Prominent Events in how Scientific Understanding of Multiple Sclerosis has Changed the Management of it.

The first known case of MS.

1395

The ever recorded case of MS is of Lidwina the Virgin, who suffered from symptoms similar to MS. (8).

First detailed diaries of MS recorded.

1822

An illegitimate grandson of King George III was also believed to suffer from MS. He kept detailed diaries of his condition which as a result was useful for later researchers. (43).

The official discovery of Multiple Sclerosis

1868

Jean-Martin Charcot carried at an autopsy on a woman who what we now know had MS. In her brain Charcot found multiple plaques of sclerosis and hence named the disease 'Multiple Sclerosis'. To treat other patients with the disease he prescribed doses of strychnine, gold, and silver to stimulate the nervous system which was unsuccessful. He also developed the 'Charcot Triad' which was a set of criteria used for diagnosing MS, it included the presence of diplopia, ataxia, and dysarthria. (8,9,43).

Discovery of Myelin.

1878

French pathologist, Louis Ranvier discovered that the gaps in the myelin sheath were important to nerve function. As a result, it was this discovery that aided the understanding of MS as it is this degradation of the myelin sheath that is presented in MS. (44).

Nobel Prize for Medicine Awarded

1906

The Nobel Prize for medicine was awarded to Dr Camillo Golgi and Dr Santiago Ramon y Cajal for the development of a new chemical which enhanced the vision of neurons under a microscope. This was a significant technological advancement for researchers as it allowed for the better study of MS. (9).

'I am dying but you are already a corpse'

1915

British writer, W.N.P. Barbellion was diagnosed with MS at age 28. For three years until his death, he kept a detailed journal of all the symptoms he experienced, this particularly helped future researchers understand the cognitive impacts of MS. (43, 45).

Dawson's Research

1916

With the improved use of the microscope in 1906, Dr James Dawson was able to conduct thorough microscopic examinations and was able to see damaged myelin in detail never seen before. (9) .

Experimental Autoimmune Encephalomyelitis (EAE) Model

1935

Prior to 1935, it was believed that it was a virus that caused the symptoms of MS but Dr Thomas Rivers from the Rockefeller Institute showed that it was nerve tissue that caused the symptoms within MS, not viruses.
In a series of experiments, he injected virus-free myelin into laboratory animals, who developed a disease similar to MS called EAE. This model demonstrated that in the proper conditions Rivers could cause the animals' immune system to attack its own myelin. (9, 46).

The Discovery of Oligoclonal Bands

1947

After electrophoresis was invented in 1942 (47), Oligoclonal bands were discovered by Dr Elvin Kabat from Columbia University. These abnormal immunologic proteins in the spinal fluid of people who suffered from MS were imperative in the future diagnosis of the disease. (9, 48).

Discovery of DNA Structure.

1953

As a result of James Watson and Francis Crick's discovery of the structure of DNA (49.) the role in which genes play in regulating our immune system became clearer. (9).

National MS Society

1960

By 1960 the National MS Society based in New York had established over 110 chapters throughout the globe to provide management support services to individuals and families who suffered from MS. This provided families with both emotional and physical support. (9).

The First Clinical Trial

1961

The first clinical trial for MS began in 1961 when it was found in a sample of 40 people who suffered from MS that the prescription of ACTH significantly improved their symptoms subjectively. (51).

ACTH the First Major Treatment for MS

1969

A second study pertaining to the use of ACTH was conducted in 1969 cooperatively by various academic institutions across the USA. It quantitatively demonstrated that the use of ACTH somewhat improved symptoms. As a result, the use of ACTH was prescribed as a treatment for MS for the following 15 years and paved the way for more effective treatments such as high dose intravenous methylprednisolone. (51).

The First FDA Approved Drug

1970

In the late 1960s to 70s, scientists researching EAE discovered that the use of copolymer-1 or glatiramer acetate appeared to protect against EAE induction and reduced symptoms. This same principle was applied to MS. Currently, copolymer-1 in the form of Copaxone is now used to modify the immune system to reduce relapses. (52).

The use of CT Scans

1976

Computerised Tomography scans were first introduced in 1976 to study the brains of patients with MS. Although the images were relatively unclear it was still a major breakthrough for those studying the brain. (51).

The use of MRI

1981

Since its development in 1981, the use of Magnetic Resonance Imaging (MRI) has been critical for diagnosing and monitoring of MS, as it has far greater abilities at identifying lesions in the brain than CT Scanning. (53).

Twin Studies show MS may be Genetic

1987

Since the 1990s various twin studies were conducted by the International Multiple Sclerosis Consortium. The studies involved over 80,000 people. IMSGC has identified around 160 genetic variations related to MS (9, 54).

Various Treatments developed in the New Millennium .

Period: 2000 to 2010

Some of the most notable medications used to manage the symptoms of MS include:
Tizanidine- Developed for the management of muscle spasms.
Sildenafil- Developed to manage reproductive issues.
Gabapentin- Developed to treat trigeminal neuralgia and pain in limbs.
Dalfampridine- Developed to improve gait.
These medications were developed in the 2000s and there is further research being conducted on other medications. (9).