AuthorNeuro Doc Gnanapavan

MS lesions that smoulder

Iron Rims image from Frontiers The characteristic feature of is multi-focal inflammatory activity; an infiltration of immune cells leading to loss of myelin and axons within these areas creating the appearance of round lesions. The natural evolution of these lesions like any area of injury in the rest of the body and shrink to a certain degree overtime. A fraction, however, continue to smoulder...

Cyclophosphamide kills immune cells dead

Most immunologists are well versed in the use of cyclophosphamide for all sorts of non-MS related inflammatory disorders; it is for all intents and purposes a ‘Domestos’. It’s dirt cheap – one 500mg vial costs £9.66 on the NHS, and is often only used as induction therapy with a few doses at time. It’s ‘Domestos’ action comes from its apoptosis (or cell...

Polypharmacy in MS

In this blog, our overarching goal has been to keep our readers up to date with the latest research in MS. One of the things I’ve noted in this time is that the vast wealth information out there isn’t insurmountable – you only need to select the ones that appeal to you, or are relevant to your practice. Information/’knowledge’ is probably the last bastion of...

This is not a drug, a leaf

Last year should probably be marked as the year of the alcohol, the year before that, Vape stores and Cannabis extracts. I remember being offered ‘Leef’ based skin care products at the airport even. Not surprisingly, given the current climes, there is even talk that COVID19 may have provided the impetus for legalization of cannabis as part of a campaign to plug the current 2tn hole in...

Food for thought

The gastrointestinal tract (image taken from The Conversation) You may not think much of your gut, which in most peoples mind is simply one giant hosepipe from start to finish. But, this week after eating something quite oily, I was painfully made aware of my gut’s existence. The gut from an energy and metabolic point of view is a very important organ, and without it you would simply be a...

Talk the talk…walk the walk

I took this figure from a paper that has little to do with the point I’m going to make here today. After having done this for a few years I hope I have earnt the right to speak my mind? Figure: Confirmed disability progression EDSS from the Avonex, Steroids, Azathioprine (AZA) study: one-third of patients shows relatively stable disease over time (taken from Berger T et al. Factors...

The far reaching arm of alemtuzumab

The immune system (image from Novus Biologicals) Whilst we talk about targeted B cell treatments, alemtuzumab possibly is what I’d term a ‘Domestos’ style drug. This type of drug is useful when your aim is to control the entire immune system quickly. Drugs similar to this are cyclophosphamide, cysclosporin and mitoxantrone; which are all considered highly active therapies. Many...

HSCT and cognition

Is Hematopoietic Stem Cell Transplantation aka HSCT the panacea that it seems. A cure all, or simply the trap of a success story? HSCT is able to stop inflammation or reduce it significantly for long periods of time. It has been shown to have positive effects on mobility and fatigue. Recently, in a single centre study, investigators also report an improvement in cognition; namely information...

Exercising during COVID19

The only habitable planet in the solar system may be imploding under the pressures of COVID-19, but it’s population on the other hand is supposedly the fittest it has ever been. It would seem more of us now have time to lift a kg weight than to place the equivalent into our stomachs. One of my MS patients even went as so far as to say that they had reduced most of their symptomatic...

The ugly fruit

There is overwhelming public interest to support COVID-19 vaccine development. In fact many have already done this. As the UK gears up to participate in its third vaccine study called ENSEMBLE, a Phase 3 clinical trial with the Janssen developed Ad26-vectored vaccine candidate shortly with participants drawn from the NHS vaccines registry, the lack of transparent participant information is...

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