Multiple Sclerosis: An Overview and History of the Disease

Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord. This typically results in loss of muscle control, vision, balance, sensation and thinking ability.

The name "multiple sclerosis" comes from the scar tissue (or sclerosis) that occurs on the brain and spinal cord through a process called demyelination. In this process, the myelin sheath that covers and insulates the nerves is destroyed. Nerves can, with time and proper health care, regain myelin, but the process is often too slow to compete with the affects of multiple sclerosis. Without myelin, electrical signals in the brain and spinal cord are disrupted (WebMD).

Most multiple sclerosis patients are diagnosed between the ages of twenty and fifty, and only five percent of patients are diagnosed before the age of twenty-one. Women are two to three times more likely to have MS. Most patients diagnosed with multiple sclerosis come from Northern European descent, but a large number of cases still exist in other races (National multiple sclerosis Society). Countries such as Denmark have 105 cases per 100,000, but Portugal has only thirteen per 100,000 (Nicolson). Doctors estimate that over 2.5 million people worldwide suffer from multiple sclerosis, and about 400,000 of those cases occur in the United States (National multiple sclerosis Society).

The most likely cause of multiple sclerosis is genetics, but other factors such as the environment and viral infections may play a role. Studies show that the prevalence of MS increases gradually with distance traveled from the equator. Other studies link pre-adolescent moves to areas with a high prevalence of MS may significantly increase an individual's chance of developing the disease. A few 'epidemics' of MS have occurred in areas such as Denmark, but there is no direct proof that an environmental factor causes MS. Some viruses, such as measles, herpes, and flu viruses have been studied in relation to multiple sclerosis, but no direct link has been made. The main accepted cause is still genetic, though researches now believe that several different genes contribute to the likelihood of developing MS. One theory is that some children are born with a predisposition for MS, and then an environmental factor may trigger the disease later in life (WebMD).

Symptoms of MS vary greatly depending on the extent of damage to the myelin. The early symptoms of MS are tingling, numbness, loss of coordination, weakness in one of more limbs, and blurred or double vision. The later symptoms of MS include slurred speech, paralysis, and a sometimes complete lack of coordination. Primary symptoms result directly from the result of the demyelination process. Secondary symptoms are caused by the primary symptoms. For example, urinary incontinence resulting from demyelination may often results in urinary tract infections, and the urinary tract infection is a secondary symptom. Tertiary symptoms are the complications (often social and psychological) that result from the primary and secondary symptoms, and a common tertiary symptom in MS patients is depression. (WebMD).

There are four clinical courses of multiple sclerosis. In Remitting/Relapsing cases, the patient experiences 'flare-ups,' or periods of time when neurological functions are noticeably worse. These periods are then followed by periods of recovery, called remissions. This is the most common course for MS, and it occurs in approximately eighty-five percent of cases. The Secondary/Progressive course of MS is seen in fifty percent of Remitting/Relapsing cases. In this course, the patient's condition continually worsens without any sign of flare-ups or remissions. This usually occurs about ten years after the original diagnosis of MS in most cases. The Primary/Progressive course affects about ten percent of MS patients overall. This course is characterized by the disease continually worsening from the very beginning. The final course, Progressive/Relapsing occurs in about five percent of all MS patients. This course is characterized by all of the worsening symptoms of MS, but it is very rarely followed by any sort of recovery period (DestinationCure.com).

True documentation and study of MS only truly started in the 1800s, so many mysteries still exist about the nature of the disease. Due to the lack of concrete information, fierce debate exists about how to treat the disease. Like many disease with no direct cure, the most accepted treatment is to treat the symptoms. Fatigue, which may result from the actual disease or from depression caused by the disease, can be treated through the use of certain drugs like Pemoline, which is a stimulant drug. Other symptoms, such as bladder disorders and urinary tract infections, can be prevented or treated through detection by urinalysis, cultures, and increased intake of Vitamin C. Drugs such as oxybutynin can be used to treat spastic bladders. Chronic constipation, often seen in very weak MS patients, can be treated through fluid intake, a high fiber diet, or a stool softener. Since many symptoms affect the muscles, drug therapy is often supplemented with an exercise program to help tone the muscle in an effort to regain and maintain muscle control. In MS cases where attacks do not remit spontaneously, the use of steroids such as methylprednisolone (ACTH) commonly occurs. ACTH helps to reduce inflammation, and laboratory studies suggest temporary improvement in the ability of nerves to conduct electrical impulses, even in areas where demyelination has occurred. Since tertiary symptoms do occur, many MS patients seek counseling to deal with the emotion issues involved in living with MS (Shuman). Recent developments in medicine have led to several disease modifying drugs that slow the progression of MS. These drugs suppress or alter the activities of the body's immune system to prevent it from further attacking and destroying the myelin. The use of such drugs often lowers the frequency and severity of attacks. The most common drugs used for this purpose today include Avonex, Betaseron, Copaxone, Novantrone, Rebif, and Tysabri (WebMD).

