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At the present time three measurement tools are generally
considered decisive as to whether someone is affected by multiple
sclerosis or not: a counter, a calendar, and a clock.
Suppose a patient, for no obvious reasons, goes through two or more episodes of a manifest dysfunction of two or more separate neuronal pathways: Whether these episodes are simply referred to as “unexplained neurological deficits”, or whether they are identified as “clinically definite multiple sclerosis” depends solely on the times at and during which the dysfunctions are present.
Brought in to resolve the dilemma of a neurological diagnosis, the counter, the calendar, and the clock also determine whether the patient’s various episodes of neuronal dysfunction are ascribed to some mysterious origin or whether they are claimed to have their cause in some particular kind of histological process, i.e. “primary or auto-immunological inflammatory demyelination”.
A patient who has been identified as having clinically definite multiple sclerosis is then reduced to the status of a test-subject qualified to be recruited for diverse clinical trials aiming at mastering an imaginary cause of a poorly defined condition. Thus, although “hope springs eternal” and “success is just around the corner”, feelings of uneasiness, even despair, persist.
The sluggishly rising tide of publications on mistaken diagnoses of
multiple sclerosis, i.e. patients in whom the diagnosis of a
curable disease has been missed, arouses immediate concern. Of more
basic interest to the issue, however, are the following principle