CategorySymptoms and treatments

Filgrastim for natalizumab-induced PML

PML, JCV infection Natalizumab (aka Tysabri), is one of the hard hitters in the DMT world and owing to its mechanism of blocking the ingress of immune cells into the brain, works quickly – achieving control in as little as 4 weeks. In the AFFIRM study, natalizumab reduced the rate of clinical relapse by 68% in the first year! But, one of the drawbacks of stopping the immune surveillance of...

HSV-2 encephalitis with Ocrelizumab

The effect of DMTs on lymphocytes causing lymphopenia (from E Fox et al. Neuol Clin Pract Feb 2019) Why does this not come as a surprise to all and sundry, the report of a potentially harmful infection following immunosuppressive treatment, but this time from the new kid on the block, ocrelizumab (Ocrevus). Not to sound cliched, but if you hadn’t seen this one coming, well then the rest is...

AAN 2019 posters #3

All good things unfortunately come to an end, and sadly this is the last in the series of three on AAN 2019 posters. What has captured my attention from this years AAN has been the varied interests of the clinician scientists who have presented their work here. This is a good sign, because without varied interests, science and ultimately progress slowly comes to a standstill. I call it the...

When B cell inhibiton simply is not good enough. Bruton’s tyrosine kinase inhibitors?

Once you know that B cells are an important target you find ways to inhibit them. One approach is to make depleting monoclonal antibodies. Another way is to to stop B cell signalling. In this study they block Bruton’s tyrosine kinase. ProfG and I spent some time trying to get our hands on one a few years ago but the company wasn’t interested in MS and expected us to pay for all the...

AAN 2019 posters #2

Well, here is part deux of the 2019 AAN posters; a veritable smorgasbord of hidden gems on Market St in Philadelphia. 1. Effect of Ibudilast on Neurofilament light chain in Progressive MS Analysis from a Phase II Trial. Fox et al. Cleveland Clinic.Previous results from the SPRINT-MS study that used 80-100mg/day of Ibudilast, showed slowing of the progression in brain atrophy (i.e. volume loss) by...

Silent progression on disease modifying treatment. Ibudilast insufficiently effective neuroproptection. What more do neuros need to know, before they implement combination treatments

Silent progression in disease activity-free relapsing multiple sclerosis. Cree BAC, Hollenbach JA, Bove R, Kirkish G, Sacco S, Caverzasi E, Bischof A, Gundel T, Zhu AH, Papinutto N, Stern WA, Bevan C, Romeo A, Goodin DS, Gelfand JM, Graves J, Green AJ, Wilson MR, Zamvil SS, Zhao C, Gomez R, Ragan NR, Rush GQ, Barba P, Santaniello A, Baranzini SE, Oksenberg JR, Henry RG, Hauser SL. Ann Neurol...

AAN 2019 posters #1

I discuss below two topics that we don’t understand well in MS. Firstly, the diagnosis of late onset MS (LOMS). Secondly, the occurrence of stroke in MS. Differential diagnosis in Late Onset Multiple Sclerosis (LOMS) – Marrodan et al. Neurology Dept., Fleni, Buenos Aires, Argentina LOMS is defined as presentation beyond the age of 50 years, accounting for less than 12% of MS cases...

Guest post: Part four of choosing a DMT

When in the police, many years ago, I went into some shocking situations. As a middle-class lad I often struggled to even understand how people could live like this. You’d never know it from external appearances with many people. If you want to gain confidence you rapidly learn to communicate at an entirely different level and understand the huge differences in interpretation of information and...

Fatigue in MS – what we don’t know?

Fatigue in MS is a strange duck, on many levels obvious and frequently described by PwMS (80-90%), but one that lacks sound medical explanation and science doesn’t even know how to test it yet. I was sure that the fatigue in MS, particularly exercise induced fatigue, was somehow related to the conduction block caused by the demyelination in the long tracts (corticospinal tract). It would...

You thought bassoon was a musical instrument. So did I. Let’s learn together and ask are we doing the right thing

Bassoon proteinopathy drives neurodegeneration in multiple sclerosis. Schattling B, Engler JB, Volkmann C, Rothammer N, Woo MS, Petersen M, Winkler I, Kaufmann M, Rosenkranz SC, Fejtova A, Thomas U, Bose A, Bauer S, Träger S, Miller KK, Brück W, Duncan KE, Salinas G, Soba P, Gundelfinger ED, Merkler D, Friese MA. Nat Neurosci. 2019 Apr 22. doi: 10.1038/s41593-019-0385-4. [Epub ahead of...

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