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My prevention hat

About three years ago I started wearing another hat; a preventive medicine hat. We started the Preventive Neurology Unit within our medical school focusing on MS, Parkison’s Disease and all-cause dementia. The unit is growing rapidly and gaining momentum. It was with great pride that I was able to attend and speak at first symposium. I have uploaded my slides for anyone who wants to download them...

The cost of MS. Filling your boots

Following on from NDG’s post on the cost of therapy.This is interesting. The outgoing corporates have sort of come clean about the costs of MS drugs. Perhaps they forgot to mention the saying Fill your own boots with cash even if you do a rubbish job. It’s like a petrol station. Get it fill up and get out of there quickly. What’s your view? November 25, 2019Qualitative study on...

Heart features of fingolimod

As we gear up for the mod wars as a number of S1P1 inhibitors arrive including siponimod and ozanimod, it will be interesting to see how fingolimod fairs. Fngolimod binds to S1P1, S1P3, S1P4 and S1P5 but the new variant bind to S1P1 and S1P5 and so avoid S1P3. This is in part the reason why fingolimod has heart issues and needs to be monitored. This risk is relatively low but needs to be checked...

A treatment for NMO

Not that long ago neuromyelitis optica was called Devics MS but it was split because it seems to have a different pathology and responds to MS drugs differently. It also more commonly presents itself East Asia. One of the features of NMO in some people is the production of an antibody to Aquaporin 4 a water channel on astrocytes. Many years ago I stained brain tissue with an antibody to...

The cost of treating MS

One of my patients recently asked if they could return their tablets back to stock as they had decided not to make the swap as initially planned. Of course, the tablets could not be returned, and it’s a couple of hundreds of pounds down the tube. The patient was not to blame for this. Why should a tablet be worth more than the currency of gold? In fact, unanimously high cost drugs top all...

A lymph gland biopsy, Do you think you would do this? It tells us the blood is different

Recently I have had to sit through some dreary EAE studies, where the animal studies were justified by saying it was impossible to know what happens in lymph nodes and bone marrow. in humans I would say do some reading and you will find that the animal studies added nothing to what we know happens in humans. Learning from other autoimmunities to understand targeting of B cells to control multiple...

Pregnancy and Iv Ig

Intravenous immunoglobulins for the prevention of postpartum relapses in multiple sclerosis. Horvat Ledinek A, Brecl Jakob G, Jerše J, Ruška B, Pavičić T, Gabelić T, Barun B, Adamec I, Rot U, Šega Jazbec S, Krbot Skorić M, Habek M. Mult Scler Relat Disord. 2019;38:101519.  OBJECTIVES:To evaluate the effect of intravenous immunoglobulins (IVIG) on prevention of postpartum relapses in women with...

We don’t know how CD20 antibodies works…but it is depletion of myelin CD8 T cells?

How does B cell depletion work. The Charcot meeting has given us nothing concrete. Is it the production of regulatory B cells or something else? So to keep on the Charcot theme of B cell therapy Some people say that it is because ocrelizumab/rituximab attacks T cells. In this new study, they look at CD8 T cells and notably myelin reactive T cells. CD8 T cells express more CD20 than other T cells...

Charcot Today. It’s not all Unknown! Can we stop memory B cells entering the CNS?

The Charot meeting has now kicked off and after the first key talks. I guess I am currently left confused, it’s the T cells, it’s the B cells, its CD8 T cells, it’s, it’s, it’s, it’s…. as Prof Hauser said today…It’s all unknown how B cell therapies work”. It’s all of them. So lots to do. The cells are all involved, but I am not...

Protecting nerves with the -imods. Is there something missing

Fingolimod is a sphingosine-1-phophaste receptor (S1PR) modulator. There are five S1PR. The immune modulating effect is mediated by S1P1R. Siponimod is an S1P1R and S1P5R selective modulator. Fingo also binds to S1P3R (this causes some of the heart related issues) and S1P4R in addition to S1P1R and S1P5R. S1P5R is found on glial cells and it has been suggested that repair and protection can occur...

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