I second that too. I hope your recovery is swift. Not sure the heat is going to be helpful. š¤· My ms hibernates when I have whole body cryotherapy. Difficult to have regularly and home options are expensive.
First of all: Thank you very much, Dr Giovannoni!!! Yes, we will cure MS! And hopefully in the next 10 years (crossing all my fingers).
Second, do give yourself the attention your hips deserve. Take care of yourself. Are clinicians good patients? Lol
Third, and my most important point that I hope doesn't get missed due to my long comment: what about developing CAR-mono after CNS glia ablation?
Ambitious, I know, but we could remove the bad/old glia, genetically engineer new monocytes (precusor cells), and repopulate the CNS with good cops ;).
I know, genius. Please tell me who is already working on it?!
What you said about an MS cure made pertect sense to me. I hope you are working hard on your exercises following your hip surgery. I'm 5 weeks post left hip replacement and 7 months post right knee replacement. I realised yesterday that my knee no longer feels like it isn't part of me. Even though I am partial weightbearing due to complex hip surgery everything is feeling a lot stronger and the improvement in my mobility since the op is amazing!
I hope you continue to have a joint recovery too Jenny. I have a niece who had 2 hip replacements in her early 30s. She had rods in her back at 18 and is amazingly a mum of 2. I think the first mum they had delivered ( by C section) who had so much in the way of joint replacements. Itās incredible what new joint can give us when it goes well
Fascinating! I had hip surgery aged 2, at 38 was told it was "now the hip of a 70 year old but look after it for as long as you can and don't get too fat"! and at 59 have had it replaced, having worn a hole in the bone at the front of my pelvis. I gather the op went, "open, try to place retractor, ah, she has no bone at the front of her pelvis, change of plan!" Well, he always had it listed as a complex op! Given that I eroded my pelvis and had severe osteoarthritis in the knee on the other leg without experiencing pain. I think an xray of the left knee, which has been grumbling since the right knee gave up, is the next plan. My pelvis imaging shows that my right hip is very happy!
I wonder what the prospects are for hip replacement with severe osteoporosis. I have a degenerating hip from an accident in my youth and I am petrified at the thought of hip surgery. Iām afraid Iām not able to ignore it much longer. (Scoliosis doesnāt help, either!)
Hmm. That doesn't sound good. My sister has scoliosis. Prof Mann said the worst case scenario for me was fully non weightbearing for at least 6 weeks. I think that was if there was a problem with the bone at the back of my pelvis. He bought these things called augments in case he had to rebuild the bone but didnt have to use them. At some point the metal work has to be anchored to the bone. I think what you need is someone like Prof Mann who can reconstruct hips rather than just do stsndard replacement.
Good luck with your hip, make sure you plan your rehab the same way you did for your spinal injury.
"The purpose of disease modification is to prevent end-organ damage." - and we're still mostly only able to prevent inflammation with any confidence. It doesn't help that with a disease called "lots of lesions" the lesions aren't really the driving factor! We only really defined what MS progression / PIRA / smouldering actually is about 8 years ago and only now are we getting to phase 3 trials for meds that might halt that.
A cure... I'd say it's a great idea to define one, but as a first step, what about defining effective management? Treatments that prevent inflammation and progression without causing collateral damage. And then add-on treatments that help repair and restore damage. Plus some sort of common protocol on how to enable patients make the best of whatever they've got left - and the resources to make that happen. I've been following some of the results from patients losing weight on glp1 treatments and the accompanying drop in inflammation, increase in mobility and drop in fatigue and cog fog. The lifestyle changes that can help (and the ways in which to support that from a healthcare perspective rather than leaving patients to sink or swim). The results from intensive neuro-rehabilitation using neubie devices and specific intensive protocols.
If it can get people who are incapable of working back into working again, back into being healthy again, completely controlling their MS even if they have to remain on some sort of treatment...
Maybe we need to use a different word, not "cure". Because most things that are cured, whether they're cancer or broken bone or an illness, they still have longer-term effects years, even decades, later. It's a cure in name only. Many people claim that the pharmaceutical industry don't wish to cure illness because it'll put them out of business - but biology doesn't work like that anyway. If you've had one illness you're at risk of developing others, even if the original illness is cured, unless the underlying factors are addressed, whatever those factors might be. In our cases an errant response to EBV. So if patients have been cured by going on an IRT, are they not still vulnerable if they get reinfected with EBV?
