How immunosuppressed are you?The duration and intensity of immunosuppression determine risks. Short-term immunosuppression from IRTs is front-loaded and don't accumulate with time,…
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Case study: how do you define a rituximab failure?This patient with MS is anxious that he may have early secondary progressive MS and rituximab is failing him. He is keen to explore AHSCT. Is this appr…
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It was the worst pain I have ever hadTrigeminal neuralgia, brief, very painful, electric shock-like episodes in the distribution of the trigeminal nerve is common in people with MS. This n…
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Case study: Ocrelizumab and the timing of the 3rd dose of the vaccine?I am getting endless questions about when is the best time to have the 3rd and/or booster dose of the COVID-19 vaccine in relation to ocrelizumab infus…
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How do I want my MS to be treated?The newsletter addresses the differences between maintenance-escalation disease-modifying therapies and immune reconstitution therapies (IRTs) and why …
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Case study: a patronizing neurologistWhen a neurologist thinks alemtuzumab is too risky the question needs to be asked ‘too risky for whom; the neurologist or the patient?’.
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What are your priorities in relation to 'Your MS'?Many readers of these Newsletters are highlighting that they haven’t seen their neurologist or a neurologist, for some time now. Many of you sta…
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Case study: are you a zombie because of your spasticity medications?Are you battling to get your nocturnal spasms under control? Are your legs collapsing when you increase the dose of your anti-spastic medication?
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Has MS affected your brainstem and cerebellum?People with MS who have lesions in the posterior fossa have a poorer prognosis. However, there are things that can be done for each of the problems tha…
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Amitriptyline: the neurologist's dirty little secretAre you taking amitriptyline? As someone with MS amitriptyline's side effect profile may not be in your best interests.
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Case study: rapidly-evolving severe MS and pregnancyThis is a very complex case of someone with recently diagnosed rapidly evolving severe MS with apparent breakthrough activity on natalizumab on a backg…
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The consequences of not treating MSAre there valid reasons not to treat MS with a disease-modifying therapy? What are the consequences of not treating MS? Is watchful waiting justified?
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