Advantages and Risks of CFD Trading – Learn to Trade CFD Better in 2019

2019 is looking to be a year that will see tremendous growth in the field of CFD trading in Vietnam. With commodity markets all increasing in value, as a CFD trader, you can enjoy having a variety of instruments to trade! This derivative domain has immense potential, and done rightly, you can move to trading contracts full-time and make consistent winnings every day. Like every coin has two sides, CFD trading does too. Advantageous as it is, the risks it carries are scarily destructive!
 
Employing the right trading strategy and following a disciplined approach will ensure losses are at a minimal, and profits are consistent. Listed below are the several advantages and risks you will experience as a CFD trader:
 

Advantages of CFD Trading 2019:

 
CFD Trading in Vietnam 2019
CFD Trading in Vietnam 2019 - Pros & Cons
 
1) Trade Both Ways: Irrespective of whether the market is rising or falling, you get to make money. CFD trading allows you to capitalize on both bullish and bearish trends, making it an incredibly flexible field! With the necessary indicators in place and a thorough session of analysis done, you can catch the precise points to open and close your position on.
 
2) Hedging: As a CFD trader, you need not close your trade out of approaching risks, you can simply hedge them against another trade. When a losing trade is, on one hand, you can open a position in the opposite direction, thereby balancing the loss or even making a little profit in the process!
 
3) Marginal Trading: You can control a CFD position of $10,000 with just $500 when the broker margin requirement is 5%. With just a little capital, you can make huge winnings! In this case, with a $500 investment, you can make $10,000.
 

Risks in CFD Trading 2019:

 
1) Overleveraging: Thinking CFDs are a means to get rich quick, traders end up leveraging beyond necessity only to lose the little made. Leveraged losses are no joke! When you over-leverage, the losses you incur will easily blow up your account. With a suitable stop order in place, however, you can minimize these risks.
 
2) No Voting Rights: CFD traders don't have the right to vote on stocks. This means you take what you are given, making trading a rigid field for you! A regular stock broker can influence the company and said stocks, but a CFD trader can't.
 
As a beginner, CFD trading is undoubtedly going to be overwhelming. Aspects like trading strategies, leverage, stop orders, etc, might go over your head! Sign up with an established broker, and enhance your CFD trading game today. Call WesternFX, and avail our best-in-class contracts solutions and services. Assisted by our experts, you can enter trades fearlessly, and emerge victorious throughout! Come; let's dominate CFD trading in Vietnam!

Top 5 Tips to do Successful Forex Trading in Vietnam

Forex trading is a truly daunting experience, not just for beginners, but established traders too. This is because it is one of the most volatile trading grounds, where almost anything can happen! One minute your trade might be going incredibly well, the next minute it sees a sharp downtrend. Understanding the various nuances of Forex trading will take time and knowledge is best gained with experience. 
 
As a beginner in this immensely lucrative field, there are some basics you should know, that will help you thrive the chaotic currency markets.
 
Here are 5 tips to follow as a Forex trading beginner: 
 
Tips for Successful Forex Trading in Vietnam
Tips to Make Better Forex Trading

 1) Always Preserve a Portion of Your Capital: When you're starting off, preserving your capital comes first. Bad trades don't announce before occurring; it is always best to be prepared. Let's assume you're working with $5000, save $1000-$1500 from it and only use the rest for trading. This helps you stay protected in the event of a losing trend and serves as risk investment.
 
2) Strategizing is the Most Important Aspect of a Trade: Forex trading victory is something that can only be achieved through the implementation of a comprehensive strategy. A trading plan monitors everything from the get-go; starting with the entry points, up until exiting a trade and avoiding losses. As a beginner, tune your focus into mastering the art of strategizing and implementing it in real-time.
 
3) Take Losses but Learn from Them: The more you try to avoid loss, the more the chances of incurring. Some trades are meant to end bitter, they can't be stopped. Even with a strong stop order in place, bad trades will make their way in. Take losses as a part of your endeavor, but learn from them. What caused the loss, how it can be avoided, find the answer to such questions and better your approach!
 
4) Stick Through Trades: Giving up halfway through a trade will be a regrettable decision. Several traders stop their exchange midway upon seeing a lack of profits. Though the most liquid market, Forex has no guarantee that every trade will work in your favor! Be patient with trades, and stick to your Forex trading strategy till the end.
 
5) Never Keep Expectations: When you're just starting Forex trading in Vietnam, your expectations from the markets should be nil. As a newbie, there is little you know, and with this little, housing expectations is a bad idea. Profit or loss, participate in trades nevertheless! Equip yourself with a strong strategy, learn markets to the best of your abilities, and expect nothing!
 
With these simple, yet effective tips, you can begin Forex trading in Vietnam right away! The final tip to perfect your beginner's approach is finding a reliable broker. Call WesternFX today and hire from our arsenal of experts! With our proven Forex trading strategies at your disposal, victory will come in no time!

What Makes You a Good CFD Trader in Vietnam | CFD Trading

To have a successful run in any trade market requires experience. This experience comes with patience and learning, learning in turn, comes with research. The ladder that takes you to the top is long! Contracts trading are one of the most profitable fields in trading today, and everyone wants to run up this ladder as quick as can be done. However, one thing eager traders fail to realize is, the higher you go, the harder you fall. Success should be chased wisely, and it is something that comes with time. 

In a rush to make good money, CFD traders make rash decisions and end up taking a fall.

How to be successful in CFD trading in Vietnam
Tips to Become Pro CFD Trader in Vietnam

Of the several requirements for becoming successful, these are the 4 most important:

1) Recurring Practice: Excellence is said by many, to be a habit, not a state of being. When you put in long hours working hard and working smart, excellence comes within reach! Practice is one of the most important aspects of CFD trading, and one you will need till the last trade. With so many strategies and timeframes to work on, practice is a must to land at the perfect trade condition. Success comes with practice and hard-work!

2) Controlling Leverage Right: What makes CFDs truly interesting is the provision to avail a borrowed sum, and hold larger positions in trades. With a leverage of 100:1, you can start with $100 and hold up to $10,000! The twist, however, is that when you lose, you lose $10,000, not $100. This is what makes leverage control crucial and a decisive factor in most trades. Without proper risk management measures in place, CFD traders can easily lose their earnings!

3) Taking and Cutting Losses: While losses have to be kept at bay, they can't be completely avoided. No matter how solid a Forex trading strategy, losses can always creep in. Learn to cut losing positions; don't hold on with hopes that the trade with a turn in favor! When a loss is made, cut the trade, take the loss and move on.

