Prognosis in the neurologic manifestations of pernicious anemia.

LLOWING the introduction of liver therapy for pernicious anemia in I9L6’ the curability of the neurologic manifestations of this disease became a matter of intense interest and large series of patients with acute, chronic and residual neurologic defects were treated with lightly cooked liver and oral liver extracts. It was found that while this treatment restored satisfactory blood levels and reversed the atrophic and inflammatory lingual changes the neurologic benefit was far less conspicuous. Some investigators concluded that liver therapy resulted in no neurologic improvement beyond that due to the correction of the anemia and betterment of the patient’s general condition, and that progressive disability might occur in some cases in spite of treatment.10 12 The most optimistic observers were of the opinion that adequate treatment arrested the progression of the disease and that some degree of functional improvement might occur when treatment was begun reasonably early.1’ 8, iS, 38, 19, 25, 28, 31 In recent years the general outlook regarding the neurologic prognosis in pernicious anemia has been altered by several factors. For one, the diagnosis is now made earlier in the illness and the neurologic disease is less advanced when treatment is begun. Concentrated liver extracts for parenteral use, although refined and tested only to give the maximal hematologic response, have abolished the uncertainties of oral types of therapy, and optimal treatment is now possible in all cases. The demonstration of unequivocal degenerative changes in peripheral nerves removed by biopsy9’ I ’ 28 has finally substantiated the many suggestions that peripheral neuropathy rather than spinal cord degeneration is actually responsible for many of the typical neurologic signs and symptoms.” 7, 13, 18, 29, 31, 32 The great recuperative power of the peripheral nerves indicates, of course, a far greater potential curability. Finally, the isolation of new vitamins in the B group has permitted experiments bearing on the problems of diagnosis and therapy. While the common crystalline vitamin B components have failed to be of direct value in the treatment of any of the clinical manifestations of pernicious anemia, each new one isolated has to be evaluated as a possible substitute or adjunct to standard therapy. The present report is based on a study of 2.0 recent patients with the neurologic manifestations of pernicious anemia whom we were able to follow with frequently repeated examinations from the start of treatment of pernicious anemia in relapse until maximum neurologic recovery had occurred. Somewhat less than one half of all our new patients were judged to have significant neurologic disease. Those chosen for study appeared to be typical of the large number of patients with this