Robby from the MS community: What current holes in research would you like to see filled?
Professor Alan Thompson, Consultant Neurologist: Well, I’m sounding a bit, this is my hobbyhorse, but I mean the holes I’d like to see filled are around mechanisms, understanding what actually happens.
I think we have a reasonable idea about what happens in relapsing remitting MS, I think we’ve a very poor idea about what happens in progression.
So I’d like to see much more around mechanisms and I think that’s a big target area because if you identify the mechanism, then you can identify treatment targets and then you identify treatments, it’s a logical sequence. And the other areas are around biomarkers…
Robby: Sorry, what are they?
Professor Alan Thompson: So, what we need are things, markers, imaging or things we can measure in the blood or in the spinal fluid that tell us what’s happening, but also help us to predict what might happen.
So that we can use those markers as, we can use them in treatment trials as an indicator of whether a drug is working or not. So they give you an early signal that something is working or not working.
Robby: Is this, you’re talking about imaging or a chemical thing?
Professor Alan Thompson: It can be either. It really doesn’t matter. It can be imaging, we’ve got some very good imaging markers, but it can also be measuring substance, like neurofilament, for example, which is one of the proteins, one of the areas that we’re measuring in the blood and in the spinal fluid.
The key thing is that it gives you an indication of what is happening in that person in relation to their condition, and ideally it helps you to predict what might happen going forward. So that’s a gap.
I think the other big gap for me is around symptom treatment and rehabilitation. This is a big, big area, it’s a very wide area. We put the two together, they’re actually quite different, managing specific symptoms, each symptom needs a particular approach.
But the whole concept of rehabilitation, can we get a better understanding of what happens in rehabilitation and can we make it more effective and more targeted.
And that’s a key element of the Progressive Alliance, is actually looking at rehabilitation and symptom management, and we’re having a major meeting in Toronto in May of next year focussing entirely on that subject.
Robby: Sure. Is this like a multi-disciplinary approach?
Professor Alan Thompson: Yeah. I think it’s always multi-disciplinary, whether you’re talking about symptoms like spasticity or pain or fatigue or cognitive impairment, it’s always multi-disciplinary, and rehabilitation I suppose is particularly multi-disciplinary in the way it functions. You need all the expertise focussing on the patient and on their symptoms.