CategoryLab Lessons

A moan…Doing trials to pat yourselves on the back for a paper and a job well-done is not what it’s about… Changing clinical practise is what it’s all about

A couple of years ago Dr Raj Kappoor and ProfG did a trial in optic neuritis and tested a sodium channel blocker to see if it could save nerves in the eye after optic neuritis. This was based on studies that MD1, 2, 3 & 4 had done in the beasties. The trial worked and it saved loss of nerves by about 30%, but then what?….Yep Nothing. I said to the neuros..”You have done a trial...

Foot drop

The study below tried to compare the clinical effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) and whether or not they were cost effective. The high drop-out rate (38%) made the study inconclusive. When we, at Barts-MS, did a clinical audit a few years ago we showed that the best predictor of falls was the need to use a walking aid; e.g. walking stick...

What, I don’t have MS?

In the study below approximately 1 in 5 people diagnosed with MS don’t have MS. This is so much higher than previous studies. I have always quoted the Danish post-mortem studies that sugget only 1 in 20 MSers are misdiagnosed. Maybe Danish neurologists are simply better at diagnosing MS compared to their American colleagues? There is no one test that can be done to diagnose MS. MS is...

Ocrelizumab’s known-unknowns

Below is the first case report of fulminant hepatitis owing to echovirus 25 in an MSers on ocrelizumab. Please note continuous anti-CD20 therapy takes out your B-cells and prevents you from forming germinal centres (where B-cells get educated to make antibodies, i.e. the B-cell’s Universities) in lymph nodes and the spleen. In other words, ocrelizumab treatment causes functional splenectomy...

Predicting a relapse

The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated. But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it...

Hepatitis post-alemtuzumab

Another alemtuzumab-related post, this time in relation to alemtuzumab-associated liver injury, which has been also been included as a complication of alemtuzumab treatment in the EMA’s SmPC (summary of product characteristics). Liver or hepatic injury can occur as part of a drug-induced injury as seen in case 2 below or as a delayed, presumably autoimmune, condition as in case 1 below...

Haemophagocytic lymphohistiocytosis post-alemtuzumab

After yesterday’s post on alemtuzumab-related posts, many people are asking about haemophagocytic lymphohistiocytosis (HLH), which has been included as a complication of alemtuzumab treatment as is now in the SmPC (summary of product characteristics). HLH is a condition in which the body makes too many activated macrophages and lymphocytes. People with HLH usually develop systemic symptoms, which...

B cell antigen making macrophages young and able to repair

CD22 blockade restores homeostatic microglial phagocytosis in ageing brains.Pluvinage JV, Haney MS, Smith BAH, Sun J, Iram T, Bonanno L, Li L, Lee DP, Morgens DW, Yang AC, Shuken SR, Gate D, Scott M, Khatri P, Luo J, Bertozzi CR, Bassik MC, Wyss-Coray T. Nature. 2019 Apr 3. doi: 10.1038/s41586-019-1088-4. [Epub ahead of print. Microglia maintain homeostasis in the central nervous system through...

Does alemtuzumab treatment increase your chances of having a miscarriage or premature birth? A large systematic review of numerous studies involving women with ‘normal thyroid function’ showed a strong association between the presence of anti-thyroid peroxidase antibodies and having a miscarriage and/or premature birth, i.e. the chances were increased by approximately 3.9x and 2.1x, respectively...

Trying to understand whether a sneaky fag is bad for you?

The Genetic Background of Mice Influences the Effects of Cigarette Smoke on Onset and Severity of Experimental Autoimmune Encephalomyelitis.Enzmann G, Adelfio R, Godel A, Haghayegh Jahromi N, Tietz S, Burgener SS, Deutsch U, Wekerle H, Benarafa C, Engelhardt B. Int J Mol Sci. 2019 Mar 21;20(6). pii: E1433. doi: 10.3390/ijms20061433. Multiple sclerosis (MS) is the most common inflammatory disorder...

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