iiinova — where your digital self keeps evolving

Prof G @gavingiovannoni.bsky.social · 24/09/2026

#MS_Selfie Q&A 190: Gabapentinoids and dementia in MS I would also review your medications to see if any other medications are interacting with gabapentin to make things worse. gavingiovannoni.substack.com/p/q-and-a-19...

gavingiovannoni.substack.com

Q&A 190: gababentinoids and dementia in MS

I would also review your medication to see if any other medications are interacting with gabapentin to make things worse.

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Prof G @gavingiovannoni.bsky.social · 22/09/2026

#MS_Selfie Q&A 189 - melanoma and HPV infection on siponimod; what should I do? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 189 - melanoma and HPV infection on siponimod; what should I do?

Question

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Prof G @gavingiovannoni.bsky.social · 21/09/2026

#MS_Selfie Q&A 188 - motor MS relapses you are not aware of are more common than you expect I would greatly appreciate your opinion on the significance of the pontine lesion and whether you would recommend an earlier follow-up MRI. gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 188 - motor MS relapses you are not aware of are more common that you expect

I would greatly appreciate your opinion on the significance of the pontine lesion and whether you would recommend an earlier follow-up MRI.

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Prof G @gavingiovannoni.bsky.social · 19/09/2026

#MS_Selfie Research: Is EBV reactivation the trigger driving MS relapses? Their proposed model is that abortive EBV reactivation occurs within a genetically permissive peripheral immune compartment before clinical relapse. gavingiovannoni.substack.com/p/is-ebv-rea...

gavingiovannoni.substack.com

Is EBV reactivation the trigger driving MS relapses?

Their proposed model is that abortive EBV reactivation occurs within a genetically permissive peripheral immune compartment before clinical relapse.

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Prof G @gavingiovannoni.bsky.social · 17/09/2026

#MS_Selfie Q&A 187: Journal Club Would you also please consider sharing your thoughts on this recent study, which found no significant differences in endpoints between “low, moderate and high efficacy” MS drugs? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 187: Journal Club

Would you also please consider sharing your thoughts on this recent study, which found no significant differences in endpoints between “low, moderate and high efficacy” MS drugs?

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Prof G @gavingiovannoni.bsky.social · 14/09/2026

#MS_Selfie Q&A 186: relabelling or reclassifying primary progressive MS Do you think neurologists and neuroradiologists should game the classification system to offer their patients high-efficacy DMTs? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 186: relabelling or reclassifying primary progressive MS

Do you think neurologists and neuroradiologists should game the classification system to offer their patients high-efficacy DMTs?

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Prof G @gavingiovannoni.bsky.social · 09/09/2026

#MS_Selfie - Q&A 185: spinal stenosis or secondary progressive MS The radiologist specifically noted that the stenosis at L2–L4 could potentially contribute to his leg weakness, ....... gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 185: spinal stenosis or secondary progressive MS

The radiologist specifically noted that the stenosis at L2–L4 could potentially contribute to his leg weakness, .......

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Prof G @gavingiovannoni.bsky.social · 07/09/2026

#MS_Selfie Q&A 184: differentiating BTKi from anti-CD20 Tolebrutinib is the outlier; it clearly had an impact on disability worsening independent of relapses and hence on smouldering MS, which differentiates it from the anti-CD20s. gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 184: differentiating BTKi from anti-CD20

Tolebrutinib is the outlier it clearly had an impact on disability worsening independent of relapses and hence on smouldering MS, which differentiates it from the anti-CD20s.

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Prof G @gavingiovannoni.bsky.social · 06/09/2026

#MS_Selfie Research - In vivo CAR T-cell therapy to treat MS The most exciting developments in MS, is the use of engineered T-cells, or chimeric antigen receptor (CAR) T-cells, as a treatment. A new study takes this treatment to the next phase. gavingiovannoni.substack.com/p/in-vivo-ca...

gavingiovannoni.substack.com

In vivo CAR T-cell therapy to treat MS

The most exciting developments in MS, is the use of engineered T-cells, or chimeric antigen receptor (CAR) T-cells, as a treatment. A new study takes this treatment to the next phase.

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Prof G @gavingiovannoni.bsky.social · 01/09/2026

#MS_Selfie CAR T-cell deaths in subjects with autoimmunity As with all new technologies, when they move from oncology to autoimmunity, there may be hurdles to overcome. gavingiovannoni.substack.com/p/car-t-cell...

gavingiovannoni.substack.com

CAR T-cell deaths in subjects with autoimmunity

As with all new technologies, when they are being transferred from oncology to autoimmunity, there may be some hurdles to overcome.

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Prof G @gavingiovannoni.bsky.social · 28/08/2026

#MS_Selfie Familial MS risk calculator I have produced familial risk tables from published data that you can download. I also created an online calculator to assess familial MS risk. Please let me know if it is useful and if you find any bugs. gavingiovannoni.substack.com/p/familial-m...

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Prof G @gavingiovannoni.bsky.social · 27/08/2026

#MS_Selfie Finding MS: health anxiety by proxy How many of you with MS or a positive family history of MS worry about your children or grandchildren developing multiple sclerosis? gavingiovannoni.substack.com/p/finding-ms...

gavingiovannoni.substack.com

Finding MS: health anxiety by proxy

How many of you with MS or a positive family history of MS worry about your children or grandchildren developing multiple sclerosis?

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Prof G @gavingiovannoni.bsky.social · 26/08/2026

#TeachNeurology - Tacit learning Do you have concerns about the next generation of medical students and trainee neurologists who are being rapidly deskilled by AI? teachneurology.substack.com/p/tacit-lear...

teachneurology.substack.com

Tacit learning

Do you have concerns about the next generation of medical students and trainee neurologists who are being rapidly deskilled by AI?

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Prof G @gavingiovannoni.bsky.social · 26/08/2026

#MS_Selfie - Q&A 183 - smouldering associated worsening Natalizumab (Tysabri) injections vs. Ublituximab (Briumvi) vs. Cladribine (Mavenclad) or Siponimod or wait for Tolebrutinib or volunteer for the Remibrutinib SPMS trial? Which would you choose? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 183 - smouldering associated worsening

Natalizumab (Tysabri) injections vs. Ublituximab (Briumvi) vs. Cladribine (Mavenclad) or Siponimod or wait for Tolebrutinib or volunteer for the Remibrutinib SPMS trial? Which would you choose?

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Prof G @gavingiovannoni.bsky.social · 24/08/2026

#MS_Selfie Q&A 182: hearing loss and MS Hearing problems are common in people with MS; they often have trouble hearing in noisy environments, such as following a conversation with a lot of background noise. Do you? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 182: hearing loss and MS

Hearing problems are quite common in people with MS; they often have problems hearing in noisy environments, i.e. following a conversation when there is a lot of other background noise. Do you?

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Prof G @gavingiovannoni.bsky.social · 20/08/2026

#MS_Selfie - Breaking news: Checkpoint inhibitors and vaccines Will Checkpoint inhibitors become the standard of care in therapeutic vaccine trials where T-cell exhaustion is a problem? gavingiovannoni.substack.com/p/breaking-n...

gavingiovannoni.substack.com

Breaking news: Checkpoint inhibitors and vaccines

Will Checkpoint inhibitors become standard of care in therapeutic vaccine trials were T-cell exhaustion is a problem?

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Prof G @gavingiovannoni.bsky.social · 20/08/2026

#MS_Selfie - A Miracle MS Cure, a Remote Island and a Fight for Survival: The True Story Behind the Film Eden At the peak of the Western eugenics movement (1920s- 40s), women with MS were routinely sterilised as they were deemed ‘unfit’ to reproduce. gavingiovannoni.substack.com/p/a-miracle-...

gavingiovannoni.substack.com

A Miracle MS Cure, a Remote Island and a Fight for Survival: The True Story Behind the Film Eden

At the peak of the Western eugenics movement (1920s-40s) women with MS were routinely sterilised as they were deemed ‘unfit’ to reproduce.

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Prof G @gavingiovannoni.bsky.social · 18/08/2026

#MS_Selfie - In defence of the term "Smouldering MS" I, or we, my collaborators and friends, are being taken to task for adding the word smouldering MS to the medical lexicon. Apparently, nobody likes the term. Do you agree? gavingiovannoni.substack.com/p/in-defence...

gavingiovannoni.substack.com

In defence of the term "Smouldering MS"

I, or we, my collaborators and friends, are being taken to task for adding the word smouldering MS to the medical lexicon. Apparently, nobody likes the term. Do you agree?