Better to monitor blood markers and retreat if things start to go south. And declare MS as being controlled and managed?
The point is to define a cure for MS. Many people with MS who get AHSCT very early in the disease course at a younger age with very little organ damage are 20-25 years out from AHSCT with no new lesions, no attacks, no disease progression and improvements in their cognition and physical condition. This situation, I think for many people with MS, can be considered a "cure". They are going about the daily lives for decades feeling like they don't have MS at all. What you describe about broken bones, cancer, or general illness as people feeling "longer-term effects years, even decades, later" does describe some people but not all. Many people are decades after broken bones, cancer and other illnesses and are feeling perfectly fine. The point is again to ram it home is Many people with MS who get AHSCT very early in the disease course at a younger age with very little organ damage are 20-25 years out from AHSCT with no new lesions, no attacks, no disease progression and improvements in their cognition and physical condition. The additional point crucially is we should be offering AHSCT to patients if they are ok with the risks involved. What you describe about people getting broken bones, cancer, or general illness as experienceing "longer-term effects years, even decades, later" can be applied to the human condition in general and is irrelevant to a "cure" definition of MS. All humans age, suffer get sick and die. All humans go through trials and tribulations. This is just part of being human.
Stopping MS from creating any more damage to the brain and spinal cord would be an excellent start. Living with smouldering MS is a very depressing experience. The knowledge that the MS will not get any worse would be fantastic news for many people.
Obviously a brain and spinal cord transplant is out of the question. Organs such as liver, kidney and skin demonstrate the ability to repair/rebuild/recover from damage but would the body repair damage to the nerves if the myelin sheath was rebuilt.
I don't think a complete cure of MS for everyone will suddenly appear but lets aim to stop MS causing organ damage. For some people this remission might be a complete cure. Am I correct is thinking that AHSCT is a cure of MS for some people?
Can we say absolutely what MS actually is, in terms of ācureā? I ask because I was recently reading Demyelination WITHOUT significant participation of immune cells from the blood, however, questions the basic premises of MS pathogenesis. Does atrophy, mitochondrial dysfunction etc all stem from the initial immune cell infiltration of blood-brain-barrier? Would a ācureā be a ācure-allā?
āI have finally succumbed to my pain and increasing disability and had my failing right hip replaced last Friday. Orthopaedic surgeons have the option of replacing a failed jointā I hope you have a speedy and full recovery. I imagine your definition of a cure with regard to your hip is to get back to ānormalā or to get back to running / long outdoor walksā¦ As an MSer I feel shortchanged by the medical profession. They canāt offer me a get back to before option or even a donāt get any worse option. Instead a āpossibility of slowing down worseningā option. Itās disappointing that we are still at the ādefining a cureā position. Surely the MS research establishment must know the drivers of tissue destruction and the focus should be on therapies to address these drivers of tissue destruction. Once this is achieved (?2050) it will define the cure for individual MSers ie āyou are EDSS 5.5 and will get no worseā. A brave MS researcher needs to get some anti- viral trials going or trials of novel therapies to address smouldering MS. We need to move beyond definitions or theyāll be another generation of MSers who will be climbing up the EDSS.
Wishing you a speedy recovery with the new hip. Go steady.
My Neurologist has noted that my RRMS is benign. No DMTs ever since diagnosis in 2019, a nod to my wellness efforts, and general applause for my cheery outlook. I am grateful for my wellness so far, but have no illusions about the future.
The hot weather has played havoc with my heat intolerance, and my walking has been a challenge. I have fallen twice in the last week, thankfully, picked up by strangers both times. Although I am a little sore, I think it's only my pride and dignity that took the brunt. The moral of these episodes is that I need to slow down and keep my 'Offer me a seat' badge on when leaving the tube so it's clear that I have mobility issues.... just in case of a tumble.
I would love to think that there would be a cure for MS in my lifetime, but I am doubtful. I said that back in the 90's when my brother was diagnosed. Although the pharmaceutical industry has advanced with DMTs and has provided a lot of solutions to PwMS, I am still skeptical as to whether they really want a cure. Just my POV and always respectful that everyone has different needs and views.
Thank you for continuing the MS research and sharing your knowledge with the community.
I don't think the DMTs have really advanced in a very meaningful way-yes, there are newer DMTs that are more efficacious against active focal inflammation, but active focal inflammation isn't the driver of long-term progression and disability accumulation, which is PIRA/neurodegeneration.