4) Performing Ample Analysis: CFD trading is a field driven by technical analysis. Without comparing past and future market trends, it is difficult gaining control over present movements. Technical analysis combined with a strong strategy can work wonders!

Forex trading in Vietnam today holds an incredibly high value. Traders from around the world are participating in these markets and winning, you can too! With an established broker like WesternFX by your side, victory is assured! Call us today and avail our stellar brokerage; be it CFDs, stocks, or CFD trading in Vietnam, with our assistance, you will emerge successful in all ventures!

3 Tips To Master Forex Through Demo Trading Account

Demo trading platforms are a boon to Forex traders. In today's era of stifle competition, the fiery desire to succeed is present in many traders. Being a field of heavy analytics, foreign exchange requires traders to be adept, sharp and immaculate in their approach. Another point to note is that mistakes aren't treated lightly in the world of currency trading! Even the smallest misstep can lead to tumbling losses. To help traders learn the art of Forex trading, demo platforms are provided. These virtual accounts allow players to test the waters of foreign exchange, with virtual money, in a risk-free environment.
 
Wondering how you can perfect your currency trading skills through demo accounts? Here's how:
 
Tips To Master Forex Through Demo Trading Account
Tips To Master Forex Through Demo Trading Account

1) Test The Boundaries: Learning is a process that needs to be done in an environment that knows no bounds; especially a field like Forex, which requires consistent analysis and research. To master this, traders make use of Forex demo accounts - which are potentially limitless. There is no cap on leverage, or capital usage, allowing users to test the limits of each implementation, and observe, learn from the various outcomes birthed.
 
2) Learn How To Strategize: Forex is known for its diverse nature, and the freedom it gives traders when it comes to strategizing. From short-term plans to long-term, you can work on various levels of strategies and tailor-make them to your comfort. On a demo account, where there are no risks, you get the chance to test out, and devise strategies that are best suited for your trading approach! Implementing a plan directly in a trade might result in unfavorable outcomes. However, on a Forex demo account, you can gauge various aspects without suffering any repercussions.
 
3) Figure Out Entries And Exits: An important aspect of your trade is going to be the point where you enter, and where you exit. In a real-time trade, doing this wrong can have severe results, which will mostly end in you losing money. On a demo platform, however, where a real trade is simulated, you can practice entry and exit to perfection.
 
Practice and research are two aspects that will occupy a permanent place on the shelves of Forex. Without consistent preparing and educating of oneself, winning a trade is close to impossible. Pair up steady research with the right brokerage, and you can conquer any market! Call WesternFX today, and avail our world-class brokerage. Be it demo accounts, or live, we will equip you with the best of all, and ensure you dominate Forex trading in Vietnam!

5 Critical Aspects That Will Define Your Forex Trading Career

Though it seems immensely complex, filled with risks, and an intimidating field, Forex trading is an incredibly interesting domain, with plenty a gain to make. Every trade market can be broken down into parts. Once you have a clear understanding of each of these segments, winning trades is a cakewalk! As a beginner, traders find themselves overwhelmed by the various aspects a single Forex trade houses. The primary reason for FX traders losing is the fact that they delve into trades without a proper understanding of foreign exchange markets, and the nature of currencies.
 
Here are the 5 core aspects as every Forex trade: 

Tips to Improve Your Forex Trading Career
Tips to Improve Forex Trading in Vietnam

1) Market Control: To win at Forex trading, a keen understanding of its markets is required. One of the reasons several traders prefer currency trading over other branches is because of its immense flexibility. From time-zones to platforms to strategies, you decide them all! So ensure you pick a market that is not too volatile and a strategy that best fits the timeframe.
 
2) Trade Quantity: Albeit Forex is generous and allows traders to hold positions of high value, as an adept trade, you will have to know for sure how much you to buy or sell. Money management is an aspect of Forex trading that seldom gets the respect it deserves. Decide beforehand, the quantity you will invest, to prevent last-moment hurdles!
 
3) Entry Points: You can't simply enter a trade; you have to enter at the most profitable point. Entry signals will show the most lucrative conditions, follow those to make the most out of a trade.
 
4) Exit Positions: Just as entry points are important, exits are too. If you want to maintain a winning position, knowing the best exit point is of paramount importance.
 
5) Cutting Losses: While losses are truly inevitable, they don't have to be held on to! As a trader, you control what happens in a trade. Cutting losses is a key part of every online trading; holding on to a losing position hoping it will magically become better is no wise act.
 
From CFD trading to Forex, the backbone remains the same. With these 5 points noted, your trading career can transition into that of a professional's in no time! Call the world-class broker - WesternFX today, and hire from our arsenal of Forex brokers. With our unparalleled brokerage, you will dominate Forex trading in Vietnam.

4 Latest Forex Trading Tips for Beginners in Vietnam

Traders from stocks, options and futures often look to migrate to the Forex market. It's incredibly huge value, and immensely lucrative nature makes Forex a massive opportunity for minting good money. However, the foreign exchange market is no small place to cover by foot! It is a domain governed by chaos, unpredictability, and huge amounts of risks. Several novice traders make the mistake of jumping into currency trading without a hint of information as to how to thrive in the grounds of foreign exchange.
 
Are you a beginner to Forex trading? 

Here are 4 amazing tips to help you through:

Latest Tips for Forex Traders in Vietnam
Forex Trading Tips for Beginners

1) Know Yourself Before You Show Yourself: Something traders fail to do, understand their own goals. Some might want to work in an intense environment, while some might want to take it slow. Not knowing your goals will lead to confusion midway, and leave you stranded! Without understanding your requirements, you will trade aimlessly. Jot down what you want to achieve, and then go get it!
 
2) Plan Your Trades: Planning isn't an improvisation done halfway through, to survive in the chaotic markets of currency exchange; you will need a solid Forex trading strategy! From making precise entry points to keeping stop orders, to exiting on a profitable note, your trading strategy should cover every aspect. Without a proper trade plan, there will be no goal in sight and path to achieve one even if there is!
 
3) Start Off Small: "But smaller investments mean smaller returns, right?" Wrong. The misconception that investing more rewards more is one that occupies every beginner's mind. Profits are made in Forex as a result of a good strategy, and calculated decisions. Invest small amounts, starting off; once you have a firm grip over the market, you can gradually increment the capital!
 
4) Keep One Egg In One Basket: Diversification is a necessity in Forex; however, this transition comes after you've become a better trader. As a novice, your focus should be on one or two currency pairs at the most. Each currency has a certain behavior, and all pairs are influenced by factors like the global economy, politics, etc! Work with a few pairs and master them before branching out.
 
