symptoms and come up with MS as a potential cause? The...

Why some treatment is better than no treatment

For Relapsing-remitting MS we currently have option of highly active therapies, as well as first-line therapies that are less efficacious. You may question why anyone in their right mind would develop a treatment that was no good, then conversely ask yourself, why if there are treatments available, even not so good ones, are some people not any of it? This is not me pitching for the next...

MS in a snapshot: Global Burden of Disease study 2016

Trying to understand disease, especially rare disorders, at a global level is a Herculean task; not only from a resources perspective, but also from the cost and logistics involved. Before, the Global Burden of Disease study presented here, there was the Multiple Sclerosis International Federation that provided up to date figures on the global epidemiology of MS back in 2008. So, almost a decade...

Calculate your risk of developing MS from first presentation

We now understand that the early features of the condition matter; the more active the disease in the first five years the more likely you are to reaching the hard disability milestones (such as requiring a walking stick) that much sooner, than if the converse were true. But what about the development of MS (or CDMS, clinically definite MS) after the first clinical symptom (CIS, clinically...

How to manage RRMS – induction followed by maintenance

I’ve been harping on about this strategy for the better half of the past two years, and lo and behold someone has actually done it, and it actually works. The drugs utilized in this study are in fact irrelevant, the importance is the strategy itself. What strategy you ask? Rodo’s Thinker! I’m glad you asked. The one where you go in with all guns blazing and then follow it up...

Loneliness in 2019

Rehabil Nurs. 2019 Jan/Feb;44(1):52-59. doi: 10.1097/rnj.0000000000000128. Loneliness in Multiple Sclerosis: Possible Antecedents and Correlates. Balto JM, Pilutti LA, Motl RW. Abstract PURPOSE: The prevalence and possible antecedents and correlates of loneliness in multiple sclerosis (MS) was examined. DESIGN: Cross-sectional, comparative study of MS (n = 63) and healthy adults (n = 21)...

Happy New Year and don’t forget to take your tablets!

Mult Scler Relat Disord. 2018 Dec 19;28:104-108. doi: 10.1016/j.msard.2018.12.025. [Epub ahead of print] Adherence to oral disease-modifying therapy in multiple sclerosis patients: A systematic review. Yoon EL, Cheong WL. Highlights Fingolimod has the longest time to discontinuation when compared to dimethyl fumarate and teriflunomide. Fingolimod may be better tolerated than dimethyl fumarate and...

The end of gadolinium use in MS imaging

Merry Christmas everyone, and Happy holidays 😊 Whilst, writing today’s blog post I find myself fortunate to be able to look back and say MS has come leaps and bounds over the last ten years, and looking ahead we stand at the cusp of an increasing number of clinical trials targeting progressive MS. Scientists and doctors have worked hard to improve the sensitivity of our diagnostic...

Can Alemtuzumab reduce CSF neurofilaments? A Barts MS Study

Amongst the heavy hitters that includes fingolimod, alemtuzumab, natalizumab and ocrelizumab, the ultimate measure of treatment effectiveness is their ability to protect brain volume loss. The release of axonal proteins, including neurofilaments, have been demonstrated to closely emulate this slow brain volume loss that we see in MS (Figure 1).  Figure 1: Scatterplots showing...

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