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St Elsewhere

Barts-MS rose-tinted-odometer: zero ★’s St Elsewhere is a euphemism in medicine for a fuck-up done under someone else’s watch, i.e. at St Elsewhere’s hospital. In this week’s NEJM there is a tragic case of a 22-year old Pakistani man who was misdiagnosed as having MS at St Elsewhere, started on natalizumab, which was ineffective, before being switched to interferon beta. By the time he was...

CSF vs. Blood neurofilaments

This blog post explains why blood neurofilament level monitoring is not ready for primetime and may never quite replace CSF NFL monitoring in pwMS.  Although blood neurofilament light chain (NFL) levels are a promising biomarker for monitoring MS inflammatory disease activity there are issues that need to be resolved.  We and others have shown that blood levels correlate with spinal fluid levels...

Beyond the B-cell

Do we have the right cell target in MS? Yes and no; we need a multicellular approach. Recently the attention in MS has been on the B-cell as if it was the holy grail of MS treatments. It is not. In several posts, over the last few weeks, I have made the case that the B-cell is important, probably as an antigen presenting cell, but it is not the ‘be all and end all’ of MS treatments. It is clear...

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