Medical history of MS

• 14th century - Individuals with a progressive illness suggestive of MS were observed.

• Multiple sclerosis first described and given its name by Jean-Martin Charcot in 1868. The personal diary of Sir Augustus d'Esté, born 1794 grandson of King George III of England, reveals a medical history  suggesting that Augustus suffered from multiple sclerosis. Charcot coined the term sclérose en plaques 20 years after the death of this patient in 1848.

• St. Lidwina (the Catholic patron saint of sickness and ice-skating) is thought to be one of the first known MS patients due to her recorded symptoms, which included violent pain in her teeth, blindness in one eye, and paralysis in her right arm. She was born in 1830 in what is now The Netherlands, and fell while ice-skating on a frozen canal in 1868. She took a long time to recover from her injuries which were followed by her other symptoms until her eventual death 39 years later. 

• 1940 - 72 years later, myelin is discovered. Myelin is the fatty protein coating acons ( nerves) which is attacked by the body’s immune system if you have MS. This is known as demyelination.

• 1948 - Roy Swank, a US neurologist who spent his career studying the link between diet and MS,  introduces a  low saturated fat diet to patients with MS in 1948.

• 1960s - MS is recognised as autoimmune disease. 

• 1980s - MRI scanners are introduced for clinical use. This enabled significant developments in understanding diseases. Using a combination of electromagnets and radio frequency waves, they provide very detailed information about soft tissues, and are now very widely used in diagnosing and monitoring the course of MS.

• 1990 - Roy Swank’s landmark study published in the Lancet - ‘Effect Of Low Saturated Fat Diet In Early And Late Cases Of Multiple Sclerosis’. Swank followed 144 people with MS over 34 years and concluded in his paper that those who stuck to less than 20g of saturated fat a day ‘showed significantly less deterioration and much lower death rates.’

• 2001 - The first set of McDonald criteria is published by a team led by Prof Ian McDonald. This is a tool for clinicians to ensure that they provide an accurate diagnosis of MS as early as possible. The guidelines have been extensively revised several times, most recently in 2017. 

Glossary 

• EMA - European Medicines Agency
• FDA - U.S. Food and Drug Administration 
• NICE - The National Institute for Health and Care Excellence (UK)

First generation in clinical practice - injectable drugs 

• 1993 - first medical treatment for MS developed - Betaferon, a self-injectable medication. 

• Other Beta-interferons include Avonex, Extavia, Plegridy and Rebif

• 1996 - Copaxone licensed to treat clinically isolated syndrome and “active” RRMS by FDA (EMA 2000) 

Second generation of DMD drugs available in clinical practice - infusions and tablets 

• 2004 - Tysabri, a monthly IV infusion, is approved by the FDA (EMA approved in 2006). 

• 2010 - First oral disease-modifying therapy approved for relapsing MS- Gilenya is approved by the FDA (EMA approved in 2011).

• 2012 - Aubagio approved by the FDA for the treatment of patients with relapsing forms of multiple sclerosis (EMA approved in 2013). 

• 2013 - Tecfidera approved by the FDA as first line treatment for relapsing MS (EMA approved in 2014). 

• 2014 - Lemtrada approved by the FDA for the long-term treatment of relapsing forms of MS (EMA approved in 2013, it is currently approved for “active” and “very active” relapsing remitting MS). 

• 2017 - The FDA approves Ocrevus (ocrelizumab) as the first disease-modifying therapy for primary progressive MS, and also as a therapy for relapsing remitting MS.

• 2019 - Already in use as an anti-cancer drug, Cladribine is licensed for the treatment of relapsing forms of MS and active secondary progressive MS by the FDA (EMA approved in 2018).  

• 2019 - EMA recommends temporary restriction on use of Lemtrada (April 2019). New reports of rare side effects affecting the immune system, liver, heart and blood vessels. Only use if two other DMDs have proved ineffective or if there are no other options.”

^{Photo by Robina Weermeijer on Unsplash}