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Prof G @gavingiovannoni.bsky.social · 17/08/2026

#MS_Selfie Q&A 181: Anti-CD20 therapies and arboviruses I am also aware that many pwMS on immunosuppressive therapies develop infection anxiety and simply avoid high-risk travel. Does this apply to you? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 181: Anti-CD20 therapies and arboviruses

I am also aware that many pwMS on immunosuppressive therapies develop infection anxiety and simply avoid high-risk travel. Does this apply to you?

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Prof G @gavingiovannoni.bsky.social · 07/08/2026

#MS_Selfie - Is the NHS working for you? The slow and fragmented digitisation of the NHS has direct, profound implications for patient care. What can you do for yourself to help? => gavingiovannoni.substack.com/p/is-the-nhs...

gavingiovannoni.substack.com

Is the NHS working for you?

The slow and fragmented digitisation of the NHS has direct, profound implications for patient care.

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Prof G @gavingiovannoni.bsky.social · 06/08/2026

#MS_Selfie - Diagnosis of acute EBV infection Diagnosing acute EBV infection is a complex process and depends on timing and the clinical context. => gavingiovannoni.substack.com/p/diagnosis-...

gavingiovannoni.substack.com

Diagnosis of acute EBV infection

Diagnosing acute EBV infection is a complex process and depends on timing and the clinical context.

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Prof G @gavingiovannoni.bsky.social · 05/08/2026

#MS_Selfie Q&A 180: MS prior to EBV infection Do a quarter of people really develop MS prior to being exposed to EBV? gavingiovannoni.substack.com/p/q-and-a-18...

gavingiovannoni.substack.com

Q&A 180: MS prior to EBV infection

Do a quarter of people really develop MS prior to being exposed to EBV?

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Prof G @gavingiovannoni.bsky.social · 04/08/2026

#MS_Selfie Q&A 179: recurrent multi-drug-resistant UTIs on an anti-CD20 therapy As your MS appears to be getting worse without obvious relapses or new MRI activity, you likely have smouldering MS and may become eligible for tolebrutinib when it gets licensed and reimbursed. buff.ly/e1ehsyN

gavingiovannoni.substack.com

Q&A 179: recurrent multi-drug resistant UTIs on an anti-CD20 therapy

As your MS appears to be getting worse without obvious relapses or new MRI activity, you likely have smouldering MS and may become eligible for tolebrutinib when it gets licensed and reimbursed.

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Prof G @gavingiovannoni.bsky.social · 03/08/2026

#MS-Selfie Newsletter - Stay Cool; Stay Safe “36%, Europe’s share of global heat deaths, despite having just 10% of the world’s population” - scary! gavingiovannoni.substack.com/p/stay-cool-...

gavingiovannoni.substack.com

Stay Cool; Stay Safe

“36%, Europe’s share of global heat deaths, despite having just 10% of the world’s population” - scary!

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Prof G @gavingiovannoni.bsky.social · 31/07/2026

#MS_Selfie Research - Anti-EBNA-1 titres and control of EBV People with exceptionally low anti-EBNA-1 antibody levels exhibit no detectable EBV shedding in their saliva. gavingiovannoni.substack.com/p/anti-ebna-...

gavingiovannoni.substack.com

Anti-EBNA-1 titres and control of EBV

People with exceptionally low anti-EBNA-1 antibody levels exhibit no detectable EBC shedding in their saliva.

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Prof G @gavingiovannoni.bsky.social · 29/07/2026

#MS_Selfie Q&A 178 - Truncal posture in MS I cannot sit up straight for one second. Unless I push hard with my elbows on my armrests, my body curls forward. Does this sound familiar? gavingiovannoni.substack.com/p/q-and-a-17...

gavingiovannoni.substack.com

Q&A 178 - Truncal posture in MS

I cannot sit up straight for one second. Unless I push hard with my elbows on my armrests, my body curls forward. Does this sound familiar?

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Prof G @gavingiovannoni.bsky.social · 28/07/2026

#MS_Selfie Newsletter - The annual follow-up appointment I would appreciate it if you could review version 2.0 of the self-management tool for your annual review and let me know if anything is missing and needs to be added. Thanks. gavingiovannoni.substack.com/p/the-annual...

gavingiovannoni.substack.com

The annual follow-up appointment

I would appreciate it if you could review version 2.0 of the self-management tool for your annual review and let me know if anything is missing and needs to be added. Thanks.

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Prof G @gavingiovannoni.bsky.social · 23/07/2026

#MS_Selfie Q&A 177 - Fampridine How soon will I be allowed to be treated with fampridine on the NHS? gavingiovannoni.substack.com/p/q-and-a-17...

gavingiovannoni.substack.com

Q&A 177 - Fampridine

How soon will I be allowed to be treated with fampridine on the NHS?

