Multiple sclerosis (MS) is the commonest non-traumatic disabling disease to affect young adults. The incidence of MS is increasing worldwide, together with the socioeconomic impact of the disease. The underlying cause of MS and mechanisms behind this increase remain opaque, although complex geneenvironment interactions almost certainly play a significant role. The epidemiology of MS indicates that low serum levels of vitamin D, smoking, childhood obesity and infection with the Epstein-Barr virus are likely to play a role in disease development. Changes in diagnostic methods and criteria mean that people with MS can be diagnosed increasingly early in their disease trajectory. Alongside this, treatments for MS have increased exponentially in number, efficacy and risk. There is now the possibility of a diagnosis of 'pre-symptomatic MS' being made; as a result potentially preventive strategies could be studied. In this comprehensive review, MS epidemiology, potential aetiological factors and pathology are discussed, before moving on to clinical aspects of MS diagnosis and management.

ObjectiveNeuronal damage is the morphological substrate of persisting neurological disability. Neurofilaments (Nf) are cytoskeletal proteins of neurons and their release into cerebrospinal fluid has shown encouraging results as a biomarker for neurodegeneration. This study aimed to validate the quantification of the Nf light chain (NfL) in blood samples, as a biofluid source easily accessible for longitudinal studies.MethodsWe developed and applied a highly sensitive electrochemiluminescence (ECL) based immunoassay for quantification of NfL in blood and CSF.ResultsPatients with Alzheimer’s disease (AD) (30.8 pg/ml, n=20), Guillain-Barré-syndrome (GBS) (79.4 pg/ml, n=19) or amyotrophic lateral sclerosis (ALS) (95.4 pg/ml, n=46) had higher serum NfL values than a control group of neurological patients without evidence of structural CNS damage (control patients, CP) (4.4 pg/ml, n=68, p<0.0001 for each comparison, p=0.002 for AD patients) and healthy controls (HC) (3.3 pg/ml, n=67, p<0.0001). Similar differences were seen in corresponding CSF samples. CSF and serum levels correlated in AD (r=0.48, p=0.033), GBS (r=0.79, p<0.0001) and ALS (r=0.70, p<0.0001), but not in CP (r=0.11, p=0.3739). The sensitivity and specificity of serum NfL for separating ALS from healthy controls was 91.3% and 91.0%.ConclusionsWe developed and validated a novel ECL based sandwich immunoassay for the NfL protein in serum (NfLUmea47:3); levels in ALS were more than 20-fold higher than in controls. Our data supports further longitudinal studies of serum NfL in neurodegenerative diseases as a potential biomarker of on-going disease progression, and as a potential surrogate to quantify effects of neuroprotective drugs in clinical trials.

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This is the largest study of OCB prevalence in MS and CIS. OCB positivity strongly predicts conversion from CIS to MS. The relationship between latitude and OCBs is confirmed, and this finding warrants further investigation.

Background and Purpose-We report the findings of a randomized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program (SEP) for patients and their informal carers. Methods-Two hundred four patients admitted with acute stroke and their 176 informal carers were randomized to receive an invitation to the SEP or to receive conventional stroke unit care. The SEP consisted of one 1-hour small group educational session for inpatients followed by six 1-hour sessions after discharge. The primary outcome measure was patient-and carer-perceived health status (SF-36) at 6 months after stroke. Knowledge of stroke, satisfaction with services, emotional outcome, disability, and handicap and were secondary outcome measures. T he need for better information, in addition to greater provision of support, has been voiced by stroke patients and their informal carers. 1 Over 10 years ago, a UK Consensus Statement on the treatment of stroke recommended that stroke patients and their informal carers were entitled to "a clear account of the nature and causes of their stroke. . . and [that] more information rather than less should be given." 2 However, evidence suggests that many patients and carers continue to express a lack of understanding about stroke and its causes, secondary preventative measures, and information about both statutory and informal support. [3][4][5] Information needs of patients and informal carers in hospital and after discharge are not being met, despite the efforts of health services and voluntary agencies. 3,4,6,7 It is not unusual for patients and carers to report that they have not received any information about their illness, despite having had discussions with health professionals and being given written information. Results-OnlyThis could occur for a number of reasons: the information was not retained due to the stress of the situation, was not clear, was too complicated, was too general, or did not address the patient or carer's own issues of concern.A study of stroke patients' and carers' satisfaction with care reported that although 89% were satisfied with their overall care, 49% were dissatisfied with the information they had received while in hospital. 8 These results were mirrored in an audit undertaken at North Tyneside General Hospital in 1996, which found that although only 15% of stroke patients and carers felt dissatisfied with their care in general, 40% of stroke patients and 45% of their informal carers were dissatisfied with the information received about stroke before discharge. In light of these findings, a multidisciplinary group consisting of stroke unit staff, community nurses, and representatives from the Stroke Association and the local voluntary sector developed a Stroke Education Program (SEP) that Received July 9, 1999; final revision received September 13, 1999; accepted September 13, 1999. The aim of the present study was to determine the effectiveness of the Stroke Education Program for improving patients' and carers' perceived health status...