CategoryTrials

Fampridine improves walking but not gait quality

In my mind there is no question that Fampridine improves walking speed in MS. It may not be long-lasting but works for that limited period that you want it to work. Fampridine works as a potassium channel blocker, increasing electrical propagation along axons leading to increased neurotransmitter release at neuromuscular junctions (NMJ) and improved walking. Here in small group of participants...

Stem cells that secrete growth factors

Neurotrophic mesenchymal stem cells (source:aviseanalytics.com) It’s nice to come back from ECTRIMS this year and start looking at what else has been published recently in MS. Harvesting your own bone marrow stem cells and changing them to cells that release neuronal growth factors has been done before. But what’s new here is placing them directly into the spine in any sizable number...

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...

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...

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...

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...

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...

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...

HSCT verses cyclophophamide for progression is no better.

Cyclophophamide is an anti-cancer drug that is not approved for MS but is used sometimes off-label. This inhibits relapses, as shown in this paper, but not quite as good as abalative HSCT stem cell therapy (This is where you get rid of the immune cells and replace the immune response using bone marrow stem cells). This inhibits relapses well, but with regard to progression they are as good or as...

The problem for nutriceuticals

You wrote to me to suggest that supplements work…. but this highlights a problem for nutriceutical studies. There is no patent protection to be had and so pharmaceutical companies are not willing to spend big bucks to do a study where anyone can come along and sell the product without any outlay for drug development. So someone says let’s do a prevention study with supplement X…...

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