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  1. A Coles
  1. Neurology Unit, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital Box 111, Hills Road, Cambridge CB2 0SP, UK; ajc1020{at}

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Michael Hutchinson, although a self-confessed “oldie”, is no reactionary. The experience of treating patients with multiple sclerosis (MS) for 35 years and observing the “consequences of the inadequacy of the present first-line therapies” has turned him into an aggressive therapist. He proposes that we focus on patients with early disease and monitor them frequently (at least 6-monthly), using clinical and MRI markers of disease activity, in order to introduce disease-modifying therapy quickly. And we should escalate therapy rapidly to second-line drugs if there is any clinical or radiological evidence of new lesion formation while on the interferons or glatiramer. All …

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