Sunday, 18 March 2018

#Thinkhand - Natalizumab preserves upper limb function in advanced disease

Most people with MS will have discrete episodes of disability - relapses - from which they get better. Unfortunately over time, many people gradually accumulate disability and stop having clear relapses. This shift is often labelled as a shift from 'relapsing' to 'progressive' disease, and once in the second phase people are often given the label 'secondary progressive MS'. While this label may not necessarily be that helpful - it make be more useful just to distinguish early from advanced MS - it is still widely in use. 

Saturday, 17 March 2018

Charcot 3: does an anti-viral inhibit MS?

Does an anti-viral inhibit MS? Charcot 1 is still not published (nudge, nudge) but it didn't work but that didn't surprise me as the treatment agent prevented virus integrating into the DNA, which was targeting a virus that had already integrated.

However there was anecdote of disease remission after taking the drug. It has happened again:

Friday, 16 March 2018

Guest Authors: The alternative view

Earlier this week a piece was published in the Annals of Neurology reporting how certain authors are on clinical trials and implying that they could be "guest authors"; celebrated “key opinion leaders” who do not contribute to trial design or execution, or manuscript drafting, but whose name lends gravitas to the study.

Today Prof A gives a response to this.

Thursday, 15 March 2018

Can interleukin-4 save nerve cells?

Untreated inflammation is bad for the brain. Over time, repeated bouts of inflammation predispose to the gradual loss of nerve cells from the brain and spinal cord. This gradual degenerative process is what we can quantify with brain atrophy and measurements of neurofilament. Loss of nerve projections (axons) begins very early in the inflammatory process, occurs both within and distant from lesions, and is probably the main driver of disability. 

Wednesday, 14 March 2018

Off-Label Use. Is it bad for business? Should it be allowed?

Should we have off-label use of MS treatments, if it competes with pharma interest?

There are many that would not contemplate this view. 

What do you think? 

Tuesday, 13 March 2018

More on endogenous retroviruses in MS

Int J Mol Sci. 2018 Mar 9;19(3). pii: E786. doi: 10.3390/ijms19030786.

Genetic Determinants of Antibody Levels in Cerebrospinal Fluid in Multiple Sclerosis: Possible Links to Endogenous Retroviruses.

Emmer A, Brütting C, Kornhuber M, Staege MS.


The pathogenesis of multiple sclerosis (MS) has not been clarified. In addition to environmental factors; genetic determinants have been implicated in the pathogenesis of MS. Furthermore, endogenous retroviruses (ERV) might play a role in MS. The presence of oligoclonal immunoglobulin in cerebrospinal fluid (CSF) is a typical feature of MS. Recently, genetic polymorphisms in loci on human chromosomes 6, 14 and 18 have been identified as major determinants of CSF antibody levels in MS. The functional relevance of these single nucleotide polymorphisms (SNPs) remains unclear and none of them is located in an open reading frame. In previous studies, we identified ERV sequences in the vicinity of MS associated SNPs. Here, we describe the identification of ERV sequences in the neighborhood of SNPs associated with CSF antibody levels. All of the identified SNPs are located in the vicinity of ERV sequences. One of these sequences has very high homology to a sequence derived from the so-called MS-associated retrovirus (MSRV). Another cluster of three ERV sequences from the immunoglobulin heavy chain locus has retained the typical organization of retroviral genomes. These observations might shed new light on a possible association between ERVs and MS pathogenesis.

Figure: MS associated SNPs are located in the vicinity of ERV sequences

I've been reading a lot of poetry of late, so here goes nothing!!!

Viruses are hot to trot,
Hot off the press,
Hot on the heals of EBV,
Undisputably not full of hot air.

Anyway, back to the topic at hand...

