MS Active Source

MS The Disease

• Introduction
• History of MS
• What is MS?
• Who gets MS?
• Symptoms of MS
• Course of the disease
• Diagnosis
• Treatment of MS

Professor Jean-Martin Charcot teaching at the Salpêtrière in Paris, France: presenting a patient to his students

Progress in the understanding and management of MS (ref m24)

MS was one of the first diseases to be described scientifically. This occurred in 1868 when Jean-Martin Charcot, a professor of neurology in Paris, described the condition in a young woman. He described the neurological symptoms and when she died examined her brain and described the characteristic scars or plaques seen in MS patients. He named the condition 'scleroses en plaques'. However, it took another century for developments in understanding the workings of the human brain and the immune system to reach a stage where the pathological processes involved in MS could be unravelled and active treatments be developed to help patients live with the disease.

The first treatment shown to relieve symptoms of an MS attack was adrenocorticotropic hormone (ACTH). In a placebo-controlled trial, ACTH was shown to speed up recovery from exacerbations. ACTH stimulates the production of corticosteroids which have an anti-inflammatory effect. ACTH therapy has since been replaced by treatment with iv corticosteroids, which are still used to treat acute exacerbations. This was the first effective therapy discovered for the treatment of MS.

The 1970s saw two important developments in the management of MS. Firstly, CAT (Computed Axial Tomography) scans and evoked potential tests were introduced for the diagnosis of MS and therefore made it easier to obtain a definitive diagnosis. Secondly, the first trials of the disease-modifying agents, IFN-beta and glatiramer acetate, began to show that these agents could slow progression of MS.

The next two decades saw further improvements in diagnosis of MS with the introduction of MRI scans to replace CAT scans in the 1980s, and approval of various IFN-betas (Avonex, Betaferon and Rebif) and glatiramer acetate (Copaxone) for the treatment of relapsing-remitting MS 1995-2002. Betaferon was the first to be approved in 1995, followed by Avonex in 1997, Copaxone in 2002 and Rebif in 1998. By the end of the twentieth century, MS had moved from being a little understood disease with no effective treatments, to being a well-understood disease with effective treatments to relieve exacerbations and slow the progression of the disease.

The twenty-first century looks set to see further developments in the understanding of the pathology of MS, which will then enable better treatments to be developed. 2006 saw the approval of a new class of disease-modifying therapy, natalizumab, a selective adhesion molecule inhibitor. The development of natalizumab (Tysabri) was made possible by the increased understanding of the pathological processes involved in MS. While Tysabri offers hope to patients who fail to benefit from IFN-beta or have highly active relapsing remitting MS, there still remain patients with other MS subtypes for whom disease-modifying therapies are currently not available. There is therefore a need for the development of further treatments to slow or halt the progression of MS. With further developments in the understanding of the pathology of MS being achieved by ongoing research, it looks likely that additional treatments will be developed in the near future.

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