Historical Descriptions of Multiple Sclerosis

Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

For over two centuries, clinicians have been aware of various conditions affecting white matter which had come to be grouped under the umbrella term multiple sclerosis. Within the last 20 years, specific scientific advances have occurred leading to more accurate diagnosis and differentiation of several of these conditions including, neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody disease. This new understanding has been coupled with advances in disease-modifying therapies which must be accurately applied for maximum safety and efficacy.

Focus or Neglect on Cognitive Impairment Following the History of Multiple Sclerosis

Cognitive disorders are now considered an integral part of the picture of multiple sclerosis. If we trace the history of the accounts of this disease, from the early descriptions by Jean-Martin Charcot, the first to provide systematic characteristics of multiple sclerosis, to present-day accounts, reports of cognitive disturbances have demonstrated an alternating trend. Cognitive disturbances were identified in the beginning, quite clearly for the times. Then, for a long time, they were considered infrequent or attributed to other factors. Finally, since the 1980s, cognitive disturbances have been the subject of increasingly in-depth studies, and are currently assumed to be a very important consequence of multiple sclerosis. In this work, the history of the description of cognitive disorders of multiple sclerosis will be retraced by analyzing the possible reasons for the differences in attention they have received over time. It emerged from the analysis that, as in the case of other pathologies, various factors have influenced how cognitive disorders have been taken into consideration. Some of these factors are inherent to the very nature of the cognitive impairments present in multiple sclerosis; others are linked to historical periods, or to the different ways of approaching the analysis of the phenomena caused by a disease. The reflections made on these topics should, among other things, increase our awareness of how scientific investigation is invariably placed in the historical context in which it is carried out.

Oral Health Status and Multiple Sclerosis: Classic and Non-Classic Manifestations—Case Report

Background: Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations. Case presentation: A 49-year-old female patient diagnosed with long-term relapsing–remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis. Conclusions: Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient’s dental status over the years.

An Update on the Measurement of Motor Cerebellar Dysfunction in Multiple Sclerosis

Multiple sclerosis (MS) is a progressive disease that often affects the cerebellum. It is characterised by demyelination, inflammation, and neurodegeneration within the central nervous system. Damage to the cerebellum in MS is associated with increased disability and decreased quality of life. Symptoms include gait and balance problems, motor speech disorder, upper limb dysfunction, and oculomotor difficulties. Monitoring symptoms is crucial for effective management of MS. A combination of clinical, neuroimaging, and task-based measures is generally used to diagnose and monitor MS. This paper reviews the present and new tools used by clinicians and researchers to assess cerebellar impairment in people with MS (pwMS). It also describes recent advances in digital and home-based monitoring for people with MS.

Neuropathological images in the great pathology atlases

In the period between Morgagni's De Sedibus (1761) and Cruveilhier's Anatomie pathologique (1829-1842), six pathology atlases were published, in which neuropathological subjects were discussed and depicted. It was a period of transition in medical, technical, and publishing areas. The first three (by Matthew Baillie, Robert Hooper, and Richard Bright) were mainly atlases derived from pathological museum specimens. They were selective rather than comprehensive. Of the other three (by Jean Cruveilhier, James Hope, and Robert Carswell), most of the observations were made during autopsies. These illustrations required special arrangements so they could be executed during the autopsies. These were available in Paris rather than in London, which is the reason why Hope and Carswell made many of the drawings in France. The plates in these three were color lithographs. Baillie's book contains only figure descriptions. Bright's and Cruveilhier's atlases provide case descriptions. Hooper and Hope provide theoretical texts and figure legends. Carswell's book has 12 theoretical sections, each followed by plates. The relative cost of the atlases varied with the number of plates. Although the authors made use of artists and engravers, several were talented artists themselves. Many common neurological diseases were depicted.

Current Utilization and Research Status of Traditional East Asian Herbal Medicine Treatment for Multiple Sclerosis: A Scoping Review

Background: Multiple sclerosis (MS) is a chronic immune-mediated inflammatory disease of the central nervous system that is gradually increasing in prevalence. The etiology of MS remains unknown; however, it is assumed to be caused by a deterioration of autoimmune regulation. Although immunomodulatory agents are a standard treatment option in patients with MS, there is insufficient evidence about their clinical efficacy in symptomatic treatment, and many MS patients resort to complementary and alternative medicine. For this reason, we conducted a scoping review to investigate the current status of the clinical evidence related to traditional East Asian herbal medicine treatment for MS and to inform future research and treatment strategies. Method: A scoping review is an emerging methodology for knowledge synthesis that adopts the Arksey and O'Malley framework. The research question was, "What has been studied about the herbal medicine treatments administered to patients with MS?" Articles published until 2019 were identified in six databases (PubMed, Embase, Cochrane, KoreaMed, NDSL, and OASIS) in March of 2020. Data from the included studies were charted and descriptively analyzed in relation to the study's research questions. Results: Of the 1,445 articles identified, 14 studies were included in this review. Single and serial case reports constituted the majority (42.86%), with 57.14% of studies conducted in China. A total of 20 prescriptions containing 95 herbs were used in the intervention and observational studies. Herbal medicines were effective at improving clinical symptoms of MS and reducing recurrence frequency. The main cause of MS was presumed to be oxidative stress, which enhances inflammation and, consequently, causes neuronal death. Conclusion: Herbal medicines were determined to improve the symptoms of MS and to reduce the frequency of recurrences. This study suggests that herbal medicines are promising and worth pursuing further studies but the state of current evidence is poor. Thus, further, high-quality studies included larger randomized trial are required.

The "Treatise on the spleen and stomach" (Pí Wèi Lùn) as the first record of multiple sclerosis in the medical literature - A hypothesis based on the analysis of clinical presentation and herbal medicine

Background

The “Treatise on the spleen and stomach” (Pí Wèi Lùn) is the work of the scholar and physician Li Gao (Jin-Yuan dynasties, 1115–1368 C.E., China). Li Gao described a clinical presentation that today would fall under the diagnosis of Multiple Sclerosis (MS) and proposed the treatment with herbal medicine and nutritional guidelines. The PWL is well known for its application in the treatment of MS and autoimmune conditions. However, this theoretical “MS” has not yet been analyzed through a scientific investigation, and research on its herbal formulations for MS is scant.

Methods

We analyzed the PWL “MS” clinical presentation considering biomedical diagnostic criteria and neurological correlates. To support our review, we searched Pubmed for studies on the PWL main herbal formulas and their herbs/isolates used for the believed “MS” which treated experimental autoimmune encephalomyelitis (EAE)/MS.

Results

We found a very close correlation between the PWL “MS” and the current MS diagnosis. Twenty four studies on the herbs-isolates showed significant amelioration of EAE, neuronal damage, and demyelination.

Discussion

Collectively, Astragali radix, Ginseng radix, Glycyrrhizae radix, and berberine containing Phellodendri cortex reduced the severity of EAE through different signaling pathways and mechanisms of action. These herbs provided a wide range of properties such as anti-inflammatory, anti-oxidant, anti-microglial activation, anti-infiltration of leukocytes, apoptotic/anti-apoptotic balance, and neuronal protection.

Conclusion

Our review proposes that the PWL is the first record of MS in the medical literature. Its formulas and herbs-isolates offer a fertile area for MS research and an invaluable potential for its treatment.

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We propose that the Pí Wèi Lùn is the first record of MS in the medical literature.

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All twenty four studies on the PWL’s selected herbs/isolates showed improvement of EAE.

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Different signaling pathways/mechanisms of action provided synergistic properties.

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In the PWL, the gastrointestinal system is key for MS and science supports it.

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The PWL offers a fertile area of research and enormous potential for MS treatment.

Multiple sclerosis - a review

Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex gene-environment interactions almost certainly play a significant role. The epidemiology of MS indicates that low serum levels of vitamin D, smoking, childhood obesity and infection with the Epstein-Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that people with MS can be diagnosed increasingly early in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy and risk. There is now the possibility of a diagnosis of 'pre-symptomatic MS' being made; as a result potentially preventive strategies could be studied. In this comprehensive review, MS epidemiology, potential aetiological factors and pathology are discussed, before moving on to clinical aspects of MS diagnosis and management.

