Sunday 2 September 2018

Tweet of the Week

Sorry Experiment failed, I can't keep up with the tweet monster.
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MS drug offers patients 'glimmer of hope' for better treatment! Why not make the more effective DMTs the standard of care? Very good news for MSers with more advanced MS (aka as chronic progressive MS). The question is will big pharma pick-up the baton and do the necessary phase 3 trials? I suspect not the IP on ibudilast is too dodgy. Phase 2 Trial of Ibudilast in Progressive Multiple Sclerosis.

When you develop adverse events when taking a placebo we call this the NOCEBO effect. This review looks at nocebo responses in brain disease trials and their potential impact. Nocebo Responses in Brain Diseases: A Systematic Review of the Current Literature.

Quantifying the level of intrathecal (within the meninges) synthesis of immunoglobulin free light chain helps with making a diagnosis of MS. It is also a biomarker of B and Plasma cell activity. We are using for the latter. Intrathecal K free light chain synthesis in multiple sclerosis at clinical onset associates with local IgG production and improves the diagnostic value of cerebrospinal fluid examination.

I really can't wait for technology to take over my job of assessing patients; it is repetitive, boring and inaccurate. I would rather spend the time speaking to my patients. Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients.

My opinion is to forget reference videos to assess motor dysfunction in MS; ditch the neurologist and use wearable or mobile technology. You will get a much more objective, continuous and richer data set. Will the regulators agree? Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis.

More real-life data showing that natalizumab is superior to fingolimod when adopting a treat-2-target strategy. If only we could sort out the PML problem most MSers would be on natalizumab
Long-term evaluation of NEDA-3 status in relapsing-remitting multiple sclerosis patients after switching from natalizumab to fingolimod.

It is a great pity that there is so little evidence to support an MS-specific dietary intervention to help MSers. This review tries hard, but can't plug the hole in the evidence. The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence.

Is this another EAE experiment creating hype and unrealistic expectations for MSers?
Intrathecal delivery of human ESC-derived mesenchymal stem cell spheres promotes recovery of a primate multiple sclerosis model.

Another methodological problem with MRI; the gadolinium effect on thalamus and whole brain tissue segmentation. I have come to the conclusion that we won't be able to use brain volume loss to monitor end-organ damage in individual MSers.

Lack of outdoor activity and hence less UVB/sunlight exposure. The more outdoor activity you have as a child the lower your risk of getting MS.

Another documented MS epidemic, only this time in Italy. Why are we not taking this more seriously? Surely we should be investing in studies?

A great article by our Barts-MS physio on the meaning of exercise and physical activity in community dwelling MSers. Please note it not just about movement. A must read.

Is it time to move up from and start a campaign? Swallowing problems are commoner that we realise in MS.

Inclusion of optic nerve involvement in dissemination in space criteria for multiple sclerosis improves the diagnostic accuracy of the new rendition of the McDonald criteria. . Should we hack the criteria and change them?