To become a successful Forex trader will take time, experience and consistency! Only 10% of the traders make profits in foreign exchange markets that are how stifle FX trading is. Join the ranks of professionals today, sign up with WesternFX! Our brokers will guide you through all hurdles, and ensure you master Forex trading in Vietnam.

Futures Trading Guide 2018 | Futures Broker Selection & Advantages

Derivative, yet lucrative element- futures contracts are agreements between buyers and sellers to buy or sell an asset at a specific price. They are known as derivatives because the contract in itself carries no value; the value depends on the price of the underlying asset. They are a standardized element, with precise quantity and quality. The exchange happens in the form of physical delivery of the asset, or through cash. A majority of futures investors rely more on asset prices than the asset itself. They make profits by speculating on price movements of assets and the particular instrument is of no interest!
 

How Futures Trading Began?


Commercial industries run on the basis of supply-demand. Agriculture, one of the biggest industries worldwide, follows the same. During times of increasing demand, products are priced higher; similarly, when the market has lesser needs for a product, its price goes down along with the demand. To protect agricultural products from this price drop, futures contracts were established between farmers and buyers. Doing so helped shied farmers from price risks by predetermining the price to sell a crop at, and the seller would acknowledge the buying price prior to the transaction.

Futures Trading in Vietnam 2018
Futures Trading Guide 2018

Futures Transitioning:
 
What started off as an agricultural benefit has moved into the global trade markets today? Today futures trading cover a wide range of commodities - metals, currencies, food, you name it! These contracts come with an expiration date, beyond which they are deemed invalid. The longer this date is, the more the contract's value. Ironically, contract values are higher, the closer they are to expire.
2 aspects to keep in mind before entering markets:
 
There are 2 simple, yet crucial things to keep in mind before trading futures.
 
1) Getting the Right Brokerage: To win at futures trading is no solo adventure; your broker plays as important a role as you do. Several brokerage firms don't offer future contracts. Partner up with a good agency, preferably a discount broker if you are new to the game since they charge lesser fee and commission. There is one too many considerations while choosing a broker! You have to have a good platform to work with, fair commission rates, and an overall experienced broker to guide you through each venture.
 
2) Types of Markets: Futures trading has found a place in the trading ecosystem, and provides several streams to pursue. There are 6 types of futures contracts - agriculture, energy, currency, equity, metals and interest rates. The best way to start your futures career is by picking a category you have prior experience in. A Forex trader will be more comfortable with currencies, a stock player might find equities better to handle! 

Advantages of Futures Trading:


Once you have the right brokerage to guide you, and an asset best suited to your interests, it's happy sailing from thereon! Futures trading contracts are amply advantageous and have a plethora of benefits.
 
1) Leveraged Environment: Leverage always draws in more crowds, simply because of the increased convenience it provides! With a nominal investment and a small amount for dedicated margin, you can hold positions of high-value effortlessly! The profits obtained from a normal trade are magnified by several times when the same is carried out with leverage. However, this is a risky tool to play with; traders often lose huge sums of money trying to chase profits.
 
2) High Liquidity: Due to its branching, you can buy/sell any commodity today! Futures trading have an immensely liquid market, with buyers and sellers at every corner. There are several liquid assets for you to choose from and finding potential buyers or sellers is immensely easy!
 
3) Discounts and Commissions: One of the problems traders face initially is the investments. No one starts off with $1 million. Futures brokers charge very less commission when compared to the other genre of online trading. With just a few dollars, you can participate in most trades, not to mention the freedom to avail leverages and amplify your capital! 

Risks Involved In Futures Trading:


As lucrative a field as futures trading is, risks lurk around every corner. One mistake can lead to massive losses!
 
1) No Control Over The Future: Ironic as it may sound, the fact remains true. Trading futures for crops, for example, may turn awry in an instant if disasters like storms occur and kill all crops! It is difficult relying on supply-demand with such unpredictable factors.
 
2) Inability to Leverage: Leverage is a weapon only when a trader knows how to use it. Several novice players make huge losses in their ventures due to the inability to use leverages properly. These are meant to boost your trades and profits, but without ample skill and knowledge, they can easily wipe your account out.
 
3) Expiration: Futures trading is time-bound. A contract on metals may suddenly drop to a lower value before expiration, making the trade completely useless. Due to these criteria, it is difficult relying on expiration dates to guarantee a profitable exchange, since a lower fluctuation can result in scary losses.
 
Futures, like every other branch of trading, have its definite set of pros, cons and risks. Ultimately, skill is what dominates the world of trades! With steady practice and consistent research, any novice can transition into a professional! Do you want to make this jump too? Call WesternFX today and avail our world-class brokerage. With us by your side, you will achieve Futures trading in Vietnam success in no time.

The Importance of Demo Trading Accounts for Beginners

One of the best teachers in Forex aren't professionals or brokers, they are demo accounts. Trading isn't a field that can be bettered at just by reading books; practical knowledge is absolutely necessary to thrive and succeed in the currency trading markets. Demo accounts serve as the best platforms for learning every aspect of a trade, from currencies to stop-losses to strategies, first-hand without suffering any real-time backlashes.
 
Here's why demo accounts are incredibly important to newbie and professional traders alike:
 
Advantages of Demo Accounts
Importance of Demo Accounts

1) For Birds Of All Feathers: Traders think Forex demo is for novices and inexperienced individuals. However, the fact remains that even professionals use demo platforms. On these accounts, there is no monetary limit; you get to work with virtual money. Devising strategies - an immensely taxing and demanding task can be done effortlessly on demo platforms and the outcomes of the plan can be gauged. Hence, demoing is a benefit for individuals of all skill-set.
 
2) No Risks Attached: Though not overly advantageous, to an extent the risk-free factors of demo accounts can be utilized positively. On these platforms, the entire environment is virtual, meaning good or bad, the outcomes will leave you unaffected. Unlike live trades, where each move will result in a significant repercussion, demo trades provide a risk-free environment, allowing you to experiment with the various elements of Forex without any worries!
 
3) Testing Brokers: Broker support will be substantial with every growing trade. Forex demo provides an amazing environment to simulate a trade, including broker support. While in a virtual deal, you can avail your agent's assistance and depending on the response, you can gauge the agency's efficiency and whether they will cater diligently in the long run!
 
4) Mastering The Trading Platform: Without learning how to use the broker-provided platform, participating in Forex is impossible! Each broker has a separate platform, and demo accounts are the best way to test them. From chart mapping tools to analytic measures, you can effortlessly test the efficiency of said platform. Without a solid trading platform, winning in foreign exchange is impossible!
 