Treating primary-progressive multiple sclerosis: potential of ocrelizumab and review of B-cell therapies

Multiple sclerosis (MS) therapy has evolved rapidly with an increased availability of several immunomodulating therapies over the past two decades. Disease-modifying therapies have proven to be effective in treating relapse-remitting MS (RRMS). However, clinical trials involving some of the same agents for secondary-progressive and primary-progressive MS (SPMS and PPMS) have been largely negative. The pathogenesis of progressive MS remains unclear, but B-cells may play a significant role in chronic compartmentalized inflammation, likely contributing to disease progression. Biologics targeted at B-cells, such as rituximab, are effective in treating RRMS. Ocrelizumab is a humanized monoclonal antibody to CD20+ B-cells that has shown positive results in PPMS with a significant reduction in disease progression. This review aims to discuss in detail the involvement of B-cells in MS pathogenesis, current progress of currently available and investigational biologics, with focus on ocrelizumab, and future prospects for B-cell therapy in PPMS.

The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis

Until recently, multiple sclerosis has been viewed as an entirely inflammatory disease without acknowledgment of the significant neurodegenerative component responsible for disease progression and disability. This perspective is being challenged by observations of a dissociation between inflammation and neurodegeneration where the neurodegenerative component may play a more significant role in disease progression. In this review, we explore the relationship between mitochondrial dysfunction and neurodegeneration in multiple sclerosis. We review evidence that the ketogenic diet can improve mitochondrial function and discuss the potential of the ketogenic diet in treating progressive multiple sclerosis for which no treatment currently exists.

1903 manuscript revived: Cerebral disturbances in multiple sclerosis (Des troubles cérébraux dans la sclérose en plaques) by Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903)

Philanthropy aimed at helping medical research has been around for a long time. In the 19th century, cash awards were distributed by the French Academy of Medicine according to criteria determined by each generous donor. It was thus that Mrs. Bernard de Civrieux endowed the Academy each year with the task of supporting one or more laureates whose work furthered understanding of "nervous diseases". In 1903, Raymond Cestan (1872-1933) and Claudien Philippe (1866-1903) were selected for their dissertation on "cerebral disturbances" during multiple sclerosis with clinical as well as anatomical-pathological effects. Never published, this innovative manuscript, taken from the library of Fulgence Raymond (1844-1910), will be analysed here after a brief biography of each author.

Using EAE to better understand principles of immune function and autoimmune pathology

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) in which myelin becomes the target of attack by autoreactive T cells. The immune components of the disease are recapitulated in mice using the experimental autoimmune encephalomyelitis (EAE) model. EAE is classically induced by the immunization of mice with encephalitogenic antigens derived from CNS proteins such as proteolipid protein (PLP), myelin basic protein (MBP) and myelin oligodendrocyte glycoprotein (MOG). Immunization of susceptible mouse strains with these antigens will induce autoreactive inflammatory T cell infiltration of the CNS. More recently, the advent of clonal T cell receptor transgenic mice has led to the development of adoptive transfer protocols in which myelin-specific T cells may induce disease upon transfer into naïve recipient animals. When used in concert with gene knockout strains, these protocols are powerful tools by which to dissect the molecular pathways that promote inflammatory T cells responses in the central nervous system (CNS). Further, myelin-antigen-specific transgenic T cells may be cultured in vitro under a variety of conditions prior to adoptive transfer, allowing one to study the effects of soluble factors or pharmacologic compounds on T cell pathogenicity. In this review, we describe many of the existing models of EAE, and discuss the contributions that use of these models has made in understanding both T helper cell differentiation and the function of inhibitory T cell receptors. We focus on the  step-by-step elucidation of the network of signals required for T helper 17 (Th17) cell differentiation, as well as the molecular dissection of the Tim-3 negative regulatory signaling pathway in Th1 cells.

