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Home > MSAA Publications > The Motivator > The Motivator: Summer/Fall 2012 > Cover Story: The Evolution of MS Diagnosis, Treatment, and Care
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The Evolution of MS Diagnosis, Treatment, and Care

Compiled and edited by Susan Wells Courtney
Reviewed by Dr. Jack Burks

MS Timeline

1380

St. Lidwina born in Holland; her progressive illness suggests a diagnosis of MS

1794

Birth of Augustus d'Este, an early case of what would later be known as MS

1838

Robert Carswell includes an illustration of a case of "a peculiar disease state," showing the features of MS

1868

Jean-Martin Charcot gives three lectures describing the features of MS and names it "sclérose en plaque disseminée"

1873-1875

A series of cases are published in London by William Moxom

1884-1887

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)

1891

The lumbar puncture technique is developed

1899

Oligodendrocytes (cells that produce and maintain myelin) are described

1906

A toxin tomyelin is suggested for the breakdown of myelin in plaques

1915

James Dawson publishes his major work on the pathology of the MS plaque

1933

Animal model of MS (EAE) is developed; folding wheelchair invented by Everest, allowing individuals with disabilities to travel by car and bring their wheelchair

1950

Roy Swank develops lowfat diet for individuals with MS; first major study conducted in the US and Canada, funded by NMSS

1951

First use of Cortisone to treat MS

1955

Kurtzke defines Disability Status Scale

1957

Interferons are discovered

1965

The initial criteria for diagnosis of MS is described

1968

Thieme develops the electric mobility scooter

1970

Acute MS flare-ups are treated with adrenocorticotropin

1972

McDonald and Halliday show that conduction is slowed or blocked along demyelinated nerves and use evoked potential methods with MS

1977

Jacobs gives interferon to MS patients intrathecally; McDonald and Halliday outline new diagnostic criteria for MS; oral baclofen approved to treat spasticity

1978

Patterns of myelin repair are demonstrated by Prineas

1980s-1990s

Tegretol® is used to treat pain; Ditropan® is used to treat spastic bladder; as with most symptom management drugs, these are prescribed off-label

1981

First MRI scan of the brain is performed and first MRI images of MS lesions produced; Jacobs reports reduced exacerbations with intrathecal interferon

1983

Poser criteria described for MS; Epstein-Barr virus suspected of being involved with MS; Kurtzke introduces Expanded Disability Status Scale (EDSS)

1987

Prozac® is approved to treat depression; first SSRI antidepressant

1988

Medtronic® Synchromed™ pump and infusion system (implanted and programmable) receives premarket approval

1990

Americans with Disabilities Act signed into law

1990s

Amantidine is used to treat fatigue

1993

Betaseron® approved; Neurontin® approved to treat pain

1995

Copaxone® approved

1996

Avonex® approved

1998

Provigil® approved to treat fatigue; Viagra® approved to treat sexual dysfunction

2000

Novantrone® approved

2002

Rebif® approved; Zanaflex® approved to treat spasticity in MS

2006

Tysabri® approved

2010

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

2011

Botox® injection approved for urinary incontinence in individuals with MS

2012

Aubagio® approved

THE FUTURE

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.

Learn about the MS Coalition

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!

Quotes

Photo of Thomas J. Murray, OC, MD, FRCPC

Thomas J. Murray, OC, MD, FRCPC

...on the history of MS treatments
Photo of Jack Burks, MD

Jack Burks, MD

...comments from MSAA's Chief Medical Officer
Photo of Donald A. Barone, DO

Donald A. Barone, DO

...on the evolution of diagnostic criteria in MS
Photo of Allen C. Bowling, MD PhD

Allen C. Bowling, MD PhD

...on wellness and complementary and alternative medicine
Photo of Stephen Krieger, MD

Stephen Krieger, MD

...on the rise of MS therapeutics and resources
Photo of Fred D. Lublin, MD, FAAN

Fred D. Lublin, MD, FAAN

...on the development of disease-modifying therapies
Photo of Randall T. Schapiro, MD, FAAN

Randall T. Schapiro, MD, FAAN

...on symptom management
Photo of June Halper, MSN, APN-C, MSCN, FAAN

June Halper, MSN, APN-C, MSCN, FAAN

...on the MS Nurse and certification
Photo of Dorothea Cassidy Pfohl, RN, BS, MSCN

Dorothea Cassidy Pfohl, RN, BS, MSCN

...on the evolution of nursing and treatment tools for MS
Photo of Megan Weigel, DNP, ARNP-c, MSCN

Megan Weigel, DNP, ARNP-c, MSCN

...on the importance of taking care of the whole patient
Photo of Patty Bobryk, MHS, PT, MSCS, ATP

Patty Bobryk, MHS, PT, MSCS, ATP

...on the changing environment of MS rehabilitation care
Photo of Carrie Bruce, MA, CCC-SLP, ATP

Carrie Bruce, MA, CCC-SLP, ATP

...on the evolution of assistive devices and technologies
Photo of Miriam Franco, MSW, PsyD

Miriam Franco, MSW, PsyD

...on the emotional and cognitive changes in MS
Photo of Herb Karpatkin, PT, DSc, NCS, MSCS

Herb Karpatkin, PT, DSc, NCS, MSCS

...on improving balance and preventing falls
Photo of Pat Provance, PT, MSCS

Pat Provance, PT, MSCS

...on exercise and ambulation aids in MS rehabilitation
Photo of Kathy Zackowski, PhD, OTR, MSCS

Kathy Zackowski, PhD, OTR, MSCS

...on occupational therapy, computer technology, and MS
Photo of Diana M. Schneider, PhD

Diana M. Schneider, PhD

Closing message...on future advances in MS

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Last Updated on Monday, 25 March 2013 13:11