Learn Forex trading first-hand with a stellar demo account. Once you've grasped market movements and learnt to operate the various analytic tools, you can confidently step into Forex! Don't settle for average, get the best - call WesternFX today and avail our world-class brokerage! From demo platforms to trading strategies, we will equip you with the best.

How to Make Forex Trading Easier to Earn More Money

The common misconception around Forex trading remains constant: it is a get-rich-quick scheme. From the outset, all that people see is rich traders and posh lifestyles. However, the difficulties involved in becoming successful and reaching the peak of currency trading are arduous! In fact, Forex can be a lose-money-quick scheme in the hands of a ill-equipped trader! With consistent learning, the foreign exchange market can be gradually mastered.
 
Forex isn't easy, but it isn't rocket-science either. Here's how you can get better at trading currencies:
 
Tips to Make Forex Easier
Tips to Make Forex Easier

1) Tailor-make Your Strategy: The initial thought of a currency trader is to follow what professionals do, with a belief of making the same profits as them. Herd mentality doesn't work out much on the long run! Each trader has a different mentality, and trading capacity. Not everyone can day-trade and not everyone has the patience to position trade. Observe yourself keenly and devise a Forex trading strategy that is best suited for your interests. Explore the advantages of Forex demo account here.
 
2) Explore All Timeframes: Keeping all your eggs in one basket is an unwise move. From currency pairs to timeframes to Forex trading strategies, there's a lot of freedom in currency trading. Though each type of strategy requires a certain amount of practice, success is possible only when you're comfortable walking a mile in all shoes! Try out different timeframes, learn each strategy and don't be afraid to exploit the choices foreign exchange offers.
 
3) Be Emotionally Sound: An underrated factor - emotions play a huge role in your trading career. The outcome of several of your endeavors depend hugely on how you approach the markets! It is common to see traders holding losing positions out of frustration or becoming over-confident and investing all their capital in a bad trade. Knowing where to draw the line is incredibly necessary in Forex trading, without this restriction, you won't last a day!
 
4) Don't Overtrade: Currency pairs, no matter how strong, have to come down at a point. Overtrading is a huge mistake several traders make, out of emotion or out of badly channeled confidence! Every trade has a lifetime, extending which will result in bad outcomes. Set a mental and physical limit on how much to trade and how much to risk.
 
Intimidating on the outside, and extremely challenging inside - that's how Forex is! However, bearing these troubles pays off. It is one of the most lucrative markets and there's immense profits to be made. With the assistance of a good Forex broker, you can dominate the game - call WesternFX! Our unparalleled services will ensure you climb to the top and stay there!

Guest post: Primary Progressive MS Research: Treatment Outcomes

This is a repost from MStranslate, with kind permission from Brett Drummond.

PPMS is characterised by a steady worsening of disease or accumulation of disability from onset without any lengthy periods of stability or ‘remission’. Some people with primary progressive MS may also experience acute attacks of active disease, commonly referred to as relapses, during which symptoms are exacerbated or new symptoms develop.


Up until the clinical trial results for ocrelizumab (Ocrevus), none of the current MS therapies appeared to have any benefits for pwPPMS. However, a recently published study in JAMA Neurology has provided some stunning new insights that may change this theory. The research was conducted using the large international multiple sclerosis clinical database, known as MSBase, and performed by researchers in the Clinical Outcomes Research (CORe) Unit associated with the Melbourne Brain Centre at the Royal Melbourne Hospital and The University of Melbourne.



In the featured video above, Associate Professor Tomas Kalincik (Research Leader, Clinical Outcomes Research Unit) describes the results of the published study. In a very logical and easy to understand way, Tomas walks us through how the study was performed and clearly illustrates the findings. Importantly, Tomas also discusses the potential outcomes of this work. In particular, he mentions how this research may provide evidence that can be used to initiate conversations with regulators in order to change the way some people with primary progressive MS access multiple sclerosis treatments. 

It is also worth noting that we are one of the first people to get access to be able to provide coverage of this research – this is due to Tomas’ desire and excitement to share the findings of the CORe team with the MStranslate community. 

Tomas approached us and offered his time and expertise to explain these findings and we are extremely appreciative of that. I think it is really important that we not only highlight when researchers do amazing work, but also when they make it a priority to ensure that their results are made accessible to the MS community.  Thank you Tomas and the CORe team!

ProfG a Week in TwitterLand

ProfG has taken to twitter to comment on posts.Should we consider a feature on his comments on the blog as it is is clear many people can't we bothered with Twitter?

Gavin GiovannoniThis study suggest that the anti-JC virus antibody index will be difficult to interpret and use to risk profile MSers on rituximab or ocrelizumab as it affects antibody production.
Anti-JC virus antibody index changes in rituximab-treated multiple sclerosis patients.
Baber U, Bouley A, Egnor E, Sloane JA. J Neurol. 2018 Aug 14. doi: 10.1007/s00415-018-8996-3. [Epub ahead of print]

Gavin GiovannonAgeing is a big problem in MS. This paper suggest it contributes to falls as well as cerebellar and cognitive dysfunction in MS.
Cerebellum and cognition in multiple sclerosis: the fall status matters.Schreck LM, Ryan SPP, Monaghan PG.J Neurophysiol. 2018 Aug 15. doi: 10.1152/jn.00245.2018. [Epub ahead of print]

Gavin Giovannoni.As a community of MS stakeholders we need to take care to produce better and more practical guidelines, particularly in relation to lifestyle issues such as physical activity. A systematic critical review of physical activity aspects in clinical guidelines for multiple sclerosis. Geidl W, Gobster C, Streber R, Pfeifer K.Mult Scler Relat Disord. 2018 Aug 3;25:200-207.


Gavin Giovannoni MSers with hypertension and/or heart disease have a much greater loss of brain volume than MSers without these comorbid diseases. Not surprising considering what we know about hypertension and brain reserve. Do you know your blood pressure?Hypertension and heart disease are associated with development of brain atrophy in multiple sclerosis: a 5-year longitudinal study.Jakimovski D, Gandhi S, Paunkoski I, Bergsland N, Hagemeier J, Ramasamy DP, Hojnacki D, Kolb C, Benedict RH, Weinstock-Guttman B, Zivadinov R.Eur J Neurol. 2018 Aug 13. doi: 10.1111/ene.13769. [Epub ahead of print]

Gavin Giovannoni‏ Instilling a small amount of ice water into the bladder of MSers and measuring the change in pressure allows urologists to diagnosis overactivity of the detrusor muscle. Low tech but potentially useful. Ice water test in multiple sclerosis: A pilot trail.Hüsch T, Reitz A, Ulm K, Haferkamp A. nt J Urol. 2018 Aug 13. doi: 10.1111/iju.13786. [Epub ahead of print]

Gavin Giovannoni‏ Another piece of dogma bites the dust. #NeuroSpeak Visual prognosis in seronegative idiopathic optic neuritis finally elucidated: as bad as that in anti-AQP4-Ab (+) optic neuritis. Visual prognosis in seronegative idiopathic optic neuritis finally elucidated: as bad as that in anti-AQP4-Ab (+) optic neuritis. Akaishi T, Nakashima I. Eur J Neurol. 2018 Aug 13. doi: 10.1111/ene.13772. [Epub ahead of print]

Gavin Giovannoni Another depressing study showing the impact a diagnosis of MS has on young adults. Why aren't we doing more to prevent this disease. 
Young adults' adjustment to a recent diagnosis of multiple sclerosis: The role of identity satisfaction and self-efficacy. Calandri E, Graziano F, Borghi M, Bonino S. isabil Health J. 2018. pii: S1936-6574(18)30139-0.