Since there is no absolute cure for multiple sclerosis, the main goal of treatment is to improve the quality of life. The stress of caring for or living with someone who has MS takes a great emotional toll on individuals close to the patient. Outside of the comforts of home, employment may become more difficult. Some employers are uncomfortable with the prospect of having a worker who suffers from MS, and some physical aspects of the workplace are simply not possible with the possibility of having an 'attack' in the workplace. In addition, the heavy fatigue experienced in the workplace often affects the patient's ability to maintain the same level of work, and that is why it is necessary to try to treat the symptoms like fatigue. For many of those diagnosed with MS, sexual function is also disrupted. While a diagnosis of MS may shed some light on previous sexual difficulties, this also leads to physical and emotional issues that must be treated somehow (Schuman). The social implications of being diagnosed with MS are enormous. As recently as 1957, MS patient Ellen Galle expressed that she simply could not tell her own husband about her diagnosis out of fear. Patients today often request that organizations such as the MS Society in Great Britain send all mail in plain envelopes so that the neighbors will not know about the disease (Nicolson).

The first major case that displays the symptoms of MS occurred in Lidwina of Schiedam (1380-1433). For thirty-seven years prior to her death, she showed symptoms that match perfectly with most accounts of MS, but her diagnosis still remains only as 'possible MS.' At the time, the disease had no name, and Lidwina told all the world that she suffered physically for the sins of others. She often suffered from pain and weakness, and she occasionally had remission periods where she displayed few symptoms. Later in her life, she claimed to have supernatural visitations and experiences, which can be attributed to the loss of proper thought process. However, it can also be attributed to 1407 superstition (Murray).

A later case, documented in Richard Gough's Antiquiteyes and Memoyres of the Parish of Myddle, shows another patient with 'possible MS.' In the book, Gough describes the parish of Myddle in detail between the years of 1700 and 1706. Margaret of Myddle had a lameness that progressed over twenty years following the birth of her child. Margaret suffered from eventual paralysis in the legs and later in the arms, and she also later developed contractures and pressure sores common in MS patients. Even at that point, Margaret's doctor recognized the disease and labeled Margaret incurable, but the disease still did not have a name or any solid information (Murray).

William Brown, a Hudson's Bay Trader began to show some symptoms of the still unnamed disease in 1811. He developed weakness in his legs as well as problems with his eyesight. He died a few years later after being relieved from his duties to the Hudson's Bay Company because he physically could not work (Murray).

Other recordings of 'possible MS' patients have been made throughout history. Augustus d'Este, cousin to Queen Victoria, documented his own disease in his diary between 1822 and 1848. Historians now agree that this disease is most certainly MS, and the in-depth diary entries helped to document some of the symptoms. Heinrich Heine (1797-1856), a famous poet, started displaying symptoms of MS at the age of thirty-five, and he died twenty-four years later (Murray).

While scientists and doctors still did not understand or have a name for the disease, documentation of autopsies dating as far back as 1838 show clear symptoms of today's multiple sclerosis patients. Doctor Jean-Martin Charcot, the 'father of neurology,' began studying a woman with a highly abnormal tremor in 1868. The woman also had slurred speech and abnormal eye movements. When the woman died, Charcot examined her brain and found the scars (plaques) common in MS patients. He compared this to similar cases and then produced a complete description of the disease, and he finally gave the disease its name. However, Charcot did not understand the cause of the disease or how to treat it; he soon discovered that the disease resisted all of his attempts to treat it. Despite the use of electrical treatment as well as the common treatments for syphilis, Charcot could not find a definite treatment for MS ("The History of multiple sclerosis").

Another scientist, Babinski (1857-1932), described in detail the various stages of myelin disintegration found in multiple sclerosis patients. Babinski even created a visual representation of the progress found in MS patients. In 1913, doctors began using a lumbar puncture to examine the cerebrospinal fluid to diagnose MS. Proteins found in the cerebrospinal fluid of MS patients are not found in healthy people, so this became the most effective method for diagnosing MS. Later, with the development of nuclear magnetic resonance tomography imagining (NMRT, MRI) around 1982, visual changes in brain tissue could be documented. Beginning in the 1990s, several medicines were developed and licensed to treat MS, but none of the drugs completely followed up on the promise to cure the disease. In 1993, doctors started using interferons to treat MS. This treatment reduced annual attacks by about one-third, but doctors still did not have a cure for patients suffering from MS (Nicolson). Towards the beginning of the twenty-first century, trials between different drugs that showed some benefit to patients with MS began. During this time, drugs such as Avonex gained approval after extensive lab work. Then, in 2001, new criteria for the definite diagnose of MS was established (Murray).

Several families across the country and around the world are affected by this powerful disease. As understanding of the disease grows, the knowledge of the public should reflect such developments.

Works Cited

"Destination Cure: The Race Against MS." DestinationCure.com. 5 April 2007. /www.destinationcure.com/index.html>

Nicolson, Malcolm and George W. Lowis. "The Early History of the Multiple Sclerosis Society of

Great Britain and Northern Ireland: A Socio-Historical Study of Lay/Practitioner Interaction in

the Context of a Medical Charity." Medical History 46 (2002): 141-174. /www.pubmedcentral.nih.gov/picrender.fcgi?artid=1044493&blobtype=pdf>

Murray, T. Jock. Multiple Sclerosis: The History of a Disease. New York: Demos. 2005.

National Multiple Sclerosis Society. 2007. 5 April 2007. PageServer?pagename=HOM_GEN_homepage>

Shuman, Robert and Janice Schwartz. Living With Multiple Sclerosis: A Handbook for Families.

New York: Collier Books. 1994.

"The History of Multiple Sclerosis." 2007. 5 April 2007.

"WebMD Multiple Sclerosis Center." WebMD. 2007. 5 April 2007. multiple-sclerosis/default.htm>