In my last installment in my Intro to MS series, Part 1 of the Hx of MS, I left off at the end of the nineteenth century with Jean-Martin Charcot. He was the first physician to diagnose MS in a living patient, and spent years trying to help her.
He was also the first to establish criteria for the diagnosis of MS – nystagmus, intention tremor, and scanning speech. Although his attempt was limited, it was important. Before this, our disease was lumped together with other “nervous disorders” popular of the time.
Several things occurred around the end of the 19th century that are important to note here.
This article from the MSAA has a complete timeline of what I’ll be describing.
In 1891, the lumbar puncture technique was developed – this is still used to this day to diagnose MS in some patients. I consider myself lucky to never have had one, as I’ve heard they’re not comfortable. at. all.
Just 8 years later, in 1899, oligodendrocytes were first discovered. These cells are responsible for the production and maintenance of myelin, obviously critical in MS.
At this point, we were still unaware of the immune system, so it would have been impossible to classify MS correctly. For years, toxins and bacteria were blamed. Once discovered and better understood, viral infections were blamed, too.
Right before World War Two, MS research had a breakthrough. Some people developed MS like symptoms after getting rabies vaccines. This led to a loooot of research on viral causation. It was assumed that the virus attacked the myelin. In 1935, this line of thinking changed.
At the Rockefeller Institute in New York City, Dr. Thomas Rivers showed that immune cells, not viruses, produced the MS-like illness. He did this by injecting animals under the right conditions to cause an MS like disease in them. They called it experimental allergic encephalomyelitis, or EAE for short.
I’m not going to lie, this makes my heart cringe. ALOT. I don’t eat animals, and I can’t imagine forcing an animal to go through a disease similar to MS for my benefit. What kind of world do we live in that this kind of thinking is considered normal? But, I digress.
This work led to a lot of the autoimmunity theories we have today. At the time however, it was mostly looked over and ignored for the toxin theory. For the next 30 years or so, lots of theories were thrown around, but very little was actually accomplished in autoimmunity.
That changed after DNA and the immune system was better understood, as well. In the 1950’s and 1960’s, with the help of data collected during WWII, many more breakthroughs occurred.
In 1955, Dr. Kurtzke defined the Disability Status Scale. It may have changed a little, but remains mostly as it was years ago. This also goes for the criteria for diagnosis of MS, redefined long after Charcot first set his standards back in the day. These weren’t described until 1965.
Interferons, which I and many fellow MS warriors are on, were discovered in 1957. Interferons, if you didn’t know, are types of immune cells that fight off certain infections.
Everyone has felt the effects of interferons; you know that icky, gross feeling the day before you get really sick? Those are interferons gearing up for the fight.
These were first given to MS patients in 1977, and by 1982, Dr. Jacobs was reporting a reduction in exacerbations for those patients on the therapy. I’ve talked about my experiences with two different interferons before, Plegridy and Rebif.
This was huge for MS patients – up until this time, we only had treatments for acute flare ups of symptoms. Starting in 1951, doctors started using corticosteroids for exacerbations.
If you’ve ever had the relief of steroids during a flare before, I don’t have to tell you how amazing that was for us.
But moving forward, we now had interferons to help prevent exacerbations, not just treat the side effects of the inflammation.
The same year Jacobs reported that the interferons indeed were working, the first MRI was done. We saw lesions up close and personal for the first time in 1981. By 1983, the scientific community was looking at the Epstein-Barr virs as a potential cause – and the EDSS, or Expanded Disability Status Scale, was introduced.
The last 35 lears have seen an explosion of medication therapies available for Multiple Sclerosis. Initially, a lot of these medications were prescribed off label. Amantidine and Provigil were approved for fatigue. Baclofen was approved for spasticity, and so was Botox for both spasticity and urinary incontinence.
The biggest explosion came in the disease modifying drug category. SO MANY therapies have come about, pretty much all in my lifetime. Rebif wasn’t approved in the US until the year I was born – 1991.
Since then, not only do we have a dozen more modifiers for RRMS, but we also now have some approved for SPMS and PPMS, too. This huge news was just announced this year.
That’s exactly what I’ll be covering in the next installment in my Intro to MS series – allll the different DMD’s, how they work, and what type of MS they’re used for.
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