Gavin Giovannoni‏  A paper showing that cerebrospinal fluid GAP-43 (a recovery marker) is raised in early multiple sclerosis. Will it be down in more advanced MS?. Cerebrospinal fluid GAP-43 in early multiple sclerosis. Rot U, Sandelius Å, Emeršič A, Zetterberg H, Blennow K.Mult Scler J Exp Transl Clin. 2018 4(3):2055217318792931.

Gavin Giovannoni‏ No wonder the early burden of MS is related cognitive impairment. The shredder damages connectivity in the MS brain. Are you surprised? Another reason to treat early and effectivelyMagnetic resonance markers of tissue damage related to connectivity disruption in multiple sclerosis. Solana E, Martinez-Heras E, Martinez-Lapiscina EH, Sepulveda M, Sola-Valls N, Bargalló N, Berenguer J, Blanco Y, Andorra M, Pulido-Valdeolivas I, Zubizarreta I, Saiz A, Llufriu S.Neuroimage Clin. 2018;20:161-168.

Gavin Giovannoni‏ Another elephant in the room (immunosuppression) is making things crowded. #ClinicSpeak Infectious complications of MS DMTs: implications for screening, prophylaxis, and management. Infectious Complications of Multiple Sclerosis Therapies: Implications for Screening, Prophylaxis, and Management.Epstein DJ, Dunn J, Deresinski S.Open Forum Infect Dis. 2018 ;5(8):ofy174.

Gavin Giovannoni‏ TEVA fights back and shows major physicochemical, biological, functional and toxicological differences between the European follow-on glatiramer acetate compared to Copaxone. Will this impact efficacy?Physicochemical, biological, functional and toxicological characterization of the European follow-on glatiramer acetate product as compared with Copaxone. Melamed-Gal S, Loupe P, Timan B, Weinstein V, Kolitz S, Zhang J, Funt J, Komlosh A, Ashkenazi N, Bar-Ilan O, Konya A, Beriozkin O, Laifenfeld D, Hasson T, Krispin R, Molotsky T, Papir G, Sulimani L, Zeskind B, Liu P, Nock S, Hayden MR, Gilbert A, Grossman I.eNeurologicalSci. 2018 May 30;12:19-30.

Gavin Giovannoni‏ Is creating a walled garden the way to deal with fake news in the MS space? Influencers and health-related professional participation on the Web: A pilot study on a social-network of MS
Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with Multiple Sclerosis. Lavorgna L, De Stefano M, Sparaco M, Moccia M, Abbadessa G, Montella P, Buonanno D, Esposito S, Clerico M, Cenci C, Trojsi F, Lanzillo R, Rosa L, Morra VB, Ippolito D, Maniscalco G, Bisecco A, Tedeschi G, Bonavita S.Mult Scler Relat Disord. 2018 Jul 31;25:175-178. 

Gavin Giovannoni‏ Mental health is a big problem for MSers. Another hidden problem highlighting how large the burden of disease we are missing by focusing on the physical. Factors associated with perceived need for mental health care in multiple sclerosis. Orr J, Bernstein CN, Graff LA, Patten SB, Bolton JM, Sareen J, Marriott JJ, Fisk JD, Marrie RA; CIHR Team in Defining the Burden and Managing the Effects of Immune-mediated Inflammatory Disease.Mult Scler Relat Disord. 2018;25:179-185
Gyllensten H, Kavaliunas A, Alexanderson K, Hillert J, Tinghög P, Friberg E. Mult Scler J Exp Transl Clin. 2018;4(3):2055217318783352.

 Gavin Giovannoni‏  MRI and CIS outcomes. Surely baseline lesion number simply indicates that CISers have had asymptomatic MS longer, hence the MS-shredder has had more time to reduce brain reserve and hence they do worse? How do we capture the time vector? Cerebrospinal fluid GAP-43 in early multiple sclerosis. Rot U, Sandelius Å, Emeršič A, Zetterberg H, Blennow K.Mult Scler J Exp Transl Clin. 2018;4(3):205521731879293

Gavin Giovannoni‏ We now have the biomarkers for microglial activation. The question is whether or not inhibiting microglia will make MS better or worse? I suspect worse. The microglial response in MS may be a positive not a negative.Comparison of two different methods of image analysis for the assessment of microglial activation in patients with multiple sclerosis using (R)-[N-methyl-carbon-11]PK11195. Kang Y, Schlyer D, Kaunzner UW, Kuceyeski A, Kothari PJ, Gauthier SA. LoS One. 2018;13(8):e0201289.

Evidence against oligoclonal bands being important?

As you may realise, I am sometimes critical of my colleagues who tend to follow dogma, without question.

This of course does me no favours with my colleagues. Maybe I should just say everything is "Great" or "Super", like I'm part of  some 1970s Sitcom :-0

For many, many years my colleagues have been hunting for the autoantigen in MS. They have got nowhere fast and we have seen more false dawns than I've had tequila sunrises.

MD2 has stuck his neck out and has suggested that we are wasting our time hunting for the causative antibody.

Indeed MD2 has suggested that the antibodies produced in the CNS are not inert and that they may simply bind to microglia via their tails rather than their heads that bind to their targets. These would serve to stimulate the microglia possibly to maintain a damaging phenotype that could drive degeneration in damaged nerves.


Paper

Pryce G, Baker D. Oligoclonal bands in multiple sclerosis; Functional significance and therapeutic implications. Does the specificity matter? Mult Scler Relat Disord. 2018;25:131-137.
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So you set up an idea and you don't try to prove it but you try to disprove it. This is called Popperian Science, after Karl Popper.

Therefore, thanks to one of the readers who did some reading and found this paper. 

