CategorySymptoms and treatments

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...

Guest post: Part three of choosing a DMT: Understanding risk

DMTs carry a much higher degree of risk than nothing at all and the reality of MS means that attitudes towards risk need adjusting. It is fine to come into the scenario assessing things in a pre-diagnosis manner, that is understandable. A patient needs educating about the whole post-diagnosis scenario now. The lens through which risk, regarding treatments, has changed. From the risks of opting...

Re-vitalise your gut

Gut microbiome The lions share of the risk (~70%) for developing MS is attributable to environmental risk, while genetics explains bulk of the remaining risk. The environmental risk factors studied in MS have been manifold, ranging from the latitude effect, to viruses, and may well explain some of the heterogeneity that we observe. For some time now, researchers have been looking at an imbalance...

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...

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