Best of luck with the new hip Prof G. I am hopeful that car t cell therapy combined with repair therapies such as PTD802, Metformin and in Crispr in the more distant future can give pwms real quality of life.
This is very interesting, thanks for sharing and opening up for comments. I'll try to share some thoughts (that you probably have already considered). For context, I've taken aHSCT, been off any DMTs for 5 years, no clear 6 month worsening of EDSS yet, no OCB, no worsening on "standard" MR interpretations (I do not know about other NEIDA findings from MR).
I think long-term changes in PROMS could be a part of the definition of a cure. Well-validated PROMS are likely to be accurate, nuanced, and tell another story compared with more "objective" findings (I'm not sure MR really reflects objective end-organ damage, to me it is an interpretation made by clinicians - I've experienced having the same MR images interpreted as being "stable" or showing a new lesion). Together, PROMS and standard outcomes tell a complete story about change over time.
For me, I experience that my levels of neuropathic pain is increasing. This is also reflected in increased doses of medication (oxcarbazepine and gabapentine). I was at 600mg pr day of oxcarbazepine 1 year after aHSCT, now I need to take 1200mg oxcarbazepine + 1200mg gabapentine to have the same effect on pain). Also, I experience increasing levels of fatigue. Reflecting this, I have an increasing time pr year being on sick leave due to MS.
Not related, but could you please make a post about the recent NEJM publication about the non-inferiority of rituximab vs ocrelizumab?
I am so sorry about the increase in your levels of neuropathic pain and your fatigue. I think you raise a critically important point about PROMS, but my understanding (limited, of course) is that the MS drugs did not show much to any efficacy for the PROMS endpoints that were used in the trials that used PROMS. This means, to me, that the pharma company sponsors of these drugs and trials won't want to use PROMS-they want to use the "good old" playbook of the endpoints of ARR and conventional brain MRI activity that they know their drugs can show excellent efficacy against whether these endpoints are meaningful clinically to PwMS, unfortunately.
Clinicians emphasize MRI images being "stable" or lack of relapses because that is what the MS drugs they push and RX show efficacy against, is what I firmly believe. These are only surrogate measures in my view, though. You are totally correctly that PROMS can tell a completely different story.
I read the NEJM publication you mention about non-inferiority of rituximab vs ocrelizumab. My understanding is that Roche/Genentech very slightly "tweaked" rituximab to turn it into ocrelizumab to get a new patent and make more crazy money, since there wasn't much money to be made from rituximab since it had gone generic. You get into the "me too" drug issue-consider why there are several extremely similar anti-CD20 drugs now: Rituximab, Ocrevus, Kesimpta, and Briumvi. Do we really need all of them? Are they different enough from each other to make any meaningful difference?
As always you make me think. My old Neurology floor nurse days of the early 1980ās, Multiple Sclerosis was a steady, predictable always trending downward disease. Doctors ordered inpatient stay for 5 day high dose Intravenous prednisone for flare ups. Lumbar punctures scare me. I saw enough complications. No practicing please. Anesthesiologist preferred. Better yet,
Find another way. Iāll bring up another diagnostic tool we need: an unbiased curious doctor could invent. Maybe the father of a brain injured child, a wife with early dementia, cancer, a doctor with kidney disease or Multiple Sclerosis.
I mean a tool to visualize, analyze, measure, interpret the status and function of the vascular-nervous systems in our bodies.
No MRIās, No Lumbar Puncture, No timed walk, math test, 9 peg test. As long as Iām wishing, can be done at any age,
Like a Space Trek tricorder. Regarding drugs. Iām too old to change. Old fashioned Glatopa. Having MRI next month. Doctor will talk to me. I will take what she recommends. Regarding Gadolinium used as MRI contrast Nanoparticles do cross the blood Brain barrier and, my unscientific belief is a spinal tap can give better access to our central nervous system. Thanks. Iām posting on my X account.
Good points thank you. I am on the third year of claribine. Week two year first, round two. No new activity but function on the decline since first year, five years back..Please remember that we are on the quest to restore damaged nerv cells. Eg NVG 291
As an MSer, Iād just like to say that I appreciate you and all your effort. Thank you.
I second that too. I hope your recovery is swift. Not sure the heat is going to be helpful. š¤· My ms hibernates when I have whole body cryotherapy. Difficult to have regularly and home options are expensive.
