From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.
In a Clinical Crossroads article published in November 2000, Lisa I. Iezzoni, MD,
discussed a 44-year-old woman with difficulty ambulating secondary
to amyotrophic lateral sclerosis (ALS) diagnosed in summer 1999.1 Initially,
Mrs D leaned on her husband's arm for support, but as she became weaker, she
began to use a cane. As her impairment in mobility progressed, Mrs D learned
to use forearm crutches and obtained a rolling walker to use at home. She
then retired from her job and moved to a wheelchair-accessible home. She became
depressed but was unable to take fluoxetine because it intensified spasticity
in her legs. At the time of the conference, Mrs D was considering using a
wheelchair or motorized scooter.
Hartman EE, Delbanco T. A 44-Year-Old Woman With Difficulty Walking, 2 Years Later. JAMA. 2002;288(20):2598. doi:10.1001/jama.288.20.2598