HistorySpeak: Lord Brain and preventing MS

Will Lord Brain be proved right? #MSBlog #HistorySpeak 

Lord Brain

"Lord Brain was one of my predecessors at The Royal London Hospital. His monograph on MS is remarkable considering when it was written. I would recommend it if you are interested in the history of MS. He has suggested that MS may be due to an infection. I am reminding you of Lord Brain's perspective a few week's before the Wolfson Institute of Preventive Medicine will be hosting a meeting to discuss EBV vaccination as a strategy to prevent MS. It is really quite amazing that we have been able to convince the epidemiology, and preventive medicine, community to accept the hypothesis that MS may be caused by EBV and that we are now planning an MS prevention study. When I hosted my first meeting on this issue over a decade ago most people were unconvinced. I suspected the stunning results of anti-CD20 as a treatment for MS may have been the tipping point. I continue to live in hope that in my lifetime we will be able to prevent MS."

Murray T. Russell Brains Review of MS. Int MS J. 2011 May;17(2):50-3.

In 1930 there were many conflicting views on the cause, incidence, precipitating factors, inheritance and treatment of MS. A young, London neurologist summarized the state of understanding of the disease with his personal view of many of the uncertain areas, and clarified the thinking for the neurological community at that time. Although his later career was influential in many fields of medicine, and his personal influence was extraordinary in many areas as an author, educator, administrator, opinion leader and historian, his review was an important milestone in the history of MS.

Pakpoor & Ramagopalan. Russell W Brain and the aetiology of multiple sclerosis--a historical perspective. QJM. 2014 Jun;107(6):423-7.

The contribution of British neurologist Russell Walter Brain (1895-1966) to the field of neurology is difficult to overestimate and his seminal work continues to influence modern neurological education and practice. In a landmark review published in the Quarterly Review of Medicine in 1930, he gives a critically important account summarising ideas of the time thought to underlie the then called 'disseminated sclerosis', a disease he notes to be, 'after syphilis, the most frequent disease of the nervous system' in the UK. Across a century and a half, vast progress has been made in attempting to elucidate the as yet unknown cause of MS, which is unravelling to be multifactorial, highly complex and likely dependent on both genetic and environmental risk factors. Brain's observations highlight the changing epidemiology of MS over the last century which are likely to provide the platform in striving towards elucidating MS causation, notably a seemingly reduced latitudinal gradient of MS incidence, an increasing female-to-male sex ratio and an increasing disease rate in dark-skinned compared to light-skinned individuals. In this report we aim to evaluate the relevance today of what we believe to have been an important review demonstrating a perspective on MS far ahead that of its time, with a focus on Brain's ideas on the aetiology of MS; many of which have stood the test of time.

Brain, W.R. Critical review: disseminated sclerosis. Q J Med 1930, 23: 343-391.