MS-Selfie

I am often accused by some commentators on social media for blaming, and by implication shaming, people with MS about lifestyle factors that may impact the long term outcome of their MS.   One person even said to me that I should “stop pushing ‘lifestyle changes’ as a code for ‘losing weight’ on people as a fix. It’s insulting and belittling” . This is in fact incorrect. My dietary recommendations...

Being a neurologist, who sees people with multiple sclerosis (pwMS), a clinical scientist, who studies the disease, and someone who is prepared to put his head above the parapet makes it hard not to disappoint people. One of the issues that I underestimated in the past is the psychological impact that MS has on you, your family, your partner and your friends. This is compounded by disappointment w...

The following is a list of questions from Dr Iman Redha our MENACTRIMS Trainee that she had after watching me give a webinar on sequencing MS DMTs in the presence of lymphopaenia. 1. Would you be worried about starting azathioprine for inflammatory bowel disease (IBD) in a patient who has a diagnosis of MS on fingolimod given the risk of lymphopenia? Yes, I would be. As you are probably aware S1P...

Case study Hi Gavin Re: Smouldering disease and relapses without MRI activity To me, the concept of smouldering disease makes sense with my MS, which still fully recovers. My EDSS is 1.5 and I am on ocrelizumab after failing alemtuzumab.  Do many neurologists buy into the concept of smouldering MS? I feel like I am hitting walls when I mention that I feel I am getting worse and have had a small ne...

Inequality is one thing that COVID-19 has shone a spotlight on and exposed the digital divide between the haves and have-nots.  What I mean about the digital divide is having rapid and ubiquitous access to the internet for information, education and health, public & other commercial online services. When designing new services there is a tendency for some people to criticise the plans by stating t...

The recognition of B.1.1.529 a new SARS-CoV-2 variant in Botswana and South Africa is worrying and unfortunately not unexpected. This is how evolution works; it is an arms race between the virus and the immune system. The worrying thing about this B.1.1.529 variant is that it has evolved from the beta or South African variant, the sheer number of mutations in its spike protein (>30), the rapid ris...

As you are aware people with MS are much more likely to split with their partners and to be living alone. Social isolation and loneliness are common problems for people living with MS. So if you are living alone please read this newsletter.  Case study One of my patients on ocrelizumab who is triple vaccinated contacted me on Monday to tell me she has COVID-19. Fortunately, she is not doing too ba...

Are you eligible for being treated with disease-modifying therapies or a DMT? This is another question that needs to be answered before you commit yourself to a specific treatment strategy or DMT. * What is multiple sclerosis (MS)? * Am I sure that I have MS? * What type of MS do I have? * What prognostic group do I fall into?   * What is the risk of not being treated with a disease-modifying ther...

Case study I am someone who is immunosuppressed, after being treated with rituximab for non-Hodgkins lymphoma (NHL) in 2012, I have had both COVID-19 vaccinations and a booster, but have produced zero antibodies after them. I was particularly interested in the ZOE podcast on 28th November - "How are COVID vaccines working in the immunocompromised?" which you took part in. Specifically, as a 57-yea...

Question 1 We know that some patients rebound when they discontinue fingolimod. When patients have clinical or radiological evidence of disease activity, and a clinical decision is made to escalate treatment, we wait until the patients have recovered from the lymphopenia. The patients don’t seem to relapse during this period of bridging? Is this correct? Question 2 If the patient develops shingles...