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Prognosis of Neurological Disorders

Andrew Wilner, MD
JAMA. 1994;271(3):246. doi:10.1001/jama.1994.03510270092050.
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This 714-page multiauthored textbook comprehensively addresses the issue of prognosis in neurological disease. The first three chapters scrutinize the very concept of prognosis. One must consistently define "success" in order to compare similar outcome studies. Psychosocial factors can affect recovery. Earlier diagnosis of more mild disease may result in "lead time bias," producing the illusion that therapeutic advances are occurring, when in fact patients only appear to live longer because they were diagnosed earlier. With the reader thus forewarned, the rest of the volume systematically explores the prognosis of all common neurological disorders.

When I was an internal medicine resident, the standing gibe about our neurological consultants was that they had fancy names for diseases but didn't change the prognosis. Data collected in this volume illustrate the areas in which neurologists do make a difference. For example, medical therapy for transient ischemic attack decreases the incidence of stroke by 20%


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