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March 17, 1999

Clinical Crossroads: A 29-Year-Old Man With Multiple Sclerosis

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(11):985-987. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-11-jbk0317

To the Editor: The article about a 29-year-old man with multiple sclerosis (MS)1 was quite illuminating with regard to the medical treatment. However, the lack of a functional approach to the patient, Mr J, is disconcerting. Mr J's history reveals right lower limb weakness as the presenting symptom followed by difficulty ascending stairs, urinary dysfunction, and anxiety concerning the progression of his disease. Never probed are the issues of fatigue (present in as many as 77% of those with MS),2,3 sexuality, cognition, vocational dysfunction, or adjustment to disability. This is despite the direct question from Dr C, the patient's primary care physician, of "What can I do to maximize the maintenance of function?"

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