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Prof G @gavingiovannoni.bsky.social · 17/07/2026

#MS_Selfie - Freeloading Economics should trump what is actually best for people with MS; i.e. neurologists should prescribe rituximab over the more expensive innovator drugs, as it saves their healthcare system money. Do you agree? => gavingiovannoni.substack.com/p/freeloading

gavingiovannoni.substack.com

Freeloading

Economics should trump what is actually best for people with MS; i.e. neurologists should prescribe rituximab over the more expensive innovator drugs as it saves their healthcare system money.

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Prof G @gavingiovannoni.bsky.social · 16/07/2026

#MS-Selfie Q&A 175: which anti-CD20 is best for me? If you had multiple sclerosis, which anti-CD20 would you want to be treated with? Is this a $Billion question? gavingiovannoni.substack.com/p/q-and-a-17...

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Prof G @gavingiovannoni.bsky.social · 15/07/2026

#MS_Selfie Q&A 174: Treating multiple sclerosis and comorbid psoriasis I have seen a handful of patients who prioritise treatment of psoriasis with one of the psoriasis-licensed biological therapies. buff.ly/FLNDrtp

gavingiovannoni.substack.com

Q&A 174: multiple sclerosis and psoriasis

I have seen a handful of patients who prioritise their treatment of psoriasis with one of the licensed biological therapies for psoriasis.

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Prof G @gavingiovannoni.bsky.social · 14/07/2026

#MS_Selfie - Incidentalomas in Multiple Sclerosis Every so often, a scan reveals something unrelated to your MS, such as a small cyst, a benign lump, a blood vessel variation, or a bit of inflammation in your sinuses. Learn more about this issue => buff.ly/enG4xWM

gavingiovannoni.substack.com

Incidentalomas in Multiple Sclerosis

Every so often, a scan reveals something unrelated to your MS, such as a small cyst, a benign lump, a blood vessel variation, or a bit of inflammation in your sinuses.

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Prof G @gavingiovannoni.bsky.social · 13/07/2026

#MS_Selfie Q&A 174 - to be treated or not to be treated I obviously don’t want to have any of these awful DMTs. Reading about people’s journeys, it seems they jump from one DMD to another. Please don't forget that procrastination is the thief of time—and opportunity's assassin. => buff.ly/F3Rh2Qm

gavingiovannoni.substack.com

Q&A 174 - to be treated or not to be treated

I obviously don’t want to have any of these awful medications. Reading about people’s journeys, it seems they jump from one DMD to another.

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Prof G @gavingiovannoni.bsky.social · 09/07/2026

#MS-Selfie Q&A 171 - Social isolation in people with MS Should I invest the time and effort in starting a digital relationship with an AI Chatbot? => buff.ly/PUz8oy6

gavingiovannoni.substack.com

Q&A 171 - social isolation in people with MS

Should I invest the time and effort in starting a digital relationship with an AI Chatbot?

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Prof G @gavingiovannoni.bsky.social · 06/07/2026

v#MS_Selfie: Can we cure MS? => The only way to find out is to define an MS cure and to look for it. gavingiovannoni.substack.com/p/can-we-cur...

gavingiovannoni.substack.com

Can we cure MS?

The only way to find out is to define an MS cure and to look for it.

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Prof G @gavingiovannoni.bsky.social · 30/06/2026

#MS_Selfie Newsletter Q&A 170: Should I have participated in the frexalimab study? What is the rationale for using frexalimab (anti-CD40L) in advanced MS? Do you think it would be superior to tolebrutinib? => buff.ly/8fSD4Tm

gavingiovannoni.substack.com

Q&A 170: Should I have participated in the frexalimab study?

What is the rationale for using frexalimab in advanced MS? Do you think it would be superior to tolebrutinib?

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Prof G @gavingiovannoni.bsky.social · 26/06/2026

#MS_Selfie Newsletter - MS Brain Health: Time for a New Era We are transitioning the leadership of 'MS Brain Health: Time Matters' to the MS International Federation and MSBase to expand its reach and ensure its longevity. buff.ly/pl1hqLT

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Prof G @gavingiovannoni.bsky.social · 25/06/2026

#MS_Selfie Q&A 169: Excessive sleepiness and MS I find my sleepiness rather embarrassing. I wonder if this is related to the hot weather, MS, or if I have another disease? => buff.ly/pK7TU5g

gavingiovannoni.substack.com

Q&A 169: Excessive sleepiness and MS

I find my sleepiness rather embarrassing. I wonder if this is related to the hot weather, MS, or if I have another disease?

