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Motor Neurone Disease – ‘at your fingertips’

This book has been written primarily for the person with motor neurone disease (MND). Just as important are relatives, friends and others who come into contact, whether at the workplace or elsewhere. The real need for this publication stems from the fact that, although there are many treatments for MND, as yet there is no cure. This state of affairs with other diseases, I am glad to relate, is steadily becoming rarer – even the two commonest causes of death, cancer and heart disease, have many remedies. These latter two conditions are well-known to the general public, but this is not the case with MND and the following pages will attempt to explain the reasons for this. MND is brought to the doctor’s attention from the earliest days of walking the wards and the reason for this is not because it is a common condition, but because, sad to say, it is a ‘good teaching case’; patients develop a multiplicity of physical signs which the student must learn to detect and deduce the cause. This is how the disorder initially impinged on my consciousness and I still have the detailed notes of my first case over a half-century ago. During my years of training to become a neurologist, one of my research projects was the ‘intravital staining with methylene blue of motor end plates in MND’. This grand sounding title meant using a recently introduced (in the 1950s) technique to show the connections between nerve and muscle; although informative, it gave no clue as to the cause of the disease, a mystery that still persists to this day, in spite of countless research approaches. As a neurologist, I had great difficulty in explaining to patients the implications of the condition but learned, on professional visits to the United States, of groups of patients with the disease and their relatives who came together to discuss their mutual problems and collect money for research. I tried to do the same in London and, although initially there was encouragement, when the disease had run its course, the interest of relatives often waned. However, the Motor Neurone Disease Association eventually came into existence and I spoke at the first meeting in London and became its Medical Patron. Also, in the 1970s, I was asked by the Medical Society of London to arrange a symposium for the Mansell Bequest for the furtherance of neurological studies. Because Dr Mansell had died from MND, it was an obvious choice as a topic for the first symposium. I could find only a dozen neuroscientists to participate and only a few of their topics were directly concerned with MND – a disheartening reflection of the lack of interest then displayed. The proceedings were published as a monograph entitled Motor Neurone Disease, which was the first of its kind in the UK. Since that time, an increasing amount of research has occurred and some of the conclusions are reported in this book. No one can guarantee a cure in the immediate future but there is now at least a drug that delays the usually inexorable progress of the disease. There is little doubt that, with increasing research and interest, the happy arrival of a cure will eventually become a reality.

Authors: Dr Stuart Neilson and Dr Frank Clifford Rose