Oligoclonal bands are a sign of immune response and the presence of antibodies in the spinal space. Genetic variations (or single nucleotide polymorphisms, SNPs) have been reported on chromosomes 6, 14 and 18 in regions involved in antibody production in MS. Endogenous retrovirus elements (are virus sequences in the human genome that are thought to be derived from retroviruses; viruses often insert a copy of their DNA into their host genome during their replication cycle, and once there are inherited through successive generations) have been also found in the human genome and may influence the expression of our own genes. Here, the authors put forward the theory that these ERV loci could drive the production of antibodies (the oligoclonal bands) in MS.

They note that surrounding the genetic polymorphisms is the presence of various ERV sequences. Particularly, surrounding the polymorphism rs9807334 on chromosome 18, the open reading frame that encodes a protease and reverse transcriptase, is highly similar to a sequence in MSRV (which has been strongly linked to MS) suggesting that ERV activity may influence antibody levels. Similarly, polymorphisms on chromosome 14 (which generates part of the antibody, specifically the heavy chain) and chromosome 6 (the Major Histocompatability Complex, a group of proteins by which foreign antigen recognition by the immune system occurs) that are more directly involved in antibody synthesis also contained in their vicinity retrovirus-like open reading frames.

It is therefore possible that during inflammation there may also be synthesis of proteins from these retroviral elements, which may generate a B cell response. Although, this needs to be investigated in greater detail.

Monday, 12 March 2018

Is Prof G a guest author or trial junkie?

Has Prof Rev C from Cambridge gone rogue and decided that he doesn’t like the MS World much, as he points the finger at Ten  Neurology Trial Junkies (known by letters of the alphabet)? 

This study looks at trial reports and concludes that certain people appear all too often. Is Prof G one of them?

Do not read if you easily get offended.

Sunday, 11 March 2018

Is it the B-cell and/or the T-cell? Prof G eats his hat.

At Barts-MS we have been pushing the B-cell hypothesis based on circumstantial evidence when a lot of genomic, and other data, make it clear that T-cells are also involved in the pathogenesis of MS. Now that the first non-depleting BTKi (Bruton Tyrosine Kinase Inhibitor) is effective in MS does this change our central hypothesis? 

Yes, I am eating my hat. I predicted that unless a BTKi was depleting it would not work in MS. Why? 

Education: Whats BTK

Bruton's tyrosine kinase (abbreviated to BTK) also known as tyrosine-protein kinase BTK is an enzyme that plays a crucial role in B-cell development.

However, whilst ProfG has been munching on his chapeau, I've been doing some reading and am not ready to let the T cell boys and girls off the hook. More B cell magic....

Saturday, 10 March 2018

Guest post: #ThinkHand Campaign for Advanced Multiple Sclerosis

I attended the launch of the #ThinkHand campaign for advanced MS by Barts MS Health at the Bankside Gallery in Southwark on Thursday 22 February.

I can still walk, but it is a very slow walk and I must use a rollator or walker. I have lost the ability to walk independently. If you fall into this category of disability then there is no drug available from the NHS to slow down the inevitable  progression of MS.

The ability to use my hands and arms is now very important for a multitude of reasons. Without them I could not use a rollator or walker.

A bit of history
All the drug therapies approved by NICE can only be prescribed for early-stage MS known as RRMS. There was a time when I could run, hop, skip and jump but that was a long time ago. It was a terrible shock when I discovered in 2001 I could not even walk in a straight line. In 2004 I was no longer able walk the dog. Now I definitely had SPMS. My consultant who I was seeing once or twice a year was powerless to do anything that might help me.

#ThinkHand Campaign for Advanced MS
The Barts MS Health team are dragging treatment for advanced MS into the 21 st  century. Here are some objectives of their #ThinkHand campaign:

  • Use the 9 Hole Peg Test (9-HPT) as a primary outcome measure in clinical trials to assesses hand function.
  • Give MS patients who cannot walk access to clinical trials
  • Perform a clinical trial for MS wheelchair users. The Chariot-MS Study that uses Cladribine has been proposed.
  • Provide an environmentally friendly 9-HPT so people with advanced MS can monitor their arm and hand function.
  • The pharmaceutical industry needs to design clinical trials that are inclusive for people with advanced MS

Multiple sclerosis is an incurable disease. There are quite a few drugs that can be given to people to slow down the progress of MS. When the consultant decides that your MS is not the Relapsing Remitting type then you are not eligible for any drug modifying therapy. Just think about that for a moment.

