CategoryCauses

Old age; how is it going to affect me?

Is ageing a disease? It is if you have MS. We have been making the argument for moving our treatment target in MS to focus on old age; i.e. how do we your HCPs get you to old age with enough brain to deal with the ravages of age-related cognitive impairment? Mechanisms of neuronal loss in MS It is clear that your brain and cognitive reserves are what protects you from the ‘normal age-related...

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...

Is it B and/or T cells and which ones?

Can studying the pathology of MS and animal models of MS teach us about the cell types driving MS? Professor Lassmann is the doyen of multiple sclerosis pathology. He makes two very important points in this review. EAE the experimental model of MS is not MS. Interestingly, most EAE models are driven by CD4+ T-cells, which is very relevant to the second point he makes. Does this mean we should not...

Blood starved MS

There is mounting evidence that the brain blood supply is affected in MS. Perfusion MRI studies have found that blood flow is globally impaired in the normal appearing brain of both relapsing and progressive forms of MS. Interestingly, there appears to be an association between this and cognitive (memory and intelligence) dysfunction in MS. In animal models, chronic hypoperfusion of the brain...

Why is everyone drinking anti-CD20 kool-aid?

Prof G will ocrelizumab and rituximab prevent SPMS? Just back from the COMBAT-MS stakeholders meeting in Pasadena with the Kaiser (Kaiser Foundation Research Institute) and Swedish (Karolinska Institute) trial teams, PCORI (Patient-Centered Outcomes Research Institute) and many brave an wonderful people with MS and their families. The COMBAT-MS study (NCT03193866) is recruiting well and is on...

Calling all vegans

As a vegan what supplements do I need to take? I am in the process of researching the dietary landscape for people with MS and will not be ready to make any firm recommendations for some time, but I can make a recommendation of what diets to avoid. The first is a strict vegan diet without supplements. My index patient was an Asian woman, in her mid-20s, with RRMS who referred for a second opinion...

The cause of Progressive MS is here. Its Grey matter Directed T cells… Really?

What is the difference between relapsing and progressive MS. This new work from one of the number one science comics now tells us that it is due to immune cells responding to a grey matter protein called beta synuclein Nature | Published: 20 February 2019 β-Synuclein-reactive T cells induce autoimmune CNS grey matter degeneration Dmitri Lodygin et al. ,  The grey matter is a central target of...

A sequence of losses

Prof G has the MS community go it wrong? In this week’s NEJM there is an insightful perspective by Louise Aronson on ageing and driving. Aronson. Don’t Ruin My Life — Aging and Driving in the 21st Century. N Engl J Med 2019; 380:705-707. Louise quotes the American poet Donald Hall, who explains in Essays After Eighty how life is irrevocably and excruciatingly changed when a person must let go of...

Playing second fiddle to the Swedes

Why can’t we use anti-CD20 therapies as immune constitution therapies? For some years we have been promoting our Barts-MS Essential DMT list to treat people with MS (pwMS) in resource-poor environments. One of the big guns on our list has been rituximab (anti-CD20).  One of the problems is that rituximab at a dose of 1g every 6 months is still too expensive to accessible for the vast...

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