Relapses in multiple sclerosis. It’s all in the brain!

Acute neurological deficits, otherwise known as relapses, characterise relapsing-remitting forms of MS.  A high annualised relapse rate is associated with disability development in the future, and current therapeutic endeavours are aimed at reducing such relapses.  Clinically, relapses are typically represented by sensorimotor deficits, gait unsteadiness, optic neuritis etc.  While cognitive decline and worsening fatigue may […]

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Psychogenic disorders and persistent disability?

Psychogenic motor disorders may be frequently encountered in “organic” neurology, especially in the world of movement disorders.  This group of disorders needs to be distinguished from malingering as the patients really feel that they have a functional deficits even though neurology can not explain the site and origins of deficits.  Indeed, transcranial magnetic stimulation studies […]

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Variants of Guillain–Barré syndrome.

Guillain-Barre syndrome (GBS) is a rare, but much taught, autoimmune disorder of the peripheral nerves.  Importantly, the variant of GBS are poorly recognized in the Western world, thereby leading to diagnostic and therapeutic delay.  In the superb review by Wakerley and Yuki, pharyngeal-cervical-brachial (PCB) variant of GBS is expertly discussed.  This must read review will […]

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Are the sphingosine wars beginning?: Ponesimod-Promising new oral agent for RRMS

Another oral agent has shown promise in a phase IIb trial for relapsing-remitting MS.  Ponesimod, a selective sphingosine 1-Phosphate Receptor 1 Agonist, reduced disease burden and activity as assessed by MRI and clinical measures (annualized relapse rates).   Safety and tolerability  were also assessed and proven to be good.   Larger trials are required to confirm […]

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Is one born to develop motor neuron disease?

Motor neuron disease is fatal and rapidly progressive neurodegenerative disorder of the human motor system.  The disorder peaks in the late 50’s early 60’s and then declines after ager 80, an unusual statistic for a degenerative disease.   In addition, familial forms of MND are increasing recognised, although the penetrance of the genotype is at best […]

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Another nail in the preverbial coffin for CCSVI theory?

Chronic cerebrospinal venous insufficiency (CCSVI) was proposed as a potential pathogenic mechanism in MS.  While pathological data to support such a theory were elusive, a world-wide craze was sett-off, mostly amongst patients, some vascular physicians and some (minority) of neurologist.  It seamed appealing that a simple vascular problem was responsible for MS, but alas subsequent […]

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The Sound of Music

My sister is doing a degree in music.  I listen, fascinated, to her stories; music school isn’t like med school.  Their days begin around noon, fellow students sport wild hair colours and outfits (tutus anyone?), and the last exam she sat was held upstairs in the local pub.   Image credit: http://www.keepcalm-o-matic.co.uk/p/study-your-exam-and-have-a-beer–1/   Most people enjoy […]

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