Multiple Sclerosis:
Scars Of Childhood

Historical Notes p 6 Charcot wrote, "We can attribute Disseminating Sclerosis to acute infections incurred in the past." Nothing happened till the patient became undernourished and physically depleated. Under such conditions the weakest point in the Spinal Cord would revolt. "Cases are numerous in which Insular [Multiple] Sclerosis has been known to occur during convalescence after the latter affection: Tremor in the limbs with more or less Paresis, Disorders of the Speech which becomes Slow and Scanning, Nystagmus and in short all the characteristic symptoms of Insular Sclerosis may exist. At times these symptoms cease and entirely disappear but they may also continue and confirmed Insular Sclerosis occurs." p7 Towards the end of the 19th century, Devic reported sixteen patients who had visual difficulty known as Optic Neuritis, associated with involvement of the Spinal Cord, which caused marked Weakness and Paralysis of the patient. Early in the 20th century, patients similar to those originally described by Devic suffering nearly complete loss of vision with severe involvement of the Spinal Cord, were reported. D. McAlpine and M. Berliner reported several additional patients with Devic's Disease in the 1930's. Dr. V. B. Dolgopol in 1938, described a case of NeuroMyelitis Optica with pathologic study after death and stated that his patient was unusual because she was Black. Devic's syndrome, characterized by severe DeMyelination, is a subvariety of Multiple Sclerosis. Dr. F.C. Stansbury recorded the details of five patients with a confirmed diagnosis of NeuroMyelitis Optica and two of his five patients occured in Blacks, but no particular emphasis was placed on the fact that from a total of twenty cases in his review, four were Black. A recent review of seventeen Black patients studied in a MS clinic revealed five of seventeen have a confirmed diagnosis of NeuroMyelitis Optica. The most recent edition of A Textbook Of Neurology, by Dr. H. Houston Merritt states that NeuroMyelitis Optica may occur as the initial symptom of Multiple Sclerosis or may develop at any time in the disease's course. The disease may occur at any age, but is more common in children than adults.

ch2 P 9 Clinical Features Of Multiple Sclerosis Clinical MS may be described as an illness in which the Brain and Spinal Cord are involved by several or many scars, which are often quite limited to certain definite areas of the Central Nervous System, thus accounting for the variability of signs and symptoms. The precise cause of the scars in the Brain and Spinal Cord has not been definitely proved. It is clear that there are many causes but the principal causative factor is related to the common Viral Infections, many of which occur years before the onset of the signs and symptoms of illness. Childhood infections such as Measles, or Ruebela, are the most closely implicated with MS. Rarely, are other Viral Infections such as Vaccinia (the Cowpox Virus commonly used to vaccinate against Smallpox) involved. In some individuals Viral Infections which occur early in life do not disappear after the acute phase; but, remain hidden or silent only to be activated and reappear in the form of a different illness, sometimes in childhood but usually early in adulthood. The beginning or the first symptoms and signs may follow closely, after a stressful experience such as an accident or a new infection. Sometimes stress related to emotional disturbances appears to play a role in the onset of symptoms or such stress may act to aggrivate the illness. Overexertion and fatigue occasionally precipitate the first signs, which are blurred vision or weakness and numbness. p 10 The variability of symptoms and signs is related to the various areas of the Brain and the Spinal Cord, which are involved in the process of forming the scar, "plaque". Scars begin to form around the blood vessels, particularly the Veins. Original signs and symptoms of scars in the Brain are very minor and cause no concern at once, but in retrospect are frequently recognized as signs in the early stage of development. Progress of illness is very slow. In many instances the disease continues in a quiescent or Benign form. Very careful inquiry into the early signs and symptoms reveals, their hidden presence in mild form extending over a considerable period of time, dating back even into childhood. The most typical early symptoms relates to visual difficulty or Double Vision. At times, the Nervous System involvement is evidenced by such symptoms as weakness in an arm or a leg, with some difficulty in walking, or numbness and tingling preceeding weakness. Weakness or numbness in a single arm or leg is frequently accompanied for a brief period by Double Vision. Numbness and tingling disappear quickly or in a matter of days and should not be hastily appraised. Neuritis is often sufficient to describe the initial symptoms and signs. Although pain is rarely an early symptom, it is at times attributed to Arthritis or a Rheumatic symptom. Signs such as numbness and tingling cease and reappear weeks or months after the initial symptoms. p 11 Neuritis involving the Visual or Optic areas is highly important in arriving at a possible diagnosis of MS. Some blurring in vision occurs temporarily following physical exercise (Uhthoff's Syndrome). Testing of vision reveals minor changes in the width of vision with some constriction of the so-called visual fields. Visual symptoms should be recorded and testing repeated at intervals, as these are among very early signs of illness related to a loss of Myelin, which