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Before it is too late
- 1. Before it’s too late: why time matters in MS João José Cerqueira School of Medicine, University of Minho, Braga
- 2. Disclosures I have received research funding from Biogen and consultancy/speaker fees from Bayer, Biogen, Merck, Novartis, Roche, Sanofi-Genzyme, Teva.
- 3. It is never too late to try to STOP multiple sclerosis
- 4. Casa roubada, trancas à porta
- 5. “MS is like hot iron, you have to beat it while it is still hot!” Cetautomatix in “The big fight!”
- 6. MS damages the entire brain Kutzelnigg et al (2005) Brain Popescu et al (2013) Continuum (Minneap Minn) NeoC9 (complement) H+E (astrocytes) Bielschowsky (axons) TypeIIlesion Nikic et al (2011) Nature Med
- 7. MS accelerates brain atrophy JNNP 2016; 87:93-99
- 8. N Engl J Med 2000; 343:1430-8. % of patients that can walk unaided MS is a disabling disease
- 9. The repairing ability of the MS brain is limited Brain (2002) 125 (9): 1972-1979.
- 10. ...particularly in “older” lesions Brain (2008) 131 (7): 1749-1758. Less than 4 years of disease 4 or more years of disease
- 11. We aren’t yet very good at promoting regeneration ECTRIMS Online Library. Cadavid D. Sep 16, 2016; 147038
- 12. ... particularly in ”older” lesions and patients ECTRIMS Online Library. Cadavid D. Sep 16, 2016; 147038
- 13. You have to act swiftly... to prevent damage
- 14. How late is too late?
- 17. Most certainly... Given the significant mean differences, the model included the following variables: disease duration, disease course, 9HPT, SDMT, Logical Memory, and WCST. As shown in Table 2, the only predictor of employment status was the SDMT, accounting for 15–20% of the variance with an overall accuracy of 67%. Mult Scler. 2014; 20:112-5.
- 18. Probably too late MS = Controls MS < Controls Neurology 2010; 75:1241-1248
- 19. Might be too late? Neurology 2012; 78:309–314. 27,6% of RIS patients had cognitive impairment
- 20. And this? Multiple Sclerosis 2015; 21:945–952.
- 21. What can we do before it is too late?
- 22. Treat early Neurology 2012; 78:1315-1322
- 24. Is there a window of opportunity? Neurology 2010;74:2004–2015 Early relapses drive progression (but later ones perhaps not so…)
- 25. Probably... J Neurol (2006) 253 : 98–108
- 26. Most certainly... ECTRIMS Online Library. Kappos L. Sep 16, 2016; 147077
- 27. Mens sana... Arch Phys Med Rehabil. 2013;94:1971-81.
- 28. …in corpore sano! J Neurol Neurosurg Psychiatry. 2016;87:181-7.
- 29. Do not smoke! Mult Scler. 2008;14:1031-5.
- 30. When is it too late? Disability Cognitive deficits Learning difficulties Brain atrophy It’s always too late
- 31. Try to stop MS before it stops YOU!
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