How good is your mobility?
Quality of walking is an indication of the severity of the MS. Long before I needed a walking stick I knew that I was unable to walk along a painted line. I could still run
but my balance was definitely squiffy. If anyone implied that I might end up in a wheelchair then I was selectively deaf. 

Today I can’t walk unaided but also I don’t need to use a wheelchair yet.

Other problems
Now my writing is almost illegible, I can’t type instead I use dictation software.  I have no feeling in my fingertips and it is very difficult to do up buttons. Is my MS better or worse than someone who has to use a wheelchair?

There are too many things you take for granted that I cannot do. The #ThinkHand campaign for advanced MS wants to make people more aware of the impact of advanced multiple sclerosis. Hope and quality of life are important for

by Patrick Burke

Patrick was diagnosed with RRMS in 1995 but believes his symptoms started in 1972. The disease turned into SPMS in about 1999/2000. He was forced to take medical retirement in 2012 and set up the website Aid4Disabled in the same year. The website is the story of his MS since retirement and it describes a wide range of objects that are readily available for disabled people to improve their quality of life. Patrick is also a member of the Barts MS Advisory Group.

Friday, 9 March 2018

Guest Post: Extending natalizumab dosing interval may reduce the risk of PML

Natalizumab extended interval dosing (EID) is associated with a significant reduction in PML risk compared with standard interval dosing (SID) in the TOUCH® Prescribing Program.

Thursday, 8 March 2018

2018 Research Day news

We are excited to announce that this year Barts-MS will be teaming up with neurologists from Glasgow and presenting a research day in Stornoway on the Isle of Lewis.

Wednesday, 7 March 2018

Reflections on 'An Instinct for Kindness'

The BBC Radio 4 dramatisation on the assisted suicide of a person with advanced SPMS has generated some heated exchanges. I have now listened to the dramatisation and have reflected on the story. It is a very touching story and I would recommend it to all people with an interest in MS. 

Tuesday, 6 March 2018

News: British & Irish MSologists are spoilt for choice

The following are two MS-related meetings happening this week. If you had a choice which one would you choose to attend?

Complementary medicine in MS

Are you a complementary or alternative medicine person? This post is about the usage of complementary and alternative medicine by people with MS.

Monday, 5 March 2018

Blogs can't see wheat from chaff...should we defend our position?

Blogs cannot separate wheat from chaff.
Burt RK, Snowden JA, Burman J, Oliveira MC, Sharrack B.
Science. 2017 Nov 3;358(6363):602.

Should we accept this claim or defend our position?

Sunday, 4 March 2018

Help ProfG become Peter Pan

 Does Prof. G suffer from the Peter Pan Syndrome*?

Ask Barts-MS - March 2018

Want to ask a question or make a point unrelated to the threads?

This is the place for you

Saturday, 3 March 2018

ACTRIMS 2018: Rituximab does not affect MRI detected meningeal lesions

Intrathecal rituximab is worth exploring as a treatment option? Can it eliminate the B-cells driving progressive disease?

Blast from the past: something the new readers don't know

You asked does Ocrelizumab need to be dosed so often?

I repost this from last year about the 4 year old data and ask why it has not been published?

We need a study to address the question, is there induction therapy potential. 

Friday, 2 March 2018

Urgent News Update: daclizumab is withdrawn from the market

The EMA has just announced that Biogen and Abbvie are pulling daclizumab from the market. Why?

Atraumatic Needles: times are changing but we need to do more

Are you about to have a lumbar puncture? If yes, what needle is your neurology team going to use to perform the lumbar puncture? If you want a simple guide to LPs please visit our LP web app.

