CategoryLifestyle and self-management

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...

Guest post: Part 2 of Choosing a DMT: the issues

Firstly, why the incredible hesitancy among some medics to flip the pyramid? Or at least break away from the Beta-interferons/Glatiramer Acetate as ‘safe’ fallback options, even when the research suggests that these days, the older first generation drugs give suboptimal outcomes compared to the modern crop. The MS neurologists that I spoke to all advocate versions of outlining the options...

Guest post: A patient’s point of view: choosing a DMT

This is a four-part post, where you’ll read about the experiences of newly diagnosed MS patients, plus my observations, with links to a some of the research underpinning them. The objective is to address some hidden and often difficult-to-address issues that come up when prescribing a DMT to a newly diagnosed patient. As a pwMS of 26y post-diagnosis in the UK, having worked in pharma, IT...

Happy Happiness Day

This the first of our Barts-MS non-personalised, more factual, blog posts. We, Barts-MS, hope you will find this format more agreeable. Happiness is associated with better health outcomes, which may apply to people living with MS and their families. More research needs to be done in this area before any definitive statements can be made in relation to applying happiness therapy as part of the...

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...

ADIOS

Yes, why can’t we use anti-CD20 therapies as an immune constitution therapy (IRT) or at least adapt the dose based on B-cell reconstitution kinetics? And if we can’t beat the Swedes why can’t we join them? ADIOS = ADaptIve Ocrelizumab dosing Study There is mounting evidence from NMO and rheumatology that anti-CD20 therapies can be used as either a maintenance therapy or an immune...

Are nutritional supplements a waste of money?

Do you take dietary supplements? If yes, are you prepared to review what you are taking and ask yourself if you need to spend the money taking something that is not supported by any evidence? In the US the Food and Drug Administration (FDA) has recently announced measures to regulate dietary supplements. The FDA Commissioner Scott Gottlieb said: “It’s clear that the US Food and Drug...

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...

To vaccinate or not?

Should your vaccine status be checked and updated before you start treatment? As part of our programme to derisk disease-modifying therapies (DMTs) for pwMS in our service, we are reviewing our vaccination policy. One issue that has emerged is the possible need to boost immunity to certain types of bacteria that are known to pose a risk in patients on long-term immunosuppression, in particular B...

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