“In 1868, Jean-Martin Charcot defined the clinical features and named the disorder we now know as multiple sclerosis (MS) – and speculation about cause and potential therapies began. Initially, the treatments applied to an MS patient were those used for any serious neurologic disease and included a list of drugs thought to be sedatives and others that were stimulants: foxglove, Indian tobacco, aconite, hemlock, coffee, musk, garlic, asafoeteda, valerian, castor, oil of amber, skunk cabbage, alcohol, ether, chloroform, opium, hops, deadly nightshade, henbane, Hoffman anodyne, and extract of hemp.

“The dark history of MS therapy has included snake venom, bee stings, malaria, colostrum, magical shoes, and rest (exercise was once thought to make MS worse). In 1970, in the beginning of my neurologic/MS career, many patients were not told that they had MS because the diagnosis was ‘too scary.’ They were told not to expect pain, cognitive problems, or depression. In fact, MS was thought to cause ‘euphoria.’

“Early in my career, with no proven therapy, there was no rush to diagnose MS. Without the right tools, a diagnosis couldn’t be reached quickly anyway. Evoked potential studies were eventually developed to assess optic nerve and other central nervous system (CNS) conduction abnormalities. More sophisticated spinal fluid analysis, including tests for immunoglobulin G index and oligoclonal bands, helped to establish the MS diagnosis.

“Over the past few decades, the advances in MS have been remarkable. There has been a revolution in understanding the disease process and remarkable advances in developing drug-based treatments. In addition, through my interest in wellness and complementary and alternative medicine (CAM), I have seen a dramatic shift in non-drug based approaches to MS.

“I am incredibly encouraged by two positive trends in MS in recent years: the development of a multitude of MS therapies, and the rise of empowered, highly-informed patients. These two trends go hand-in-hand, for as clinicians have more numerous and more complex treatment options to offer to our patients, the need for patient education and awareness has become more crucial than ever.

“The field of MS therapeutics has been at the leading edge of innovative research into the treatment of neurologic illness. Having nine disease-modifying agents, and a full pipeline of newer molecules that may prove successful in the treatment of MS, have transformed the care of MS.

“Life with MS has certainly evolved over the past two decades. MS remains a mysterious disease that clearly has an effect on the brain and spinal cord. It is caused by an attack of the immune system, initiated by some unknown stimulus. Its complexity involves genetics and potentially some unidentified infectious agent. We have learned a number of details surrounding these issues, but the heart of the matter remains unknown.

“The MS Nurse is a competent expert who collaborates with those affected by MS. He or she shares knowledge, strength, and hope. As the role of nurses continues to evolve, there is a need to establish a cohesive model of MS nursing practice, along with specific standards in MS nursing care.

“Looking back to the 1980s, the best we could do was to ‘put out fires’ when caring for the person with MS. By this, I mean treating exacerbations with steroids or ACTH and using physical and occupational therapy to minimize disability. In the 1990s, the disease-modifying therapies were introduced. For the first time, we were able to influence the natural course of MS, but we also had to learn how to best use these medications, cope with side effects, and maximize adherence.

“I began my career as a nurse practitioner in MS in 2001. Despite having been through three diagnostic criteria changes, I still consider myself new to the disease, because I have never known a time without disease-modifying therapy (DMT).