Wednesday, 28 February 2018

Genes with progression show us it is inflammatory Start to Finish.

Ageing is part of the MS process.
If you are interested in what genes are turned on read here.

But it is very clear that inflammation is part of Advanced (progressive) MS

Tuesday, 27 February 2018

Monday, 26 February 2018

Cellular Expression of CD49d

Natalizumab blocks binding to CD49d = alpha 4 integrin = very late antigen 4

Can more be done to derisk natalizumab; the case for EID?

Extended-interval dosing (EID) breathes new life into natalizumab. Does this mean our #BrainAttack trial in CIS and an ASCEND II+ trial in SPMS (including wheelchair users) has a chance of getting done (wink-wink)?

Sunday, 25 February 2018


Pregnancy is an important issue with regard to MS, so we try and post the research even if we have nothing much to say

Saturday, 24 February 2018

Education PNS and CNS axons

Peripheral nervous system and central nervous system nerve axons

Mark Baker tells you more about nerves

#ThinkHand Awareness Speech

My speech from our #ThinkHand Awareness event on Thursday night. 

Friday, 23 February 2018

HSCT and T cells and MS and memory B cells

What cells are important to target in HSCT?

TeamG in the News...used for Crowd funding

ProfG and DrK were in the media yesterday as they launched their #Thinkhand campaign.

Yep this is old news on the blogsphere, but the Evening Standard (Local London Newspaper) picked up the story and pulled a fast one

Thursday, 22 February 2018

Putting the CART before the horse: could CAR-T cells be a last-resort therapy in MS to rival HSCT?

First off, apologies my long winter hibernation from the blog. As you may have gathered (if anyone is paying close attention to my blogging habits) I'm no longer full-time at BartsMS, and have been working in mental health down the road at Mile End. There are loads of interesting things to say about the overlap between MS and mental health, lots of which have been discussed before on the blog. 

#ThinkHand: Today is MS Hand Awareness Day

We are hosting our #ThinkHand Awareness event tonight. The good news is that will be there to help promote the campaign. The following are some YouTube clips, from their reporters, explaining the campaign and how you can help. 

Thank you for helping and spreading hope for the million-plus people who have MS and are using a wheelchair.

Wednesday, 21 February 2018

Barts Health CSF Neurofilament light chain (NfL) request

As promised, any clinician based in the UK can request the neurofilament light chain for Multiple Sclerosis. Your hospital laboratory would need to discuss the transfer of you CSF sample to our lab:

Dr David Holden
Centre for Neuroscience and Trauma,
Queen Mary University of London,
4 Newark St
E1 4AT


A sample request form is below:

The final report that you receive will look something like this:

If there are particular questions with regard to sample volume, storage and transport Dr Holden will be able to answer them.

Vitamin C for myelination

What has vitamin C got to do with MS?

Our Prime Minister has the decency to send her apologies

We are hosting our #ThinkHand awareness event tomorrow night. We were hoping to get Theresa May to attend and endorse the event. At least she responded. JK Rowling didn't even acknowledge our invitation. Very poor form? 

Tuesday, 20 February 2018

CSF neurofilament light chain and OCB predict conversion to MS in RIS

CSF neurofilaments are ready for prime time. Do you agree? Wouldn't you as someone with MS not want to know what their CSF NFL levels were? 

Inflammation and nerve damage occur before you even know you have MS

I didn't realise that NDG had done this but here are my thoughts...

Monday, 19 February 2018

Here comes #ChariotMS. Or does it?

Is the #ChariotMS study worth funding? Is upper limb function worth saving in people with more advanced MS?

The objectives of our #ThinkHand awareness event, which we are hosting this Thursday night, is to celebrate hand function in people with MS and to promote #ChariotMS to the wider community.

Risk of haemolytic anaemia after alemtuzumab

Alemtuzumab use has been associated with the development of secondary autoimmunities.

