1. Multiple Sclerosis ResearchWhy lumbar punctures may be important for MSers with progressive MS!Gavin Giovannoni

2. Placebo tablet 300 MSers Year 1Year 2Year 3600 MSers 300 MSersActive tablet 3. PlaceboActiveDisability Year 1 Year 2 Year 3Time 4. 300 MSersYear 1 Year 2Year 6Year 7 Year 3 Year 4 Year 5600 MSers 300 MSers RecruitmentTrial Data analysis Registration 7 years 5. Gorilla 6. Drums 7. Spinal fluid neurofilament levelsSpinalfluidneurofilament levels Disability (EDSS) and 3 yearsPetzold et al. J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):206-11. 8. Spinal fluid neurofilament levelsSpinalfluidneurofilament levels Disability (EDSS) and 3 yearsPetzold et al. J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):206-11. 9. Axonal damage in relapsing MS is markedly reduced by natalizumabGunnarsson et al. Ann Neurol 2010; Epub. 10. Axonal damage in relapsing MS is markedly reduced by natalizumabGunnarsson et al. Ann Neurol 2010; Epub. 11. Axonal damage in relapsing MS is markedly reduced by natalizumabGunnarsson et al. Ann Neurol 2010; Epub. 12. Axonal damage in relapsing MS is markedly reduced by natalizumab =Gunnarsson et al. Ann Neurol 2010; Epub. 13. 30 MSers placebo tablet 6 months6 months6 months 6 months60 MSers30 MSers active tablet LP1 LP2LP3 Recruitment TrialData analysis 2 years 14. 600 MSers for 7 years 60 MSers for 2 years3 LPs = 10x as many trials in a of the time 15. Can we make LPs safer? 16. Two types of spinal needle tips: the Quincke and SprotteTraumaticorcutting needleAtraumaticor non-cutting needleEvans R W et al. Neurology 2000;55:909-914 17. Ultrasound-guide lumbar punctures 18. Would you be prepared to have three lumbarpunctures to help find an effective treatmentfor progressive MS?Please let me know by completing the survey on www.multiple-sclerosis-research.orgThank you! 19. Can you seen the Gorilla playing the drums?