MS over 150 Years

With so much information available about Multiple Sclerosis (MS) today, it’s hard to believe that is wasn’t until relatively recently that the painstaking medical detective work into the condition started to unravel some of its mysteries.

The earliest recorded description of MS goes back to the 14th century, but it was a French medical professor named Jean-Martin Charcot, now known as the “Father of Neurology”, who first officially identified the condition in 1868. Fortunately for modern medicine (but very unfortunately for her), Charcot’s housemaid developed a strange tremor, slurred speech and abnormal eye movements that the professor studied closely but was unable to successfully treat. After she died, he performed an autopsy and discovered the characteristic brain plaques of MS, connecting them with the symptoms he’d observed. So began a period of intense research and technological advances that would begin to unlock the secrets of MS1.

Following Charcot’s observations, MS became recognized on both sides of the Atlantic, and by the end of the century the medical experts of the time knew about as much as was possible from physical observation alone. However, they continued to be puzzled by the mysterious condition, as it appeared to manifest itself differently from patient to patient and was more common in women, and not directly inherited2.

Technological Advances

The dawn of the 20th century brought advances in technology that allowed scientists to study brain tissue in microscopic detail for the first time. In 1916, a Scottish pathologist named Dr. James Dawson, described, in great detail, the inflammation around blood vessels and damage to myelin seen in the brains of people with MS – this seminal work has stood the test of time and is still the basis of today’s understanding3.

It’s generally thought that a German doctor, Rudolf Virchow, was the first to discover myelin (the protective sheath surrounding nerve fibers) in 18544. It was only the discovery of the cells that generate myelin (named oligodendrocytes) in 1928 by a Spanish neuroscientist named Pio del Rio Hortega that brought a clearer understanding of how MS affects the body5. In 1925, Lord Edgar Douglas Adrian figured out that myelin was involved in nerve conduction, and demonstrated that any damage to myelin meant a breakdown in electrical impulses; explaining the seemingly random symptoms of MS3.

In the 1930s, a major breakthrough came when Dr. Thomas Rivers of New York’s Rockefeller Institute was able to show that the symptoms of MS could be recreated by getting the immune system to attack myelin3.

Advances in Treatment

Up until the early 90s, treatment for MS consisted largely of managing the complex array of symptoms. Then in 1993, came a crucial breakthrough when the first disease-modifying therapy (DMT) was approved for people with MS. The drug acted on the immune system to reduce the frequency and severity of relapses, helping to prevent damage to the central nervous system, and in turn many of the symptoms MS can bring. By 2008, six injection and infusion DMTs were available6. Later in 1998, Beta Interferons (a form of cell-signaling) were introduced to help those with Secondary Progressive MS (SPMS)3.

For people living with the condition, the outlook is certainly more hopeful as a result of these new drug therapies. A study in 2015 found that 39% of people living with MS were unemployed, highlighting the lowest unemployment record for people with MS7.

Improvements in MS Assessment

The research of Dr. Elvin Kabat from Columbia University, USA into the immunology of MS in 1947, led to him noticing that people with MS had unusual protein by-products in their cerebrospinal fluid (the special fluid that circulates around the brain and spinal cord). This discovery led to the use of lumbar puncture testing, a procedure still used in MS assessment today8.

New Scanning Techniques

Also in the 1960s, imaging techniques began to emerge for MS, and a decade later radiologists began using computerized tomography (CT) scans to create images of the brain, something that had previously been impossible in living patients. In the late 1970s, CT scans gave way to magnetic resonance imaging (MRI), which produced more detailed images of the inside of the body, including the brain and provided researchers with a more sophisticated way of testing drugs for MS9, 10.

New Theories

As well as better diagnosis, the 21st century has brought with it a number of interesting new theories about risk factors for MS. One study published in 2000 in The Proceedings of the Nutrition Society, for example, suggested that vitamin D could help protect against the disease11. More recently, possible links with the contraceptive pill, smoking and obesity have all been identified12.

Our understanding of MS continues to evolve, but with advances in immunology (the science of the body’s immune system), epidemiology (the study of patterns of disease in the population) and genetics (the study of genes and inheritance), it’s likely that our knowledge will grow and that experts may, someday, get closer to finding a cure. Something Professor Jean-Martin Charcot (and his housemaid) could only have dreamed of when he first recorded those strange symptoms, in a notebook, in Paris, all those years ago.

References:

  1. Website ‘Wikipedia’ Jean-Martin Charcot. Available at: https://en.wikipedia.org/wiki/Jean-Martin_Charcot
  2. Website ‘Multiple Sclerosis association of America’ History of Multiple Sclerosis. Available at: https://mymsaa.org/ms-information/overview/history/
  3. Loren A. Rolak, M.D., Marshfield Clinic. The History of MS: The basic facts. Available at: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-History-of-Multiple-Sclerosis.pdf
  4. Website ‘Wikipedia’ Myelin. Available at: https://en.wikipedia.org/wiki/Myelin
  5. Website ‘Wikipedia’ Pio del Rio Hortega. Available at: https://en.wikipedia.org/wiki/P%C3%ADo_del_R%C3%ADo_Hortega
  6. Website ‘Up to date’ Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults. Available at: https://www.uptodate.com/contents/disease-modifying-treatment-of-relapsing-remitting-multiple-sclerosis-in-adults
  7. Lavanya Vijayasingham and Fatima Fanna Mairami, Employment of patients with multiple sclerosis: the influence of psychosocial–structural coping and context. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053901/
  8. David A. Hafler, Multiple Sclerosis. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC362131/pdf/JCI0421357.pdf
  9. Website ‘Wikipedia’ History of computed tomography. Available at: https://en.wikipedia.org/wiki/History_of_computed_tomography
  10. Website ‘Wikipedia’ Magnetic resonance imaging. Available at: https://en.wikipedia.org/wiki/Magnetic_resonance_imaging
  11. Michael F Holick, Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. The American Journal of Clinical Nutrition, Volume 79, Issue 3, March 2004, Pages 362–371, https://doi.org/10.1093/ajcn/79.3.362
  12. Website ‘Medscape’ MS linked with use of hormonal contraceptives. Available at: https://www.medscape.com/viewarticle/821579
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