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Judging the effectiveness of MS treatments is tricky, largely as a consequence of the unpredictable clinical course of MS. Another challenge is to document disease progression, a problem accentuated by subclinical lesion activity and progressive atrophy found on MRI that neither the patient nor the physician can suspect.1 Clearly, we must seek improved clinical methods for evaluating patients with MS2 that extend the standardized disability status scales introduced by Kurtzke 40 years ago.3 Modern eye movement testing offers several possible advances. Eye movement examination has become more sensitive as clinicians have applied physiology to develop new tests.4 Topologic diagnosis grows ever more specific as anatomists refine the neural circuitry of eye movement control.5 This issue of Neurology contains two reports that demonstrate how the sensitivity and specificity of eye movement disorders can be productively used in evaluating MS.
Frohman et al.6 describe how an eye movement disorder can be used to identify an optimal technique for imaging brainstem lesions. They demonstrate that proton density imaging is particularly sensitive for lesion detection in the medial longitudinal fasciculus (MLF) in patients with documented internuclear ophthalmoplegia (INO). The neural circuitry involved in INO is …
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