Talk:Multiple sclerosis/Archive 4

natalizumab has been pulled from the market for treatment of MS because of unacceptable risk for a viral brain infection called progressive multifocal leukoencephalopathy, or PML. Sorry I don't have the time right now to edit the page but perhaps someone else can. I'll check back later... — Preceding unsigned comment added by Crazyflag (talk • contribs) 21:39, 15 February 2012 (UTC)

It was returned to the market, because it was regarded as useful despite the (small but non-zero) risk of PML. I have just scanned Google News and have not found anything to suggest that the drug was again withdrawn. JFW | T@lk 21:57, 15 February 2012 (UTC)

Tests for JCV virus are done before you get it nowadays. I find it remarkably coincidental that Tysabri causes Roseola outbreaks. All supposition, but isn't it strange that you should see a manifestation of HHV-6 viral activity during treatment with this drug?89.100.48.115 (talk) 19:41, 18 May 2012 (UTC)

Peotrovitch (talk · contribs) changed the intro to reflect that claim that the role of autoimmunity in MS is questioned. This was based (according to the edit summary) on this news report in which scientists discuss their findings from doi:10.1038/nn.3062. This study has not appeared in print yet. According to the abstract, it was an in vivo mouse study that mainly looked at what happened if you killed oligodendrocytes and whether this would trigger anti-myelin immunity. The authors must have good reason to extrapolate these findings in their press releases, but I don't think we can say that it displaces 1000s of previous studies without a very strong secondary source. JFW | T@lk 11:19, 29 February 2012 (UTC)

Kmeadus (talk · contribs) added the following to "Management of the effects of MS":

This is based on the source doi:10.1177/1352458511415143, which is a primary research study looking at sports participation and relapse of MS. It is a retrospective observational study. I don't think it is suitable to support the claims made on the basis of relative methodological weakness, and we should only use a WP:MEDRS-compatible secondary source to support such a claim. The text also contains editorialising phrases ("it is important that [patients] realize"). JFW | T@lk 13:01, 13 March 2012 (UTC)

Good call. I was going to make the same point and roll back the edit but you beat me to it. Dubbin^{u | t | c} 20:59, 13 March 2012 (UTC)

Great minds edit alike. JFW | T@lk 09:30, 14 March 2012 (UTC)

Reply to User:Jfdwolff. Recently I have begun to believe that MS is in fact not an autoimmune disease and I have serious problems finding literatur that prove that it would primarily be an autoimmune disease. Do you have any good articles that can at least supply me with some evidence. To me i seems more logic that it would primarily be a neurodegenerative disorder with secondary inflammation. Alas, there is no answers. Please read Trapp and Nave 2008 ^[1], it is an eye-opener. Unsigned by Physician89 (talk · contribs)

Fascinating. The DOI is doi:10.1146/annurev.neuro.30.051606.094313. Without reading the article (no access), it is difficult to understand why someone would recover fully from a relapse if the main pathology is degenerative. Even if the primary insult is degenerative, the predominanat pathology still seems to be inflammatory. JFW | T@lk 08:38, 10 December 2012 (UTC)

I guess it's because it appears contraintuitive that it have taken a while get to this point. Of course inflammation is a big part of the patients life and there is a consensus around the fact that inflammation is the cause of the exacerbation/relapse. But treatment of the inflammation does not appear to affect the progression of the disease as much as it does in other autoimmune diseases. What correlates better to progression is the degenerative aspects such as volume loss and axonal degradation. Most of the long-term disabilty cannot be explained by pure inflammation, it could be explained by irrepairable damage done by previous inflammation of course. The question that no one has an answer to is whether inflammation causes this process or if the inflammation is a patient's response to the degradation. Assuming it is the response then the primary progressive MS patient is the ideal patient as he/she has no inflammatory response. This fits well because on a population level PPMS is more common in the higher ages. Also when relapse-remitting patients transform into secondary progression the inflammatory aspects of the disease often stops, this often roughly occure at the same age when PPMS patients typically present. The hypothesis therefore is that something happens in the brain during the relapse-remitting phase that a majority respond to with inflammation. The inflammation might be beneficial in the future when treatment is available for the degeneration because it allows for earlier diagnosis. Anyway, this are all just a hypothesis and should not confuse people and should not appear on the front of the MS wikipage. What could be done is to downtone the autoimmunity though. Physician89 (talk) 23:31, 13 December 2012 (UTC)

Surely there are more recent articles on prognosis than the studies done inthe 1980s before the widespread use of interferons? --5telios (talk) 11:58, 20 March 2012 (UTC)

Interferons only diminish relapse rates but there is no data to suggest that they delay progression. JFW | T@lk 21:55, 20 March 2012 (UTC)

The cause of MS has been sought after for a long time. Has anyone added a section on this? I'm fairly sure it's viral, caused by the HHV-6a virus, though some studies dispute this. There are lots of anti viral compounds available from nature. Papers are still being reviewed. Etiology of MS should include EBV, HHV-6, CCSVI (though this can be caused by HHV-6), lack of vitamin D, irregular sleep patterns (maybe) and genetics. Where you live makes a difference too. Shtanto (talk) 18:13, 22 May 2012 (UTC)

Did you consider reading the "Causes" section of the article? Simply put, the experts acknowledge that it is still idiopathic. We don't do research here, we summarize what the best available sources have published. LeadSongDog come howl! 19:39, 22 May 2012 (UTC)

Your personal convictions are of little relevance, and the data on CCSVI is very doubtful. Secondary sources, as LeadSongDog says, are the only suitable sources for a topic like this, and etiologies not listed in such sources are very unlikely to be relevant for the general reader.