It is a case of some one with MS who had a B cell cancer. They were given a stem cell cell transplant (HSCT) and they became oligoclonal band negative. However, disease activity continued.

Therefore, oligoclonal bands can't be a driver of progression, can they?


Paper


BACKGROUND:Allogeneic hematopoietic cell transplantation (allo-HCT) has been proposed as treatment for multiple sclerosis (MS) and other autoimmune diseases.
AIMS:To describe the effects of allo-HCT on the course of MS in a 49-year-old woman with longstanding progressive MS who was treated with allo-HCT for follicular lymphoma.
METHODS:Non-myeloablative conditioning allo-HCT, examination for IgG oligoclonal bands and measurement of CXCL13 and matrix metalloproteinase-9 (MMP-9) concentration in the cerebrospinal fluid (CSF).
RESULTS:Despite the disappearance of oligoclonal bands in CSF, disease progression and CSF inflammation was observed.
CONCLUSIONS:We hypothesize that CXCL13 and MMP-9 detected in CSF may reflect ongoing, pathogenic immune activation even after the eradication of intrathecal IgG synthesis. This suggests that progressive MS may depend more on innate than on adaptive immune activation.

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Maybe, but we have to figure out what could be happening before we give up on the idea. In this study the person had a B cell lymphoma and is treated with cyclophosphamide (CNS penetrant) and fludarabine (CNS penetrant) immunosuppressive agents capable of killing dividing (B) cells. The lymphoma is put under control and the person does a stem cell transplant. 

The transplant then starts to attack the body (Graft verses host disease). This means that the graft will attack anything that expresses transplantion antigens called the human leucocyte antigens (HLA) or major histocompatibility complex (MHC) antigens. 

B cells express high amounts of both class I and class II MHC and so will be targeted by the new immune system coming from the transplant. This could easily destroy B cells in the CNS that produce oligoclonal bands, especially as the MS would have made the CNS more leaky to immune cells. Also because of the MS, nerve cells sometimes express MHC class I and so could get attacked and damage too.

Indeed the graft immune system can target and kill any host cell expressing MHC class II and MHC class I antigens. These (MHC class I) are expressed by the skin and other tissues, which why the graft verse host disease occurs can be easily visible (I'd show you a picture but it is rather gross and will put you off your food). 

To treat this the person gets more immunosuppression  (cyclosporin A, mycophenylate) including anti-TNF. This latter agent has been associated with triggering the development of MS in some people.


This person started developing new lesions (i.e. sub-clinical relapsing MS), but when tested they had become oligoclonal band negative. But would this mean that the cells causing graft verses host disease were entering the CNS and causing damage. Could this be the cause of the lesions? However, it could certainly cause the production of cytokines that keep microglia activated, meaning that you don't need oligoclonal bands to do this job.

However, the the person was having spinal cord lesions and their movement got worse.  They got graft verses host disease again and this goes chronic for months before it is put under control. 

Then the person gets tacrolimus, or FK506, which is an immunosuppressive agent. Although this may have neuroprotective potential,  it can also cause neurological problems in some people. Is this part of the problem and the worsening of neurological problems for this person? I don't know. However there are a lot of confounding possibilities so that we can not be sure if this kills off the B cell ideas.

The idea but forward by MD2 was that activated microglia may be a central part of progressive MS. There are probably different routes to achieve this.  In this study they find CXCL13 (CXCL13 is a small chemokine  that chemokine is selectively chemotactic for B cells , such as memory B cells, by interacting with chemokine receptor CXCR5) and MMP9 (a metalloprotease associated with inflammation) Would we want this.

Do you have any ideas, I may be talking tosh.

Keep the anti views coming.

Guest post: Does degradation of brain fats cause MS?

This is to let you know about a research project based on a novel idea of how MS develops. I am a pathologist, and have spent most of my career on medical research. I am returning to researching on MS after a long period of working on the arterial disease that causes heart attacks and strokes. The reason for my return to MS work is that I believe that MS may develop in a way similar to arterial disease when the details of the process, the molecules concerned, are considered. 


I have sent a grant application to the MS Society to support this work. Also I have been able to start it right away with the help of QMUL science students doing laboratory projects.

In arterial disease, the particles carrying fats through the blood to all parts of the body become lodged in the walls of arteries. There the fats in them degrade, and it is known that they are then treated by the body as foreign. As a consequence an inflammatory response develops, in which white cells from the blood accumulate. The walls of the artery then thicken, so much so that the flow of blood is impeded, and supply to vital organs such as the heart is diminished.

In the brain, there is much fat in the myelin covering of nerves. In MS, this nerve coating and the cells making it are attacked by inflammation. Other researchers have found that there is an immune response against damaged fats in MS. This has been found in the fluid surrounding the brain, the cerebrospinal fluid. 

Furthermore, one particular type of antibody immune response against damaged fats predicts a severe future course of the disease. I therefore propose that some initial local damage to the myelin coat of a nerve, perhaps by a common or transient infection, results in the formation of damaged fats in the brain. Then in individuals that are predisposed, perhaps for genetic reasons, an immune response is generated against the damaged fats. It is known that some immune responses generate disease rather than protect against it, and in MS more damaged fats may be formed. So this response itself may result in more local damage to the myelin and in this way an expanding MS plaque develops in the brain. It is interesting that both arterial and MS disease grow in a similar way as expanding local plaques.

The research project is in two parts. At the moment we are testing samples of cerebrospinal fluid from MS patients, obtained from the MS Brain Bank, for an immune response of antibodies to damaged fats. We have developed a straightforward assay for this. Later we shall look using powerful microscopic techniques for the presence of the damaged fats and the immune response against them in MS. This will be done in brain tissue, particularly in the MS plaques. The tissue has been obtained from MS patients who have died and donated their brains to the MS Tissue Bank.

The significance of this research is that if it is successful, it will help the understanding of how MS develops. This will mean that the direction of work on the development of drugs can be focused better. Already it fits with recent developments, as drugs designed to destroy the cells that make the antibodies are effective in some people with MS. The assay we are currently developing may be useful in the diagnosis of MS and the prediction of its future course.

by Dr Robin Poston, Centre for Microvascular Research, William Harvey Research Institute, Queen Mary University of London.



Dr Robin Poston is a pathologist who has spent much of his career in research, and has worked on atherosclerosis almost throughout. He was a student at King’s College, Cambridge University, where he first studied physical sciences and then medicine. Clinical training followed at the Middlesex Hospital, London, where he joined the Immunology laboratory at the Middlesex Hospital Medical School to start research on the immunology of atherosclerosis. Subsequently he was appointed a Lecturer in the Department of Pathology, Guy’s Hospital Medical School, and in 1979 presented some of the early ideas about atherosclerosis as an inflammatory disease to the Royal Society of Medicine.

