Saturday, 30 June 2018

Stornoway research day series: How do disease modifying therapies work?

The Mouse Doc explains how disease modifying therapies work in the body to help to treat multiple sclerosis. He describes the problems with the animal model of MS, and the fact that the disease may well be a B-cell disease, rather than a T-cell disease.

Friday, 29 June 2018

Guest post: MS Perceptions: help us understand how we understand MS

It is actually surprising how little most people know about MS. 

This is important because people who know someone with MS usually want to offer help and support, but don’t know what to offer. 

Thursday, 28 June 2018

Off-label disease modification for people with multiple sclerosis in resource poor settings.

Drugs are rationed on the basic of cost-effectiveness. This is all well and dandy if you live in a place where you can get access to treatment x or y because you have socialized medicine or access to a health insurance scheme. 

However, live outside these regions and your annual income may be less than the cost of all current MS drugs.

If you live as a pwMS or work as a Neurologist in a resource poor country you need to read this paper. This was written by one of our Non-UK based Neurologists. It is open access and can be read by anyone.

Wednesday, 27 June 2018

Stem cell therapies for MS - why we need to get it right

Hi, my name is Niall (pronounced Neil) and I'm a neurologist working with people affected by MS in the West of Scotland area.

I grew up in Lanarkshire and I became interested in MS when I was working as a trainee in Dundee.  It's a complex disease and looking after people affected by MS in clinic gives you a chance to get to know them a bit over the years which is quite nice.  It's also fairly sad when you see how much damage uncontrolled MS can do to a person.

Monday, 25 June 2018

MS in the courtroom

We have made the case in the past that one of the ways healthcare professionals will begin to treat MS more actively is via the courts. In the meeting below we will be presenting a hypothetical case scenario of a patient who lost brain due to a delay in diagnosis and a delay in accessing a highly effective treatment. The consequences for this individual were profound and he is now suing the NHS and his neurologist for loss of earnings. 

The main purpose of the meeting is to review the evidence for treating MS early and effectively, i.e. applying all the management and treatment principles captured in our 'Brain Health: Time Matters in MS' policy document. The real value of this meeting for HCPs is not DrK and myself discussing the scientific or medical rationale for this strategy, but the legal perspective, in particular, the variance is MSology practice. When do you become an outlier, either an under-treater or an over-treater, and when do you expose yourself to a legal challenge from your patients?

If you are a card-carrying HCP you are welcome to attend. Due to ABPI rules, MSers can't attend.  Tickets are limited and are being allocated on a first come first serve basis.  





Walking-the-talk or not-walking-the-talk

You may know by now that 'The Dream Team' completed the 3-peaks challenge in less than 24-hours yesterday. Well done. Their aim was to raise more than £5,000 for the MS Society. The MS Society is a remarkable organisation; an organisation the wider MS community could not manage without. They not only look after their members locally but take on very important national tasks such as lobbying, advocacy, education, setting the research agenda and supporting research. The MS Society, therefore, needs your support. If you haven't done so already can you please help and make a small donation, it would be greatly appreciated? 

The Dream Team

Sunday, 24 June 2018

Stornoway research day series: Vitamin D

Dr Stewart Webb talks about Vitamin D and its role in multiple sclerosis. He discusses bone health, falls and fractures.

Saturday, 23 June 2018

MS Dream Team are on their way!

The team arrived in one piece at Fort William (the home of the tallest peak in Scotland: Ben Nevis) just shy of midnight yesterday. This morning we’ve packed and re-packed our bags, tried out our UK MS Society t-shirts (some of us need to lose weight...), and are deligently checking the weather hour to hour for a wee glimpse of the sun. Scotland even at her worst is simply breathtaking.

Driving up last night, we witnessed rows of white vans passing us in the opposite direction at 11pm and immediately knew that the first few teams have managed to scale Ben Nevis in 5 hours. Those of you’ve who have been up Ben Nevis will already know that a tourist is quoted 7 hours by the locals. Fingers crossed that we achieve a quick time today. From Ben Nevis, we will drive to the Lakes to scale Scafell Pike in the dark and then onto Wales to climb Snowdon. Our goal is to achieve all of this in 24 hours.

