Editing Multiple sclerosis (section)

=== Diagnosis history ===
The first attempt to establish a set of diagnostic criteria was also due to Charcot in 1868. He published what now is known as the "[[Charcot's neurologic triad|Charcot triad]]", consisting of nystagmus, [[intention tremor]], and [[telegraphic speech]] (scanning speech).<ref name="Milo">{{cite journal | vauthors = Milo R, Miller A | title = Revised diagnostic criteria of multiple sclerosis | journal = Autoimmunity Reviews | volume = 13 | issue = 4–5 | pages = 518–524 | date = April 2014 | pmid = 24424194 | doi = 10.1016/j.autrev.2014.01.012 }}</ref> Charcot also observed cognition changes, describing his patients as having a "marked enfeeblement of the memory" and "conceptions that formed slowly".<ref name="Charcot1" />

The diagnosis was based on Charcot triad and clinical observation until Schumacher made the first attempt to standardize criteria in 1965 by introducing some fundamental requirements: Dissemination of the lesions in time (DIT) and space (DIS), and that "signs and symptoms cannot be explained better by another disease process".<ref name="Milo" /> The DIT and DIS requirement was later inherited by the Poser and McDonald criteria, whose 2017 revision is in use.<ref name="Milo" /><ref name=Oh2018>{{cite journal |vauthors=Oh J, Vidal-Jordana A, Montalban X |title=Multiple sclerosis: clinical aspects |journal=Curr Opin Neurol |volume=31 |issue=6 |pages=752–759 |date=December 2018 |pmid=30300239 |doi=10.1097/WCO.0000000000000622 |url=https://repositorio.ufms.br/handle/123456789/4900 |archive-date=25 November 2024 |access-date=2 June 2024 |archive-url=https://web.archive.org/web/20241125061549/https://repositorio.ufms.br/handle/123456789/4900 |url-status=live }}</ref>

During the 20th century, theories about the cause and pathogenesis were developed and effective treatments began to appear in the 1990s.<ref name="pmid1897097722"/> Since the beginning of the 21st century, refinements of the concepts have taken place.  The 2010 revision of the McDonald criteria allowed for the diagnosis of MS with only one proved lesion (CIS).<ref name=mcdonald2010>{{cite journal | vauthors = Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS | title = Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria | journal = Annals of Neurology | volume = 69 | issue = 2 | pages = 292–302 | date = February 2011 | pmid = 21387374 | pmc = 3084507 | doi = 10.1002/ana.22366 }}</ref>

In 1996, the US National Multiple Sclerosis Society (NMSS) (Advisory Committee on Clinical Trials) defined the first version of the clinical phenotypes that is in use. In this first version, they provided standardized definitions for four MS clinical courses: relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP), and progressive relapsing (PR). In 2010, PR was dropped and CIS was incorporated.<ref name=mcdonald2010 /> Three years later, the 2013 revision of the "phenotypes for the disease course" were forced to consider CIS as one of the phenotypes of MS, making obsolete some expressions like "conversion from CIS to MS".<ref>{{cite journal | vauthors = Lublin FD, Reingold SC, Cohen JA, Cutter GR, Sørensen PS, Thompson AJ, Wolinsky JS, Balcer LJ, Banwell B, Barkhof F, Bebo B, Calabresi PA, Clanet M, Comi G, Fox RJ, Freedman MS, Goodman AD, Inglese M, Kappos L, Kieseier BC, Lincoln JA, Lubetzki C, Miller AE, Montalban X, O'Connor PW, Petkau J, Pozzilli C, Rudick RA, Sormani MP, Stüve O, Waubant E, Polman CH | title = Defining the clinical course of multiple sclerosis: the 2013 revisions | journal = Neurology | volume = 83 | issue = 3 | pages = 278–86 | date = July 2014 | pmid = 24871874 | pmc = 4117366 | doi = 10.1212/WNL.0000000000000560 }}</ref> Other organizations have proposed later new clinical phenotypes, like HAMS (Highly Active MS).<ref>{{cite journal | vauthors = Sørensen PS, Centonze D, Giovannoni G, Montalban X, Selchen D, Vermersch P, Wiendl H, Yamout B, Salloukh H, Rieckmann P | title = Expert opinion on the use of cladribine tablets in clinical practice | journal = Therapeutic Advances in Neurological Disorders | volume = 13 | pages = 1756286420935019 | date = 24 June 2020 | pmid = 32636933 | doi = 10.1177/1756286420935019 | pmc = 7318823 | doi-access = free }}</ref>