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An unchanging man faced with changing times

Christian Confavreux
DOI: http://dx.doi.org/10.1093/brain/aws135 1663-1665 First published online: 24 May 2012

John Kurtzke's dedication to the study of multiple sclerosis has not waned since the early 1950s. Neurologists are indebted to him for establishing the universally known eponymous Disability Status Scale which, since its introduction in 1955, has allowed patients with multiple sclerosis to be ranked according to impairment and disability (Kurtzke, 1955). The scale has well-identified limitations and has undergone refinement by creation of the ‘expanded’ scale (Kurzke, 1983), which was unwillingly endorsed by its author: ‘Personally, I would change my system only, perhaps, by returning to the DSS vice the EDSS. We have more steps, but I really wonder if the gain is worth [it] … ’ (Kurtzke, 1989). In clinical metrics, more subtleties often result in less accuracy, precision and reproducibility. The scale has been exposed to an unceasing fire of repeated attacks during the Holy Grail-like search for an ideal clinical scale for multiple sclerosis (Amato et al., 1988; Willoughby and Paty, 1988). However, despite multiple assaults, the (Expanded) Disability Status Scale still stands alone, entrenched in the clinical consciousness of every specialist. And it is likely to remain so.

Providing further understanding of multiple sclerosis, John Kurtzke has previously studied two cohorts of the US army veterans, some of whom developed multiple sclerosis. The World War II/Korean Conflict cohort included 527 males with multiple sclerosis in army service at some point between 1942 and 1951. These studies led to the publication of many papers thoroughly and comprehensively describing the natural history of multiple sclerosis (Nagler et al., 1966; Kurtzke et al., 1977). By categorizing the veterans with multiple sclerosis by place of birth and location at service entry, the study demonstrated a north–south gradient in incidence of the disease and showed that the latitude-related risk of developing multiple sclerosis is set during infancy (Beebe et al., …