AuthorNeuro Doc Gnanapavan

Is fingolimod safe in pregnancy?

Safety of Disease Modifying Treatments (DMTs) whilst pregnant and breastfeeding (from Practical Neurology journal) The risk-mitigation strategies surrounding DMTs in pregnancy haven’t come that far over the last two decades. So far, we have abstain from pregnancy, stop treatment prior to pregnancy, stop if you discover that you’re pregnant, or switch to Copaxone during pregnancy...

Multiple Sclerosis Research

A comment on the Multiple Sclerosis Research Blog In a world where it is easier to be lost than discovered, dissonance is the word of the day. When you have a serious medical condition, your day to day life is suddenly uncertain and unpredictable, your mood, a narrative from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – DSM-5 for short, and its 186 footnotes...

Filgrastim for natalizumab-induced PML

PML, JCV infection Natalizumab (aka Tysabri), is one of the hard hitters in the DMT world and owing to its mechanism of blocking the ingress of immune cells into the brain, works quickly – achieving control in as little as 4 weeks. In the AFFIRM study, natalizumab reduced the rate of clinical relapse by 68% in the first year! But, one of the drawbacks of stopping the immune surveillance of...

HSV-2 encephalitis with Ocrelizumab

The effect of DMTs on lymphocytes causing lymphopenia (from E Fox et al. Neuol Clin Pract Feb 2019) Why does this not come as a surprise to all and sundry, the report of a potentially harmful infection following immunosuppressive treatment, but this time from the new kid on the block, ocrelizumab (Ocrevus). Not to sound cliched, but if you hadn’t seen this one coming, well then the rest is...

AAN 2019 posters #3

All good things unfortunately come to an end, and sadly this is the last in the series of three on AAN 2019 posters. What has captured my attention from this years AAN has been the varied interests of the clinician scientists who have presented their work here. This is a good sign, because without varied interests, science and ultimately progress slowly comes to a standstill. I call it the...

AAN 2019 posters #2

Well, here is part deux of the 2019 AAN posters; a veritable smorgasbord of hidden gems on Market St in Philadelphia. 1. Effect of Ibudilast on Neurofilament light chain in Progressive MS Analysis from a Phase II Trial. Fox et al. Cleveland Clinic.Previous results from the SPRINT-MS study that used 80-100mg/day of Ibudilast, showed slowing of the progression in brain atrophy (i.e. volume loss) by...

AAN 2019 posters #1

I discuss below two topics that we don’t understand well in MS. Firstly, the diagnosis of late onset MS (LOMS). Secondly, the occurrence of stroke in MS. Differential diagnosis in Late Onset Multiple Sclerosis (LOMS) – Marrodan et al. Neurology Dept., Fleni, Buenos Aires, Argentina LOMS is defined as presentation beyond the age of 50 years, accounting for less than 12% of MS cases...

Fatigue in MS – what we don’t know?

Fatigue in MS is a strange duck, on many levels obvious and frequently described by PwMS (80-90%), but one that lacks sound medical explanation and science doesn’t even know how to test it yet. I was sure that the fatigue in MS, particularly exercise induced fatigue, was somehow related to the conduction block caused by the demyelination in the long tracts (corticospinal tract). It would...

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...

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