Gavin Giovannoni

London

Professor of Neurology and Writer at Barts-MS

Writer at MS-Selfie

I published “Can artificial intelligence algorithms fall in love?” on @Medium https://t.co/0r8JsLayv2

Articles

Q&A 86: STRATIFY-JCV (Tysabri) versus ImmunoWell (Tyruko)

1 week ago | gavingiovannoni.substack.com | Gavin Giovannoni

I am a 54-year-old woman and have been living with relapsing MS since 1995, initially presenting as optic neuritis. It took 12 years before I was formally diagnosed in 2007, at which point I started interferon-beta-1a (Avonex). Over the years, I experienced two or three minor relapses (sensory symptoms) that, until 2018, had minimal impact on my daily life.
Do you know your QRISK3 score?

1 week ago | gavingiovannoni.substack.com | Gavin Giovannoni

I have been promoting the holistic management of multiple sclerosis using the marginal gains framework for over a decade. The principles are simple: do anything you can to change small things that, when added together, make a significant difference to MS outcomes. A core strategy is adopting a brain-healthy lifestyle to prevent or aggressively treat comorbidities that affect brain health. What surprises me is how few MS (pwMS) people take this on board.
Identifying axonal injury through the eye: can the cornea provide new clues to axonal injury in MS?

1 week ago | msard-journal.com | E. Ann Yeh |Michael Levy |Chris Hawkes |Gavin Giovannoni

EditorialArticles in Press106449 1Department of Pediatrics (Neurology), SickKids Research Institute, Division of Neurosciences and Mental Health, Hospital for Sick Children, University of Toronto 2Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK 3Department of Neurology, Massachusetts General Hospital and Harvard Medical School 4Dept of Neurology, John Hunter Hospital, University Newcastle Publication History: Published...
Q&A 85: RIS or RRMS? What about PPMS?

1 week ago | gavingiovannoni.substack.com | Gavin Giovannoni

Dear Professor,Life has a way of throwing unfortunate coincidences at us. I am writing to discuss the recent case of a close friend. She is a 40-year-old female currently under observation for suspected demyelinating disease, with a differential diagnosis between Radiologically Isolated Syndrome (RIS) and early Relapsing-Remitting Multiple Sclerosis (RRMS). She is asymptomatic.
News: good and bad

2 weeks ago | gavingiovannoni.substack.com | Gavin Giovannoni

A short newsletter to highlight news. The tolebritinib data has finally been published and not only vindicates that BTK (Bruton Tyrosine Kinase) is a valid therapeutic target targeting B-cells and likely CNS macrophages and microglia but also makes the case for CNS penetrant therapies. The tolebrutinib results are a landmark in MS drug development and usher in a new phase of MS therapeutics that goes beyond targeting relapses and focal MRI activity to target smouldering MS. I hope Prof.
Dengue fever and exotic infections

2 weeks ago | gavingiovannoni.substack.com | Gavin Giovannoni

I am on holiday with my wife in Bali, a small island in the South of the Indonesian archipelago. It is my first trip to Indonesia; it is beautiful, and the people are so welcoming. The culture is fascinating and very rich with otherworldly traditions and rituals. This also explains why I have not addressed many of the questions in my inbox from subscribers. Earlier this week, we met a young woman from the UK who is living and working in Bali as a digital nomad.
Q&A 84: rituximab, rituximab, rituximab: is this the only option for treating breakthrough MS disease activity?

3 weeks ago | gavingiovannoni.substack.com | Gavin Giovannoni

I am a woman in my early 40s who was diagnosed with RRMS in 2018 after a relapse where I experienced numbness in my right leg. Back in 2015, I suddenly lost the ability to walk normally on my left leg, which was unfortunately misdiagnosed as a hip injury. I still have residual symptoms from that relapse and can only walk a maximum of 3 km. In my family, we are three siblings, all of whom have MS.
Q&A 83: cladribine vs. siponimod vs. tolebrutinib for smouldering MS

4 weeks ago | gavingiovannoni.substack.com | Gavin Giovannoni

I am a 44-year-old woman with longstanding MS. I was initially treated with interferon-beta (Avonex) for several years, but I stopped to have a family. I never restarted treatment and have not been on any DMT for over 15 years. I have had no relapses, but I am steadily getting worse. Reduced walking distance, fatiguable foot drop, poor balance and worsening bladder symptoms. My neurologist has suggested either cladribine or siponimod. What would you recommend?
Challenging the dogma around the focal MS lesion

1 month ago | gavingiovannoni.substack.com | Gavin Giovannoni

Do we need to challenge the dogma that traditional MRI is good enough to monitor MS? Our current treatment target in MS is no evident inflammatory disease activity or NEIDA. In other words, there should be no relapses or focal MRI activity (new or expanding T2 lesions or Gd-enhancing T1 lesions). Question: Is the NEIDA treatment target appropriate? I don’t think so for several reasons. If you have MS, you are likely to attribute new neurological symptoms, particularly if they persist, to a relapse.
Q&A 82: dopamine agonists for restless legs syndrome - a no-no

1 month ago | gavingiovannoni.substack.com | Gavin Giovannoni

I have multiple sclerosis and restless legs syndrome. My neurologist started me on low-dose pramipexole for restless leg syndrome. I started on the lowest dose of 0.088mg dose at night, but over the last few years, I have had to increase the dose to control my restless legs. I am now taking three 0.35mg tablets at night, which controls my symptoms very well and gives me a good night's sleep.