CategorySymptoms and treatments

Pain in optic neuritis – the importance of careful history taking

Optic neuritis (source: Quora) I was recently the on-call Neurologist for The Royal London Hospital, which over the weekend can have an immense catchment area extending as far as Southend Hospital. It was during said on call that I was contacted by the on-call registrar. The story was of a pregnant lady experiencing unilateral eye pain and profound visual loss. Their working diagnosis was...

Rebound after switching with fingolimod

Rebound in MS disease activity occurs when coming off highly-active drugs. It refers to a return in MS activity that is more than before. The drugs most likely to demonstrate this are the highly-active treatments that are given on a regular basis (i.e. maintenance treatments, such as natalizumab and fingolimod – it is too early to say with ocrelizumab) that create a gating system for the...

Real-world figures on the efficacy of anti-CD20 in PPMS

In the UK ocrelizumab, an anti-CD20, is licensed for the treatment of Primary Progressive MS (PPMS) and Relapsing Remitting MS (RRMS). Rituximab, although not licensed for use in MS in the UK is also an anti-CD20 therapy with immunosuppressive properties. The two are matched in their efficacy in terms of reduction in disease progression (see Figure below) and serum neurofilament (sNfL) in PPMS...

Hit and Run or Should I say Hit and Crawl. The speed at which white matter damage leads to grey matter changes

We often hear “I swapped to drug X or Y and I still feel I am getting worse”. This not surprising because it takes time for the attacks to run their course, So in this study they looked to see how quickly damage to the white matter (myelinated axons= nerve body) took to show itself by loss of neurons in the grey matter (nerve heads). Here they imaged people repeatedly and they looked...

Psoriasis as a side effect of Ocrelizumab

I would be interested to know how many of you have experienced this with ocrelizumab (Ocrevus)? Is it a rare event or more or less uncommon (see Figure below). How to classify the likelihood of side effects Case 1 in this publication is a 40y old female with PPMS (Primary Progressive MS) who developed after the first half year of treatment, pustules, loss of skin, redness of her palms and soles...

AAN2022 Natalizumab and the Me-Too

Natalizumab is being used by ProfK in the AttackMS trial, which is to treat at first sign to prevent subsequent attacks, whilst diagnostic work-up is done and getting people onto highly effective treatment quickly. This is going to use standard monthly intravenous dosing. This is relatively safe to use for a couple of years and it gives people breathing-space to decide how best to move forward...

My predictions for 2022 foresee choppy waters for Clemastine

Figure: Myelin formation (source: Jackman et al. Physiology (Bethesda). 2009 October ; 24: 290–297. doi:10.1152/physiol.00016.2009) Clemastine is a first generation anti-histamine used to relieve the signs and symptoms of hay fever. However, it is its purported remyelination properties have garnered great interest in the MS community. No fairy tale run smoothly as you can see from this recent...

How does anti-CD20 work?….Boy are we making it complicated

Understanding CD20+ T cells in MS Anti-CD20 monoclonal antibodies have shown some efficacy in patients with multiple sclerosis (MS). Although CD20 is mostly expressed by B cells, a subpopulation of CD20+ T cells has been identified. The origin of CD20+ T cells and their role in autoimmune diseases are not fully elucidated. Now, Ochs et al. found that T cells can acquire...

What your personality says about you?

Oddly enough Freud’s Theory on Personality still applies to this day and age. The array of competing forces between the ‘Id, Ego and Superego’ describe one’s personality to tee. But, psychoanalytics aside, I would like to mention for those researching/designing MS treatment programmes, structuring them in accordance with a persons underlying subconscious personality can...

Loneliness and MS: Could e-health be a Solution?

By Rachel Horne For people with multiple sclerosis, we know this much is true. Dealing with the physical side of the disease is just one part of the struggle. Feeling alone is another. Not only are people with MS significantly more prone to loneliness compared to the general population, but strong evidence shows it also puts our brain health and overall health at risk. It can lead to depression...

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