The curious incident of disability in multiple sclerosis trials.

摘要

There was a time when a neurologist could choose, rightly or wrongly, to downplay the significance of the first symptoms of demyelination: the "clinically isolated syndrome". No longer. Within minutes of an internet search, the person affected by, say, optic neuritis is faced with the possibility they might experience attacks of diverse symptoms, some indeterminate time away, and so develop "multiple sclerosis". And with that prospect come the spectres of disability, marginalisation, and frustrated ambitions. Sooner or later, come the questions: what does the future hold? Am I going to end up in a wheelchair? Handling this situation is a severe test of a neurologist's technical and pastoral skills. MRI brain scans can be useful; abnormalities consistent with plaques at presentation increase the risk of subsequent conversion to multiple sclerosis. For instance, 14 years later, nearly 90% of those who had an abnormal MRI scan will have developed multiple sclerosis, compared with less than 20% of those who had a normal MRI scan.