Antibodies to Red blood cells can be one of these

Sunday, 18 February 2018

Changing Documents. Will it impact on changing practice?

All senior scientists who work in the University sector in the UK are being monitored for their output to determine whether they are of International standing and whether their work has any Impact.

Check this out to explain (CLICK. Performance culture is ruining scientific research), it's quite a sorry state of affairs.

What is Impact?

Does the work change clinical practice? or perhaps science practice or policy? 

Sometimes we have to remind you of the stuff we have done.

Friday, 16 February 2018

Thursday, 15 February 2018

Crowd-funding: Listeriosis Prevention Pack

We, Barts-MS, and the NHS needs your help to try and prevent Listeriosis after alemtuzumab treatment. We are raising money to produce a Listeriosis Prevention Pack. 

Barts-MS Listeria Prevention Pack Prototype

Drugs doing more than one thing, it's not always good

Morrow SA, Rosehart H, Sener A, Welk B. Anti-cholinergic medications for bladder dysfunction worsen cognition in persons with multiple sclerosis. J Neurol Sci. 2018 385:39-44.

Bladder dysfunction is common in persons with MS (PwMS), often due to muscle overactivity. Anti-cholinergic medications are considered the first line treatment for bladder dysfunction and are known to worsen cognition in healthy older adults and in persons with dementia. Yet, it is not known if these medications have the same effect on PwMS. Thus, the Objective of this prospective matched-cohort study was to determine if anti-cholinergic medications affect objective measures of cognition in PwMS. 

We recruited PwMS starting either oxybutynin or tolterodine (cases). Cases and controls were tested with the Brief International Cognitive Assessment for MS (BiCAMS) battery prior to starting anti-cholinergic medications and 12weeks later.
  The primary outcome was change on the Symbol Digit Modalities Test (SDMT) between groups; secondary outcomes were changes on the other BiCAMS measures. Analysis to assess the significance of between group differences was performed at 12weeks. Forty eight PwMS starting anti-cholinergic medications and 21 matched PwMS controls were recruited. There was a significant difference (p<0.001) in the change on the cognitive measures over 12 weeks between groups. The controls demonstrated improvement, consistent with practice effect, while the cases remained unchanged. This study demonstrates that anticholinergic medications may have a negative effect on cognition in PwMS.

Anti-cholinergic drugs block acetyl (ace-eee-tile) choline activity. Aceyl choline is a neuro-transmitter. Acetylcholine functions in both the central nervous system (CNS) and the peripheral nervous system (PNS). In the CNS, cholinergic projections from the basal forebrain to the cerebral cortex and hippocampus support the cognitive functions of those target areas. In the PNS, acetylcholine activates muscles and is a major neurotransmitter in the autonomic nervous system.The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousalThere are two main classes of acetylcholine receptor, nicotinic and muscarinic. Block acetylcholine and you can get dry mouth constipation  flush skin.

You can get leakage from a bladder because the muscle is contracting too much, anti-cholingrerics can block this. If you can't go, cholinergic agonists can contract the bladder to empty it.  However in addition to blocking over active bladder, it can block nerve action involved in thought processes. 

Why is this important? Because it shows you that the body can use the same system to control more than one function. They could be have universal good things but they can be opposing one good and one bad. Many of the the agents that promote remyelination have alternative functions and don't be surprised is some of those found to be useful in myelination may have unwanted effects. But do we need to take remyelinating drugs forever or just for a short time so that myelination starts?

Wednesday, 14 February 2018

Education: What is a nerve impulse?

What is a nerve impulse? How does a nerve axon generate it and allow signalling using impulses from one place to another?

