AuthorNeuro Doc Gnanapavan

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...

Your genes and you

Genetic studies in MS are a vast mountain and not simply a mound, with sample sizes ranging into the thousands. Climbers and mountaineers seek out free-standing mountains (i.e. mountains that are not part of a mountain range) as their relief from other peaks of equal height makes them an impressive sight to behold. The Matterhorn, Switzerland – a free-standing mountain Do genetic studies...

Your race in MS

Race, ethnicity, creed – all architectural descriptors, some complex, others less so, depending on your perspective. When it comes to illnesses however, you are largely referencing race (the inheritance of your DNA) and ethnicity (the branch of race that your DNA occupies). We may be different in a number of ways, but our illnesses are a great equalizer. There is no such thing as race...

Counting the cost, T2 lesions

Counting the cost and paying the price are not one and the same. For decades MRI has been the way by which all and sundry have monitored MS disease activity. But, what does it all mean? And, how good is it really? Recently, in a natural history evaluation of MS disease activity, the Barcelona group looked at MRI scans of those presenting to their centre on whom they had at least 10 years of...

Telling signs

Despite advances in MRI, the diagnosis of MS is hard for the non-specialist. A Swiss study recently found that the delay in MS diagnosis is more than 2 years in 40% of PwMS. Surprised? You should be, because according to this study by 2016-2017 the delay in diagnosis had only improved by half as much since the year 2000! What is not surprising, however, is that in a majority of instances this...

Brain volume loss in MS

Cognition (thinking, memory and learning) is known to be affected in MS. This is more so in progressive MS. In a study last year, it was found that those with more structural damage to the brain at baseline were more likely to have cognitive issues. And more likely that not cognitive issues were encountered if the brain cortex was involved (the area comprised of the surface of the brain where...

Shrinking MS lesions – anything to take note of?

Are you surprised that some MS lesions shrink in size? It has nothing to do with quantum mechanics – Planck’s constant or Pym particles. However, it has been noted for a while now that in some individuals their MS lesions could shrink. The prevailing hypothesis is that shrinking lesions represent resolution of the underlying inflammation or even possibly repair. Others believe, like...

JCV index and the effect of DMTs

JCV STRATIFY (anti-JCV antibody) test has been utilized for more than decade to de-risk natalizumab treatment and other DMTs for risk of PML (Progressive Multifocal Leukoencephalopathy). Cases of PML have occurred predominantly in natalizumab, but less commonly with fingolimod (Gilenya), dimethylfumerate (Tecfidera) and rituximab. A high JCV antibody index value indicates that the risk of...

All for one and one for all

“All for one and one for all”- The Musketeers FACTS Fact 1 – Siponimod (Novartis Pharmaceuticals) trialed for SPMS, but the FDA label sits as Clinically isolated syndrome (the first clinical episode), Relapsing-remitting MS, and active Secondary progressive MS. Fact 2 – Ocrelizumab (Genentech, Roche Pharmaceuticals) trialed for RRMS/PPMS; the latter has been shown to be...

ECTRIMS 2019: Biomarkers

ECTRIMS, Stockholm Biomarkers session Finally in the ECTRIMS mood! Hundred Unbelievable that an year has passed already since the last one, but before I get maudlin, lets get some focus back in. I’ll be co-chairing a session this Friday with Dr Salzer, from Umea University, Sweden (Rituximab man). You can see all the topics of discussion in the program above, but for those of you who...

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