TagPML

Do no harm

Primum non-nocere is a Latin phrase that means “first, do no harm”.  On the tube this morning I recognised one of our medical students reading Henry Marsh’ book “Do no harm”.  He is a semi-retired neurosurgeon, turned author, who uses his past patients to discuss ethical dilemmas and to criticise the NHS. His book does showcase the life of a surgeon, warts and all.  It is clear that to be a...

The Time-to-Think DMT

At an MS Masters Forum in Rome yesterday I was teaching MSologists and MS clinical nurse specialists using a recently created board game, which I like to think of as being MS Monopoly. MS monopoly is based on a game of chance that lets you discuss case scenarios and make treatment choices. Then you roll a dice, which determines the outcome of your choice.  Two things emerge from playing the game...

De novo PML on ocrelizumab

In my career as a neurologist, I have seen three patients who developed PML (progressive multifocal leukoencephalopathy) without any apparent risk factors apart from being old. They were all over 70. Prior to the HIV epidemic, about 1 in 10 patients with PML did not have an obvious underlying risk factor except for age or immunosenescence of the elderly.  Immunosenescence is the term...

PML carryover onto ocrelizumab

I have just received the following information from Roche, which is reassuring in that As of July 3rd 2019, the Roche can confirm there have been no new carry-over cases of PML in MS patients treated with ocrelizumab since their last update in April 2019. The seventh case was reported in March 2019.As of April 2019, over 100,000 people have been treated with ocrelizumab globally, within a...

Japan epicentre of an Asian MS epidemic

I am about to return from a short MS meeting in Tokyo. This was my first exposure to Japan and Japanese culture. It is everything and more than I expected. I am beginning to get a sense of what ikigai means. Ikigai translates ‘to a reason for being, encompassing joy, a sense of purpose and meaning and a feeling of well-being’. Ikigai derives from iki, meaning life and kai, meaning the realisation...

Filgrastim for natalizumab-induced PML

PML, JCV infection Natalizumab (aka Tysabri), is one of the hard hitters in the DMT world and owing to its mechanism of blocking the ingress of immune cells into the brain, works quickly – achieving control in as little as 4 weeks. In the AFFIRM study, natalizumab reduced the rate of clinical relapse by 68% in the first year! But, one of the drawbacks of stopping the immune surveillance of...

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