When I started the team, the participants were hand picked for their dedication to Multiple Sclerosis work and the rare disorders, and it goes without saying that they also have superb fitness levels. Everything you’ll see on our Just Giving page and Twitter (@neurognanapavan) gives a good indication of our efforts to organise this challenge. The first training events began 4 months ago, and all the logistics of the challenge have been self-organised (we decided as a team that we will not use one of the commercial companies for this). There have been ups and down and owing to medical issues and scope of the endeavour we currently stand at 4 members (outlined below).

  • Professor Alasdair Coles (Professor of Neurology, Cambridge).
  • Dr Emre Amirak (Associate Medical Director in pharma, ex-cardiothoracic surgeon).
  • Dr Violeta Sanchez (Consultant Neurologist, Barts Health)
  • Dr Sharmilee Gnanapavan (Consultant Neurologist, Barts Health)

Our families and friends have listened to us at ad nauseam about this day, some of it with reservations but ultimately they understand that what makes us persistent in our obstinacy at work, is also driving this. So hear’s to the #MSDreamTeam a partnership made in common goals and a start of a good friendship.

Stornoway research day: What does the future hold?

Prof G discusses upcoming treatments for progressive MS and the importance of maintaining brain health and upper limb function. 

Friday, 22 June 2018

News: NICE approves ocrelizumab

NICE considers ocrelizumab to be less effective than alemtuzumab. 

Guest post: A snapshot of current disease modifying therapies

There are many disease modifying therapies (DMTs) available for people with Relapsing MS in 2018. DMTs work to prevent MS relapses in the future, and to minimize new MRI activity over time. With many options, it can be hard to decide which therapy to start on, or which one to switch to. 

Thursday, 21 June 2018

Stornoway research day series: The cost of MS

Dr Niall MacDougall discusses the economics behind MS and the cost to the individual, families and society.

Wednesday, 20 June 2018

Guest post: MSexism

Is the MS world biased against women?

Another week - another news headline about how women are paid less than their male counterparts. This time it is consultants working in the NHS - and Jeremy Hunt, the UK Health Secretary, has vowed to tackle the pay gap.

So what does this have to do with multiple sclerosis?

A lot, I believe.

Monday, 18 June 2018

Happy Anniversary Prof G

It is 25 years to the day that I arrived in London to start my PhD on body fluid biomarkers in MS. 

What has changed in the last 25 years?

Stornoway research day series: Self-management

MS Specialist Nurse for the Western Isles, Rachel Morrison, talks about the importance of self-management in multiple sclerosis. And she covers some top tips for managing your own condition.

Sunday, 17 June 2018

Stornoway research day series: Understanding your MS symptoms

Dr Stewart Webb defines what multiple sclerosis is, and what's going on in the body when you feel certain MS symptoms. 

Saturday, 16 June 2018

Stornoway research day series: How nutrition and exercise can make a difference

Our Glasgow colleague Dr Sarah Martin discusses different diets that claim to improve MS symptoms in this talk for the people with MS and their families on the Western Isles.

Friday, 15 June 2018

Stornoway research day series: What makes up the neurologist's toolkit?

Neuro Doc Gnanapavan discusses the ways that neurologists currently diagnose and monitor MS in their patients. 

New primary progressive study - ORATORIO-HAND

Yesterday there was a press release from Roche announcing ORATORIO-HAND a new phase 3 trial in people with PPMS, but only this time recruitment will extend beyond EDSS 6.0 up to EDSS 8.0, i.e. wheelchair users. The primary outcome will be the 9-hole peg test.

For people in the field of MS, the announcement of the ORATORIO-HAND trial represents a milestone in the history of MS. It challenges the dogma that once you have more advanced MS (progressive disease) that you are 'irredeemable' and sends a message of hope to all people with MS in wheelchairs that we haven't forgotten you.

I hope that our long-running #ThinkHand campaign will play a part to play in getting the wider MS community and other relevant stakeholders behind this study.

Alison Thomson presenting our #ThinkHand campaign at the 2016 MS Trust Conference 

Thursday, 14 June 2018

Stornoway research day series: Current and upcoming treatments

Another talk from our Stornoway research day series. Here, Dr Pushkar Shah talks about multiple sclerosis treatments that are currently available, and ones that are being developed. 

NIH Grand Round: what is an IRT?

