19 year old man had two years of vision loss who later developed limb weakness and stiffness and neurogenic bladder. MRI showed THIS. Diagnosed [erroneously] with NMOSD. Homocysteine level sky-high. folate/b12 at low end of normal. The real diagnosis?

Theories about how epstein barr virus infection could cause multiple sclerosis pubmed.ncbi.nlm.nih.gov/41505824/

Risk factors for multiple sclerosis pubmed.ncbi.nlm.nih.gov/41505824/

The Hercules trial (tolebrutinib vs placebo in secondary progressive ms) was "positive," but if you remove the 12.8% of people with enhancing lesions on baseline MRI, the difference is no longer statistically significant HR 0.777 (CI 0.601, 1.006)

51 year old woman with dystonic spasms of the right arm and face. MRI showed this. Diagnosis?

Do Vaccines Cause Multiple Sclerosis? youtu.be/PUwkCmXcpDU?...

The FDA explains its rejection of the multiple sclerosis drug tolebrutinib in a Complete Response Letter (CRL). "A favorable benefit-risk profile could not be established for any patient subpopulation" download.open.fda.gov/crl/CRL_NDA2...

The oral bacterium Fusobacterium nucleatum is linked to higher disability in multiple sclerosis. Those with high levels were >3 times more likely to have at least moderate disability (EDSS >/=4). Data from Japan www.nature.com/articles/s41...

Sometimes, kesimpta (a b-cell depleter used for multiple sclerosis) can cause low t-cells which occurred in 7/38 people in this study. Authors argue this is due to T cells with the CD20 cell surface protein (CD3 + CD20+ cells) journals.sagepub.com/doi/10.1177/...

The rate of different subtypes of multiple sclerosis in pediatric onset MS (POMS), adult onset MS (AOMS) and late onset MS (onset after age 50, LOMS) pubmed.ncbi.nlm.nih.gov/41488586/

MS "Crap Gap": A Problem. youtu.be/iHYoLMkEY18?...

3D-DIR MRI sequences of the MRI (images c/d) are better than FLAIR (images a/b) at visualizing multiple sclerosis plaques near the cortex (arrows) pubmed.ncbi.nlm.nih.gov/41464105/

5 Questions Every MS Patient Must Ask Their Neurologist by @AaronBosterMD youtu.be/cVqE933zAyg?...

Autoimmune diseases are becoming more common over time. pmc.ncbi.nlm.nih.gov/articles/PMC...

There is a very small (though statistically significant) association between prior antibiotic exposure and subsequent diagnosis of multiple sclerosis. This meta analysis suggests 18% more prior antibiotic exposure in people with MS. pubmed.ncbi.nlm.nih.gov/41443021/

Brainstem lesions in MS are also perivenular, often appearing radially in a "sunray" pattern. Authors include Dr. Gavin Giovannoni and Dr. Dr. Klaus Schmierer pubmed.ncbi.nlm.nih.gov/41447908/

The Australian STOP-MS will evaluate the drugs spironolactone and famciclovir (which inhibit EBV replication in basic science studies) to prevent disability progression in MS. pubmed.ncbi.nlm.nih.gov/41450528/

The FDA rejects tolebrutinib, an oral Bruton’s tyrosine kinase inhibitor, for non-relapsing secondary progressive multiple sclerosis www.thepharmaletter.com/pharmaceutic...

Seroprevalence of Epstein Barr Virus (EBV) in low MS prevalence areas Greenland and Uganda vs. higher prevalence areas Denmark and Pennsylvania. Delayed EBV infection linked to clinical mono and high risk of MS

This article from 2006 describes an astounding risk of multiple sclerosis in an Old Colony Mennonite community of 1 in 32, roughly 10-15 times the risk in Canada and the US! They hypothesize smoking and curing meats with nitrates/nitrites is a factor. www.sciencedirect.com/science/arti....

Does Salt Cause Multiple Sclerosis? youtu.be/bu_kqoKuKSw?...

22.5% of people with MS have at least one other autoimmune disease, most commonly hypothyroidism, type 1 diabetes, and psoriasis (data from Spain) pubmed.ncbi.nlm.nih.gov/41429303/

Can you take rituximab for MS once yearly instead of every six months? Our data in Southern California suggests no evidence of disease activity (NEDA) was similar with both treatment regimens despite significant B-cell repopulation with annual dosing. www.neurology.org/doi/10.1212/...

DECEMBER LIVE STREAM NOW! by @aaronbostermd.bsky.social ASK ME ANYTHING MULTIPLE SCLEROSIS! www.youtube.com/live/KOgy0Fo...

32 year old man with hiccups, nausea, and cough followed weeks later by bouncing eye movement, difficulty swallowing, and then weakness of the limbs. MRI cervical spine showed THIS. Diagnosis?

