The second article of our ‘A Day in the Life’ blog campaign gives credit to the significant improvements in the MS field over the past three decades. Renowned neurologist Alan Thompson writes about the landmarks along his neuroscience journey which started with a thesis in 1982 and lead to the position of Dean in a research faculty.
My days just seems to get busier and busier, but in a good way! The number and variety of activities, all worthwhile, all challenging and all productive increases exponentially.
It would have been impossible to predict as I started work on my thesis in 1982 – studying biomarkers in the spinal fluid for the then untreatable condition of multiple sclerosis – that we would now be grappling with complex algorithms and intricate guidelines for the dozen or more treatments available for patients with this condition.
I find difficult to put in words the transformational impact that these treatments have had on the world of multiple sclerosis. They vary in efficacy, side-effect profile and mode of administration. Their emergence has now become the exemplar of a therapeutic success in neurology. As we move to refining our approach though personalised medicine – the right treatment for the right patient at the right time – we can anticipate even better outcomes.
A neurologist’s journey
But the journey of discovery is far from over. It is frustrating to think that some of the most fundamental questions asked by persons with multiple sclerosis – such as ‘what causes this condition’ or ‘what is going to happen to me’ – remain unanswered. It is also sobering to think that despite all our treatments we have nothing to offer those with progressive MS, numbering up to 1,5 million world-wide.
The cause and mechanisms underlying progression has been an interest of mine since I came to London in 1985. There I had the good fortune to meet and subsequently work for the person who was to become my mentor, Professor Ian McDonald. He was always ahead of his time. He developed biomarkers that we now take for granted. His work included visual evoked potentials and particularly the application of magnetic resonance imaging (MRI).
MRI has transformed our ability to diagnose early, explore mechanisms and monitor with extreme sensitivity. Professor MacDonald encouraged me to focus on primary progressive MS and this has been one of my main interests over these 30 years. But it was not a popular area and it has only been with the development of the Progressive MS Alliance, four years ago that progressive MS has moved center stage.
The Progressive MS Alliance
The Alliance has been a great example of how a powerful vision – ‘finding new treatments for progressive MS’ – can unite different sectors and overcome historical barriers. It has been extraordinary to see the level of engagement and commitment internationally. As so often happens, when you shine the spotlight on a particular area, things start to happen. For example, it has been very encouraging to see positive phase III trials in progressive MS over the last year. Even more exciting for me are some of the exploratory Phase II trials looking at neuroprotection.
It is very clear that if you want to get things done, particularly if they are challenging, you must work with like-minded colleagues who have the same vision and spirit of collaboration. I saw that initially with Ian McDonald and it has remained true to the present day. I have been very fortunate to work with enthusiastic colleagues here in London but also in the US, Zurich and Barcelona. This spirit of collaboration has been fundamental to the success of the Alliance.
So when balancing my portfolio of activities – ranging from being Dean of a research intensive neuroscience Faculty in London, leading the scientific steering committee of the PMSA, editing an MS journal or continuing my clinical and research activity – it can be difficult to find the time needed. But when it is so exciting and so productive, I just make the time!