The Evolution of MS Diagnosis, Treatment, and Care
Compiled and edited by Susan Wells Courtney
Reviewed by Dr. Jack Burks
St. Lidwina born in Holland; her progressive illness suggests a diagnosis of MS
Birth of Augustus d'Este, an early case of what would later be known as MS
Robert Carswell includes an illustration of a case of "a peculiar disease state," showing the features of MS
Jean-Martin Charcot gives three lectures describing the features of MS and names it "sclérose en plaque disseminée"
A series of cases are published in London by William Moxom
Numerous lectures and published case reports; optic neuritis andmyelitis described (1884); infection suggested as a cause (1884); family with 12 cases of MS described (1885); toxins suggested as a cause (1887)
The lumbar puncture technique is developed
Oligodendrocytes (cells that produce and maintain myelin) are described
A toxin tomyelin is suggested for the breakdown of myelin in plaques
James Dawson publishes his major work on the pathology of the MS plaque
Animal model of MS (EAE) is developed; folding wheelchair invented by Everest,
allowing individuals with disabilities to travel by car and bring their wheelchair
Roy Swank develops lowfat diet for individuals with MS; first major study conducted in the US and Canada, funded by NMSS
First use of Cortisone to treat MS
Kurtzke defines Disability Status Scale
Interferons are discovered
The initial criteria for diagnosis of MS is described
Thieme develops the electric mobility scooter
Acute MS flare-ups are treated with adrenocorticotropin
McDonald and Halliday show that conduction is slowed or blocked along demyelinated nerves and use evoked potential methods with MS
Jacobs gives interferon to MS patients intrathecally; McDonald and Halliday outline new diagnostic criteria for MS; oral baclofen approved to treat spasticity
Patterns of myelin repair are demonstrated by Prineas
Tegretol® is used to treat pain; Ditropan® is used to treat spastic bladder; as with most symptom management drugs, these are prescribed off-label
First MRI scan of the brain is performed and first MRI images of MS lesions produced; Jacobs reports reduced exacerbations with intrathecal interferon
Poser criteria described for MS; Epstein-Barr virus suspected of being involved with MS; Kurtzke introduces Expanded Disability Status Scale (EDSS)
Prozac® is approved to treat depression; first SSRI antidepressant
Medtronic® Synchromed™ pump and infusion system (implanted and programmable) receives premarket approval
Americans with Disabilities Act signed into law
Amantidine is used to treat fatigue
Betaseron® approved; Neurontin® approved to treat pain
Provigil® approved to treat fatigue; Viagra® approved to treat sexual dysfunction
Rebif® approved; Zanaflex® approved to treat spasticity in MS
Extavia® approved; Gilenya™ approved; Botox® injection approved for adult upper-limb spasticity; Nuedexta™ approved for the treatment of pseudobulbar affect (PBA); Ampyra™ approved to improve walking in individuals with MS
Botox® injection approved for urinary incontinence in individuals with MS
Possible approvals of Dimethyl Fumarate (DMF); Lemtrada™; ocrelizumab; daclizumab; Tovaxin®; laquinimod; and many more!
Introduction: A Long and Difficult Road
The evolution of multiple sclerosis (MS) diagnosis, treatment, and care, from the early 1800s to today, has been an extremely long and difficult road for researchers, medical professionals, and members of the MS community alike. Through the 1800s and up until the mid 1900s, without the diagnostic tools of today, some individuals showing signs of MS may not have received a diagnosis during their lifetime.
Additionally, doctors did not know what might be causing MS or if it might be contagious. As more cases came to light over the years, more confusion occurred over what to do and how to treat this mysterious illness. Medical professionals and well-meaning laypeople were grasping at straws to find an effective treatment, relying on trial and error while testing a wide range of unusual medications and unexpected therapies.
Rigorous, randomized, double-blinded studies were necessary for effective treatments for MS to finally be identified. Despite nearly two centuries of scientific observation and research, the first real treatment did not become available until 1993. Diagnosis was another great challenge, and the tools needed for this did not become available until the mid-to-late 1900s. While the technologies are vastly improved, diagnosis still remains a challenge in some instances.
Members of the MS community may feel some comfort in knowing that their diagnosis can now be made with far more certainty than just a few decades ago. And for those with relapsing forms of MS, nine disease-modifying therapies are presently available to slow disease activity. These treatments have been of enormous benefit to the majority of individuals with MS.
For individuals with relapsing as well as progressive forms of MS, many resources are now available to help with medical care, wellness strategies, rehabilitation therapies, and assistive equipment. These are all aimed at making life with MS healthier, safer, more comfortable, and more productive. Research into potential treatments for progressive forms of MS, as well as repair of damaged myelin and nerves, continues at a rapid pace.
While no one welcomes MS into his or her life, this is a better time to be faced with the challenge. Between ongoing studies around the world, devoted MS organizations, and incredible teams of neurologists, nurses, and therapists, members of the MS community have more support and more hope for the future than ever before.
About this Article
This article is a collection of quotes from several top experts in the field of MS, each talking about the important contributions he or she has found to make a difference in the lives of individuals with MS. Some of the experts are members of MSAA's Healthcare Advisory Council, while others are among the medical professionals with whom MSAA has worked previously, assisting with our various educational programs for patients and professionals. Space does not allow us to quote all of the wonderful MS experts with whom we have worked in the past, but we are extremely grateful for those willing and able to participate in this special article.
Our group of experts includes neurologists and researchers as well as nurses and therapists. Following our first two introductory experts, and before our closing message, we have grouped the balance of professionals in the following order: first by field, and then alphabetically within their field. We start with neurologists and researchers, then nurses, followed by therapists. Everyone is of equal importance in the care of individuals with MS, but grouping them this way allows for a smoother transition between topics.
Our first introductory contributor to this article is Thomas J. Murray, OC, MD - an MS historian who literally wrote the book on MS history! Titled Multiple Sclerosis: the history of a disease (Demos Medical Publishing, 2005), this reference, along with Dr. Murray, was of great help in developing our timeline. Many thanks also go to Dr. Randy Schapiro and speech-language pathologist Carrie Bruce for their contributions to the timeline. Space does not allow us to include all of the historical events that occurred during the past two centuries that helped to shape the history of MS, but we have highlighted some of the more notable ones.
In his quote, Dr. Murray gives a very brief history of MS treatments during the 1800s and early 1900s, leading up to the time when an accurate understanding of the disease became a reality. This is followed by our second introductory quote, from MSAA Chief Medical Officer Jack Burks, MD, who gives his insightful view of the past 50 years on the evolution of MS diagnosis, treatment, and care. From there, we have many interesting, informative, and inspiring contributions from 14 other experts.
Finally, we conclude our article with a closing message from Diana M. Schneider, PhD. She is a medical writer, publisher, and researcher - and a regular contributor to our magazine. Dr. Schneider may be best known at MSAA for her annual MS Research Updates. We hope you enjoy this collection of quotes from these highly regarded medical professionals!