AuthorNeuro Doc Gnanapavan

Clinical trials vs. real-world data in MS

We probably don’t really require a study to tell us that those participating in clinical trials are not exactly the same as the general population that may take a particular treatment – we already know this. However, when it comes to MS drugs it is worth noting what the differences between the two populations are. According to Rojas et al., upon reviewing 18 clinical trials and 73...

Adenovirus infection after HSCT

Adenovirus is pretty common in the general population, responsible for the common cold, sore throat, bronchitis, diarrhea and conjunctivitis. It is harmless in most instances and like the herpes virus, most of us remain latently infected. During periods of immunosupression, however, the adenovirus can reactivate causing untoward trouble. The latter can range anywhere from organ-specific...

As the New Year dawns, a look back @ Barts neurofilament service

Back in 2015 there was a great need to prognosticate in MS, predict high risk subjects from low risk, and select appropriate treatments based on disease activity in MS. We envisaged back then that the neurofilament test (a neuronal protein that is released during damage) would be a robust marker for risk-stratification in MS, and introduced into our clinical practice at Barts, instead of it being...

To botox or not to botox

That is the question: Whether ’tis nobler in mind to sufferThe slings and arrows of bladder instability,Or to take arms against a sea of troubles,And by opposing end them? –Shakespeare a’la NDG Bladder botox treatment If you suffer from bladder dysfunction, ask yourself why put with the dry mouth from Vesicare and Co., when a few injections of botox per year will do? It works...

Gripes about DMF

In real-world terms, figures from the Swedish MS registry demonstrate that most PwMS discontinue a first-line DMT within 2 years of starting. Side effects make up bulk of the reasons, followed by lack of efficacy. When you consider highly-active treatments, their high efficacy outcomes go a long way to compensating for their down-side. When faced with the low efficacy drugs, their side effect...

Neutropenia with ocrelizumab

If you buy into the mantra that a B cell therapy only works on B cells, then think again. Like a debutante three years shy of their first season, successful targeted therapies in the immune world are disappointing to say the least, and most definitely fall short of initial expectations. B cell ontogeny Ocrelizumab a humanized monoclonal antibody targeting CD 20 on the surface of B cells during...

Sustainable career in MS

Believe it or not, over a life-time an average person spends 3,750 days at work. Work provides income, independence, structure to the day, social interactions, and personal satisfaction from a task well done. Based on published figures the workforce population is aged between 15-64; with 50-64 and 25-34 year olds contributing to the bulk of this (see Figure below). And MS is in the thick of it...

The cost of treating MS

One of my patients recently asked if they could return their tablets back to stock as they had decided not to make the swap as initially planned. Of course, the tablets could not be returned, and it’s a couple of hundreds of pounds down the tube. The patient was not to blame for this. Why should a tablet be worth more than the currency of gold? In fact, unanimously high cost drugs top all...

The effect of epilepsy on lifespan

Approximately 30% of the general population are expected to experience a fit at some stage of their life. The occurrence of repeated fits (or epilepsy) is less common, and is more likely if you have underlying brain injury or abnormalities in you brain waves (as demonstrated by the electroencephalogram or EEG). The risk of epilepsy, however, trebles when you have MS – affecting 3% of...

Menopause in MS

Regardless of from whence you hail, if you’re a woman you are twice as likely to be diagnosed with MS than a man. It is probably one of the most constant and persistent risk factor in MS. Hidden beneath this risk is the effect of hormones on the immune system. For instance, until the age of puberty, the frequency of MS is similar in both boys and girls. The cases start to become female...

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