The Humbling History of Multiple Sclerosis

Posted By SHL Librarian

MRI snapshotPresented by: Jeffrey Dunn, MD
Associate Director, Stanford Multiple Sclerosis Center

Lecture Overview:
mri.GIF

  • The symptoms of multiple sclerosis have been described since the 1300s, but it wasn’t until the early 20th century that a unified picture emerged
  • The biggest breakthroughs in understanding and treating MS have taken place when researchers and physicians work together
  • While excellent therapies currently exist, advanced imaging and technologies like proteomics are leading to the promise of more targeted and effective treatments

In the late 1300s outside Rotterdam, a young woman suddenly collapsed, suffering limb weakness, face pain and vision problems. Her symptoms were well documented as her health deteriorated, and she was later canonized as St. Lidwina, the patron saint of ice skating. She also appears to have been the first documented case of multiple sclerosis-a theory substantiated when her body was exhumed for study 650 years later.

Augustus d’Este, an illegitimate son of King George III, kept a detailed journal for more than 20 years that documented his health problems, even though, in 1822, no one yet knew what condition he had. He described his symptoms so clearly that later researchers were able to definitively diagnose him as having multiple sclerosis.

“Over the years, individual cases of MS have been reported in great detail,” said Jeffrey Dunn, MD, co-director of the Stanford Multiple Sclerosis Center, who discussed the past, present and future of MS at a presentation sponsored by The Health Library on May 15. “But it wasn’t until physicians and researchers started to compare notes and share experiences that a unified view of multiple sclerosis emerged.”

That first cohesive perspective of MS-one that connected the symptoms with anatomical changes-was introduced in 1869 by Jean-Martin Charcot, who is considered the father of modern neurology. He meticulously tracked the symptoms of one of the patients in the Paris hospital where he worked and taught. The autopsy of her brain revealed hard nodules, which he called sclerosis of plaques.

Additional reports throughout the 1800s described “strange cases” of this new disease, but it was considered rare, a perception that changed dramatically: By 1950, neurologists considered MS one of the most common neurological diseases in America.

“It’s important to look forward because the future of multiple sclerosis is one of hope,” said Dunn. “But we can understand the future better by looking at the past.”

MS appears to be more common among people of Northern European descent, although it is becoming more common in people with Latino backgrounds. While factors such as fat in the diet, industrial development, toxic exposure, vitamin D and viral exposure have all been attributed to inducing MS, its probable cause is most likely a combination of genetic and environmental factors, said Dunn

“No two cases are alike, which is one of the most challenging aspects of MS, but most cases present in a certain way,” he said. “Monthly MRIs show MS progression and plaques as white spots that show up and then disappear, like fireflies. Symptoms relapse in about 85 percent of cases, and the disease does tend to slow down over time. But MS is not only different in each patient; it changes over time even within an individual in many cases. Even more problematically, there are no biomarkers for the disease and no metrics for disability.”

Physicians learned to recognize MS because of improved technologies, such as magnetic resonance imaging (MRI), and because there were more neurologists with the skills to make the difficult diagnosis. Today there are six FDA-approved treatments for MS, and despite the challenges from new limitations on using placebos in clinical trials, Dunn said there are almost 70 new therapies in various stages of trials, many of which will be tested at Stanford.

Dunn explained the strategies and the trial-and-error studies behind several of the current therapies, some of which were originally designed as chemotherapies, treatments for other diseases and even carpet dye.

“The biggest advances in discovery take place when clinical care and research are combined together and allowed to interface,” said Dunn. “New technology like advanced microscopic techniques and proteomics, which maps proteins, gives us the chance to translate discoveries to humans and positions us to find specific therapies.”

About the Multiple Sclerosis Center at Stanford Hospital & Clinics

The Multiple Sclerosis Center provides comprehensive, specialty care, using state-of-the-art techniques to diagnose, evaluate, manage and treat adult patients with MS. Its team of neurologists offers particular expertise in diagnostic and treatment challenges, combining individualized care with promising clinical research opportunities. One of only two dedicated MS centers in the Bay Area, its physicians and staff offer a unique depth of knowledge for MS patients.

The Center provides:

  • comprehensive patient care
  • neurological tests and assessments
  • access to clinical trials
  • state-of-the-art technologies, including MRI and electrodiagnostics
  • a localized clinical immunology infusion service
  • information on new treatments and current research
  • recommendations for follow-up services

The Multiple Sclerosis Center is located on the third floor of the Boswell Building of Stanford Hospital & Clinics in the Neuroscience Clinic, Room A301.

Hours are 8:30 am-5 pm Monday-Friday.

Tel: 650-723-6469

About the Speaker
Dr. Dunn is the associate director of Stanford’s Multiple Sclerosis Center and an associate professor of neurology and neurological sciences. He is a board-certified neurologist specializing in the diagnosis, treatment and clinical research of multiple sclerosis and demyelinating disease.

With a focus on clinical care, he also conducts research on combination therapy and emerging immunotherapy and has worked as a principal investigator for clinical research studies sponsored by the NIH and other organizations. Dr. Dunn served as president and chief medical officer of the “MS Hub,” a novel regional care center at Evergreen Healthcare in Kirkland, Washington, before joining Stanford in early 2008.

Dr. Dunn earned his MD from Temple University and did his specialty training in neurology at the University of Washington.

For More Information:

Stanford Health Library can do the searching for you. Send us your medical questions.

Stanford Multiple Sclerosis Center
http://www.stanfordhospital.com/clinicsmedServices/COE/neuro/multipleSclerosis/default

National Multiple Sclerosis Society
http://www.nationalmssociety.org/index.aspx

Multiple Sclerosis Foundation
http://www.msfacts.org/index.php

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm#104833215