CategorySymptoms and treatments

Not All Data is Created Equal. Brain Atrophy

ProfG has put an interesting question about whether DMT are all born equal. Whilst the influence on relapse rates is much clearer in terms of the hierarchy, the effects on brain atrophy has led ProfG to ask a sensible question. It was suggested that HSCT and alemtuzumab are up there at the top of the pile in the atrophy states, leaving the B cell therapies in their wake. B cell therapies are...

What is happening to my cortex?

A very common analogy is the comparison of MS to an iceberg. Why? Only one-eighth of an iceberg is visible above the water; to see what is below the water line requires specialised technology. The MS iceberg analogy refers to several observations: 1. For each clinical relapse, 10 or more MRI visible lesions are seen on MRI.2. For each visible white matter lesions on MRI, there are at least an...

To T or not to T (2)

Prof G what happens to MS disease activity if you stimulate T-cells? About 2 years ago I attended a grand round during which a patient with a history of RRMS had had a catastrophic relapse after receiving ipilimumab for metastatic melanoma. The patient has a massive brain stem relapse and her MRI showed multiple Gd-enhancing lesions with several pseudotumoral lesions. She was in a bad way...

Slowing conversion to SPMS, why we need Neurological Chicxulub for MS

Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis. Brown JWL, Coles A, Horakova D, Havrdova E, Izquierdo G, Prat A, Girard M, Duquette P, Trojano M, Lugaresi A, Bergamaschi R, Grammond P, Alroughani R, Hupperts R, McCombe P, Van Pesch V, Sola P, Ferraro D, Grand’Maison F, Terzi M, Lechner-Scott J, Flechter S, Slee M...

To B or not to B

Is targeting the B-cell sufficient to get on top of MS or do we need something extra? I spoke at the MS Nurses’ MS@TheLimits2019 meeting at the Royal College of Physicians yesterday. My brief was to cover the role of B-cells in the pathogenesis of MS and to review the converging evidence that supports B-cells being the central player in the pathogenesis of MS. It is clear that depleting B...

From the horse’s mouth

The following is an online presentation from Prof. Richard Burt on their latest HSCT results. His presentation was embargoed until today. Enjoy.

When I was asked whether or not these are the most important trial results I have seen in the MS space. What do you think I said?

HSCT is highly Effective

In this study the results of a randomisation non-ablative HSCT stem cell therapy compared to current DMT and it does better. Much better This is not surprising we know that immune depleteion is effective. Effect of Nonmyeloablative Hematopoietic Stem Cell Transplantation vs Continued Disease-Modifying Therapy on Disease Progression in Patients With Relapsing-Remitting Multiple Sclerosis A...

How to manage RRMS – induction followed by maintenance

I’ve been harping on about this strategy for the better half of the past two years, and lo and behold someone has actually done it, and it actually works. The drugs utilized in this study are in fact irrelevant, the importance is the strategy itself. What strategy you ask? Rodo’s Thinker! I’m glad you asked. The one where you go in with all guns blazing and then follow it up...

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