To the Editor.—
In the article "The Diagnosis of Multiple Sclerosis," by Hart and Sherman (1982;247:498), the authors try to give guidelines regarding the diagnostic process in patients suspected of having multiple sclerosis (MS). They point out the importance of history-taking and clinical examination, but the information given about frequency and value of clinical symptomatology is misleading. In Table 3 ("Common Symptoms and Signs in Multiple Sclerosis Suspects"), the symptoms of blurred vision and paresthesias are common early disturbances, but the others mentioned are not. Fecal incontinence, for instance, is a rare and late symptom (5% in established cases), and does not support an initial diagnosis of MS.1Among the signs listed in Table 3, impaired visual acuity, asymmetric brisk tendon reflexes, and Babinski's signs are relatively common, but pareses—not even mentioned in Table 3—are the most common2 (Table). Some of the common signs are so nonspecific, however,
Poser S. Symptomatology and Diagnosis of Multiple Sclerosis. JAMA. 1982;248(9):1065. doi:10.1001/jama.1982.03330090037018
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