1997 Dystel Prize to Dr. John F. Kurtzke.

Dr. John E Kurtzke of the Veterans Affairs Medical Center in Washington, D.C. was awarded the 1997 John Jay Dystel Prize for Multiple Sclerosis Research at the annual meeting of the American Academy of Neurology in Boston this April. Dr. Kurtzke is chief of the Neuroepidemiology Section at the VA Center -- a field of study he virtually invented.

His name, if not his work, is familiar to many people with MS today through their experience with the Expanded Disability Status Scale -- he EDSS or commonly, the Kurtzke scale. It measures the level of physical disability caused by MS. Dr. Kurtzke developed this tool for physicians and researchers in 1955 and has led periodic efforts to refine, improve, and apply it throughout his career.

Neuroepidemiology

This jaw-breaking name covers the study of neurologic disease by examining trends in large groups of people. Most of what is now known about who gets MS, and the relative roles of inheritance, gender, and geography as risk factors, emerged from epidemiology. But there was a time when this kind of study in diseases of the brain and nervous system received almost no attention.

Enter Dr. John Kurtzke, as a young neurologist in the late 1940s. When World War II was over, the U.S. military had the largest repository of medical histories of healthy young adults ever assembled. There were important needles in this huge haystack: for example -- who in this group developed MS? What characteristics did they share? How did these data compare to what was known about MS prevalence and incidence elsewhere in the world? Teasing out the answers required dogged determination and considerable brilliance.

"Dr. Kurtzke's ability to assimilate and disseminate data on the global distribution of MS is unmatched," said Dr. Cedric Raine, the 1996 Dystel Prize recipient. "Many intriguing avenues of research have emerged from his careful analyses."

What's in a scale?

For families struggling with MS, the invention of a scale to measure the progress of MS problems may not seem an advance in the fight against this disease. But without a way to describe precisely the progress of MS in a common language, and thus to measure the results of treatment, there would be no way to move ahead. The Kurtzke scale is an essential element in the gold standard needed to test a new MS treatment -- the double-blind randomized clinical trial.

"The exciting therapeutic advances of the last few years would have remained in a gray zone," said Dr. John Richert, a noted MS expert in the Department of Neurology at Georgetown University Medical Center. "Likewise, without the Kurtzke scale for demonstrating efficacy, our patients would be contending with any number of worthless medications.

"The effort that went into devising the scale and, more importantly, into verifying its validity, is legendary," Dr. Richert concluded.

When a cure for MS is finally found -- the medication that stops this disease cold -- a version of Dr. John Kurtzke's scale and the legacy of his methodology will have played an essential part.