Thanks as ever for the post. Congrats on new hip and all the best for a great recover!. J š
Best wishes for a swift recovery Prof G :) Thanks for your ongoing work and keeping us patients informed x
First of all: Thank you very much, Dr Giovannoni!!! Yes, we will cure MS! And hopefully in the next 10 years (crossing all my fingers).
Second, do give yourself the attention your hips deserve. Take care of yourself. Are clinicians good patients? Lol
Third, and my most important point that I hope doesn't get missed due to my long comment: what about developing CAR-mono after CNS glia ablation?
Ambitious, I know, but we could remove the bad/old glia, genetically engineer new monocytes (precusor cells), and repopulate the CNS with good cops ;).
I know, genius. Please tell me who is already working on it?!
Might need to reprogramme the glia rather than ablating them. I look into the science in more detail.
What you said about an MS cure made pertect sense to me. I hope you are working hard on your exercises following your hip surgery. I'm 5 weeks post left hip replacement and 7 months post right knee replacement. I realised yesterday that my knee no longer feels like it isn't part of me. Even though I am partial weightbearing due to complex hip surgery everything is feeling a lot stronger and the improvement in my mobility since the op is amazing!
I hope you continue to have a joint recovery too Jenny. I have a niece who had 2 hip replacements in her early 30s. She had rods in her back at 18 and is amazingly a mum of 2. I think the first mum they had delivered ( by C section) who had so much in the way of joint replacements. Itās incredible what new joint can give us when it goes well
Fascinating! I had hip surgery aged 2, at 38 was told it was "now the hip of a 70 year old but look after it for as long as you can and don't get too fat"! and at 59 have had it replaced, having worn a hole in the bone at the front of my pelvis. I gather the op went, "open, try to place retractor, ah, she has no bone at the front of her pelvis, change of plan!" Well, he always had it listed as a complex op! Given that I eroded my pelvis and had severe osteoarthritis in the knee on the other leg without experiencing pain. I think an xray of the left knee, which has been grumbling since the right knee gave up, is the next plan. My pelvis imaging shows that my right hip is very happy!
I wonder what the prospects are for hip replacement with severe osteoporosis. I have a degenerating hip from an accident in my youth and I am petrified at the thought of hip surgery. Iām afraid Iām not able to ignore it much longer. (Scoliosis doesnāt help, either!)
Hmm. That doesn't sound good. My sister has scoliosis. Prof Mann said the worst case scenario for me was fully non weightbearing for at least 6 weeks. I think that was if there was a problem with the bone at the back of my pelvis. He bought these things called augments in case he had to rebuild the bone but didnt have to use them. At some point the metal work has to be anchored to the bone. I think what you need is someone like Prof Mann who can reconstruct hips rather than just do stsndard replacement.
Good luck with your hip, make sure you plan your rehab the same way you did for your spinal injury.
"The purpose of disease modification is to prevent end-organ damage." - and we're still mostly only able to prevent inflammation with any confidence. It doesn't help that with a disease called "lots of lesions" the lesions aren't really the driving factor! We only really defined what MS progression / PIRA / smouldering actually is about 8 years ago and only now are we getting to phase 3 trials for meds that might halt that.
A cure... I'd say it's a great idea to define one, but as a first step, what about defining effective management? Treatments that prevent inflammation and progression without causing collateral damage. And then add-on treatments that help repair and restore damage. Plus some sort of common protocol on how to enable patients make the best of whatever they've got left - and the resources to make that happen. I've been following some of the results from patients losing weight on glp1 treatments and the accompanying drop in inflammation, increase in mobility and drop in fatigue and cog fog. The lifestyle changes that can help (and the ways in which to support that from a healthcare perspective rather than leaving patients to sink or swim). The results from intensive neuro-rehabilitation using neubie devices and specific intensive protocols.
If it can get people who are incapable of working back into working again, back into being healthy again, completely controlling their MS even if they have to remain on some sort of treatment...
Maybe we need to use a different word, not "cure". Because most things that are cured, whether they're cancer or broken bone or an illness, they still have longer-term effects years, even decades, later. It's a cure in name only. Many people claim that the pharmaceutical industry don't wish to cure illness because it'll put them out of business - but biology doesn't work like that anyway. If you've had one illness you're at risk of developing others, even if the original illness is cured, unless the underlying factors are addressed, whatever those factors might be. In our cases an errant response to EBV. So if patients have been cured by going on an IRT, are they not still vulnerable if they get reinfected with EBV?
Better to monitor blood markers and retreat if things start to go south. And declare MS as being controlled and managed?
