Objective: To explore the long-term outcomes of patients with clinically isolated syndromes from the Barcelona cohort. Methods: We selected patients with a follow-up longer than 10 years to (1) estimate the risks of multiple sclerosis (MS) and disability accumulation according to the baseline number of T2 lesions and to compare treated versus untreated patients and early versus delayed treatment, and (2) to study baseline features of patients with aggressive MS (Expanded Disability Status Scale (EDSS) ⩾6.0 at 10 years). Results: In all, 401 patients were included (mean follow-up of 14.4 (standard deviation of 2.9) years). A higher number of T2 lesions was associated with an earlier MS diagnosis and an earlier risk of irreversible disability. Early treatment was associated with a decreased risk of EDSS of 3.0: adjusted hazard ratio = 0.4, 95% confidence interval = (0.2, 0.7). Patients with aggressive MS differed in their baseline brain magnetic resonance images: The median (interquartile range) number of T2 lesions and contrastenhancing lesions (CEL) was 71 (28-95) versus 7 (1-19) and 3 (1-24) versus 0 (0-1), respectively. The cut-offs that better classified patients with aggressive MS were 20 for T2 lesions and 2 for CEL. Conclusion: Although MS natural history is changing, a high lesion load at onset is helpful to identify patients at risk of presenting an aggressive MS.

We report the case of a 9-year-old girl admitted with fever, headache, and a cerebrospinal fluid lymphocytic pleocytosis. Polymerase chain reaction was positive for human herpes virus 6. She subsequently developed ataxia and bilateral loss of vision. Magnetic resonance imaging (MRI) showed bilateral optic nerve lesions with extension to optic chiasm and a short-segment myelitis. Serologic studies were positive for Borrelia burgdorferi IgM. Anti-aquaporin 4 antibody was negative and anti-myelin oligodendrocyte glycoprotein antibody (MOG) positive. After intravenous methylprednisolone, ceftriaxone, and intravenous immunoglobulin, her vision slowly recovered. The patient was discharged with only mild visual acuity loss, 1 month after admission. Brain MRI was repeated later and was normal and MOG assay became negative. In our view, this patient suffered from a postinfectious, anti-MOG-mediated, spinal cord and optic nerve demyelination. Borrelia burgdorferi infection is associated with neurologic manifestations in up to 15% of cases.1 Optic neuritis related with Lyme borreliosis has been reported infrequently and there is uncertainty about the validity of the diagnosis in many cases.2 Neurologic manifestations associated with human herpes virus 6 (HHV6) infection are usually febrile seizures in infants and encephalitis in immunosuppressed patients. 3Optic neuritis may have multiple causes, including infection and several autoimmune diseases, such as multiple sclerosis, acute disseminated encephalomyelitis, or neuromyelitis optica spectrum disorders.We describe a case of one female adolescent with antimyelin oligodendrocyte glycoprotein (MOG)-positive optic neuritis and myelitis. She had a positive polymerase chain reaction for HHV6 in cerebrospinal fluid and positive enzyme-linked immunosorbent assay and Western blot for Borrelia burgdorferi in serum. We propose that our case expands the spectrum of the association between infection and immunemediated MOG demyelination. Case ReportA previously healthy 9-year-old girl of African descent living in the Azores Islands was admitted to her local hospital with a 6-day history of a febrile illness, headache, and somnolence, previously treated with amoxicillin-clavulanic acid without resolution of symptoms. She had no history of recent travel. Her white blood cell count was 16340/mL (80% neutrophils) and c-reactive protein 0.88 mg/dL. Cerebrospinal fluid examination revealed a cell count of 95 cells/mL, with lymphocytic predominance and elevated protein (66 mg/dL). Polymerase chain reaction in the cerebrospinal fluid was positive for HHV6 and negative for Borrelia burgdorferi, and no serologic tests were performed regarding HHV6. Four days later, she presented with gait imbalance, abdominal pain, and dysuria. Neurologic examination was positive for gait ataxia with a positive Romberg sign. She underwent treatment with a 21-day course of ganciclovir (10 mg/kg/d) and was discharged on the 26th day after admission with a normal physical examination. Brain

Introduction: Some patients with epilepsy identify weather as a typical seizure trigger. However, it is yet to be confirmed. Thus, we aimed to evaluate possible relationships between daily meteorological conditions and the daily incidence of seizures. Methods: This was a retrospective single center study that included adult patients who were admitted to the emergency room of a tertiary hospital in Lisbon, with a seizure, between January and December 2015. The influence of temperature, atmospheric pressure, relative humidity, wind, precipitation, sunlight duration, and the seasons on seizure frequency was evaluated. Results: Three hundred seven seizure episodes were included (from 286 patients) in a total of 365 days, 117 (38.1%) first unprovoked seizures and 190 (61.9%) with previous seizure episodes. There were 82 days with higher incidence of seizures (≥2) and 171 days without seizures. We found a statistical significant relation between lower ambient temperatures, higher atmospheric pressure, and higher maximum humidity with days with two or more seizures. We also found a statistically significant higher incidence of seizures in the winter days (p-value: 0.001) and in days with lower daylight duration (10.8 vs. 12.7 h; p-value: 0.0001). With the exception of humidity, these findings remained true when analyzing the subgroup of patients with previous seizures, but there was no significant difference in the subgroup of first unprovoked seizures. Conclusions: Our results support the possible influence of the weather on seizure frequency in the overall admissions of the emergency department of a tertiary hospital. In particular, these findings suggest that winter conditions, such as, lower ambient temperatures, higher atmospheric pressure, higher humidity, and reduced sunlight exposure, may have impact in the occurrence of higher incidence of seizures in patients with epilepsy.