is the principle defect in Multiple Sclerosis. A careful examination by the eye specialist reveales some pallor of the Optic Discs in the back of the eye. This form of MS has been referred to as NeuroMyelitis Optica. Visual difficulty occurs as an attack of Optic Neuritis causing visual loss and some blindness, eventually to be followed by weakness in the legs and definite signs of MS. Occasionally the early symptoms have been diagnosed as acute EncephaloMyelitis often accompanied by Double Vision. The tendency for symptoms and signs to fluctuate is characteristic of Multiple Sclerosis, and the majority of patients have definite periods when they are free or relieved of symptoms. These periods occasionally last for months or years. In only one patient in every ten do symptoms and signs progress at a steady rate from the beginning. The patient often has true Dizziness with loss of balance. Speech is affected and jerkiness or Ataxia, persists from the beginning. Dr. Douglas McAlpine, recognized as a world authority on MS supports the concept that a Benign form of the disease occurs. A restricted course can last for twenty or more years; by contrast, frequent relapses with persisting weakness and Ataxia or difficulty with sphincters such as Bladder control often point to a more Progressive form of the disease. Consequently, the process is severe in some body functions; whereas, it may be very slow or quiescent in others. ch 3 p 13 About Measles And Multiple Sclerosis Measles is one of the oldest and most widespread diseases of mankind. The word "Measles" could be of German origin: masa, meaning the spot. Rubella and Morbilli are other names, but confusing, since in several European countries, Rubella is a word used for Rubella or German Measles. Historically, Thomas Sydenham first distinguished Smallpox, Measles, and Scarlet Fever as three seperate Diseases in 1670 - 1674. Although Measles was suspected of being a Virus disease early in the twentieth century; it was not until 1954 when Drs. John F. Enders and Thomas C. Peebles, were sucessful in growing the Measles Virus in tissue culture, that the Viral cause of Measles was proven. p 14 Measles Virus is included in the subgroup of MyxoViruses along with other Viruses: Newcastle Disease Virus, Influenza like Viruses and Distemper Virus in dogs and minks and the Virus of a disease in cattle called Rinderpest. The Measles, Distemper and Rinderpest Viruses are interrelated and may all represent the same Virus in their respective hosts: humans, dogs and cattle. The incubation period of Measles is usually ten to eleven days. The sequence after exposure may be outlined as follows: Virus multiplies in the respiratory passages, then spreads to Lymph Glands and into the blood. Virus continues to multiple in Lymph Glands until the first symptoms: fever, aching, inflammation about the eyes and conjunctiva, appear. A runny nose and cough result from inflammation in the Bronchi of the Lungs. The lining cells of the respiratory passages develop large giant cells. These cells are found in almost every organ, including Lymph Nodes, Intestines, Tonsils, the Appendix and Spleen. p15 The disease then progresses to the classic eruptive stage appearing on the twelfth to fourteenth day after exposure. Peeling begins in three to four days, when the rash becomes brownish with some scaling or Desquamation. After seven days to two weeks, pigmentation and scaling begin to subside and rapid recovery takes place in uncomplicated cases. Prior to the introduction of the Measles vaccine in 1963, over 400 deaths a year from Measles occured in the United States this death rate has been sharply reduced coincident with the use of the live Measles vaccine. Very rarely the Measles vaccine has resulted in a serious form of Encephalitis referred to as (SSPE) Subacute Sclerosing PanEncephalitis. p16 The incidence following vaccination of this very rare form of Measles Encephalitis is about the same as that caused by the wild disease prior to the introduction of the vaccine, that is: one per million. The Measles Virus may persists in the body and account for lifetime Immunity enjoyed by the majority of human beings, who have recovered from Measles. The long-range consequences of aftereffects of the live Measles vaccine are still unknown, because insufficient time has elapsed to asses its full effect. SSPE may occur five to twenty years after childhood Measles, and the interval may be longer in the more chronic aftereffect such as Multiple Sclerosis. The complications of Measles are severe, one severe form consists of bleeding, which on occasion has been referred to as "Black Measles". Another very serious complication is Measles Encephalitis, which may occur at any time during the course of the disease. Most recently this serious complication has been considered to be caused by the Measles Virus. However, the isolation of the Virus directly from the Brain and Spinal Fluid has been difficult but has now been accomplished in several laboratories. The most important evidence that the Measles Virus is primarily responsible for the changes in Measles Encephalitis resulted from the finding that fatal cases of Measles Encephalitis show all the classic findings produced by the Measles Virus in the body. These consist primarily of Virus inclusion bodies found in the Brain cells in experimental as well as natural Measles. When studied by the light and electron microscope, the changes are identical with those known to be caused by proved Measles infection in tissue culture cells. _______________________ Continued_in_(#09-02) ~~~~~~~~~~~~~~~~~~~~~~~