Pharmacotherapeuetic Options for the Treatment of Multiple Sclerosis

Multiple sclerosis is the most common progressive and disabling neurological condition in young adults. Neuro-inflammation is an early and persistent change and forms the basis of most pharmacotherapy for this disease. Immunomodulatory drugs are mainly biologies (β-interferons, a four amino acid peptide, and a monoclonal antibody to a cell adhesion molecule on the blood-CNS barrier) that either attenuate the inflammatory response or block the movement of immune cells into the CNS. They reduce the rate of relapse, but have little or no effect on the progression of disability. The market landscape for MS drugs is in the midst of major change because the patent life of many of these medicines will soon expire, which will lead to the emergence of biosimilars. In addition, new small molecule immunomodulatory and palliative drugs have entered the market, with more in the pipeline; a number of monoclonal antibodies and other immunomodulatory drugs are also in clinical development.

Cyclin-dependent kinase 5 activity is required for T cell activation and induction of experimental autoimmune encephalomyelitis

Cyclin-dependent kinase 5 (Cdk5) is a ubiquitously expressed serine/threonine kinase. However, a requirement for Cdk5 has been demonstrated only in postmitotic neurons where there is abundant expression of its activating partners p35 and/or p39. Although hyperactivation of the Cdk5-p35 complex has been found in a variety of inflammatory neurodegenerative disorders, the potential contribution of nonneuronal Cdk5-p35 activity has not been explored in this context. We describe a previously unknown function of the Cdk5-p35 complex in T cells that is required for induction of experimental autoimmune encephalomyelitis (EAE). T cell receptor (TCR) stimulation leads to a rapid induction of Cdk5-p35 expression that is required for T lymphocyte activation. Chimeric mice lacking Cdk5 gene expression in hematopoietic tissues (Cdk5(-/-C)) are resistant to induction of EAE, and adoptive transfer of either Cdk5(-/-C) or p35(-/-) encephalitogenic lymphocytes fails to transfer disease. Moreover, our data reveal a novel mechanism involving Cdk5-mediated phosphorylation of the actin modulator coronin 1a on threonine 418. Cdk5-deficient lymphocytes lack this posttranslational modification of coronin 1a and exhibit defective TCR-induced actin polarization and reduced migration toward CCL-19. These data define a distinct role for Cdk5 in lymphocyte biology and suggest that inhibition of this kinase may be beneficial in the treatment of T cell-mediated inflammatory disorders.

The impact of stressful life events on risk of relapse in women with multiple sclerosis: A prospective study

Purpose

The aims of this study were first, to examine the general relation between stressful life events (SLEs) and clinical relapses in women with multiple sclerosis (MS) and second, to investigate the relations of the specific stressor attributes of duration, type, and severity on MS exacerbations.

Methods

Twenty six ambulating women with relapsing-remitting MS were followed-up for a mean of 56.3 weeks. Patients documented SLEs weekly in self report diaries which were then collected at regular pre-scheduled clinic visits every 4 weeks. SLEs were classified as short-term if they had subjectively no lasting effect and long-term if they had a subjectively felt psychological impact that lasted at least 10–14 days after the event. The severity of SLEs was determined using the Recent Life Change Questionnaire.

Results

Experiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7–16.4, p = 0.003). The presence of at least one long-term SLE was associated with three times (95% CI 1.01–9.13, p < 0.05) the rate of MS exacerbation during the following 4 weeks. There was no significant association between the severity (95% CI 0.99–1.01, p > 0.05) or the type (χ2 = 7.29, df = 5, p > 0.05) of stressor and the risk for relapse.

Conclusion

Ambulatory women with relapsing-remitting MS who experience cumulative SLEs may be at a greater risk for relapse. Duration is the only stress attribute that seems to increase the risk for relapsing in contrast to stress type and stress severity that were not found to interact with MS exacerbation.

Management of progressive multifocal leukoencephalopathy associated with natalizumab--possibilities and responsibility

Multiple sclerosis (MS) is prevalent in areas with many inhabitants of Scandinavian descent, and a 'Viking gene' hypothesis has been suggested for the dissemination of the disease. It is therefore relevant to search Norse sagas for descriptions of clinical pictures which could have been MS. The saga of Bishop Thorlak describes a woman named Halldora, who suffered from transient paresis between 1193 and 1198. The diagnosis is uncertain, but the story shows that symptoms associated with MS were known in Iceland at the end of the 11th century.