CategoryClinicSpeak

Watchful waiting 2

Barts-MS rose-tinted-odometer: zero-★s (still seeing red) Did you know that MS disease activity defines if you are eligible for therapy and which therapy? The following is a list of definitions that are generally applied to MS in England.  Inactive: Patients with MS with no relapses or imaging features of disease activity in the last 2 years.  Active: Patients with active disease are defined...

To switch or not to switch that is the question

Barts-MS rose-tinted-odometer: ★★★ The one good thing about thinking aloud is that your colleagues’ chip in and provide feedback. Case 2 from my ‘ethical quandary post‘ is generating an important debate about whether to support this patient’s decision to switch therapy or not. As a reminder, this is the 40-year old woman who started natalizumab as a first-line therapy 11...

Framing

Barts-MS rose-tinted-odometer: zero-★’s – still seeing red When the EMA doubted its wisdom and ran scared on alemtuzumab, after an Article 20 review of its benefits and risks, I was inundated with emails and queries. “Gavin, didn’t you see this coming? Surely, alemtuzumab should never have been licensed as a 1st-line treatment for active MS? Clearly, the FDA got this right and the EMA made...

Robotnik

Barts-MS rose-tinted-odometer: seeing red I would like to thank all my colleagues who have written to me in the last few weeks in support of the blog, and what it stands for, as it emerges like a phoenix from its latest existential crisis. Photo by Nader Abushhab on Unsplash It is interesting that many of my colleagues who have written to me privately seem reluctant to stick their heads above the...

Regrets

Barts-MS rose-tinted-odometer: ★★ Shortly after leaving Queen Square to take up my current position at Barts and The London Juliet Solomon, a good friend, and one of the research managers who had an office opposite me on the 6th floor of the Institute of Neurology sent me a signed copy of the ‘The Book of Regrets’ she had compiled as a present. She has asked celebrities to write essays on...

An ethical quandary

Barts-MS rose-tinted-odometer: ★★ The two case studies below are creating an ethical quandary in my MS practice. Can you help me please? Case 1The first is the 40-year old woman with MS who is NEDA-2 (no evident disease activity) on DMF (Tecfidera) with no documented relapses in the last 4 years and a series of annual MRI scans with no new or enlarging T2 MS lesions. However, there has been a...

Flashback

Barts-MS rose-tinted-odometer: ★ When I described in a post that I was having flashbacks, related to possible post-traumatic stress disorder (PTSD) from my accident, it struck a chord with pwMS who bravely described their own flashbacks about the way their diagnosis of MS was handled. In response to this, we teamed up with shift.ms to do an online survey of its members. We advertised the survey...

The Star-MS trial: to be HSCTed or not

Barts-MS rose-tinted-odometer: ★★★ There is little doubt in my mind that HSCT is the most effective DMT we have for treating MS. The latter is based on NEDA (no evident disease activity) rates post-HSCT and brain volume loss data after year one. HSCT appears to put the majority of treated patients into long-term remission and normalises end-organ damage as measured by brain volume loss. In...

#MSCOVID19: adenoviral vector vaccines

Barts-MS rose-tinted-odometer: ★ You may have heard that the FDA has suspended dosing of the J&J COVID-19 vaccine as they have identified 6 cases of thrombosis in young woman similar to that described below with the Oxford-AstraZeneca vaccine (see articles below).  It looks like the complication may therefore be due to the vectors, i.e. adenoviruses, rather than the SARS-CoV-2 spike protein...

How soon does the shredder begin to shred?

Barts-MS rose-tinted-odometer: zero-★s She was only 26-years and she couldn’t understand why she was falling behind her peers at work. She started working at an ultra-competitive law firm after finishing as one at the top of her peer group at Oxford. She was clearly the best-performing intern in the 2017 intake, which is why she was kept on after her internship. However, things were now...

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