The effect of interferon beta-1b treatment on MRI measures of cerebral atrophy in secondary progressive multiple sclerosis.

The recently completed European trial of interferon beta-1b (IFN beta -1b) in patients with secondary progressive multiple sclerosis (SP multiple sclerosis) has given an opportunity to assess the impact of treatment on cerebral atrophy using serial MRI. Unenhanced T-1-weighted brain imaging was acquired in a subgroup of 95 patients from five of the European centres; imaging was performed at 6-month intervals from month 0 to month 36. A blinded observer measured cerebral volume on four contiguous 5 mm cerebral hemisphere slices at each time point, using an algorithm with a high level of reproducibility and automation. There was a significant and progressive reduction in cerebral volume in both placebo and treated groups, with a mean reduction of 3.9 and 2.9%, respectively, by month 36 (P = 0.34 between groups). Exploratory subgroup analyses indicated that patients without gadolinium (Gd) enhancement at the baseline had a greater reduction of cerebral volume in the placebo group (mean reduction at month 36: placebo 5.1%, IFN beta -1b 1.8%, P < 0.05) whereas those with Gd-enhancing lesions showed a trend to greater reduction of cerebral volume if the patient was on IFN<beta>-1b (placebo 2.6%, IFN beta -1b, 3.7%; P > 0.05). These results are consistent with ongoing tissue loss in both arms of this study of secondary progressive multiple sclerosis. This finding is concordant with previous observations that disease progression, although delayed, is not halted by IFN beta. The different pattern seen in patients with and without baseline gadolinium enhancement suggests that part of the cerebral volume reduction observed in IFN beta -treated patients may be due to the anti-inflammatory/antioedematous effect of the drug. Longer periods of observation and larger groups of patients may be needed to detect the effects of treatment on cerebral atrophy in this population of patients with advanced disease

Insular sources of thirteenth-century polyphony and the significance of Notre Dame

SIGLEAvailable from British Library Document Supply Centre-DSC:DX191397 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Casting beams of darkness into Bartók's Cantata Profana

Béla Bartók’s Cantata Profana (1930) retains ambiguities inherent in the Romanian myth on which it is based – a story of nine hunting-lads magically transformed into stags. This article explores the mysterious elements through psychoanalysis, positing links between darkness, Bartókian ‘night music’, and the Unconscious. Other aspects of the musical language suggest representations of Lacanian processes, specifically a regressive fantasy to the mental order of the ‘Real’. This is linked to Bartók’s experience of childhood illness, a time of perfect maternal love but profound bodily betrayal, suggesting that the stag-body represents a strong, proud transformation, ‘replacing’ the debilitated body of childhood memory. Musically, the ‘mirror-image’ scales of the opening and ending of the work are re-examined. It is proposed that they represent Bartók acknowledging loss, most importantly the loss of the myth of ‘pure sources’, which had sustained him, both musically and psychologically, up until then. This loss inevitably sought expression after a disastrous polemical debate forced him to abandon the idea of musical purity in folksong

Texture analysis of spinal cord pathology in multiple sclerosis

Texture analysis was applied to MR images of the spinal cord in an attempt to quantify pathological changes that occur in multiple sclerosis (MS). Texture features quantify macroscopic lesions and also the microscopic abnormalities that may be undetectable using conventional measures of lesion volume and number. Significant differences in texture between normal controls and MS patients were seen. Texture differences were detected between normal controls and relapsing-remitting patients before detectable spinal cord atrophy. There was also significant correlation between texture and disability. The segmentation and texture analysis technique demonstrates intraobserver coefficients of variation ranging from 0. 6-8.2%. Texture analysis has potential as a tool for monitoring changes associated with the development of disability in patients with MS. Reproducibility and sensitivity must be improved to use the technique for serial monitoring in individuals

Shortening inpatient stay for stroke

Patients who have had a stroke benefit from organised inpatient care in a stroke unit,1 although the optimum model for care has yet to be determined

Cognitive dysfunction after isolated brain stem insult. An underdiagnosed cause of long term morbidity

Cognitive dysfunction adversely influences long term outcome after cerebral insult, but the potential for brain stem lesions to produce cognitive as well as physical impairments is not widely recognised. This report describes a series of seven consecutive patients referred to a neurological rehabilitation unit with lesions limited to brain stem structures, all of whom were shown to exhibit deficits in at least one domain of cognition. The practical importance of recognising cognitive dysfunction in this group of patients, and the theoretical significance of the disruption of specific cognitive domains by lesions to distributed neural circuits, are discussed