CategoryThought-4-the-day

#T4DT: Do you have a sleep disorder?

Over 70% of pwMS have a sleep disorder with about 40-45% having obstructive sleep apnoea. The latter is massively underdiagnosed and needs to be actively screened for to be detected. I suspect having MS increases one’s chances of developing OSA by affecting the tone and function of the so called bulbar or throat muscles. This problem is that OSA affects quality of sleep and leaves most people...

#T4TD colour vision

When your neurologist looks in your eyes with an ophthalmoscope he/she is looking for the telltale signs of previous damage to the optic nerve. The sign we look for is optic disc pallor. The optic disc is made up of nerve fibres from the retina, which then pass out of the back of the eye to form the optic nerve. If you have had optic neuritis in the past and have lost nerve fibres this can be...

#T4TD Anticholinergics

Are you taking anticholinergics?  It is clear that centrally acting anticholinergic drugs, which block so-called muscarinic receptors, are being used by many people with multiple sclerosis as DIY agents to promote remyelination. The scientific rationale for this practice is based on preclinical work in cell culture systems and animal models and one proof-of-concept study of clemastine in pwMS...

#T4TD onychogryphosis

When last did you cut your toenails?  In patients who I  think are vulnerable, I always try to take the time to look at their feet. Unfortunately, because of COVID-19-induced NHS service changes, this is very difficult using telemedicine. Poor foot hygiene and uncut toenails are in my experience an integrator of neglect. As the feet are generally hidden from view people with MS often...

#T4TD Infected

Did you know that a third of relapses are triggered by infections, typically non-specific viral infections?  The observation that a relapse is more likely to occur in the so-called ‘at risk’ period, typically 5-6 weeks after infection than at other times predates the disease-modifying therapy era of MS. The mechanism is thought to be that infection boosts the immune system non-specifically, which...

#T4TD Driving at night

Did you know that more than half of people with established multiple sclerosis (pwMS) have had an episode of optic neuritis (an MS lesion in the optic nerve)? Not all episodes of optic neuritis cause symptoms and can be subclinical. We detect the latter using visual evoked potentials that show slowed conduction in a particular optic nerve.  When optic neuritis recovers the conduction speed of...

#T4TD when it comes to Anti-CD20 therapy body size counts

Did you know that if you are a large person standard dose ocrelizumab is not as effective as it is in a small person?  When looking at the efficacy of anti-CD20 therapies such as ocrelizumab you shouldn’t bother looking at relapses and focal MRI activity (Gd-enhancing lesions or new T2 lesions) when comparing effectiveness between doses and competing products. Relapses and MRI lesions are...

#T4TD falls and fractures

Did you know that people with MS have a six times higher risk than age-matched controls of having a long bone fracture of the lower limb? The reason for this is that pwMS often have balance problems, unsteadiness of gait (ataxia), lower limb weakness (dropped foot) and are maybe excessively sedated from their medications. All these factors increase your chances of falling. In addition, pwMS are...

#T4TD vascular comorbidities

Did you know if you have MS and vascular comorbidity you are likely to need a walking stick approximately 6 years earlier than if you did not have vascular comorbidity?  Importantly this 6-year difference in reaching EDSS 6.0 (requiring a walking stick) is larger than the treatment effect of a platform DMT. As vascular comorbidities are largely preventable are you doing anything to prevent or...

#T4TD menstruation

Women with MS may notice increased fatigue and intermittent symptoms in the second half of their menstrual cycle and during menstruation. Why? After ovulation, a woman’s body temperature rises by ~0.4℃ (range = 0.3 to 0.6℃) which in someone with MS is enough to cause temperature-dependent conduction block. In addition, the process of menstruation involves a mild systemic inflammatory reaction...

Translate

Categories

Recent Posts

Recent Comments

Archives