Absolutely agree that many, if not all, "cures" are simply "cures in name only," unfortunately.
The point is to define a cure for MS. Many people with MS who get AHSCT very early in the disease course at a younger age with very little organ damage are 20-25 years out from AHSCT with no new lesions, no attacks, no disease progression and improvements in their cognition and physical condition. This situation, I think for many people with MS, can be considered a "cure". They are going about the daily lives for decades feeling like they don't have MS at all. What you describe about broken bones, cancer, or general illness as people feeling "longer-term effects years, even decades, later" does describe some people but not all. Many people are decades after broken bones, cancer and other illnesses and are feeling perfectly fine. The point is again to ram it home is Many people with MS who get AHSCT very early in the disease course at a younger age with very little organ damage are 20-25 years out from AHSCT with no new lesions, no attacks, no disease progression and improvements in their cognition and physical condition. The additional point crucially is we should be offering AHSCT to patients if they are ok with the risks involved. What you describe about people getting broken bones, cancer, or general illness as experienceing "longer-term effects years, even decades, later" can be applied to the human condition in general and is irrelevant to a "cure" definition of MS. All humans age, suffer get sick and die. All humans go through trials and tribulations. This is just part of being human.
Hello ProfG,
Good luck with the hip replacement.
Stopping MS from creating any more damage to the brain and spinal cord would be an excellent start. Living with smouldering MS is a very depressing experience. The knowledge that the MS will not get any worse would be fantastic news for many people.
Obviously a brain and spinal cord transplant is out of the question. Organs such as liver, kidney and skin demonstrate the ability to repair/rebuild/recover from damage but would the body repair damage to the nerves if the myelin sheath was rebuilt.
I don't think a complete cure of MS for everyone will suddenly appear but lets aim to stop MS causing organ damage. For some people this remission might be a complete cure. Am I correct is thinking that AHSCT is a cure of MS for some people?
Second that: stop the MS from getting worse, somehow
Second that.
Yes some people claim AHSCT cures some people of MS.
Can we say absolutely what MS actually is, in terms of ācureā? I ask because I was recently reading Demyelination WITHOUT significant participation of immune cells from the blood, however, questions the basic premises of MS pathogenesis. Does atrophy, mitochondrial dysfunction etc all stem from the initial immune cell infiltration of blood-brain-barrier? Would a ācureā be a ācure-allā?
āI have finally succumbed to my pain and increasing disability and had my failing right hip replaced last Friday. Orthopaedic surgeons have the option of replacing a failed jointā I hope you have a speedy and full recovery. I imagine your definition of a cure with regard to your hip is to get back to ānormalā or to get back to running / long outdoor walksā¦ As an MSer I feel shortchanged by the medical profession. They canāt offer me a get back to before option or even a donāt get any worse option. Instead a āpossibility of slowing down worseningā option. Itās disappointing that we are still at the ādefining a cureā position. Surely the MS research establishment must know the drivers of tissue destruction and the focus should be on therapies to address these drivers of tissue destruction. Once this is achieved (?2050) it will define the cure for individual MSers ie āyou are EDSS 5.5 and will get no worseā. A brave MS researcher needs to get some anti- viral trials going or trials of novel therapies to address smouldering MS. We need to move beyond definitions or theyāll be another generation of MSers who will be climbing up the EDSS.
Wishing you a speedy recovery with the new hip. Go steady.
My Neurologist has noted that my RRMS is benign. No DMTs ever since diagnosis in 2019, a nod to my wellness efforts, and general applause for my cheery outlook. I am grateful for my wellness so far, but have no illusions about the future.
The hot weather has played havoc with my heat intolerance, and my walking has been a challenge. I have fallen twice in the last week, thankfully, picked up by strangers both times. Although I am a little sore, I think it's only my pride and dignity that took the brunt. The moral of these episodes is that I need to slow down and keep my 'Offer me a seat' badge on when leaving the tube so it's clear that I have mobility issues.... just in case of a tumble.
I would love to think that there would be a cure for MS in my lifetime, but I am doubtful. I said that back in the 90's when my brother was diagnosed. Although the pharmaceutical industry has advanced with DMTs and has provided a lot of solutions to PwMS, I am still skeptical as to whether they really want a cure. Just my POV and always respectful that everyone has different needs and views.
Thank you for continuing the MS research and sharing your knowledge with the community.
