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February 19, 1982

The Hot Bath Test and Multiple Sclerosis

JAMA. 1982;247(7):979. doi:10.1001/jama.1982.03320320019015

To the Editor.—  In the article "The Hot Bath Test in the Diagnosis of Multiple Sclerosis" by Hershel Goren, MD, and Amir S. Malhotra, MD (1981; 246:1113), the neurological changes that occurred in 17 of their 20 patients with multiple sclerosis (MS) resolved when body temperature returned to normal. While the worsening that accompanies hyperthermia in MS is generally transient,1,2 we have observed three persons who experienced debilitating, long-lasting neurological complications after hot bath testing.The patients ranged in age from 19 to 53 years, and all had "possible MS." Visual impairment appeared with elevation of body temperature in two patients and papillitis was noted within 24 hours. Hot bath testing in the third patient resulted in a moderate, left hemiparesis. This deficit was resolving at 48 hours when she became hemiplegic during a hot shower.The hot bath test is not without risk. Because of its possible serious