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Excess mortality during pandemic tops 14 million

 

The World Health Organization estimates that excess mortality during the COVID-19 pandemic (2020-2021) globally was 14.91 million. Excess mortality includes reported COVID deaths (5.42 million) as well as unreported COVID deaths, all-cause mortality where COVID played a role, and excess deaths related to healthcare delivery. This methodology was used to more accurately reflect deaths directly and indirectly related to the pandemic. Read More

Evolving picture of cognitive dysfunction in MS

 

Recent imaging studies in multiple sclerosis have focused on the association between cognitive dysfunction and grey-matter tissue loss, most notably of the cerebral cortex and thalamus. For example, at the American Academy of Neurology annual meeting, an analysis of the SPRINT-MS trial proposed that lower thalamic volume at baseline may be a useful predictor of physical, cognitive and visual disability in progressive MS (Nicholson et al. AAN 2022;S12.007). Thalamic volume at the time of relapse may also be predictive of cognitive recovery as assessed by the Symbol Digit Modalities Test (SDMT) (Weinstock et al. AAN 2022;P14.010). As such, thalamic volume (but not T2 lesion volume in this study) may serve as a marker of cognitive reserve. Read More

CLINICAL CASES IN MS – CASE 5: A CLINICALLY STABLE PATIENT PLANNING A PREGNANCY

 

Click here to complete the questionnaire

Alison, 31, is a lawyer, married with no children. She was diagnosed with RRMS in 2014. Her initial presentation was vertigo, diplopia and mild ataxia. EDSS score was 2.0. She was started on glatiramer acetate but was switched to fingolimod in 2016 after experiencing two relapses.

She has been clinically stable since 2016. Her EDSS score is unchanged. Her last MRI eight months ago revealed three new lesions, one enhancing, but she was happy on therapy and did not want to make a switch at that time.

The patient tells you she wants to get pregnant in the next 6-12 months.

Questionnaire

Question 1: Is Alison being adequately managed on her current treatment?

Question 2: How would you manage Alison’s transition off fingolimod prior to her pregnancy?

Question 3: Assuming all vaccines and TB skin testing are up-to-date, what testing is needed when transitioning from fingolimod to another higher efficacy agent (e.g. natalizumab, ocrelizumab, cladribine)?

Question 4: What would be your approach if Alison said she wanted to get pregnant in 12-24 months (rather than in 6-12 months)

Question 5: Alison opted to switch to ocrelizumab as her disease modifying therapy. She received three cycles of ocrelizumab, became pregnant, carried her baby to term, and had a healthy baby girl. Post-partum she is keen to restart treatment with a DMT. She plans to breastfeed. You advise her to: