Tagbrain volume loss

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...

AAN 2019 posters #2

Well, here is part deux of the 2019 AAN posters; a veritable smorgasbord of hidden gems on Market St in Philadelphia. 1. Effect of Ibudilast on Neurofilament light chain in Progressive MS Analysis from a Phase II Trial. Fox et al. Cleveland Clinic.Previous results from the SPRINT-MS study that used 80-100mg/day of Ibudilast, showed slowing of the progression in brain atrophy (i.e. volume loss) by...

A sequence of losses

Prof G has the MS community go it wrong? In this week’s NEJM there is an insightful perspective by Louise Aronson on ageing and driving. Aronson. Don’t Ruin My Life — Aging and Driving in the 21st Century. N Engl J Med 2019; 380:705-707. Louise quotes the American poet Donald Hall, who explains in Essays After Eighty how life is irrevocably and excruciatingly changed when a person must let go of...

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...

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...

The Learner

Do we need to include cognition as a treatment target in multiple sclerosis? In every clinic, I do patients with MS complain of cognitive symptoms. Either it is increasing forgetfulness, difficult multi-tasking, the inability to learn and use a new technology or cognitive fatigue. Case study: One of my high functioning patients, who worked in a large City law firm, simply could not keep up and...

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...

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...

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