CategorySymptoms and treatments

A moan…Doing trials to pat yourselves on the back for a paper and a job well-done is not what it’s about… Changing clinical practise is what it’s all about

A couple of years ago Dr Raj Kappoor and ProfG did a trial in optic neuritis and tested a sodium channel blocker to see if it could save nerves in the eye after optic neuritis. This was based on studies that MD1, 2, 3 & 4 had done in the beasties. The trial worked and it saved loss of nerves by about 30%, but then what?….Yep Nothing. I said to the neuros..”You have done a trial...

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...

Predicting a relapse

The longer I work in MS the more I realize how unpredictable it is. There are complications in diagnosis, in assessing treatment efficacy, in prognosticating, and in achieving homogeneity in clinical practice. The complications are complicated. But what if you have a test done, albeit quite randomly and it tells you something bad is going to happen in the near future – would you ignore it...

Alemtuzumab use put on Restriction

The European Medicines Agency (EMA) has started a review of alemtuzumab following recet reoports of sde effects affecting the heart, blood vessels, liver and immune system.  These side effects are rare but potentially serious. As a temporary measure while the review is being carried out, the EMA has advised that alemtuzumab should only be started in people with relapsing remitting MS that...

A treatment for PML

It seems this is PML week. first PML on alemtuzumab and now this….a treatment for PML or is that that Two I first thought wow….but then I read the title and I thought that maybe I’m being a bit thick here because I have seen a few people wetting their pants on twitter with excitement on this news, but maybe I am missing something? You have a disease that causes white blood cells...

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...

DMF versus Teriflunomide

Treatment algorithm (Ingwersen J et al.) Did I hear you say injectables, what injectables? The turf war in the first-line RRMS treatments is clearly between the two oral therapies; dimethyl fumarate (DMF) and teriflunomide (Teri)!Each have their Achilles heel. DMF with its lymphopenia (drop in lymphocyte counts) and Teri with its transaminitis. So, it isn’t surprising that the weighing...

Blood starved MS

There is mounting evidence that the brain blood supply is affected in MS. Perfusion MRI studies have found that blood flow is globally impaired in the normal appearing brain of both relapsing and progressive forms of MS. Interestingly, there appears to be an association between this and cognitive (memory and intelligence) dysfunction in MS. In animal models, chronic hypoperfusion of the brain...

Alemtuzumab rescue therapy for rebound after stopping natalizumab

Natalizumab is an effective strategy for achieving disease control in those with highly-active MS, but owing to the risk of progressive multifocal leucoencephalopathy (PML), often needs to be de-escalated. However, discontinuation of natalizumab therapy is not without its own risks; the biggest risk being rebound activity, which rarely may be a flare beyond that of pre-treatment disease activity...

Translate

Categories

Recent Posts

Recent Comments

Archives