Multiple sclerosis—an enigma

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The accurate diagnosis of multiple sclerosis may be one of the easiest in medicine to make in some instances, but on other occasions it may be one of the most difficult. Literally volumes have been written about this disease, in regard to etiology, symptoms, and treatment; yet, concerning most of these aspects there is little total agreement among clinicians. However, nearly everyone is willing to admit that no one really knows what constitutes multiple sclerosis as a clinical entity; no one knows the cause of it; and, thus far, there is no really satisfactory treatment for this condition.

Multiple sclerosis or, as it is sometimes designated, disseminated sclerosis, insular sclerosis, or Charcot’s term sclérose en plaques,1 was first recognized and described by Carswell2 (1838) and Cruveilhier3 (1829–1842).

According to Greenfield,1 Charcot is credited with being the first physician to recognize the pathologic features of this disorder and, his report of the triad of the clinical manifestations of the disease—intention tremor, scanning speech, and nystagmus—has been referred to by most clinicians who have written about multiple sclerosis.

Observations concerning multiple sclerosis, which have accumulated from a neurologic practice at the Cleveland Clinic, make me realize how difficult a problem is this fairly common neurologic entity. Unfortunately, the term disseminated sclerosis has in many instances become a sort of clinical catchall to include many disorders the clinician is unable to establish as clear-cut entities. Someday in the future the complex condition of multiple sclerosis as now described may no . . .



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