At Guy’s Hospital, he trained as a pathologist in immunology and histopathology, and in the 1980s set up a diagnostic immunohistochemistry service. In 1992-6 he published seminal work on the involvement of leukocyte adhesion molecules in atherosclerosis: his paper on ICAM-1 has been one of the most cited in the American Journal of Pathology. For this study he introduced colour image analysis, which since has been used extensively for the quantitation of histological research. Other fields of research around that time were multiple sclerosis and asthma.

Teaching of medical students was another extensive facet of his work, and he organised many pathology courses. In 2004 he set up the Graduate and Professional Entry Course for the medical school of King’s College London, which involved compressing the normal first two years of teaching into one.


In 2008 he moved to the William Harvey Research Institute of the Barts and the London Medical and Dental School, part of Queen Mary University of London. Although now officially retired, he continues with research on atherosclerosis, and recently again on multiple sclerosis.

To Reduce the Risk of Moral Catastrophes, Should Society Hire Lots of Philosophers?

In June, I wrote a post arguing that future generations might find our generation especially morally loathsome, even if we don't ourselves feel like we are morally that bad. (By "we" I mean typical highly educated, middle-class people in Western democracies.) We might be committing morally grievous wrongs -- atrocities on par with the wrong that we now see in race-based slavery or the Holocaust or bloody wars of conquest -- without (most of us) recognizing how morally terrible we're being.

In Facebook discussion, Kian MW pointed me to a fascinating article by Evan G. Williams, which makes a similar point and adds the further thought, bound to be attractive to many philosophers, that the proper response to such a concern is to hire lots of philosophers.

Okay, hiring lots of philosophers isn't the only remedy Williams suggests, and he doesn't phrase his recommendation in quite that way. What he says with that we need to dedicate substantial societal resources to (1) identifying our moral wrongdoing and to (2) creating social structures to implement major changes in light of those moral discoveries. Identifying our moral wrongdoing will require progress, Williams says, both in moral theory and in related applied fields. (For example, progress in animal ethics requires progress both in moral theory and in relevant parts of biology.) Williams' call for dedicating substantial resources toward making progress in moral theory seems like a call for society to hire many more philosophers, though I suppose there are a variety of ways that he could disavow that implication if he cared to do so.

The annual U.S. military budget is about $700 billion. Suppose that President Trump and his allies in Congress, inspired by Williams' article, decided to divert 2% of U.S military spending toward identifying our society's moral wrongdoing, with half of that 2% going to ethicists and the other half to other relevant disciplines. Assuming that the annual cost of employing a philosopher is $150,000 (about half salary, about half benefits and indirect costs), the resulting $7 billion could hire about 50,000 ethicists.

[With 50,000 more ethicists, these empty chairs could be filled!]

Two percent of the military budget seems like a small expenditure to substantially reduce the risk that we unwittingly perpetrate the moral equivalent of institutionalized slavery or the Holocaust, don't you think? A B2 bomber costs about $1-$2 billion. The U.S. government might want to consider a few bomber-for-philosopher swaps.

I write this partly in jest of course, but also partly seriously. If society invested more in moral philosophy -- and it needn't be a whole lot more, compared to the size of military budgets -- and if society took the results of that investment seriously, giving its philosophers prestige, attention, and policy influence, we might be morally far better off as a people.

We might. But I also think about the ancient Athenians, the ancient Chinese, and the early 20th-century Germans. Despite the flourishing of philosophy in these times and places, the cultures did not appear to avoid moral catastrophe: The ancient Athenians were slave-owners who engaged in military conquest and genocide (perhaps even more than their neighbors, if we're grading on a curve), the flourishing of philosophy in ancient China coincided with the moral catastrophe of the period of the Warring States, and the Germans perpetrated the Holocaust and helped initiate World War II (with some of the greatest philosophers, including Heidegger and Frege, on the nationalistic, anti-Semitic, political right).

Now maybe these societies would have produced even worse moral catastrophes if philosophers had not also been flourishing in them, but I see no particular reason to think so. If there's a correlation between the flourishing of philosophy and the perpetration of social evil, the relationship appears to be, if anything, positive. This observation fits with my general concerns about the not-very-moral behavior of professional ethicists and philosophers' apparent skill at post-hoc rationalization.

I'm not sure how skeptical to be. I hesitate to suggest that a massive infusion of social capital into philosophical ethics couldn't have a large positive impact on the moral choices we as a society make. It might be truly awesome and transformative, if done in the right way. But what would be the right way?

[photo credit: Bryan Van Norden]

Guest Post: Language and MS: Why Our Words and Stories Matter

Question. Those with multiple sclerosis: do you remember the exact words your neurologist used to break the news of your diagnosis?


And those on the other side: MS neurologists and health professionals. Can you recall the most difficult conversation you’ve had with someone with MS and the words you used?


Thought so.


Words matter in medicine - especially with a disease like multiple sclerosis where the impact on quality of life can be catastrophic and the emotional component runs so high.


Words can also be inadequate. How does one describe pain? Or weakness? Or how does one, as a health practitioner, offer words of hope when there is almost none?


And words change  - depending on time and shifting sensitivities. Take the word ‘disease’. Before typing it out - five sentences earlier - I paused. Was it the most appropriate word to describe MS? Neurologists overwhelmingly use the term disease, but the NHS and three UK charities - the MS Society the MS Trust and Shift.ms - prefer ‘condition’ to describe MS.


“We tend to avoid the words illness and disease as we think condition is less aggressive and negative,” says Janice Sykes, Information Officer at the MS Trust, a UK charity. Miranda Olding, a Clinical Nurse Specialist in MS, also calls MS a condition though she concedes at her therapy centre “we do talk a lot about disease-modifying treatments.” She also uses words like inflammation and lesion, but avoids ‘scarring'.


There is also the semantic quandary of how best to describe someone with MS. In 2016 David Baker, Professor of Neuroimmunology at Barts and the London, looked at how people with MS preferred to be referred to in scientific publications - compared to what academics called them. After analysing three surveys, Baker and his colleagues found those with MS liked the descriptor ‘person with MS' (pwMS) followed by MSer. Academics, by contrast, generally used the term ‘patient’ - which those with MS found to be outdated and paternalistic.


I get this. However when you go on the internet, it seems a very different story. People don’t just ‘have’ MS these days. Instead they call themselves ‘MS survivor,’ a 'MS warrior’ or a ‘MS hero'. War and violence metaphors are freely appropriated. Those with MS are ‘standing up’ to it, ‘battling’ it or even single-handedly ‘slaying the MS Monster.’  


