Tolbutamide in Treatment of Multiple Sclerosis and Parkinsonism

To the Editor:—  Since tolbutamide has attained widespread use in the treatment of diabetes, there have been several reports of its use in unrelated disorders, including schizophrenia, acne, angina pectoris, intermittent claudication, paralysis agitans, and, most recently, multiple sclerosis. The possibility that the drug might be of value in these conditions was usually suggested initially by improvement in the condition of patients who had a combination of diabetes and one of the above diseases. However, it should be noted that therapy in all of these diseases has been notoriously difficult to evaluate in the past either because of their variable course, characterized by remissions and exacerbations or because of a pronounced placebo effect. Confirmatory reports have not been forthcoming, and other investigators working in several of the above areas have not been impressed by the value of the drug.The occasional value of serendipity in medical discoveries cannot be denied.