World Brain Day 2021: An interview with Professor Alan Thompson

Interview conducted by Emily Henderson, B.Sc.Jul 21 2021

Thought LeadersProfessor Alan ThompsonProfessor of Clinical Neurology & NeurorehabilitationUniversity College London (UCL)

In commemoration of World Brain Day 2021, News-Medical spoke to renowned neurology expert Professor Alan Thompson from University College London about his incredible career in brain research.

Please could you introduce yourself and tell us about what inspired your incredible career in brain research?

My name is Alan Thompson and I am a Professor of Neurology and NeuroRehabilitation at the UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery. I have also been Dean of the UCL Faculty of Brain Sciences and Pro Vice-Provost for London.

I was drawn into my career in Brain Research through my fascination for Multiple Sclerosis, a common condition in Ireland, and the perhaps naïve belief that I could make a difference in our understanding of the condition, thereby developing effective treatments and improved management for those with MS, improving their quality of life and well-being.

I was very fortunate to have two great mentors, Professor Michael Hutchinson in Dublin, and Professor Ian McDonald in London, who supported and guided me during the critical early stages of this journey.

World Brain Day is celebrated around the world every year. This year it is dedicated to multiple sclerosis (MS) which is a neurological disease affecting 2.8 million people globally. Could you tell us more about multiple sclerosis and why it affects so many people?

Multiple Sclerosis is a complex, disabling neurological condition which involves a number of processes including inflammation, demyelination, and axonal damage and loss. The precise cause of MS is not clear but it is a complex mix of genetic and environmental factors. MS tends to affect young people in the prime of their lives and is one of the most common disabling neurological conditions affecting this age group.

In the majority of those affected, the condition begins with attacks or episodes (called relapses) after the initial episode which is called a clinically isolated syndrome. Common initial episodes involve the optic nerve and both sensory and motor pathways. The majority of those affected enter a progressive and more disabling phase of the condition after a variable period.

Multiple Sclerosis. Image Credit: Miriam Doerr Martin Frommherz/Shutterstock.com

There are treatments available for multiple sclerosis but access to this medication is still unavailable in many parts of the world. Why is this and what can be done to help improve access to all?

Few neurological conditions have seen such therapeutic advances as Multiple Sclerosis – particularly for the earlier relapsing/remitting phase of the condition (around 20 treatments now available).

However there is a very broad range of ease of access and it can be very poor in middle and lower-income countries – mainly because of cost and the limited health services available. It needs a concerted international effort if this is ever to change.

The key messages this year for world brain day 2021 is disability, prevalence, education, access to treatment, and advocacy. What can people, governments, and organizations do to help raise further awareness of multiple sclerosis and its symptoms?

A collaborative worldwide approach is required and umbrella organizations such as the MS International Federation and the International Progressive MS Alliance are well placed to help coordinate and drive this endeavor.

A lot of your research throughout your career has involved multiple sclerosis. Why have you found this to be such an important part of your work?

As a junior doctor, I was struck by how little we were able to do to help people affected by MS (at that time there was no effective treatment) – we just seemed to be watching them deteriorate.

I felt there was a real opportunity to improve our understanding of MS and was particularly struck in the early 1980s by the insights Magnetic Resonance Imaging (MRI) could provide – in investigation, diagnosis and as important biomarkers in clinical trials. I have been particularly focused on exploring mechanisms of disability using this ever-evolving tool.

MRI Scan. Image Credit: Shidlovski/Shutterstock.com

What areas of brain research are you currently focusing on?

I am involved in a number of areas – from the clinical side, improving diagnosis and working on phenotypes alongside engagement in clinical trials, while on the research side my focus has been more on exploring mechanisms of disability – particularly relating to the spinal cord and focusing on progressive forms of MS.

