As part of the normal process of inflammation the body clears up the debris/damage caused during the fight to kill the infection by the white blood cells. This happens in MS after the demolition derby that causes the MS attack. People with relapsing-remitting MS are good at dealing with the damage (tow trucks) caused by the attack and have modern tow trucks to clear the debris and repair the damage.
However, as you get older your tow trucks become more vintage. These work less efficiently than modern tow trucks and the damage in the car park may not be dealt with as quickly as it once was. People that are prone to get progressive MS are probably more likely to have vintage tow trucks that do not deal with the attack as well as one would like.
As the weight of all the car debris accumulates in the carpark, it causes the foundation to collapse and a hole develops in the carpark, this is the beginning of progressive MS. It can start after relapsing MS, as secondary progressive MS, but may develop shortly after the onset with primary progressive MS.
“Why doesn’t progressive MS respond to the MS drugs that hit Relapsing MS?” 
However, as you get older your tow trucks become more vintage. These work less efficiently than modern tow trucks and the damage in the car park may not be dealt with as quickly as it once was. People that are prone to get progressive MS are probably more likely to have vintage tow trucks that do not deal with the attack as well as one would like.
As the weight of all the car debris accumulates in the carpark, it causes the foundation to collapse and a hole develops in the carpark, this is the beginning of progressive MS. It can start after relapsing MS, as secondary progressive MS, but may develop shortly after the onset with primary progressive MS.
We will start to find out next time. TTFN
Another bleeding cliffhanger! Please tell us why these drugs don't resond in progressive MS. I think that it's because the current crop of drugs only work outside the CNS and in progressive MS the drugs need to penetrate the BBB and work inside the brain and spine.
ReplyDeleteThere MouseDoctor; hopefully I've done your work for you, or at least speeded it up. Now tell us what drugs may help us out?
This is a good clip from American filmmaker Cameron Crowe's new PEARL JAM documentary -"P:20" - that provides a visual basis for your hole in the car park metaphor - http://bcove.me/f0tpn4ym
ReplyDeleteAlthough most of the drugs used for MS are indeed active outside the CNS, this is probably not the case for Gilenya, which accumulates in the brain.
ReplyDeleteThe studies in Progressive MS with this drug is ongoing. However, on reflection I am not sure if the brain penetration would matter as Gilenya works by affecting white blood cell activity outside the brain although it has potential to do other things to brain cells.
However, you are right I think that we do need to get drugs into the brain to stop white cell function there, but I fear that it is not so simple. I think more is needed to deal with this problem, as we will explore.