Some MS History – 4/18

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I decided to look up the history of Multiple Sclerosis today and found some interesting things. Unknown by many including me this is a very old disease. The French neurologist Jean-Martin Charcot (1825–1893) was the first person to recognize multiple sclerosis as a distinct disease in 1868.

Charcot was a professor at the University of Paris and considered “the father of neurology”. Just think, 1868! And still no cure for this lovely disease! Charcot summarized previous reports and added his own clinical and pathological observations. Charcot called the disease “la sclerose en plaques”.

Drawings from autopsies done as early as 1838 clearly show what we
now recognize as MS. Then, in 1868 Charcot carefully examined a young woman with a tremor. He had never seen this type of tremor before. He noted her other neurological problems including slurred speech and abnormal eye movements. He compared them to other patients he had seen. When the woman died he examined her brain and found the characteristic scars or “plaques” of Multiple Sclerosis.

It was Charcot and the use of the anatomoclinical method that made the first correlations between the clinical features of MS and the pathological changes noted post-mortem. The recognition of MS as a distinct disease was quite a feat for the time. Many diseases in the early 19th century were categorized as either neurological or psychiatric.

Diseases would have been grouped into a general class of “nervous disorders” with no separation between individual conditions. Such an attempt at the classification of neurological diseases had not been undertaken prior to Charcot. Only a small group of illnesses such as epilepsy, paraplegia, and neurosyphilis were differentiated at the time.

Even though Charcot discovered MS in 1868 it was not the first case. The first clearly recognizable case of multiple sclerosis appears to have been that of Augustus d’Este (1794–1848). He was the grandson of George III of England and cousin of Queen Victoria. It was the Queen who carefully documented his illness in a diary.

Other historians believe that Lidwina of Holland, born in 1380, had multiple sclerosis. That’s just crazy! During the next century various theories were proposed to explain the cause of multiple sclerosis including infection and toxins.

The first drugs for MS acted by modulating the immune system. They were approved by the Food and Drug Administration (FDA) and became available in the 1990s. The chief technological advance that allowed physicians to view the disease process was magnetic resonance imaging or MRI. The MRI is what ultimately led to the FDA approval of MS drugs. In terms of understanding the disease process the MRI has been for multiple sclerosis what chest radiography was for tuberculosis.

Sir Robert Carswell noted the presence of demyelinating lesions associated with MS. Then Jean Cruveilhier was the first to document the clinical findings from a patient that would later develop demyelinating lesions. The implications of these findings were not fully understood.

Charcot’s detailed description of MS in 1868 accompanied by the first drawings illustrating the expansions of lesions from the ventricles into the cerebral hemispheres. These provided the earliest insight into the pathology of MS involving both the brain and spinal cord. He would go on to fully describe the various forms of MS (cephalic, spinal, and mixed/cerebrospinal), once again correlating the symptoms at presentation with findings post-mortem.

In addition to lecturing about this disease on a regular basis Charcot was the first person to diagnose MS on a living patient. In fact, he even formulated a triad for diagnosing MS (nystagmus, intention tremor and scanning speech.) Though lacking in specificity it remains important as it was an attempt to separate this disease from similar diseases affecting the nervous system.

Remarkably, the relevance of some of Charcot’s histopathological observations have only recently been acknowledged such as axonal transaction within plaques and remyelination. To sum this up MS has been around since at least the 1800’s! Although we now have drugs to slow the disease down there isn’t a clear cut cure yet. I took one of those drugs (Copaxone shots) for 20+ years and it didn’t seem to slow anything down as I’m now considered PPMS.