However, it is in my role as Chair of the Scientific Steering Committee of the Progressive MS Alliance that I feel I have the most impact. It has been exciting and very rewarding to see how this (relatively recently established) organization has brought researchers, clinicians, people affected by MS, and industry colleagues together to raise the profile and drive the research agenda of Progressive MS.

How has the ongoing COVID-19 pandemic affected your research?

Inevitably it has delayed my own imaging research but also has delayed the work of the Alliance’s international networks over the last 18 months.

However, it has also brought out the determination, resilience, and collaboration of our community and it is remarkable to see how all our activities have re-started with renewed energy and enthusiasm.

COVID-19 has also taken up a huge amount of research over the last year with many scientists and organizations working together to develop effective treatment strategies.  How could this level of collaboration be used to develop effective treatment strategies to stop the progression of multiple sclerosis?

It is a great model of concerted, collegiate activity – which resulted in progress at speed, navigating long-standing obstacles, which innovative approaches. This is particularly relevant when we think about how we trial in MS and how we can accelerate our processes for effective treatments in progressive MS.

Throughout your incredible research career what has been your proudest moment?

I would have said that my findings around the pattern of MRI abnormalities in primary progressive MS was my proudest moment but now I would be more inclined towards the work of the Progressive MS Alliance which has had a real impact – and of course receiving the Charcot award last month – which really reflected all the work my colleagues and team have done over the last 30 years.

Finally, do you believe that with continued research and further awareness, we could help slow, and eventually stop, the progression of multiple sclerosis?

Absolutely – I think we are already well on the way to slowing – and will eventually stop progression – probably well before understanding MS sufficiently to prevent it.

Where can readers find more information?

Papers relating to Multiple Sclerosis:

1. Thompson AJ, Banwell BL, Barkhof F…Cohen J.  Diagnosis of multiple sclerosis:  2017 revisions of the McDonald criteria.  Lancet Neurology 2018; 17:162-173. (IF 30.039).  Citations: 980. Link: https://www.sciencedirect.com/science/article/pii/S1474442217304702
2. Montalban X, Gold R, Thompson AJ et al.  ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis.  Multiple Sclerosis Journal, online 20 January 2018 (IF 5.412); European Journal of Neurology 2018; 25:215-237 (IF 4.516 ).  Citations:  72. Link: https://journals.sagepub.com/doi/full/10.1177/1352458517751049
3. Thompson AJ, Baranzini S, Geurts JJ, Hemmer B, Ciccarelli O.  Multiple Sclerosis. The Lancet 2018; 391 (10130):1622-1636 (IF 60.392).  Citations: 41. Link: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30481-1/fulltext
4. Ontaneda D, Thompson AJ, Fox RJ, Cohen JA.  Progressive multiple sclerosis:  prospects for disease therapy, repair, and restoration of function.  The Lancet 2017; 389:1357:1366. (IF 60.392) Citations:  77. Link: https://www.sciencedirect.com/science/article/pii/S0140673616313204

• Atlas of MS Epidemiology report and the MSJ article on the report
• Atlas of MS Clinical Management of MS report and the Lancet article for World Brain Day that discusses this data

Regarding the WHO Essential Medicines List work :

• EML application (Lancet) and the original EML application (WHO site)
• Essential Medicines for people with MS (Lancet)
• Healthcare disparities for people with MS (Lancet)

About Professor Alan Thompson

I am currently a consultant neurologist at Queen Square and a Professor of Neurology and NeuroRehabilitation at UCL. I am Dean of the UCL Faculty of Brain Sciences – one of UCL’s largest and most successful Faculty and have, in addition, the exciting role of Pro Vice-Provost London. I am the editor-in-chief of the Multiple Sclerosis Journal which goes from strength to strength and, of course, I chair the Scientific Steering Committee of the Progressive MS Alliance.   

I went into the field of Multiple Sclerosis in the hope that I might be able to make a difference and it has been wonderful to see how it has gone from an untreatable to a treatable condition over the last twenty years – and it will be great to see the same pattern evolving for those with the progressive form of the condition.