The impulse may be thought of as a message or wave.  A ‘message’, for example on a telegraph, or a ‘wave’ in the sea initiates at one point and ends up elsewhere. The message needs the medium: the wave may have travelled great distances, but it cannot exist without the sea, whereas the sea itself has not moved. Likewise, the anatomical connectivity of an axon does not change as impulses are transmitted. A telegraph message requires an unbroken line. If the telegraph line somewhere between Laramie and Denver in the old West is broken, then the message does not get through and the bandits might escape justice. There is a similarity here with the nerve impulse and the axon. The axon has to make the impulse and provide a conduit for its conduction.

Monday, 12 February 2018

Guest post: Why hasn't the reality of hidden disabilities caught on yet?

Twice in the past couple of months I’ve been reduced to tears because I’ve seen media stories about people with hidden disabilities being treated appallingly by people in customer-facing positions who should be the ones leading the way when it comes to helping those who might need that extra bit of help. In both the stories, the two women were told they didn’t “look disabled.” 

As someone with MS who most of the time looks perfectly healthy, it’s something that really resonates. I hope that you will share this post far and wide, if nothing else so that every individual who reads this will remember that old saying “don’t judge a book by its cover.”

Sunday, 11 February 2018

My trip to Lucerne and the Charcot Project

A few weeks ago I was invited to give a lecture at the annual Swiss MS Society meeting on 'The Charcot Project' and the rationale behind using anti-viral drugs to treat MS.

As promised my slides from the meeting; they should be self-explanatory:

Saturday, 10 February 2018

What is your risk of developing PML on fingolimod?

The following update on PML risk on fingolimod was released to us by Novartis. 

Will this new data lead to a change in practice? 

Friday, 9 February 2018

Guest post: The argument for legalising cannabis for medicinal use

Note: This is a post which talks about the effects of PPMS in a way that some readers may find upsetting.

We are a regular family who has been virtually decimated by MS.

Education: Cannabis

If you are interested in the biology of cannabis you can flick through these slides

Thursday, 8 February 2018

Neural Stem cells to the Rescue?. Phase I trial results

VK Harris et al. Phase I Trial of Intrathecal Mesenchymal Stem Cell-derived Neural Progenitors in Progressive Multiple Sclerosis
EBiomedicine DOI:


Multiple sclerosis is one of the leading causes of disability in young adults. Our study is the first evidence suggesting that a cell-based therapeutic approach is capable of reversing disability in multiple sclerosis. Results of our study add to existing evidence demonstrating the safety and tolerability of intrathecal administration of autologous mesenchymal stem cell-derived neural progenitors. The study was associated with repeated administrations of cells freshly harvested from culture, as opposed to cryopreserved cells thawed at the bedside, which may have contributed to the observed efficacy of the treatment. The continued development of this therapeutic approach will likely have implications for treating other neurological diseases.

