Clinical characteristics of autopsy‐proved multiple sclerosis

TnE CLINICAL PICTURE of any disease is built upon the combined experience of many clinicians whose diagnostic accuracy is eventually checked against postmortem findings. The situation in regard to multiple sclerosis has been complicated by the fact that signs and syniptoms may be transient, that no specific diagnostic laboratory procedures exist, and that the number of autopsies is relatively small. Many epidemiologic studies, purporting to demonstrate similarities and differences in the clinical manifestations of multiple sclerosis in different countries and different populations have been based almost exclusively on unconfirmed diagnoses. The need for establishing clinical diagnostic criteria on a sound basis remains unfilled. Fifteen years have elapsed since Carter, Sciarra, and Merritt published their classical article “The Course of Multiple Sclerosis as Determined by Autopsy Proven Cases.”l Recently, one of us reviewed the clinical characteristics of twenty-five autopsy-proved cases of multiple sclerosis collected from a variety of sources in the United States.2 Because relatively few cases were readily available in the United States, additional autopsy-proved cases of this disease were sought in England and in Norway. These two countries were chosen primarily because of the reported frequency of the disease, the fine quality of medical care, and, particularly in Norway, the high percentage of postmortem examinations obtained routinely. Searching for foreign cases also provided an opportunity to examine clinical records written by neurologists who had had somewhat different clinical training from that of American neurologists. This paper presents an analysis of the clinical records of a total of 111 autopsy-proved cases of multiple sclerosis from England, Norway, and the United States.