Multiple Sclerosis:
Scars Of Childhood

Preface

p vi

This book has been titled "MS-Scars of Childhood" because there is evidence that the disease starts years before the first symptoms appear, most likely in childhood.

There's also increasing evidence that "scars" are the result of damage caused by Viruses of such common contagious disease of children as Measles, Chicken Pox or Small Pox vaccination.

These Viruses may persist in certain cells in the body for months or years before they cause disease. Another disease that is similar to MS in the kind of scarring to the Brain, called SSPE (Subacute Sclerosing PanEncephalitis) has been proved to be caused by Measles Virus.

This book is a compilation of chapters about subjects related in one way or another to MS. Part I is about patients. It describes the disease and explains how it causes the symptoms and signs. It discusses exacerbations, remissions, and prognosis.

Part II is devoted to the progress being made in research, which is opening up new horizons and offering new hope to MS patients.

The deep concern for further understanding of the many unsolved problems relevant to MS is emphasized, by the impressive dollar amounts (exceeding $21,000,000. per year) funded for research by the National Multiple Sclerosis Society, the National Institute of Neurological and Communicative Disorders and Stroke, several Foundations and private donors.

Benefits to mankind must surely come from a concentrated and fusion of knowledge as it accumulates in laboratories and clinics around the world.

There is hope that someday MS will no longer be one of the serious illnesses of human beings. Like PolioMyelitis, Rabies, and SmallPox, it can conceivably be eradicated from the world.

J.M.A.

Foreword

p vii

The common childhood diseases like Measles, Influenza, Rubella, Mumps, and Vassinia Virus infection, were often serious diseases the consequences and sequela of which could be fatal or produce long lasting, sometimes devastating illness.

These common diseases, in just the right circumstances, or by infecting just the right child, could produce very serious consequences.

The stage of life, the particular Genetic makeup - stage of Immunologic responsiveness - could transform these common contagions or vaccinations into the most devastating diseases of mankind.

Increasing evidence, derived in part from a surging technology, especially in the Immunologic and Virologic fields, has revealed the nature and hazard of latent and continuing Virus infections.

Thus, dologies have been confirmed - when scientists developed many of Adam's interpretations - utilizing today's sophisticated techniques to address the questions which he had brought into such sharp focus.

viii

In this volume, written for the patient with Multiple Sclerosis, members of his family, nurses, social workers, and general physicans on whom much of the care of the Multiple Sclerosis patients develops, Dr. John Adams explains with admirable clarity the modern view of the associations between Multiple Sclerosis and common Virus infections.

Without imposing unnecessary concerns with high technology, we are given a picture of Multiple Sclerosis which includes its discovery, definition as a disease, and clinical picture.

His simple yet accurate description gives us both an authoritative and optimistic perspective. Even some pf the exciting current experimental leads that are yielding trials of new forms of treatment for Multiple Sclerosis are cautiously described and analyzed.

I agree with Dr. Adams that continued pursuit of research efforts to define the Etiology of Multiple Sclerosis in terms of common Virus infections, that in some way go wrong and are not handled properly in some of many persons infected, promises to yield improvement in early diagnosis, bringing powerful new tools of ImmunoTherapy, AntiViral therapy and ImmunoProphylaxis to the conquest of Multiple Sclerosis.

These tools in turn promise to provide substantial improvement in outlook and, ultimately, I contend, the means of prevention of this dread disease.

Much challange, several discoveries, and a great deal of work lie ahead, before all this can be realized; but one can think about Multiple Sclerosis these days with guarded optimism, because of the progress Adams sees in the research of this field.

This book will offer hope in concrete terms from one who knows Multiple Sclerosis intimately to those who must suffer the disease, or maintain, encourage and treat its victims.

It has been a pleasure for me to renew contact with my teacher of yesteryear through this book. Once again, I have learned much and have been inspired by his teaching.

Robert A. Good, Ph.D.
President & Director
Sloan-Kettering Institute for Cancer Research
New York, NY

Introduction

p ix

It was a hundred years ago that Jean Martin Charcot (1825 - 1893) recorded the classic signs and symptoms of Multiple Scleroisis, which he said were Tremor and Nystagmus - jerky eye movements when the patient looks to one side or the other and occasionally with upward gaze.

The third symptom which he elaborated was a resitant or slow jerky type of talking called Scanning Speech. Charcot was the first to describe concisely the changes in the Brain - as seen by the microscope - after the patient had passed away.

He pointed out that the coverings of the nerves were destroyed, and he called this DeMyelination or a lack of Myelin. At the same time the nerve itself did not appear to be harmed; but, continued in the presence of the scarred tissue called a plaque.

The process of destruction affects the coverings of the nerves (Myelin) first, but it also occurs in little islands or discrete areas about the Veins in the Brain and the Spinal Cord. The exact mechanism by which this occurs was unknown to Charcot, and still remains unknown today.

Viruses which cause common illnesses in childhood after a rather long period of silence may become active and account for higher levels of AntiBodies, protein substances in blood Serum which interfers with the action of the Viruses.

The author and D.T.Imagawa (1962) found that patients with MS had high levels of Measles AntiBodies in their blood Serum and Spinal Fluid.

This interference effect might explain why MSers have periods when they are much better. As the interfering process wears out, recurrence of symptoms such as a decrease in vision or hearing is likely.

p x

Dr. J.H.D. Millar (1971), a distinguished Neurologist at Queens Univin Belfast, Ireland, points out in his book Multiple Sclerosis is a disease which often may be traced from early childhood.

The symptoms may be very mild with recovery apparently taking place, or attacks become severe and the patient develops a serious disability.

While MS may develop in childhood, it is relatively uncommon and most signs and symptoms begin between the ages of twenty and forty years.

Millar also emphasized the fact that MS occurs most frequently in the Temperate or Northern climates of the world, and more commonly in whites than in blacks. The disease may be acquired in childhood from an outside agent rather than some inherited defect.

The natural resistance of the body is important; it's known that certain illnesses and injuries often cause a worsening of the symptoms.

Though there are unquestionably mild forms of MS, often called Benign, many patients ultimately become disabled by symptoms such as weakness and tremor or jerking, with speech becoming less understandable.

Urinary and skin problems develop with signs of infection; the patient finally succumbing to some other event apart from actual Brain involvement.

Multiple Sclerosis is probably the nost common nonsurgical disease of the Nervous System, accounting for the tremendous effort being expended by everyone, to learn more about this tragic and little understood disease.

There are many facts coming to light as the result of research, and the prospects for prevention and treatment will undoubtedly emerge as a result of intensive research into widely different hypotheses or theories of cause and related mechanisms of this illness.

p xi

Certainly the relationship of slow and persistent Viruses is related to many who are suffering from MS or closely related DeMyelinating Diseases. Evidence also points to the enviroment that may have an influence exerting its effects in childhood, with a long latent or silent period before disease becomes apparent.

Not only is the patient ill but the disease involves his or her entire family. The patient wishes to be a part of the family as long as possible and close to friends and neighbors.

It is estimated that one person out of every thousnad will develop MS. The average age of onset of illness is between twenty and forty years with an average length of life of twenty years after onset.

Multiple Sclerosis is not only a disease with potentially crippling features, but one producing Anxiety, Depression and fear as natural consequences of its diagnosis.

Dr. B.H. Smith of State Univ of New York states: "These reactions have inevitable sexual repercussions." Some Neurologists advise patients against becoming pregnant. Such warnings may induce a fear of pregnancy reflecting the patient's attitude towards sexual relations.

In 1971 a review of MS states, "It now seems possible that the Central Nervous System complications of Measles infection may appear in three forms:

1. Acute form
2. SubAcute form - SSPE
3. Chronic form - Multiple Sclerosis"

In summary, it would seem that a Viral hypothesis can best explain most of the Epidemiological and experimental data on MS better than any other hypothesis currently available.

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.

Clinical Features Of Multiple Sclerosis

ch2
p 9

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.