Whereas cognitive deficits in multiple sclerosis (MS) were documented in the original clinicopathological description by Charcot, the extent and nature of cognitive dysfunction was poorly understood in the U.S. until over a century later. Our objective was to discern reasons for this misunderstanding and to examine forces shifting this topic to center stage of research and increased awareness in clinical practice. We hypothesized that during the 19th century, conflict between psychiatrists and neurologists over control of treatment of the mentally ill fueled a misunderstanding of the nature of MS which led neurologists to treat diseases of the body, and psychiatrists, diseases of the mind. The importance of cognitive deficits in MS was thus minimized until scientific breakthroughs could once again bring them to light. As the rift between disciplines peaked, awareness of cognitive deficits diminished, and vice versa. This may have been one contributing factor affecting how MS was mistakenly conceptualized for a century.
A thorough understanding of Multiple Sclerosis (MS) is necessary to offer individuals informed options for treatment and planning. To assist in this quest, the following historical analysis examined how MS has been conceived from the 14th century through the early 20th century. Primary sources were consulted whenever possible, and many of the original archival materials were accessed by the first author (MB) during an on-site visit to the Rare Book Room of the New York Academy of Medicine. There is a striking similarity between how MS symptoms have presented throughout history compared with the 21st century. Sensorimotor and cognitive sequelae have been observed in patients since the 1800s. Cognitive symptoms were acknowledged in the 1800s, but disregarded in the early 1900s and were not given recognition again until the latter part of the 20th century. If conceptualizations of MS are inaccurate, patients will not be served well. In contrast to the shared symptomatology across time, early conceptualizations of etiology and treatment choices differed dramatically from today, a genuine reflection of the times in which they were created.
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