CategorySymptoms and treatments

Inauguration Day

No, not THAT type of inauguration on the US Capitol facing the National Mall, but rather facing an audience in the Blizard Institute’s Perrin Lecture Theatre, colour scheme of which is modelled on a Poppy field, as ‘In Flanders Fields‘, with mostly green and a few dotted red seats. ProfAngray and myself gave our inaugural lectures there last night, in my case this was three...

Who would have guessed but DMDs improve survival

The number of times I’ve been asked whether DMTs have any impact in survival is countless. For those of you who are aware of the effect of MS on survival these study findings will be of great interest to you. It will also hopefully gets people who are still unsure about starting treatment off the fence. In a large review of administrative health databases in Canada amounting to 35,894 MS...

My own cannabis experiment

By Patrick Burke I’ve had MS since 1972 and it has had a huge impact on my life. It now affects me in every which way.  The wonderful NHS prescribes drugs that will ease my symptoms, so every day I have to take a cocktail of pills. I thought the time had come to look at other solutions, so I decided to do my own cannabis experiment. Over the last ten years the pain, twitches and...

Does Teriflunomide as a DMT warrant discussion?

Speaking as a clinician who goes by the mantra ‘treat early, treat hard’, platform therapies as a whole receive less attention from me than highly-active treatments. However, I know that they have a place in the MS armamentarium and admittedly, I have a more than few patients on Teriflunomide. Some of whom have been stable on it for many years, whilst others I’ve had to transfer...

Thyroid problems post alemtuzumab in MS, the endocrinologists take on this

Thyroid dysfunction is the commonest treatment related side effect after alemtuzumab. Alemtuzumab targets CD52 on the surface of T and B cells taking them out of circulation. The precursor cells to the adult T and B cells are left intact because of their lack of the CD52 surface marker. After cell depletion, which occurs very quickly there is then a period of immune reconstitution resulting in...

Mesenchymal stem cells lower neurofilament levels in progressive MS

You would have heard about HSCT for MS, but Mesenchymal stem cells (MSC) are a very different type of treatment and less well known than HSCT. In fact, I would go so far as to say that interest in this therapeutic option is almost non-existent. However, when I came across a recently published biomarker paper on this topic I thought it would be interesting to have another look at it. Further...

When should I stop my interferon-beta safely?

Figure: EDSS score There are two main reasons for stopping an MS drug: 1) it no longer works for you i.e. there is break through disease activity, in which case you should be on a better drug, or else 2) it no longer works for you as you have now entered the progressive stage of your disease. The latter has proven very difficult to define clinically and radiologically, making it harder to know...

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...

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