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Beyond NEDA

Prof G are we being lulled into a false sense of security by being told that we have no evident disease activity (NEDA)? A patient of mine, who I have been looking after now for over 11 years, asked me in clinic a few weeks ago why despite being NEDA for 6 years, on a highly effective maintenance DMT (fingolimod), has she gone from being able to run 5-10 km to needing a stick and barely managing...

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What’s your excuse?

What will it take to get me to stop smoking? If you are a smoker and continue to smoke you need to think about how you want to manage your own MS. We debate endlessly about the lack of progress in developing effective treatments to slow down the worsening of MS and ignore the obvious. The first study below implies that by simply stopping smoking it will have a major impact on the outcome of your...

To vaccinate or not?

Should your vaccine status be checked and updated before you start treatment? As part of our programme to derisk disease-modifying therapies (DMTs) for pwMS in our service, we are reviewing our vaccination policy. One issue that has emerged is the possible need to boost immunity to certain types of bacteria that are known to pose a risk in patients on long-term immunosuppression, in particular B...

EBV infects T-cells

Why are experts important? In the so-called post-truth era experts are derided and ignored. Not at Barts-MS. Last Friday we held a lock-in to review and discuss our EBV research programme and bring in expertise from outside our group. We were fortunate to have card-carrying EBV experts, oncologists, B-cell biologists and protein and antibody experts around the table. A central plank of the EBV...

We sincerely apologize, but you don’t have MS

The rate of misdiagnosis of MS around the globe is roughly a quarter. We are so focused in making an early diagnosis in MS that before we know it, it’s a runaway train. Sometimes, even the best of us need to eat our words, and admit to having a made a mistake. The diagnosis of MS is not easy; how many of you have googled non-specific symptoms and come up with MS as a potential cause? The...

HSCT Citizens’ Jury

Prof G, why do you talk with a forked tongue? I am taking stick from many readers about my stance on HSCT. I implied in a comment yesterday that I would seriously consider it as a first-line treatment if I had MS, but in reality, I don’t offer or support HSCT for my own patients with MS as first-line therapy. Some readers are accusing me of double-standards. Should I walk the talk and put my head...

Making B cells

We have been discussing whether Epstein Barr Virus could trigger MS, without the requirement for T cells. It is thought that high-affinity (strong binding) isotype–switched (Antibodies such as IgG that develop from proteotypic IgD or IgM producing B cells) antibodies by B cells depends on signals from CD4+ Thelper cells. Antigen (Ag) binding to surface Ig molecules (BCRs) causes naive (mature) B...

Brain Atrophy

ProfG has been addressing the issue of brain shrinkage and asking-Which agents are the best? We may not all agree on what is the best, but one can ask what is/are the worse. If we can address this problem and agree, then surely it is time to say “It’s rubbish! Throw it in the Bin!” (A comment I once heard at an MS Life meeting) The obvious answer is……yep you guessed...

What is end-organ damage?

Help! How do I manage progressive brain atrophy in a patient who is NEDA-3? End-organ damage is a catch-all phrase for the degeneration of the brain; it occurs as part of the ageing process that some consider pathological and others as a normal fact of life. I have hinted that I consider it both because end-organ damage is potentially modifiable via lifestyle modifications and pharmacological...

Guest post: Sex and MS

Just as in anyone’s life, sex with MS can be fun, intense, routine, boring, passionate, flirty, dirty, easy, comforting, fraught with difficulties, or all of the above! Sexuality and sensuality is an integral part of being human and, depending on the individuals involved, has varying degrees of importance at different times in a relationship. For this article, I’m leaning heavily on an excellent...

Prof G how much brain have I lost this year?

How soon will MSers have brain volume measurements as part of their annual assessments? As a reader of this blog, you may be aware that ‘life is a sexually-transmitted age-dependent terminal neurodegenerative disease’. Homo sapiens, as a species, is pushing its biological capabilities to its limits. We have conquered most diseases that used to cull us before our mid-thirties and the end of our...

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