Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Translations
    • Topics A-Z
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Translations
    • Topics A-Z
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Articles
  • Issues
  • Practice Current
  • Practice Buzz

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology Clinical Practice
Home
A peer-reviewed clinical neurology journal for the practicing neurologist
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Articles
  • Issues
  • Practice Current
  • Practice Buzz

LETTER #2 RE: The financial contribution of the multiple sclerosis specialist

  • Josh Torgovnick, MD, NYU Langone Medical Center, New York, NYdrjosh49@msn.com
Submitted August 16, 2017

I read the article by Dr. Berger1 with interest. The United States already has the most expensive medical care in the world without a comparable improvement in outcome. The Revised McDonald criteria are clear about the evaluation after 2 attacks: if dissemination in space and time and objective evidence of 1 lesion and good history for a second are present, no further testing is necessary.2 With a spinal cord lesion, a pattern-shift visual evoked response (PSVER) might be useful but I disagree with using a battery of evoked potential (EP) tests. Lumbar puncture should no longer be needed if history and MRI are typical. It is textbook3 that oral steroids, 1250mg of prednisone are equivalent to 1gm of solumedrol and patients can carry this on vacations or other travel and not need to be hampered by IVs. A baseline optical coherence tomography (OCT) is reasonable but no one knows how often to repeat it. Many patients with MS don't progress4 and identifying that group is more important than the financial benefits of which Dr. Berger speaks. Lastly, the history and physical live on and tests are still extensions of these.

Disclosures: The author reports no disclosures.

References:

1. Berger JR. The financial contribution of the multiple sclerosis specialist. Neurol Clin Pract 2017;7:246-255.

2. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Ann Neurol 2011; 69:292-302.

3. Weiner HL, Stankiewicz JM, editors. Multiple Sclerosis: Diagnosis and Therapy. Wiley-Blackwell, 2012: p.197.

4. Sartori A, Abdoli M, Freedman MS. Can we predict benign multiple sclerosis? Results of a 20-year long-term follow-up study. J Neurol 2017;264:1068-1075.

Navigate back to article

Neurology: Clinical Practice: 13 (1)

Articles

  • Articles
  • Issues
  • Popular Articles

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology: Clinical Practice |  Print ISSN: 2163-0402
Online ISSN: 2163-0933

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise