W. Ian McDonald Wins 1999 Dystel Prize.

Advances in research methods and technologies have allowed for more sophisticated insights into how MS works--and better treatments. For the past 35 years, W. Ian McDonald, distinguished neurologist and researcher, has been a major player in this work. Dr. McDonald has been awarded the 1999 John Dystel Prize for MS Research to recognize his many contributions to MS research. W. Ian McDonald, MB, ChB, PhD, is emeritus professor of clinical neurology at the Institute of Neurology at University College London, and is active in the International Federation of MS Societies.

Ian McDonald always wanted to go into medicine, and neurology was the area that most fascinated him. He completed medical school training in New Zealand, including 4 years in a research lab. He went on to finish his clinical training in London, and since then has divided his time between seeing patients with MS and other neurological diseases and doing lab research.

It has been a productive arrangement. Problems that come up in his practice often give rise to questions about the underlying mechanisms. Back in the lab, Ian McDonald might design a research project to address these questions, sometimes discovering information that can be used productively in clinical practice.

Not that scientific research often proceeds so smoothly. The title of Dr. McDonald's talk at the 1999 American Academy of Neurology conference was "Chance and Design in the Progress of MS Research". His own problem-solving successes have resulted from setting up welldesigned studies--and then keeping an eye out for what doesn't neatly fit and finding a way to account for the discrepancy.

We now know that when nerve fibers are demyelinated because of MS, they lose their ability to conduct nerve impulses--resulting in the "short-circuiting" that causes the various symptoms. Dr. McDonald did the first research in the early 1960s that revealed this. His findings opened one of the crucial doom to further MS research.

In 1972, Dr. McDonald built on this earlier work and began studying conduction in the optic nerve using a new kind of electronic measure, the Visual Evoked Potentials (VEP). During the VEP test, a series of patterns is flashed in front of a person's eyes, and the response time to these changes is measured. People with optic neuritis showed a dramatically slowed response time. "Could the use of VEP in people with MS reveal something about the pathology of the disease?" Dr. McDonald asked. The results he got surprised him. When he tested people with MS who had recovered from optic neuritis, their VEP results remained abnormal. VEP turned out to be the first noninvasive diagnostic and monitoring test of MS. He published these results, with Martin Halliday and Joan Mushin, in 1973.

The challenge of finding better ways to diagnose MS and gaining more understanding of the disease continued to bedevil Dr. McDonald in the 1980s. He began working with MRI (magnetic resonance imaging) and established the first MRI facility for use in MS at the Institute of Neurology, University College London. Dr. McDonald's MRI studies not only allowed for better diagnosis of MS, they brought a clearer understanding of the role of inflammation in the central nervous system and a better description of the difference between primary-progressive and secondary-progressive MS.

What's on the horizon for MS research? "We still need to understand the real mechanism of damage in MS. Why do axons (nerve fibers) degenerate when there is inflammation present?" Dr. McDonald said. He is confident that advanced MRI, quantitative MRI, spectroscopy, and functional imaging will help scientists to finally understand these mechanisms. Then, Dr. McDonald thinks, scientists may be able to develop targeted protective agents to shield the nerve fibers.

"MS is one of the most complex diseases I know of," said Dr. McDonald. He continues to be on the lookout for the chance glitch or the odd result that might lead the way to the next important discovery.

RELATED ARTICLE:

The John Dystel Prize for Multiple Sclerosis Research was established in 1994 by Marion and Oscar Dystel in honor of their son, John, whose promising legal career was cut short by progressive MS. The prize of $7,500 is given jointly by the Society and the American Academy of Neurology. It is the only professional award given annually to honor outstanding contributions to MS research. The Society has also established the Ralph I. Strauss Award of $1 million to the scientist or scientists who find a means of preventing or arresting MS.

Lorna Smedman is managing editor of this magazine.