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system and is one of the leading causes of disability in young adults. Cell therapy is emerging as a therapeutic strategy to promote repair and regeneration in patients with disability associated with progressive MS.
We conducted a phase I open-label clinical trial investigating the safety and tolerability of autologous bone marrow mesenchymal stem cell-derived neural progenitor (MSC-NP) treatment in 20 patients with progressive MS. MSC-NPs were administered intrathecally (IT) in three separate doses of up to 1 × 107 cells per dose, spaced three months apart. The primary endpoint was to assess safety and tolerability of the treatment. Expanded disability status scale (EDSS), timed 25-foot walk (T25FW), muscle strength, and urodynamic testing were used to evaluate treatment response. This trial is registered with, number NCT01933802.
IT MSC-NP treatment was safe and well tolerated. The 20 enrolled subjects completed all 60 planned treatments without serious adverse effects. Minor adverse events included transient fever and mild headaches usually resolving in <24 h. Post-treatment disability score analysis demonstrated improved median EDSS suggesting possible efficacy. Positive trends were more frequently observed in the subset of SPMS patients and in ambulatory subjects (EDSS ≤ 6.5). In addition, 70% and 50% of the subjects demonstrated improved muscle strength and bladder function, respectively, following IT MSC-NP treatment.
The possible reversal of disability that was observed in a subset of patients warrants a larger phase II placebo-controlled study to establish efficacy of IT MSC-NP treatment in patients with MS.
Here are exerts from the paper which is open acess
"The clinical feasibility of IT MSC-NP treatment in MS was initially investigated in six patients with advanced MS treated with two to five injections of escalating doses of autologous MSC-NPs. PwMS were followed an average of 7.4 years after initial injection. There were no serious adverse events or safety concerns noted, and the treatments were well-tolerated. Four of the six patients showed a measurable clinical improvement following MSC-NP treatment". 
In this current study "eligible patients had clinically definite SPMS or PPMS with significant disability (EDSS ≥ 3.0) that was not acquired within the 12 months prior to enrollment. The inclusion of patients with a relatively stable disease state was designed to allow better discernment between natural disease progression and treatment-related events. To minimize additional variables, patients who were already receiving disease-modifying therapies (DMT) upon entering the study continued as a concomitant treatment through the course of the study". 
"There were no serious adverse events or hospitalizations associated with IT MSC-NP treatment" 
"The safety data was further supported by a lack of any change in brain MRI scans during the study. Specifically, no new T2 lesions or changes in disease burden were observed". 
"The study design was not blinded, and there were no placebo controls". 
Therefore, be warned the power of the placebo should not be under-estimated. The placebo effect where you get better after taking nothing can be immense and has sent many good ideas to their graves.
The primary post-treatment clinical assessments were conducted at three and six months following the third treatment and compared to baseline (pre-treatment) in order to determine trends in efficacy. Of the 20 study subjects, 15 (or 75%) demonstrated neurological improvement associated with IT MSC-NP treatment. 
Improvements were documented in the following areas: EDSS, MRC muscle strength scale, timed 25-ft walk (T25FW), and/or bladder function.Of the remaining subjects, two showed disease worsening despite the treatment, and three subjects showed no change.
The predefined endpoint was adverse effects but secondary endpoints were evidence of efficacy allowing the centre to pick and choose and so data hack to spin the best story. 

So as you can see 4 people showed qute a bit of improvement and there were reports of improvement for other outcomes notably the lower limbs and bladder rather than upper limbs and cognition.

So first things first you can see it is not a miracle cure and therefore we need to view these results positively, but also objectively. 

The myth being spun is that stem cells will turn back the clock and for most people here, this is not the case, so we need to understand the reality of these studies. It is a start

This study injected live growing cells and so they are producing a group of "potential goodies" that may be growth factors.

Wednesday, 7 February 2018

Worldwide occurance of JC virus

Are you JCV positive? What are your chances of being positive? 

Tuesday, 6 February 2018

Education: About EBV Infection

A post for people who need to know more about EBV.

That damned, elusive EBV

Will this study get the field behind the EBV hypothesis once and for all? Or will it be another bun fight?

Sunday, 4 February 2018

Walking speed improvements

Walking improvement can be achieved with fampridine, which is a slow release formulation of an old drug called 4-aminopyridine. 

Here, we have a slow release of a different old drug (amantadine) to also improve walking speeds.

Questions and answers Feb 2018

If you have a question this is the place for you

Saturday, 3 February 2018

How easy is it to design an algorithm to sequence DMTs?

Last week DrK and I joined an esteemed panel of academic neurologists (all male, unfortunately*) to discuss issues around the sequencing of DMTs.

*We need more women on platforms such this and other MS-related committees. The gender divide is very large in the field of MS. It is very embarrassing to me as a father and husband; my daughters and my wife are card-carrying feminists and every bit as capable as their male peers.  

The following is my presentation that many of you requested. You can download it from SlideShare.

Friday, 2 February 2018

Request a blog post from Barts-MS

Reader, sometimes we tell you want we want to tell you. Sometimes we tell you what we're working on or what we've read about. Now, we'd like YOU to tell us what you want to read.

