Tagsmouldering MS

#Smouldering-MS: the BTK inhibitor race is on

Barts-MS rose-tinted-odometer: ★★★ Mouse Doctor studied zoology and as a result, he tends to use animal analogies to describe various phenomena. In the past, he has been known to use his favourite invertebrates to describe some neurologists or even groups of neurologists. Why invertebrates? If anyone comes up with the correct answer I will send you an MRI scanner lego set as a prize. ...

Smouldering MS: Is 20 years a long time?

Barts-MS rose-tinted-odometer: zero stars or one ★ depending on your disposition I prepared this post not knowing that Prof. Laura Airas has submitted a guest post in response to a request from the Mouse Doctor. Before reading this post please make sure you read her blog post first. It provides an important counterbalance to my contrarian view below. Thank you. More than 20 years ago, when I was...

Beyond NEDA: protecting the end-organ or your brain

Barts-MS rose-tinted-odometer: zero-★’s  It became clear to me at least 6 years ago that we need to go beyond NEDA (no evident disease activity) when treating MS and we have to focus on protecting the end-organ, i.e. normalising the brain volume loss that occurs in people with MS (pwMS). To do this you really need to diagnose and treat MS as effectively as possible early on. From a research...

Dodging COVID-19 to fly to Copenhagen

I arrived late last night in Copenhagen to give a keynote lecture at their Danish MS Society’s annual conference. Copenhagen airport was eerily quiet; COVID-19 is clearly having a dramatic effect on flying. I was asked to give an overview of emerging treatment targets and outcomes in MS. My focus is going to be smouldering MS. I had to cut the section on prevention from my talk; prevention...

MS@theLimits 2020

Barts-MS rose-tinted-odometer ★★★ The Barts-MS team is heavily engaged with the 2020 MS@theLimits meeting at the Royal College of Physicians. Two things to note is the gender bias in favour of female speakers. This was in response to criticism about the male dominance at the last MS@theLimits meeting in 2018. I am speaking today about some of my ideas around ‘the real MS’ or...

Premature Ageing

One of my colleagues, with whom I was co-authoring an editorial on smouldering MS, demanded I delete the section on premature ageing being a factor driving delayed worsening of disability in people with MS (pwMS). I refused so we had to pull the editorial. The fact that he is quite old and doesn’t like the hypothesis of brain & cognitive reserve being neuroprotective explains his position. He...

Will the real MS say hello?

The difference between religion, a belief system, and science, an experimental system, is that you can falsify the latter, but not the former. So when KoL (key opinion leaders) say they believe something they don’t really mean it literally. What they are really stating is a hypothesis that needs to be interrogated.  So when I say that relapses and focal MRI activity are not MS, but are...

What’s in a name?

The Barts-MS team are in the final stages of preparing a UK MS Society grant application to tackle the ‘real MS’ that lives inside you. Our focus is on studying or defining what is smouldering MS. This is a massive unmet need and refers to what we currently call inactive SPMS and PPMS. This is likely to affect a lot of you; at present, you remain in the so-called untreated MS camp. Ocrelizumab...

My ‘Smouldering MS Clinic’

I finished yesterday emotionally burnt-out; “broken and useless, no longer working or effective” or “kaput” as the Germans would say. I did an all-day clinic with my registrar off sick; it was hard and brutal.  On my way home I wondered to myself if I should change the name of my MS clinic to the ‘Smouldering MS Clinic’. Virtually all of my patients had smouldering MS or as some of you would...

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