AuthorNeuro Doc Gnanapavan

Re-vitalise your gut

Gut microbiome The lions share of the risk (~70%) for developing MS is attributable to environmental risk, while genetics explains bulk of the remaining risk. The environmental risk factors studied in MS have been manifold, ranging from the latitude effect, to viruses, and may well explain some of the heterogeneity that we observe. For some time now, researchers have been looking at an imbalance...

Predicting a relapse

The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated. But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it...

Ageing brain – lessons from childhood MS

Childhood onset MS has some unique features compared to adult onset MS. Firstly, it tends to be more active than adult onset MS with a greater number of relapses and more MRI activity, but equally has better reparative capacity and a later onset of progressive disease. But this is as far as the dis-similarities go. If it walks like a duck and quacks like a duck, I call that bird a duck! In a two...

MS susceptibility is it puberty, or is it something else?

The risk of developing MS reportedly increases with early puberty, particularly in women. This leads to interesting hypotheses around the effect of hormones on the maturation of the immune system. But what if there was another equally plausible reason for this finding? For instance, having more body fat at childhood leads to earlier puberty, which in turn is also associated with an increased risk...

DMF versus Teriflunomide

Treatment algorithm (Ingwersen J et al.) Did I hear you say injectables, what injectables? The turf war in the first-line RRMS treatments is clearly between the two oral therapies; dimethyl fumarate (DMF) and teriflunomide (Teri)!Each have their Achilles heel. DMF with its lymphopenia (drop in lymphocyte counts) and Teri with its transaminitis. So, it isn’t surprising that the weighing...

Blood starved MS

There is mounting evidence that the brain blood supply is affected in MS. Perfusion MRI studies have found that blood flow is globally impaired in the normal appearing brain of both relapsing and progressive forms of MS. Interestingly, there appears to be an association between this and cognitive (memory and intelligence) dysfunction in MS. In animal models, chronic hypoperfusion of the brain...

Alemtuzumab rescue therapy for rebound after stopping natalizumab

Natalizumab is an effective strategy for achieving disease control in those with highly-active MS, but owing to the risk of progressive multifocal leucoencephalopathy (PML), often needs to be de-escalated. However, discontinuation of natalizumab therapy is not without its own risks; the biggest risk being rebound activity, which rarely may be a flare beyond that of pre-treatment disease activity...

MS DMTs that hit the regenerative note

Santiago Ramon y Cajal Who said that the brain doesn’t regenerate? Well, it was the neuroscience Dogma as far back as philosophy. But, not in certain quarters; Santiago Ramon y Cajal (1852-1934), widely believed to be the father of modern neuroscience in his treatise ‘Degeneration and Regeneration of the Nervous System’, alludes to the potential of the brain to regenerate in the...

MS as an indication for HSCT – an American perspective

Dr Luddites As HSCT’s (Haemopoeitic Stem Cell Transplantation) popularity grows, the need for guidance and regulation grows in equal measure. Which is why in 2015, the American Society for Blood and Bone Marrow Transplantation (ASBMT) designated MS as a ‘developmental’ indication for HSCT, but has since reconsidered its position.It must be remembered that HSCT is a technology...

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...

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