Comment below with a burning question, or a topic you wish to be covered, or an aspect of MS that you'd like us to explain. We'll find someone in the team to write that post for you over the coming weeks.

What do you want to know about MS?

Thursday, 1 February 2018

Does your age predict how well you respond to DMTs?

Did you know that if you have MS and are older than 53 years of age you are unlikely to respond to DMTs?

Wednesday, 31 January 2018

The B cell tide has turned

Now the geneticists are getting involved with suggesting B cells are important in MS.

Was our paper on B cells in MS so ace and compelling?:-)

Is there someone you want to hear from?

You will have noticed over the last 5 months that we have been trying to get more guest bloggers engaged with our blog. We would love to increase the volume of guest posts to increase the diversity of opinions and topics on all things MS. Variety is the spice of life and a lot of what we have to say is repetition. 

We don't want to bore you! You need to hear from other experts in the field. If you know someone engaged in MS who has something to say please ask them to contact us ( about doing a guest post.

Tuesday, 30 January 2018

A stressed life

Do you suffer from post-traumatic stress disorder? Did you know MS is a potential cause?

Monday, 29 January 2018

Disease activation after alemtuzumab. Was it the B cells? or the fingolimod?

Rebound disease activity in people taking alemtuzumab.

Whats it the B cell surge or

Because they had taken fingolimid

Do you want to learn about MS and live in the Middle and Far East?

It is clear that the incidence and prevalence of MS are increasing globally. We are in the throes of an MS pandemic. The one region that is documenting and seeing this change in MS epidemiology is the Middle East and North Africa. 

In response to the unmet need, Barts-MS have been invited by the Alfaisal University and Global Academy for Health Sciences (GAHS) to run an MS teaching course in Dubai on the 30th & 31st March 2018. You may be interested in attending.

Sunday, 28 January 2018

Astrocyte as bad guys. A piece in the jigsaw

Whilst hunting through some papers MD2 came across the following paper. I don't remember seeing it and don't remember posting on it, so a year late, I thought I would give it an airing especially since the senior author recently passed away.
However we are looking for Jigsaw pieces to help understand progressive MS and this, which looks at astrocyte activity, may be one of them

Saturday, 27 January 2018

Trial in Remyelination is safe in humans

You want to hear about remyelination trials and here is one. The idea that there are naturally occurring antibodies that promote remyelination was suggested by the group of Moses Rodriguez at the Mayo clinic many, many years ago. 

Friday, 26 January 2018

Is the problem of MS due to EBV in the B cells?

What genes are active in MS? 

In this study they looked at lesions and surrounding white matter and found a load of CD8 T cells, a lot of CD20 B cells and a few CD4 T cells and plasma cells (antibody making cells).

The B cells contained EBV 

Thursday, 25 January 2018

Education: How does a nerve fire?

We have talked about how does a nerve work a number of times but watching a video is much easier.

This video was spotted by one out our readers and I think that it explains how a nerve impulse travels pretty nicely.

Wednesday, 24 January 2018

Tragic news: have you had your flu jab?

I have just heard the tragic news that one of my patients, who was admitted to intensive care over the weekend with pneumonia as a complication of influenza,  sadly passed away last night. I called the patient's partner to express my sympathy and was surprised to hear that she had not had this season's flu jab. This is a problem. 

We are in the throes of a major, and more virulent, flu epidemic than usual. People with MS are at high risk and are therefore eligible for the dwindling stocks of this season's flu vaccine. There has been a national appeal for all high-risk patients to get vaccinated. 

If you live in the UK and have not yet had the vaccination please contact your GP for an appointment to have the vaccine. In some parts of the country, you can get vaccinated by your pharmacist. For more information please read the NHS webpage on the vaccine. 


The interpretation of results can depend on the way you look at things.

Look at this picture. What do you see?
Do you see an old woment (you see a nose) or a young women (you see a jaw)?

Now Look at this. What do you see?
Don't know what this is?.
An educational comment for pwMS and researchers