This book provides general information on health care and is not intended to be a substitute for the advice of your doctor. You should consult your doctor before starting any medical treatment or program to discuss your individual needs and obtain information about symptoms and treatments. This book is not a substitute for medical diagnosis, and you are advised to speak to your doctor for specific information on personal health matters.
The Discovery of MS
The first description of what was probably MS dates back to August 4, 1421, when Jan Van Bieren, Count of Holland, described the “strange disease of the virgin Lidwina,” who in 1395, at the age of 15, developed severe facial pain and leg weakness after falling on the ice while skating. Within a few years her problems had increased: her legs were so weak that she could not walk, she had leg numbness and she was intermittently blind in one eye. She died in 1433 at the age of 53 .
The first descriptions of the physical changes that MS produces in the brain and spinal cord came almost simultaneously, in 1835, from Jean Cruveilhier, professor of pathologic anatomy in the Sorbonne’s Faculty of Medicine in Paris, and Robert Carswell, a Scotsman who worked at the Hôpital de la Pitié in Paris for 3 years. However, the first scientific description of the signs and symptoms of MS came from Jean-Martin Charcot (1825–1893). Charcot outlined a condition called la sclérose en plaques—in effect, multiple sclerosis—which he had first become familiar with while watching its gradual development in a maid employed in his house. From1862 to 1870, Charcot worked at La Salpêtrière, a Paris asylum for beggars, the aged, the infirm and the insane. There, he examined thousands of patients. His findings led him to correlate the signs and symptoms of MS with the disease-related anatomical changes seen at autopsy. Following Charcot’s description, the disease was increasingly recognized. When the German pathologist Muller wrote a book on the subject in 1904, he cited more than 1,100 published papers relating to the subject. Charcot’s scientific exploration of MS paralleled the creation of neurology, the specialty branch of medicine that deals with diseases of the nervous system. In those early days, the only way to determine what was going on in a person was through neurological examination—that is, by having the person demonstrate how well certain functions of the nervous system (vision, balance, reflexes and so on) were working. Today we have a variety of special tests to help us diagnose the disease.
Types of MS
Charcot understood that MS is a variable disease with different forms. Today, physicians categorize MS as one of two main types. If recurrent attacks of neurological symptoms are followed by periods of improvement the disease is called relapsing-remitting MS. This is what Jane has. If, on the other hand, the symptoms worsen over time without any periods of improvement, the disease is called progressive MS. This is what Bob has. The types of MS will be explained in more detail in later chapters.
What is MS?
What is happening in the nervous system of someone who has MS? Where is the damage done? Keeping in mind that we still don’t know enough about the disease, here are the answers, based on our current level of knowledge.
The Nervous System
It would be impossible to overstate the importance to us of a normally functioning nervous system. This system is responsible for everything that makes us thinking, feeling, mobile beings. Different parts of the nervous system control different functions, so damage to particular areas results in loss of particular functions. To give a simple example: if the nervous tissue in your right eye is destroyed, you lose vision in your right eye. The brain and spinal cord make up the central nervous system (CNS). From the CNS, nerves extend throughout the body to make up the peripheral nervous system. Significantly, MS affects only the central nervous system. Comments in this book apply only to the central nervous system, unless otherwise noted.
The brain itself consists of two main areas: a pair of hemispheres on top, and the brainstem on the bottom. The hemispheres (one on each side) are connected together by a bundle of fibers called the corpus callosum. Each hemisphere is divided into four main lobes, each of which has specialized functions. The frontal lobes are used mainly for planning, judgment and movement; the temporal lobes for memory; the parietal lobes for sensing; the occipital lobes for vision. Deep within the hemispheres lies the limbic system, an area involved in our emotions.
The brainstem carries electrical impulses from the hemispheres down to the nerves in the spinal cord, and from the spinal-cord nerves up to the hemispheres. Just behind the brainstem lies the cerebellum, the organ that controls our sense of balance and coordination.