Brain Volume Presentation for MS Bloggers

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Brain Volume Presentation for MS Bloggers

  1. 1. What is your brain worth to you? Gavin Giovannoni Barts and The London
  2. 2. Control Multiple sclerosis RIP
  3. 3. 730 HP ? 30 BP Brain Power (BP)
  4. 4. Brain atrophy occurs across all stages of the disease De Stefano, et al. Neurology 2010 n= 963 MSers
  5. 5. www.multiple-sclerosis-research.org
  6. 6. www.multiple-sclerosis-research.org
  7. 7. www.multiple-sclerosis-research.org
  8. 8. Defining the window of opportunity to treat MS?
  9. 9. 21-year long-term follow-up of IFNb-1b study time from study randomization to death Early treatment (3 years) with IFNb-1b was associated with a 47% reduction in the risk of dying over 21 years compared with initial placebo treatment Goodin et al Neurology. 2012 Apr 24;78(17):1315-22. At risk: IFNB-1b 250 µg Placebo 124 123 124 120 121 117 118 109 104 88 HR=0.532 (95% CI: 0.314–0.902) 46.8% reduction in hazard ratio Log rank, P=0.0173 IFNB-1b 250 µg Placebo 65% 70% 75% 80% 85% 90% 95% 100% 0 2 4 6 8 10 12 14 16 18 20 22 Proportionofpatientswhoarestillalive Time (Years)
  10. 10. Theoretical model: treat early and effectively Natural course of disease Later intervention Later treatment Treatment at diagnosis Intervention at diagnosis Time Disease Onset Disability
  11. 11. Defining your treatment strategy?
  12. 12. survival analysis “hit hard and early ” MS is an autoimmune disease hypothesis 15-20 year experiment What is your treatment philosophy? maintenance-escalation vs. induction
  13. 13. Can you name me any diseases that you don’t treat early?
  14. 14. Time is Brain Conclusion
  15. 15. Definition of dementia Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living, lasting more than six months, not present since birth, and not associated with a loss or alteration of consciousness. • Normal activities of daily living • Physical • Mental • Social • Occupational • Lasting more than six months • Not present since birth • Not associated with a loss or alteration of consciousness        “Multiple sclerosis is therefore a preventable dementia.”
  16. 16. www.multiple-sclerosis-research.org

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