Tagbrain volume loss

How important is your brain volume?

Barts-MS rose-tinted-odometer: ★★★★★ (A blue sky and sunflower yellow Tuesday; #87CEEB #ffda03) I bang on about treating-2-target beyond NEIDA (no evident inflammatory disease activity) and targeting the end-organ, i.e. to try and normalise brain volume loss (BVL). The aim is to get pwMS to old age with a healthy brain so that they can age normally. Who wants to be at risk of premature...

Anti-CD20 vs. Teriflunomide

Barts-MS rose-tinted-odometer: ★★ (seeing blue) When I state that the real MS is smouldering MS and that relapses and focal MRI activity are not the disease I really mean it.  PwMS who are NEDA-2, without relapses and with no new MRI lesions, but getting worse must have something going on in their brains and spinal cords. This is why we need to go beyond NEIDA (no evidence of inflammatory...

Which side of the fence are you on?

Barts-MS rose-tinted-odometer: zero-★s (still seeing red) Apologies some more definitions:  Side of the fence: used to refer to either of the opposing positions or interests involved in a particular situation. Status quo: the current situation; the way things are now. The MS community, i.e. patients and HCPs are content with the status quo and aren’t looking for a change.  NEDA: no...

To switch or not to switch that is the question

Barts-MS rose-tinted-odometer: ★★★ The one good thing about thinking aloud is that your colleagues’ chip in and provide feedback. Case 2 from my ‘ethical quandary post‘ is generating an important debate about whether to support this patient’s decision to switch therapy or not. As a reminder, this is the 40-year old woman who started natalizumab as a first-line therapy 11...

Swiss-cheese

Barts-MS rose-tinted-odometer: zero-stars What do you say when I colleague chastises you for stating the fact that MS is potentially a ‘preventable dementia’? This particular colleague was clear that there is no need to draw any parallels between MS and other neurodegenerative diseases because of the negative connations that the term dementia has. I had to remind him that MS ticks all...

#ThinkCognition: how precious is my brain?

Barts-MS rose-tinted-odometer: ★ As someone with MS do you worry about how you are going to cope with ageing and old age?  As MS shreds both your brain and cognitive reserve will MS bring forward and accelerate the ageing process and the time when you may develop neurodegenerative diseases such as Alzheimer’s disease? These are all hypotheses but are very relevant to people with MS (pwMS) and...

A false sense of security?

Just catching up with my reading. Whilst I was away on holiday the ASCLEPIOS I and II trials was published in the New England Journal of Medicine.  There is little doubt that ofatumumab is superior to teriflunomide when it comes to suppressing focal inflammation, i.e. relapses, MRI activity and peripheral blood neurofilament levels. However, ofatumumab’s effectiveness against teriflunomide on the...

Beyond the B-cell: cognitive dissonance

I continue to be amazed when I hear senior MS neurologists make the claim they have never prescribed alemtuzumab or referred any of their patients for HSCT and don’t intend to do so either. These same neurologists seem to be happy with natalizumab and ocrelizumab as their #1 high-efficacy go to DMTs. When I challenge them with the exceptional longterm outcomes for pwMS treated early with...

Classification of progressive MS

Typically the onset of disease progression in MS is ‘silent’ and differs from person to person. Not surprisingly, attempts at defining at least clinically has not been an exact science. In a letter to Annals of Neurology Gil-Perotin et al. (Valencia) ask an important question, whether progression during the relapsing phase of MS is the same as in secondary progression (refer to MS...

How conscientious are you?

Conscientiousness like other higher function traits is advantageous to the modern society in aggregate, as well as individually. It may even be evolutionarily adaptive: “In several respects, conscientiousness is an unusual personality trait. Because hunter-gatherer life did not require as much planning and memory for debts and duties as life in larger-scale societies with more complex...

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