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Background: Evidence suggests that Epstein-Barr virus (EBV) plays a role in triggering or perpet-

Background: The McDonald criteria include MRI evidence for dissemination in space and dissemination in time for the diagnosis of multiple sclerosis in young adult patients who present with clinically isolated syndromes (CIS) typical of the disease. Although a major advance, the criteria have limited sensitivity for making an early diagnosis. Objective: To compare the performance of McDonald criteria and modified McDonald criteria for dissemination in space and time for assessing the development of clinically definite multiple sclerosis. Methods: McDonald criteria were modified using the combination of a less stringent definition for dissemination in space and allowing a new T2 lesion per se after three months as evidence for dissemination in time. Modified and McDonald criteria were applied in 90 CIS patients at baseline and at three month follow up scans. Results: Both criteria were highly specific (.90%) but the modified criteria were more sensitive (77% v 46%) and more accurate (86% v 73%).Conclusions: These modified criteria should be evaluated in other CIS cohorts.A n essential requirement in making the diagnosis of multiple sclerosis is that there should be objective evidence for central nervous system (CNS) white matter lesions disseminated in both space and time. Past criteria relied mainly on clinical evidence for dissemination in space and time.1 However, in 2001 new (McDonald) criteria were published that allowed MRI evidence for dissemination in space and time in the diagnosis of multiple sclerosis in patients who experienced a single acute clinical episode considered characteristic of the disease (known as a clinically isolated syndrome (CIS)).2 While the McDonald criteria have high specificity for the subsequent development of clinically definite multiple sclerosis (CDMS) when applied in CIS cohorts followed prospectively, 3 4 they have several limitations.5 6 Notably, the complex magnetic resonance imaging (MRI) criteria for dissemination in space 7 8 (table 1) have been considered too stringent, and the dissemination in time criterion of a new gadolinium enhancing lesion after three months has limited sensitivity in making an early diagnosis. The dissemination in space criteria also include gadolinium enhancement, which-strictly speaking-is a feature of lesion activity rather than location.An early and accurate diagnosis of multiple sclerosis is increasingly important for counselling individual patients and potentially for making decisions on the use of disease modifying treatments. We were therefore interested in whether the MRI criteria for dissemination in space and dissemination in time could be modified so that they improve the accuracy of early diagnosis. In this report we describe the findings using the combination of a less stringent definition for dissemination in space and allowing a new T2 lesion per se after three months as evidence for dissemination in time. METHODS Rationale for modified criteria Dissemination in spaceThe MRI criteria for dissemination in space were modified with th...

In recent years, criteria for the diagnosis of multiple sclerosis (MS) have changed, mainly due to the incorporation of new MRI criteria. While the new criteria are a logical step forward, they are complex and-not surprisingly-a good working knowledge of them is not always evident among neurologists and neuroradiologists. In some circumstances, several MRI examinations are needed to achieve an accurate and prompt diagnosis. This provides an incentive for continued efforts to refine the incorporation of MRI-derived information into the diagnostic workup of patients presenting with a clinically isolated syndrome. Within the European multicenter collaborative research network that studies MRI in MS (MAGNIMS), a workshop was held in London in November 2007 to review information that may simplify the existing MS diagnostic criteria, while maintaining a high specificity that is essential to minimize false positive diagnoses. New data that are now published were reviewed and discussed and together with a new proposal are integrated in this position paper.

Attempts at improving physical activity rates among the population are central to many government, public health, and third sector approaches to encouraging health behaviours. However, to date there has been little attempt by public health to embrace different theoretical-methodological approaches, relying instead upon largely quantitative techniques. This paper argues that through a development of a framework of affect amplification, public health approaches to physical activity should incorporate the choreographing of spaces of movement. Drawing on two case studies, both incorporating ethnographic methodologies, this paper complicates the idea that public health can rely on individual or population level approaches that overlook affective and spatial entanglements. This paper concludes by outlining offer a series of ideas to encourage physical activity participation.

The findings confirm that brain atrophy occurs during the earliest phases of MS and suggest that 1 year longitudinal measures of MRI change, if considered together with baseline MRI variables, might help to predict clinical status 6 years after the first demyelinating event in CIS patients, better than measurements such as lesion or brain volumes on baseline MRI alone.

MRI variables obtained at the onset of a clinically isolated syndrome can predict future development of cognitive abnormalities. Our findings may have implications in monitoring and treating patients.

In established multiple sclerosis, magnetization transfer ratio (MTR) histograms reveal abnormalities of normal-appearing white matter (NAWM) and grey matter (NAGM). The aim of this study was to investigate for such abnormalities in a large cohort of patients presenting with clinically isolated syndromes suggestive of multiple sclerosis. Magnetization transfer imaging was performed on 100 patients (67 women, 33 men, median age 32 years) a mean of 19 weeks (SD 3.8, range 12-33 weeks) after symptom onset with a clinically isolated syndrome and in 50 healthy controls (34 women, 16 men, median age 32.5 years). SPM99 software was used to generate segmented NAWM and NAGM MTR maps. The volumes of T2 lesions, white matter and grey matter were calculated. Eighty-one patients were followed up clinically and with conventional MRI after 3 years (n = 61) or until they developed multiple sclerosis if this occurred sooner (n = 20). Multiple regression analysis was used to investigate differences between patients and controls with age, gender and volume measures as covariates to control for potential confounding effects. The MTR histograms for both NAWM and NAGM showed a reduction in the mean (NAWM, 38.14 versus 38.33, P = 0.001; NAGM 32.29 versus 32.50, P = 0.009; units in pu) and peak location, with a left shift in the histogram. Mean NAWM and NAGM MTR were also reduced in the patients who developed clinically definite multiple sclerosis and multiple sclerosis according to the McDonald criteria but not in the 24 patients with normal T2-weighted brain magnetic resonance imaging (MRI). MTR abnormalities occur in the NAWM and NAGM at the earliest clinical stages of multiple sclerosis.