One of the vexing problems in neurology is the lack of objective criteria for evaluating the degree of activity of the demyelinizing process in patients with multiple sclerosis and allied diseases. The very nature of these diseases makes it extremely difficult to translate signs and symptoms into terms of activity. An actively demyelinizing lesion may be hidden in a "silent" area of the nervous system, while symptoms which appear to indicate progression of the disease may actually be manifestations of the reparative process of gliosis. The various disability scales that have been proposed for measuring the severity of the disease fail to take into account the fact that old lesions, which are quiescent or healed, may prevent the appearance of new symptoms and signs indicative of renewed demyelinization. The evaluation of proposed therapeutic regimens has been hindered by the fact that prolonged periods of observation are necessary for appreciation of
POSER CM, CURRAN GL. Cerebrospinal Fluid Free Cholesterol as Index of Activity of Multiple Sclerosis and Allied Diseases. AMA Arch NeurPsych. 1958;80(3):304–313. doi:10.1001/archneurpsyc.1958.02340090040005
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