Thursday, 8 October 2015

I want to see the poster

You said I want to see the poster (Charcot 1). 
Here it says nothing of relevance.

As I have said over and over and over again, 
the results will be known 
when its published.

News from the Pit

You have been waiting for news from the pit. ProfG will tell you that the Red Queen is alive and well and the stands at ECTRIMS2015 are a big as ever.

It is amazing that one company has built their advertising campaign around the concept of the 40watter.

A few days ago we wrote about the intellect of your neuros and the power of an electric light bulb. In the stand they test your knowledge before telling you their drug is great. However, I can hear Scottie shouting “Captain we do nee have the power” (This is for the (Star) trekkies) as you get the answer to the question wrong and your bulb dims to 10watts and god forbid a fairy.

However to lighten the load, Neuros are being entertained to 360 vision. 

You put you googles and earphones on and you enter the 3D virtual world of our subliminal drug advert. 

Maybe this is the treatment of the future...3D goggles, so rather than being stuck in your house you will be running through fields and swimming in a lake….lovely. 

Maybe you can have a trip into the pit at ECTRIMS. 

In it you can see the Ashley Madison for Neuros-ECTRISM2015 (see below) Stand:-).

However make sure you don’t see antibiotics, as one of the companies I saw wasn’t cleaning the googles between people.

Also when you stick your finger on the touch screen, think whose nose the last finger has seen:-(

Burning Debate Today

Another Live Debate

View the ECTRIMS Website

Social Media Session, Hall D

16:00 - 17:00 Burning debate: To LP or not to LP...should neurologists be doing monitoring LP's on their patients?

C. Oreja-Guevara (Madrid, Spain)

16:00 - 16:10 Speaking for the motion
F. Piehl (Stockholm, Sweden)

16:10 - 16:20 Speaking against the motion
A.J. Coles (Cambridge, United Kingdom)
16:20 - 17:00 Q&A

Times Are: Local European Time

imaging PML

Wattjes MP, Wijburg MT, Vennegoor A, Witte BI, de Vos M, Richert ND, Uitdehaag BM, Barkhof F, Killestein J; Dutch-Belgian Natalizumab-associated PML study group.MRI characteristics of early PML-IRIS after natalizumab treatment in patients with MS.
J Neurol Neurosurg Psychiatry. 2015 Sep 14. pii: jnnp-2015-311411

OBJECTIVE:The early detection of MRI findings suggestive of immune reconstitution inflammatory syndrome (IRIS) in natalizumab-associated progressive multifocal leukoencephalopathy (PML) is of crucial clinical relevance in terms of treatment decision-making and clinical outcome. The aim of this study was to investigate the earliest imaging characteristics of PML-IRIS manifestation in natalizumab-treated patients with multiple sclerosis and describe an imaging pattern that might aid in the early and specific diagnosis.
METHODS:This was a retrospective study assessing brain MRI of 26 patients with natalizumab-associated PML presenting with lesions suggestive of PML-IRIS during follow-up. MRI findings were evaluated considering the imaging findings such as mass effect, swelling, contrast enhancement, new perivascular T2 lesions and signs suggestive of meningeal inflammation.
RESULTS:Contrast enhancement was the most common imaging sign suggestive of PML-IRIS, seen in 92.3% of the patients (with patchy and/or punctuate pattern in 70.8% and 45.8% respectively), followed by new T2 lesions with a perivascular distribution pattern (34.6%). In those patients with contrast enhancement, the enhancement was present in the lesion periphery in 95.8% of the patients. Contrast-enhancing lesions with a perivascular distribution pattern outside of the PML lesion were observed in 33.3% of the patients. The most common overall pattern was contrast enhancement in the border of the PML lesion with either a patchy or punctuate appearance in 88.5% of all patients.
CONCLUSIONS:Contrast enhancement is the most common earliest sign of natalizumab-associated PML-IRIS with a frequent imaging pattern of contrast-enhancing lesions with either a patchy or punctuate appearance in the border of the PML lesion.

Maybe DrK will comment on this, but this study suggest ways to spot Immune Reconstitution Inflammatory Syndrome (IRIS) that can occur when you have subclinical PML/PML, a brain full of JV virus, and you have stopped natalizumab so the immune cells specific for the virus, enter the CNS and kill virally infected cells quicker than virally-infected cells can kill virally infected cells which are the oligodendrocytes leading to worse demyelination than your current MS and the resultant nerve loss that follows this and the consequent deterioration of the affected individual.

NeuroSpeak: safety issues

Safety issues in relation to DMTs #MSBlog #ECTRIMS2015 #NeuroSpeak

"For those who attended the Excemed teaching course on Tuesday; as promised I have uploaded my slides onto SlideShare. It seems as always that PML dominates the discussion."