AuthorNeuro Doc Gnanapavan

Thyroid disease with Alemtuzumab – risk mitigation

There is a popular old saying in English – “forewarned is forearmed”. Prior knowledge that something is going to happen offers tactical advantage, whether you’re at war or simply everyday life. The difficulty, however, is that more often than not we are transfixed by the detail of the matter, resulting in numerous avenues of investigation in the process, some of which are...

Is cholesterol truly bad for you?

Low-density lipoprotein particle, apolipoprotein B (blue) is surrounded by various forms of cholesterol (orange and yellow) and other lipids. JUAN GAERTNER/SCIENCE PHOTO LIBRARY Scientists have known for a long time that cholesterol like other basic food components forms an essential component in a healthy human body. It forms the cell membrane architecture (or the cell wall), helps produce the...

HSCT in MS, more a remission than a cure

In a prose to seduce the weary palate, the British neurologist, I recollect saying: “What should be the aims of HSCT treatment? At worst, remission. At best, a cure“. I may just have to eat my words… In a small study from Uppsala University (n=45), Larsson et al. report the effects of HSCT on neuronal damage (using neurofilament levels) and inflammation (IgG index and...

A cost too high? The cost-effective analysis (CEA) of our current DMTs

‘Primum non nocere’ – Do no harm; the Hippocratic injunction. It could be argued that perhaps were are too ready to dose our expectant patients with the next golden ticket in MS. Mayhap, withdrawal of the long list of medications that they are already on, can prove to be just as efficacious? Yet, I am not a great supporter of masterful inactivity on the part of the physician...

HSCT, is it remission, or is it a cure for MS?

Most of you who read the blog know that I’m highly cynical when it comes to the word ‘CURE’ in the same sentence as a brain disorder or autoimmunity. In fact, it’s very similar to hearing the word VEGAN in the same sentence as pizza or donuts (apologies to any vegans who are currently sitting across from one of these right now; there’s always tomorrow). Why? Where do...

Reporting of side effects in RRMS trials

Most research is about investigating the known unknowns. In other words, investigators have a certain hypothesis, but also a range of plausable possibilities as outcomes. However, in some instances the outcome is unexpected – the unknown unknown. Rare side effects are an example of this, and not always evident in the initial randomized-placebo (dummy treatment) controlled clinical trials...

Classification of progressive MS

Typically the onset of disease progression in MS is ‘silent’ and differs from person to person. Not surprisingly, attempts at defining at least clinically has not been an exact science. In a letter to Annals of Neurology Gil-Perotin et al. (Valencia) ask an important question, whether progression during the relapsing phase of MS is the same as in secondary progression (refer to MS...

How conscientious are you?

Conscientiousness like other higher function traits is advantageous to the modern society in aggregate, as well as individually. It may even be evolutionarily adaptive: “In several respects, conscientiousness is an unusual personality trait. Because hunter-gatherer life did not require as much planning and memory for debts and duties as life in larger-scale societies with more complex...

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...

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