AuthorNeuro Doc Gnanapavan

Botox for hand tremors

Image from Verywell Health Hand tremor in MS can be very debilitating leading to an inability to hold things, as well as leading to hand weakness. In many instances, this is due to involvement of the cerebellum (part of the brain dealing with coordination), rather than the basal ganglia that is involved in Parkinson’s. MS-related tremors tend to respond poorly to oral medications used for...

Having sight but no vision

The blurring of vision in MS is synonymous with optic neuritis in most instances, however visual defects also occur secondary to lesions in the brain proper. These are often silent or misconstrued as the former. Below is a pictorial representation of potential field defects based on the area of lesion location within the visual pathways of the brain: Little is known of the evolution of these...

All clear on the disability progression?

Confirmed Disability Progression (CDP):Measures the increase in a patient’s EDSS score that is sustained over a pre-determined time period, which means a patient’s physical disability has increased. As more more drugs enter the MS market, the line between what drugs are used where (RRMS vs progressive MS) has begun to blur. This matter is further complicated by most of us not understanding the...

Plot thickens: MS versus other antibody disorders

The MSVirtual2020 late breaking news was announced this weekend. Despite a diagnostic biomarker for neuromyelitis optica (the Aquaporin 4 antibody), it remains difficult differentiate NMO from MS clinically. Dr David Leppert from Basel, Switzerland presented their findings on biomarkers of the innate immune system, focusing on neutrophil activity markers (a type of immune cell) in the...

T cells bite the dust

An interesting presentation from this years MSVirtual2020 was presentation by Dr Beatrice Wasser on ‘GlcNac signalling to reduce T cell pathogenicity in MS’. Abstract Background: Both adaptive and innate immune cells infiltrate the CNS during multiple sclerosis (MS) and in its animal model experimental autoimmune encephalomyelitis (EAE). Pathogenic T cells are known as key drivers of...

Progressive MS – Masitinib another duck lines up at MSVirtual2020

There is further hope in the horizon for progressive MS. The Phase III clinical trials were announced at MS Virtual 2020 this Sunday, adding a second third agent to the potential hopefuls in the progressive MS armamentarium. The first two being ocrelizumab and siponimod. Masitinib is designed to block the activity of multiple cell types, including microglia/macrophages, neutrophils, mast cells...

An App to sniff out MS

Like a pig snouting truffles, can Artificial Intelligence diagnose MS? I used to think neurologists did this – one has a nose for these things 😉 The app uses a matrix involving a ‘mood questionnaire’ to figure out well being; ‘symbol matching’ to assess cognition; ‘walking’ using a step tracker; ‘u-turn’ assessing ability to turn;...

MS Virtual 2020: Biomarkers

It’s that time of the year again, ECTRIMS in conjunction with its American counterpart, ACTRIMS will now be featured as a virtual conference in the coronavirus era. The program is more streamlined than before, running between Fri, Sep 11 – Sun, Sep 13, 2020. This year, my focus will be again be on the biomarkers session (Fri, Sep 11) eager to see what’s new and what’s not...

Walk beside me…just be my friend

“Don’t walk in front of me… I may not followDon’t walk behind me… I may not leadWalk beside me… just be my friend”― Albert Camus Since lock-down or ‘knock-down’ as I like to call it, I’ve succumbed to the reading club. I have just completed the reading of ‘Motion of the body through space’ by Lionel Shriver, which in my haloed opinion is the most depressive book that...

Neurofilament and vitamin D supplementation

In a moderately sized study from Finland, investigators wanted to know whether the addition of vitamin D to interferon-beta-1b (a first line disease modifying treatment) had a favourable outcome on disease activity. In order to assess this they measured serum (blood) neurofilament levels a protein found in neurones as a marker of MS disease activity. What they found was that the addition of...

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