To the Editor.
—The report by Livingstone and Sack1 dealing with the four siblings with varying degrees of congenital joint contractures and born to a mother with multiple sclerosis (MS) is interesting, but the conclusions drawn are questionable for several reasons.Based on a single observation of arthrogryposis multiplex congenita (AMC) (three siblings had other skeletal abnormalities), the authors recommend that "because MS frequently affects women in their reproductive years, counseling and treatment must be undertaken with awareness of the possibility of AMC."The information concerning the illness of the mother is inadequate. The symptoms mentioned would be compatible with other neurologic diagnoses, and no data are given on cerebrospinal fluid findings, visual evoked potentials, or other modern methods (eg, nuclear magnetic resonance) for ruling out other diseases.2The authors refer to a study by Hall and Reed3 in which three similar cases are reported. But
Poser S. Arthrogryposis Multiplex Congenita. Arch Neurol. 1986;43(1):8–9. doi:10.1001/archneur.1986.00520010008005
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