Xx
I don't think the DMTs have really advanced in a very meaningful way-yes, there are newer DMTs that are more efficacious against active focal inflammation, but active focal inflammation isn't the driver of long-term progression and disability accumulation, which is PIRA/neurodegeneration.
Best of luck with the new hip Prof G. I am hopeful that car t cell therapy combined with repair therapies such as PTD802, Metformin and in Crispr in the more distant future can give pwms real quality of life.
This is very interesting, thanks for sharing and opening up for comments. I'll try to share some thoughts (that you probably have already considered). For context, I've taken aHSCT, been off any DMTs for 5 years, no clear 6 month worsening of EDSS yet, no OCB, no worsening on "standard" MR interpretations (I do not know about other NEIDA findings from MR).
I think long-term changes in PROMS could be a part of the definition of a cure. Well-validated PROMS are likely to be accurate, nuanced, and tell another story compared with more "objective" findings (I'm not sure MR really reflects objective end-organ damage, to me it is an interpretation made by clinicians - I've experienced having the same MR images interpreted as being "stable" or showing a new lesion). Together, PROMS and standard outcomes tell a complete story about change over time.
For me, I experience that my levels of neuropathic pain is increasing. This is also reflected in increased doses of medication (oxcarbazepine and gabapentine). I was at 600mg pr day of oxcarbazepine 1 year after aHSCT, now I need to take 1200mg oxcarbazepine + 1200mg gabapentine to have the same effect on pain). Also, I experience increasing levels of fatigue. Reflecting this, I have an increasing time pr year being on sick leave due to MS.
Not related, but could you please make a post about the recent NEJM publication about the non-inferiority of rituximab vs ocrelizumab?
I am so sorry about the increase in your levels of neuropathic pain and your fatigue. I think you raise a critically important point about PROMS, but my understanding (limited, of course) is that the MS drugs did not show much to any efficacy for the PROMS endpoints that were used in the trials that used PROMS. This means, to me, that the pharma company sponsors of these drugs and trials won't want to use PROMS-they want to use the "good old" playbook of the endpoints of ARR and conventional brain MRI activity that they know their drugs can show excellent efficacy against whether these endpoints are meaningful clinically to PwMS, unfortunately.
Clinicians emphasize MRI images being "stable" or lack of relapses because that is what the MS drugs they push and RX show efficacy against, is what I firmly believe. These are only surrogate measures in my view, though. You are totally correctly that PROMS can tell a completely different story.
I read the NEJM publication you mention about non-inferiority of rituximab vs ocrelizumab. My understanding is that Roche/Genentech very slightly "tweaked" rituximab to turn it into ocrelizumab to get a new patent and make more crazy money, since there wasn't much money to be made from rituximab since it had gone generic. You get into the "me too" drug issue-consider why there are several extremely similar anti-CD20 drugs now: Rituximab, Ocrevus, Kesimpta, and Briumvi. Do we really need all of them? Are they different enough from each other to make any meaningful difference?
As always you make me think. My old Neurology floor nurse days of the early 1980ās, Multiple Sclerosis was a steady, predictable always trending downward disease. Doctors ordered inpatient stay for 5 day high dose Intravenous prednisone for flare ups. Lumbar punctures scare me. I saw enough complications. No practicing please. Anesthesiologist preferred. Better yet,
Find another way. Iāll bring up another diagnostic tool we need: an unbiased curious doctor could invent. Maybe the father of a brain injured child, a wife with early dementia, cancer, a doctor with kidney disease or Multiple Sclerosis.
I mean a tool to visualize, analyze, measure, interpret the status and function of the vascular-nervous systems in our bodies.
No MRIās, No Lumbar Puncture, No timed walk, math test, 9 peg test. As long as Iām wishing, can be done at any age,
Like a Space Trek tricorder. Regarding drugs. Iām too old to change. Old fashioned Glatopa. Having MRI next month. Doctor will talk to me. I will take what she recommends. Regarding Gadolinium used as MRI contrast Nanoparticles do cross the blood Brain barrier and, my unscientific belief is a spinal tap can give better access to our central nervous system. Thanks. Iām posting on my X account.
Until we know what causes it how can a cure be found ? Just asking
But that is the point. We are now pretty sure that EBV causes MS.
Absolutely, 1000% agreed!
Good points thank you. I am on the third year of claribine. Week two year first, round two. No new activity but function on the decline since first year, five years back..Please remember that we are on the quest to restore damaged nerv cells. Eg NVG 291
Thanks for the post, as always. Hope the op went well - and your recovery is swift!