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To the Editor.—In their article entitled "Systemic Lupus Erythematosus and Multiple Sclerosis in Identical Twins," which appeared in the Archives (119:302 [March] 1967), Drs. Holmes, Stubbs, and Larsen used what should be regarded as insufficient evidence to make a diagnosis of multiple sclerosis in case 1. Evidence cited is onset of bilateral corticospinal tract weakness at age 15 years, temporal pallor of the optic nerve heads, first zone colloidal gold curve, and elevated IgG in cerebrospinal fluid, and finally, significantly elevated IgG, IgA, and IgM in serum.
Evidence for more than one lesion in the central nervous system occurring at separate time intervals is needed to diagnosis multiple sclerosis clinically. Temporal pallor of the optic discs may be within normal limits unless supported by visual field loss or history of visual loss and, hence, cannot be accepted as a second site for lesion. Serum protein abnormalities in multiple sclerosis have
Silberberg DH. DIAGNOSIS OF MULTIPLE SCLEROSIS. Arch Intern Med. 1967;120(4):515. doi:10.1001/archinte.1967.04410010129023
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