Multiple sclerosis is a disease of the central nervous system characterized clinically by recurring episodes of neurological disturbance which, especially early in the course of the disease, tend to remit spontaneously, although as time goes by there is often a gradual accumulation of disability. The course of the disease is quite variable, at one extreme lasting for 50 years without the development of significant disability, and at the other terminating fatally in a matter of months. Overall, about one quarter of patients remain able to work for up to 15 years after the first recognized clinical manifestation, and the mean duration of life is approximately 25 years from that time. Nevertheless, because the disease commonly affects young adults and produces disability in the prime of life, the economic burden is heavy, in the United States averaging $15,000 per annum per family with a member afflicted (Inman 1983 data, cited in McDonald and Silberberg, eds. 1986, 180).

Overview

Multiple sclerosis is a remarkable disease. It was first clearly described more than 120 years ago in a way which we would recognize as a modern, pathologically based account that discusses the clinical features of the illness and their possible pathophysiology (Charcot 1868). It is only since the early 1970s, however, that real progress has been made in understanding its nature, course, and pathogenesis. It was discussed in treatises on pathology by R. Carswell (1838) and J. Cruveilhier (1835–42), and more knowledge was added by E. Rindfleisch (1873), but the French school did most to delineate the disease.