CategoryCauses

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...

What to do about my haloes?

Why do MS lesions with an iron halo continue to expand? The slowly expanding MS lesion or SEL is where the money or lack of money is. In my post ‘explaining why you are getting worse despite being NEDA‘ I mention SELs as one of the reasons that underlie progressive MS and are largely unresponsive or poorly responsive, to standard DMTs. Danny Reich’s team at the NIH have...

How Does Cladribine Work?

Here is a new offering from the CLAD lads :-), and follows on from the information that we got from the European Medicines Agency and from stuff in the public domain. This is not a pharma supported piece of work and they may have different views of how cladribine works or how they want to portray how they think this works, but as usual for us, it contains ideas of the unknown. Things we and...

What’s your excuse?

What will it take to get me to stop smoking? If you are a smoker and continue to smoke you need to think about how you want to manage your own MS. We debate endlessly about the lack of progress in developing effective treatments to slow down the worsening of MS and ignore the obvious. The first study below implies that by simply stopping smoking it will have a major impact on the outcome of your...

EBV infects T-cells

Why are experts important? In the so-called post-truth era experts are derided and ignored. Not at Barts-MS. Last Friday we held a lock-in to review and discuss our EBV research programme and bring in expertise from outside our group. We were fortunate to have card-carrying EBV experts, oncologists, B-cell biologists and protein and antibody experts around the table. A central plank of the EBV...

We sincerely apologize, but you don’t have MS

The rate of misdiagnosis of MS around the globe is roughly a quarter. We are so focused in making an early diagnosis in MS that before we know it, it’s a runaway train. Sometimes, even the best of us need to eat our words, and admit to having a made a mistake. The diagnosis of MS is not easy; how many of you have googled non-specific symptoms and come up with MS as a potential cause? The...

What is end-organ damage?

Help! How do I manage progressive brain atrophy in a patient who is NEDA-3? End-organ damage is a catch-all phrase for the degeneration of the brain; it occurs as part of the ageing process that some consider pathological and others as a normal fact of life. I have hinted that I consider it both because end-organ damage is potentially modifiable via lifestyle modifications and pharmacological...

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