As promised the following is my slide deck from my presentation at the NIH grand round on Tuesday morning (12-June-2018). I was surprised to find out that none of the MSologists at the NIH prescribe DMTs; they leave the decision up to the treating neurologist. The NIH MSologists only see patients as part of research protocols. However, the resources at their disposal for research is quite extraordinary. They are a very privileged group of researchers.

After the meeting, someone asked me what excites me most about MS research at the moment? Can you guess what I said?

Wednesday, 13 June 2018

Stornoway Research Day series: Can we prevent or slow down MS?

Dr K discusses the difference between insidious MS symptoms and ageing, progressive MS and relapsing remitting. He explains the Think Hand campaign and the research into preventing and slowing down MS.

Tuesday, 12 June 2018

NIH Charcot Lecture 2018

I delivered my Charcot lecture at the Washington Press Club, to approximately 125 people, last night. My main message was that there are compelling reasons to do MS prevention studies and if we don't start them ASAP we will be letting down the next generation of people who will develop MS. I view this as a ticking time bomb. The continual increase in the incidence of MS across the world, particularly in places like Scotland and central Canada, indicates that we have an epidemic on our hands. Don't you think we need to do something about it?

Thank you for completing the MS prevention survey; I included the results in my talk and one very touching and poignant quote.

4am knows all my secrets

Mult Scler Relat Disord. 2018 May 23;24:32-37. doi: 10.1016/j.msard.2018.05.016. [Epub ahead of print]

Analysing the relationship between polysomnographic measures of sleep with measures of physical and cognitive fatigue in people with multiple sclerosis.

Sunday, 10 June 2018

Stornoway Research Day: The mouse doctor's talk!

Here is the second in our series of the Stornoway Research Day talks. The Mouse Doc talks about how disease modifying therapies work.

Keep an eye on our Youtube channel for all the other talks.

Watch How Disease Modifying Therapies Work.

Saturday, 9 June 2018

Stornoway Research Day: The first video!

As you may remember, last month the Barts-MS and Glasgow teams went to Stornoway on the Isle of Lewis. Over two days the team gave talks to healthcare professionals and people with MS from the Western Isles.

Friday, 8 June 2018

Saúl post: Hold your horses: Are you telling me that MS can cause impulsivity?!

Neuropsychiatric disorders and cognitive impairment have a negative impact on daily functioning and quality of life of MSers. While much research has focused on comorbid depression in pwMS, less attention has been given to the association between MS and impulsive behaviour. 

Thursday, 7 June 2018

Wednesday, 6 June 2018

Atraumatic LP needles: what you need to know

This week's BMJ has a rapid recommendation piece on the advantages of using atraumatic needles in routine clinical practice. Let's hope this will now drive the necessary changes we have been arguing for, for several years. Our aim is to get neurologists and MSers to rethink CSF analysis for monitoring MS.

Tuesday, 5 June 2018

Sunday, 3 June 2018

Managing expectations: can we cure MS?

When I was at the ANZAN meeting in Darwin I was shown the results of a recent survey of Australian people with MS regarding their research priorities. The number one unmet need was for researchers 'to find a cure for MS via repair and regeneration of cells'. This is easier said than done. I also have problems linking 'an MS cure' with the concepts of 'repair and regeneration'. In this post, I try and explain why.

Although a large part of this post is repetitive from past posts, sometimes it is helpful to repeat oneself. 

Saturday, 2 June 2018

Cladribine for People with Progressive MS.There are options available

Today we provide further evidence that people with Progressive MS can respond to DMT

MS is neurodegenerative from day one to the last day and is also inflammatory from day one to the last day.

Why don't we do something about the inflammation in MS in every one?. 

Friday, 1 June 2018

Ask a Question June

If you have a question unrelated to other posts.

This is the place for you

Don't start treatment too late

Don't leave it too late before you start Treatment,

How much more evidence do we need?

ANZAN W. Ian McDonald Memorial Lecture

I have just had a very enjoyable meeting in Darwin and want to thank the Australian and New Zealand Association of Neurologists (ANZAN) for being so hospitable and for inviting me to give several talks, in particular, the Ian McDonald memorial lecture. 

The following is my presentation that you can view as a slideshow or you can download from SlideShare. I have also provided the links for you to read about Ian McDonald.

W. Ian McDonald (1933-2006)