NEW CONCEPT OF CRITICAL STEPS IN COURSE OF CHRONIC DEBILITATING NEUROLOGIC DISEASE IN EVALUATION OF THERAPEUTIC RESPONSE

Abstract

THE EVALUATION of response to therapy in multiple sclerosis is complicated by well-known difficulties (Brickner,¹ Putnam,² and Schumacher³). One of these is the frequently noted discrepancy between the extent of recovery of individual signs and symptoms (e. g., reflexes, strength) and the degree of change in the over-all disability status, as expressed most strikingly by the quality of locomotion, as well as by the ability to carry out other complicated tasks. It is not uncommon to find a comparatively small amount of improvement in individual signs and symptoms associated with a great deal of improvement of overall disability status, and, conversely, fairly significant degrees of improvement in individual signs and symptoms failing to be reflected in commensurate improvement in the over-all disability status. It is tempting—and sometimes valid—to consider this discrepancy as due to the fluctuations of emotional overlay; but this is by no means so in