REHABILITATION OF MULTIPLE SCLEROSIS: CLASSIFICATION OF DEGREE OF DISABILITY AND PROGNOSIS

In order to establish the quantitative method to evaluate the effect of therapy and rehabilitation on clinical status of patients with multiple sclerosis, we divided 31 patients into four clinical formas: spinal form, optico-spinal form, brainstem-cerebello-spinal form, and optico-brainstem-cerebello-spinal form, and used McAlpine's and Kurtzke's method for assessment of their degree of disability. Improvement indexes were calculated by subtraction of Kurtzke's 6 different functional scores, i. e. pyramidal, cerebellar, brainstem, sensory, bladder and bowel, and visual function scores, at dischage from those at admission. In case of McAlpine's score, we compared scores st admission with those at discharge. As a whole, the patients showed significant improvement from 2.55±1.43 (mean±SD) at admission of McAlpine's score to 1.74±0.95 at discharge. When using Kurtzke's method, improvement index was 3.22±2.32 and this value was also significant. Brainstem-cerebello-spinal form showed most striking improvement assessed by McAlpine's method, and optico-brainstem-cerebello-spinal form gained best result when Kurtzke's method was used. This discrepancy of results obtained using these different methods, might be due to the fact that McAlpine's method reflects mainly the pyramidal function and Kurtzke's method reflects the cerebellar and brainstem functions. Actually both brainstem and cerebellar functions scores showed most remarkable improvement by assessment with Kurtzke's method. The spinal form showed the poorest outcome by assessment of both methods. We would like to emphasize that it is necessary to consider clinical forms and use quantitative scores of disabled functions, to assess the prognosis of the patients with multiple sclerosis.