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It was another clue to the timeline . Betaseron , interferon beta-1b , was the first disease modifying therapy for relapsing-remitting MS approved by the FDA . The projected initial supply wasn ’ t enough , and a lottery was used to determine which patients received the medication . Interferon beta-1b was launched in 1993 . Thirty years have passed since our first FDA-approved medication for MS .
“ I was on all the old injection drugs . They called them the ABCs .”
To be certain , I recited the names , and he nodded to all of them . The first generation of MS medications were mostly self-injections and came out in the 1990s and early 2000s . Our first oral medication was not approved until 2010 . We have gone from one medication in 1993 to over 20 in 2023 , with the promise of new , more effective therapies on the horizon .
“ I ’ ve been doing pretty well . I haven ’ t had any problems over the years .”
“ I ’ m glad to hear it ,” I responded . “ Has anyone shown you your MRIs ?”
He shook his head . “ I ’ ve never seen my brain before .”
It ’ s always surprising for me to hear a patient say they ’ ve never seen their MRIs . These days , a typical patient with MS will receive a brain MRI every one or two years . Over a lifetime , that ’ s a lot of scans to never see .
I slowly went through his last brain MRI , explaining the parts of the brain , what they control , what a typical MS lesion looks like , what we think causes the lesions and why we give contrast . I then pulled up the oldest MRI I could find in our imaging system . I put it side by side with the latest and pointed out the subtle changes .
“ Wow , that ’ s pretty amazing ,” he said in astonishment . “ You know , I remember a long time ago when my doctor held my films up to the light to see my brain . Can you believe technology these days ? We ’ ve come a long way .”
I looked at him and smiled . This small comment is what makes taking a history the best part of my day . It allows me to take a moment to appreciate medicine ’ s past . It has been 45 years since the first brain MRI , and 30 years since the first medication for multiple sclerosis . As the years go by , there will be less patients to remind us of a time when we had few evaluations and treatments to offer . We really have come a long way .
Dr . Ganesh is a practicing neurologist at Norton Neuroscience Institute ’ s Hussung Family Multiple Sclerosis Center .
This essay was a submission to the 2023 Richard Spear , MD , Memorial Essay Contest .
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