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Richard A. Rudick, MD, Discussant

JAMA. 1998;280:1432-1439.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DELBANCO: Mr J is a 29-year-old, married engineer who works in a biomedical laboratory. He was found to have multiple sclerosis (MS) 14 months prior to this conference. Shortly thereafter, he sought care from a general internist, Dr C, at the Beth Israel Deaconess Medical Center and a neurologist at another medical center. He has health insurance through a commercial managed care plan.

A few months after Mr J developed Bell palsy, which resolved fully, he noted weakness in his right leg while skiing. The weakness progressed, and he consulted a neurologist when he returned home. Physical examination and magnetic resonance imaging (MRI) were compatible with demyelinating disease. During the subsequent year, Mr J noted slowly progressive weakness associated with exercise, again primarily involving the right leg. He experienced some difficulty with urination, in both initiating and ending the stream. He observed some tremor . . . [Full Text of this Article]

MR J: HIS UNDERSTANDING AND PERCEPTIONS

DR C: HIS UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR RUDICK

What is MS?

Why Did I Get It (What Causes MS)?

Will My Children Get It (What Are the Genetics of MS)?

What Will Happen to Me (What About Disease Course and Prognosis)?

Disease Course.—

Prognosis and Prognostic Markers.—

Rationale for Disease Therapy at the Time of Diagnosis.—

What Medical Therapy Should Be Recommended and How Should Mr J Be Monitored?

Evidence for Effective Disease-Modifying Drugs.—

My Recommendation for Mr J

What Lifestyle Changes, Medications, or Treatments Will Help Maintain Function and Improve Quality of Life?

QUESTIONS AND DISCUSSION

Dr Rudick is Director, Mellen Center for Multiple Sclerosis Treatment and Research, Professor of Neurology, Cleveland Clinic Foundation, and Professor of Neurology, Ohio State University, Cleveland.

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A 29-Year-Old Man With Multiple Sclerosis, 1 Year Later
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