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Prof G @gavingiovannoni.bsky.social · 19/06/2026

#MS_Selfie Newsletter Q&A 168 - Is it a relapse on ofatumumab? The question of whether this is a new relapse or the emergence of smouldering MS in a pathway with reduced reserve is difficult without examining you and doing an MRI of your brain and spinal cord. => buff.ly/EGl82BH

gavingiovannoni.substack.com

Q&A 168 - Is it a relapse on ofatumumab?

The question of whether this is a new relapse or the emergence of smouldering MS in a pathway with reduced reserve is difficult without examining you and doing an MRI of your brain and spinal cord.

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Prof G @gavingiovannoni.bsky.social · 15/06/2026

#MS_Selfie Newsletter - Are MS prognostic calculators useful? I would be interested to know if you find this beta version of our prognostic calculator useful. Is it simple enough to understand? What changes would you recommend? => buff.ly/BO7oCsh

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Prof G @gavingiovannoni.bsky.social · 12/06/2026

#MS_Selfie Q&A 167: remyelination therapies I want to remind you that treating MS early and effectively does away with the need for remyelination therapies. => buff.ly/sCHw6BL

gavingiovannoni.substack.com

Q&A 167: remyelination therapies

I want to remind you that treating MS early and effectively does away with the need for remyelination therapies.

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Prof G @gavingiovannoni.bsky.social · 10/06/2026

#MS_Selfie MS-Risk Calculator version 3.0 The overall odds ratio for family history of any autoimmune disease ranges from 1.4 to 2.0 across studies, suggesting shared genetic susceptibility and potentially common environmental triggers. => GAVIN GIOVANNONI buff.ly/VLZrq4n

gavingiovannoni.substack.com

MS-Risk Calculator version 3.0

The overall odds ratio for family history of any autoimmune disease ranges from 1.4 to 2.0 across studies, suggesting shared genetic susceptibility and potentially common environmental triggers.

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Prof G @gavingiovannoni.bsky.social · 09/06/2026

#MS_Selfie Research - New hope for preserving mobility in SPMS How siponimod delays wheelchair use in people with SPMS => buff.ly/f6ilOoG

gavingiovannoni.substack.com

New hope for preserving mobility in SPMS

How siponimod delays wheelchair use in people with SPMS

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Prof G @gavingiovannoni.bsky.social · 08/06/2026

#MS_Selfie Newsletter - Finding MS before it finds you FIND‑MS Early Detection Workshop Westfields Marriott, Washington Dulles Chantilly, Virginia, 4th-5th June 2026 => buff.ly/ujTsY0w

gavingiovannoni.substack.com

Finding MS before it finds you

FIND‑MS Early Detection Workshop Westfields Marriot, Washington Dulles Chantilly, Virginia, 4th-5th June 2026

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Prof G @gavingiovannoni.bsky.social · 05/06/2026

#MS_Selfie Newsletter => Q&A 166: Fampridine or not? Coming to terms with smouldering MS (or not). There is a lot that needs to be done before giving in to smouldering MS. What about fampridine or tolebrutinib? buff.ly/Lp8oT6g

gavingiovannoni.substack.com

Q&A 166: Fampridine or not?

Coming to terms with smouldering MS (or not). There is a lot that needs to be done before giving into smouldering MS. What about fampridine or tolebrutinib?

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Prof G @gavingiovannoni.bsky.social · 01/06/2026

A new HANDling of progressive MS and progressive MS trials. Some further thoughts on the O'HAND study and an important message for MS trialists => www.sciencedirect.com/science/arti...

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Prof G @gavingiovannoni.bsky.social · 26/05/2026

#MS_Selfie Q&A 165: irradiated blood after cladribine Do you really need irradiated blood after cladribine or alemtuzumab? => buff.ly/t0Pfy6F

gavingiovannoni.substack.com

Q&A 165: irradiated blood after cladribine

Do you really need irradiated blood after cladribine or alemtuzumab?

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Prof G @gavingiovannoni.bsky.social · 15/05/2026

#MS_Selfie book review - You are not alone, and you are not a selfish pig A review of The Selfish Pig’s Guide to Caring by Hugh Marriott gavingiovannoni.substack.com/p/you-are-no...

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