Mike Barron

New MS Therapies: A Hard Pill to Swallow?

Dr. Slater, thank you for your excellent commentary. My comments are in regards to the emergence of PML in the MS patient community: Could it be possible that any current or future emergence of PML in the world's MS patient population be solely attributed to unwary attending physicians who aggressively and ethically prescribe immune modifying/suppressing therapy or disease modifying treatment to “suspected” or “typical” MS-like patients with progressive disease? An inadequate or incorrect differential diagnostic algorithm may not adequately exclude PML or differentiate PML from MS on initial presentation of clinical symptoms along with inconclusive macroscopic findings on MRI. It seems highly probable that a very small fraction of the world’s currently over-diagnosed ms patient population could be considered “suspect” MS-like patients with other types of neurological disease or infection such as progressive multifocal leukoencephalopathy, PML. Clinical data seems to be slowly emerging that once “suspected” MS patients later re-diagnosed with PML, were NOT actual MS patients on initial diagnosis prior to discovery of PML infection specifically causing the patients neurological deficit and symptoms. To date not one iota of epidemiological or pathological clinical data has been published or presented to support a very weak hypothesis that virulent or dormant subclinical PML and acute or chronic MS can exist in tandem as co-morbidities in the white matter of the brain or CSF of any affected patient.

Mike Barron