Sunday, 18 February 2018

Changing Documents. Will it impact on changing practice?

All senior scientists who work in the University sector in the UK are being monitored for their output to determine whether they are of International standing and whether their work has any Impact.

Check this out to explain (CLICK. Performance culture is ruining scientific research), it's quite a sorry state of affairs.

What is Impact?


Does the work change clinical practice? or perhaps science practice or policy? 

Sometimes we have to remind you of the stuff we have done.

Friday, 16 February 2018

Thursday, 15 February 2018

Crowd-funding: Listeriosis Prevention Pack

We, Barts-MS, and the NHS needs your help to try and prevent Listeriosis after alemtuzumab treatment. We are raising money to produce a Listeriosis Prevention Pack. 


Barts-MS Listeria Prevention Pack Prototype

Drugs doing more than one thing, it's not always good

Morrow SA, Rosehart H, Sener A, Welk B. Anti-cholinergic medications for bladder dysfunction worsen cognition in persons with multiple sclerosis. J Neurol Sci. 2018 385:39-44.

Bladder dysfunction is common in persons with MS (PwMS), often due to muscle overactivity. Anti-cholinergic medications are considered the first line treatment for bladder dysfunction and are known to worsen cognition in healthy older adults and in persons with dementia. Yet, it is not known if these medications have the same effect on PwMS. Thus, the Objective of this prospective matched-cohort study was to determine if anti-cholinergic medications affect objective measures of cognition in PwMS. 

We recruited PwMS starting either oxybutynin or tolterodine (cases). Cases and controls were tested with the Brief International Cognitive Assessment for MS (BiCAMS) battery prior to starting anti-cholinergic medications and 12weeks later.
  The primary outcome was change on the Symbol Digit Modalities Test (SDMT) between groups; secondary outcomes were changes on the other BiCAMS measures. Analysis to assess the significance of between group differences was performed at 12weeks. Forty eight PwMS starting anti-cholinergic medications and 21 matched PwMS controls were recruited. There was a significant difference (p<0.001) in the change on the cognitive measures over 12 weeks between groups. The controls demonstrated improvement, consistent with practice effect, while the cases remained unchanged. This study demonstrates that anticholinergic medications may have a negative effect on cognition in PwMS.


Anti-cholinergic drugs block acetyl (ace-eee-tile) choline activity. Aceyl choline is a neuro-transmitter. Acetylcholine functions in both the central nervous system (CNS) and the peripheral nervous system (PNS). In the CNS, cholinergic projections from the basal forebrain to the cerebral cortex and hippocampus support the cognitive functions of those target areas. In the PNS, acetylcholine activates muscles and is a major neurotransmitter in the autonomic nervous system.The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousalThere are two main classes of acetylcholine receptor, nicotinic and muscarinic. Block acetylcholine and you can get dry mouth constipation  flush skin.


You can get leakage from a bladder because the muscle is contracting too much, anti-cholingrerics can block this. If you can't go, cholinergic agonists can contract the bladder to empty it.  However in addition to blocking over active bladder, it can block nerve action involved in thought processes. 


Why is this important? Because it shows you that the body can use the same system to control more than one function. They could be have universal good things but they can be opposing one good and one bad. Many of the the agents that promote remyelination have alternative functions and don't be surprised is some of those found to be useful in myelination may have unwanted effects. But do we need to take remyelinating drugs forever or just for a short time so that myelination starts?


Wednesday, 14 February 2018

Education: What is a nerve impulse?

What is a nerve impulse? How does a nerve axon generate it and allow signalling using impulses from one place to another?

The impulse may be thought of as a message or wave.  A ‘message’, for example on a telegraph, or a ‘wave’ in the sea initiates at one point and ends up elsewhere. The message needs the medium: the wave may have travelled great distances, but it cannot exist without the sea, whereas the sea itself has not moved. Likewise, the anatomical connectivity of an axon does not change as impulses are transmitted. A telegraph message requires an unbroken line. If the telegraph line somewhere between Laramie and Denver in the old West is broken, then the message does not get through and the bandits might escape justice. There is a similarity here with the nerve impulse and the axon. The axon has to make the impulse and provide a conduit for its conduction.



Monday, 12 February 2018

Guest post: Why hasn't the reality of hidden disabilities caught on yet?

Twice in the past couple of months I’ve been reduced to tears because I’ve seen media stories about people with hidden disabilities being treated appallingly by people in customer-facing positions who should be the ones leading the way when it comes to helping those who might need that extra bit of help. In both the stories, the two women were told they didn’t “look disabled.” 

As someone with MS who most of the time looks perfectly healthy, it’s something that really resonates. I hope that you will share this post far and wide, if nothing else so that every individual who reads this will remember that old saying “don’t judge a book by its cover.”



Sunday, 11 February 2018

My trip to Lucerne and the Charcot Project

A few weeks ago I was invited to give a lecture at the annual Swiss MS Society meeting on 'The Charcot Project' and the rationale behind using anti-viral drugs to treat MS.



As promised my slides from the meeting; they should be self-explanatory: