Multiple Sclerosis

Challenges

At the present time three measurement tools are generally considered decisive as to whether someone is affected by multiple sclerosis or not: a counter, a calendar, and a clock.

Suppose a patient, for no obvious reasons, goes through two or more episodes of a manifest dysfunction of two or more separate neuronal pathways: Whether these episodes are simply referred to as “unexplained neurological deficits”, or whether they are identified as “clinically definite multiple sclerosis” depends solely on the times at and during which the dysfunctions are present.

Brought in to resolve the dilemma of a neurological diagnosis, the counter, the calendar, and the clock also determine whether the patient’s various episodes of neuronal dysfunction are ascribed to some mysterious origin or whether they are claimed to have their cause in some particular kind of histological process, i.e. “primary or auto-immunological inflammatory demyelination”.
A patient who has been identified as having clinically definite multiple sclerosis is then reduced to the status of a test-subject qualified to be recruited for diverse clinical trials aiming at mastering an imaginary cause of a poorly defined condition. Thus, although “hope springs eternal” and “success is just around the corner”, feelings of uneasiness, even despair, persist.

The sluggishly rising tide of publications on mistaken diagnoses of multiple sclerosis, i.e. patients in whom the diagnosis of a curable disease has been missed, arouses immediate concern. Of more basic interest to the issue, however, are the following principle considerations:

The improper functioning of any organ, and thus also of a nervous pathway, for any period of time will, of and by itself, never reveal a dysfunction’s cause.
The succession, in a patient, of diverse neurological episodes of unexplained nature does not justify the assumption that all of these episodes were provoked by only one cause, let alone one determinate cause.
Finally, no neurological or any other clinical examination can truly anticipate or provide a substitute for findings obtained in anatomical-pathological or histological studies.

This book invites the reader to embark on a critical reappraisal of the subject of multiple sclerosis, to discover where and why medical thinking on multiple sclerosis has gone wrong – and how a more fruitful era of medical treatment of the disease can be initiated.