High Dose Vitamin D Toxicity youtube.com/shorts/LXAgN...

This Retrospective cohort study (not a randomized trial) suggests ocrevus was slightly more effective at preventing MS disability progression. Ocrevus was linked to a 6% lower risk of moderate disability ( EDSS≥4) 95% CI: –11.28% to –0.46%; p=0.033) www.medrxiv.org/content/10.6...

Loss of the "swallow tail sign" (loss of high intensity of the dorsal substantia nigra) on 7-T MRI scan is associated with parkinson's disease. It is often asymmetrical (notable on the right side of image C) pubs.rsna.org/doi/10.1148/...

Here is a case report of some with MS developing Neutropenia (low levels of neutrophils, a type of white blood cells) as a side effect of ocrevus 6 years after starting the drug. This can also occur with similar drugs such as rituximab www.cureus.com/articles/439...

Patient-Derived Monoclonal Myelin Oligodendrocyte Glycoprotein Autoantibodies Mediate Cytotoxicity www.neurology.org/doi/10.1212/...

Prior antibiotic use is slightly associated with an increased risk of multiple sclerosis according to this meta analysis (for instance, the odds radio for prior sulfonamide use and MS risk was 1.30 (95%CI: 1.23-1.38) (I2=22.1%, P<0.001) www.maedica.ro/articles/202...

The sensitivity of Oligoclonal Bands isolated to the cerebrospinal fluid in Multiple Sclerosis Compared to Other Neurological Disorders onlinelibrary.wiley.com/doi/10.1111/...

Answering MS Questions #4 (Birth Control, Anticholinergics, MRI, Fibromyalgia, Exercise, Vitamin K) youtu.be/hS5uf04IF3I?...

Mediterranean diet is linked to a lower risk of multiple sclerosis (data from 41,428 participants in the Swedish National March). "Each one-point increase in the Mediterranean Diet Score was associated with a 14% lower MS risk" Cohort.)https://journals.sagepub.com/doi/10.1177/13524585251396408

In a press release, Sanofi announces that tolebrutinib (an oral bruton's tyrosine kinase inhibitor) was not successful in slowing disability progression in primary progressive MS (PERSEUS trial data). They intend to pursue FDA approval for SPMS www.globenewswire.com/news-release...

Quiz time. What was the risk of Guillain-Barre syndrome (GBS) with the infamous 1976 Swine Flu Vaccine which was suspended December 16, 1976?

How @aaronbostermd.bsky.social does things differently at the Boster Center for MS youtu.be/pM4d4SGXRpM?...

Spinal Cord Anatomy Explained by Neurologist youtube.com/shorts/Rz4M1...

high dose ocrevus (1200mg and 1800mg) was not more effective than standard dose ocrevus (600mg). [data from the GAVOTTE trial]

Tristan Jass Brain Cyst Explained by Neurologist youtube.com/watch?si=cP1wk-sJU8R2LKMl&v=uNdX7T8tJGY&feature=youtu.be

Out of pocket health care costs for people with multiple sclerosis are steadily rising, mostly driven by the increased cost of medication, "increasing by 818.0% from $228 in 2002 to $2093 in 2021" despite numerous generics and biosimilars jamanetwork.com/journals/jam...

Basketball YouTube Star Tristan Jass announces he will have brain surgery for a right temporal lobe cyst discovered in 2019 after a seizure. This cyst slowly grew over 6 years and had a small enhancing component on a 2025 MRI, so surgery was recommended. youtu.be/UUPt35etmAQ?...

Longitudinal proteomic profiling of cerebrospinal fluid in untreated multiple sclerosis defines evolving disease biology www.nature.com/articles/s41...

Vitamin D and MS youtube.com/shorts/jW_ju...

subcutaneous ocrevus has been added to Australia’s Pharmaceutical Benefits Scheme and should be cheaper and more available to Australians, with a price reduction from $16,500 to as low as $31.60 www.news.com.au/lifestyle/he...

Alcohol & Multiple Sclerosis: Can You Drink? youtu.be/mmDyu_GT3aI?...

A man in his 50s with one month of fever and numbness in the extremities. MRI showed THIS. Multiple sclerosis? No! Brain biopsy was consistent with primary large B-cell lymphoma, and he was treated with R-MPV www.jstage.jst.go.jp/article/jslr...

The NEW 2024 MS Diagnostic Criteria Explained by @aaronbostermd.bsky.social RIS, kappa light chain in CSF, central vein sign, paramagnetic rim sign, anti-MOG in children, age > 50. youtu.be/HOTDtZQLo2k?...

Multiple Sclerosis Diagnostic Criteria for Someone with a Single Attack youtube.com/shorts/Xcz2v...