This notion of 'fighting disease’ is not new. In the mid-seventeenth century, the famous British physician Thomas Sydenham introduced the concept into western medicine when he declared that a “murderous array of disease has to be fought against, and the battle is not a battle for the sluggard.”  

Thomas Sydenham by Mary Beale

In recent years, however, the linkage of military language to MS has grown. Does anybody in the MS world wince when there is talk of the immune cells 'attacking the myelin sheath’ or mention is made of ‘breaching the blood brain barrier’? No. We accept this terminology without questioning its adversarial tone or wondering if such words are, in fact, suitable when it comes to medicine and healing.


Not surprisingly, the press, policy makers and charities have adopted these combat metaphors. They’re effective and highly motivating. A few months ago, for example, the National MS Society launched its ‘Whatever it Takes' campaign featuring posters - in stark black and white - of those with MS. Underneath are taglines: “MS broke my body. I will never stop, never quit,” says Kevin diagnosed in 1999. Or there is Yvette, in boxing gloves: “MS causes debilitating fatigue. I will knockout MS.”


Personally I find this tie-in between fighting and MS uncomfortable. Does this mean from the moment you are diagnosed you should enter the metaphorical boxing ring or the theatre of war and launch an all-out assault against MS? Isn’t coping with a serious chronic disease enough? And what happens if you ‘lose’ the fight against MS?


Others with MS have taken a very different tack when it comes to describing themselves. In her seminal essay “On Being a Cripple” (links to a PDF) Nancy Mairs defiantly labels herself a cripple - saying it accurately reflects her reality.


Mairs acknowledges this might make people wince, but “perhaps I want them to wince. I want them to see me as a tough customer, one to whom the fates/gods/viruses have not been kind, but who can face the brutal truth of her existence squarely. As a cripple, I swagger.”


Mairs also wants to be honest: “Cripple seems to me a clean word, straightforward and precise… As a lover of words, I like the accuracy with which it describes my condition: I have lost the full use of my limbs. ‘Disabled,’ by contrast, suggests any incapacity, physical or mental. And I certainly donʼt like ‘handicapped,’ which implies that I have deliberately been put at a disadvantage, by whom I canʼt imagine (my God is not a Handicapper General)…”

Nancy Mairs in 1986, by Jim Hepworth.Credn b

Along with the rise of MSers fashioning their own labels, there has also been a huge increase in the number of people writing their own MS personal stories. Go online and you will find dozens, if not hundreds, of blogs focusing on symptoms, treatment options and the challenges of living with MS.


The rise of the internet has made this largely possible. But I also believe the democratisation of medicine has played a role. Until recently physicians were pretty much the only ones writing patient’s stories or ‘illness narratives’, according to Mike Bury in his essay “Illness narratives: fact or fiction?.


Before the rise of bio-medicine in the mid to late 19th century, Bury writes, great emphasis was placed on a doctor taking a detailed history of their (usually upper class) patient - asking questions about circumstances, environment and even moral beliefs. From this they would come up with a diagnosis and treatment. To be honest, they didn’t have much else in their doctor’s bag. Understanding of anatomy and physiology was basic; physical examinations were, at best, rudimentary. Story was everything.


The advent of scientific medicine and the growth of modern hospitals and laboratories changed all this. Emphasis switched away from the patient’s experience to biological causes of illness. Blood tests replaced blood letting. In recent years, however, there has been a shift away from this medical model, Bury says. He cites several reasons: the rise in chronic diseases, the huge expansion of medical information and the shift to holistic, patient-based care. These days patients are reclaiming ownership of their bodies - and their stories.


Sociologist Arthur Frank applauds such a move. In his influential book, The Wounded Storyteller, Frank says stories written by the ‘wounded’ allow them to gain control over their illness, accept it and reflect on how it has shaped them. “Stories are a way of redrawing maps and finding destinations,” he writes. They are also key to helping - and healing - others in a similar situation. “As wounded, people may be cared for, but as storytellers, they care for others.”


Nobody understands this better than George Pepper, Co-founder and Chief Executive of Shift.ms. Told at the age of 22 he had MS, Pepper found it difficult to meet others in a similar situation: young, recently diagnosed and struggling to accept they had a life-long condition. So in 2009 with the help of friends, he set up the web-based charity and social network Shift.ms.


What makes Shift.ms unique is that it’s ‘user-led’ meaning its 17,000 members (and growing) supply and drive its content. A large chunk of the site is dedicated to members explaining how MS affects them: from their diagnosis, to their fears and onto the impact it has on relationships, families and career. “Every person with MS has a story to tell, and by telling it, it helps other understand they are not alone,” says Pepper.


The MS Trust reports a similar situation. In 2011, it set up a ‘Your Stories' section on their website. Last year the pages received about 3-4,000 views per month. That figure is looking to double this year. “There has definitely been a shift in people looking to fellow MS peers to help put things into context,” says Sykes.


I understand. Even with the best will in the world - and there is much out there - doctors and health professionals can not perform this service. It is the actual act of writing one’s own MS story that can be empowering and cathartic; a way of shaping the chaos that surrounds a disease so unpredictable as MS.


And this holds true, I believe, no matter who tells the story, from where or what time.  A case in point is Sir Augustus d’Este - the illegal grandson of King George III - and the earliest recorded person with MS. Starting in 1822 - when he first experienced blurred vision - until 1846, d’Este kept a diary detailing his symptoms and treatments which included leeching, ‘electrification’ and orders to “eat beef steaks twice a day, drink London Porter, Sherry and Madeira wines.”

Sir Augustus d'Este as a boy (it is 'possibly' d'Este, not confirmed) V&A collection

Reading a copy of the diary today is terribly poignant. Obviously the style is different, but what shines through is how similar d’Este’s experience with MS was - more than one hundred and seventy years ago - compared to today. We read of his bewilderment with his growing symptoms, his pleasure when they (temporarily) abate; his attempts to find a cure and his disappointment when they don’t work. And we can not fail to be cheered by his optimism - even when he progresses from stick, to his “chair on wheels” then finally to bed. What makes it all the more poignant is knowing, that it is unlikely d’Este will get the happy ending he wants and that we want for him.


Words and stories matter especially in MS. Sometimes they may not be the exact words we want to hear - or the stories may have a different closing than we would wish. But the importance is that we have them.


By Rachel Horne



Rachel is a journalist interested in health and women's issues. She has an Hons BA from McGill University and a Masters from Columbia University School of Journalism. Previously she covered international news in China and financial news for CNN in London. She has MS.