I do object to using the Cochrane Collaboration as a source when it comes to etiology. Cochrane studies treatments, not pathophysiology, and their classification is not in itself authoritative. JFW | T@lk 21:35, 22 May 2012 (UTC)

Objection noted. What alternative secondary sources would you suggest as reliable current information for that aspect? LeadSongDog come howl! 15:38, 23 May 2012 (UTC)

Any recent review article on the condition will make some allusions to its suspected aetiopathological mechanism. There are several already cited. JFW | T@lk 21:48, 24 May 2012 (UTC)

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I want to edit a new external link which will be helpful to people searching for information about multiple sclerosis. The link is http://www.lifeandms.com/

ALRstark (talk) 13:17, 25 May 2012 (UTC)

 Not done As it's a commercial website of a pharmaceutical company. Dru of Id (talk) 19:19, 25 May 2012 (UTC)

Oliver J. DeSofi, author of Caregiving: My Story, Your Guide (Dec 2010)This book describes the 24 year documented progression of an MS patient and the personal experiences of her caregiver husband.Seidler1 (talk) 15:42, 27 June 2012 (UTC)

Okay and? Doc James (talk · contribs · email) (please reply on my talk page) 16:59, 27 June 2012 (UTC)

I would prefer to have everyone use generic names

But it's a fact of life that doctors, patients and others regularly refer to drugs by their brand names. Even the medical journals use brand names. The NEJM used "BG-12", not "dimethyl fumarate".

WP:MEDMOS says, "Write for the average reader and a general audience—not professionals or patients."

If we eliminate the brand names, non-specialist readers will have a more difficult time understanding this article. Having to click to another article to understand the first article is also difficult.

Some drugs may have different brand names in different countries, and I don't think we should use long lists of drug names in many countries, but we can and should use the most common names in English-speaking countries, and many of the drugs have only one brand name. --Nbauman (talk) 21:20, 27 September 2012 (UTC)

Most meds have dozens of brand names. They should be listed on the page for that med not within the articles themselves IMO. Drug reps of course refuse to use anything but brand names. Most of the time we should simply be using the classes of medications followed by a generic name of one or two meds within that class in the main article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:16, 27 September 2012 (UTC)

BG-12 is not really a brand name but an investigational compound name. Interestingly some drugs continue to be called by their investigational name well after they have acquired generic and brand names. TK506 and STI571 are good examples. JFW | T@lk 22:20, 27 September 2012 (UTC)

Some people are more familiar with the brand name than with the generic name. Would you agree with that?

Question: Will it be easier for the general reader to understand this passage if we add the most common brand names for these drugs, or will it be more difficult?

Will it be easier for the general reader to understand this passage if he doesn't have to click a link to another page? --Nbauman (talk) 07:04, 28 September 2012 (UTC)

There are more than 2000 brand names for acetaminophen / paracetamol. There are people for which each individual brand name is more familiar. We do not add all 2000 brand names every time we mention acetaminophen. Yes this is an extreme example but most meds have at least 10 brand names.

But to answer your question adding all these brand names clutters the text and thus IMO makes the text less understandable. Than their is the potential harm in that different brand names may indicated different generic meds is different countries (deaths have resulted from where a person with a prescription containing a brand name went to another country handed it to the pharmacist was given what the brand name was in that country and not what it was in his home country. Other issues with brand names is that they increase costs and confuse both patients and physicians (the least we at Wikipedia can do is not perpetuation their use within our articles on disease) Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:42, 28 September 2012 (UTC)

I once strongly opposed the use of brand names because, as you said, brand marketing increases the cost and is inherently promotional. However, I had to give up. I was forced to acknowledge that some brand names are so popular among both medical professionals of all kinds and the general public (the target audience for Wikipedia) that they won't know what I'm talking about if I only use generics rather than using both. For example, the acronyms for chemotherapy protocols don't make sense if you refer to Adriamycin only as doxorubicin.

For most of these MS drugs there is only one common brand name, and that's all we need to use. Referring to natalizumab in the JAMA style book style as "natalizumab (Tysabri)" doesn't clutter the text or make it less understandable. If the reader is familiar with the name Tysabri but not natalizumab, as many are, it makes the text more understandable. The alternative, of clicking on every generic name until you find out which one is Tysabri, is certainly more difficult and confusing.

Question: Do you think that, for readers who are more familiar with the brand name than the generic name, it will clutter the text and make it more or less understandable to have the most common brand name along with the generic, as "natalizumab (Tysabri)"? --Nbauman (talk) 22:50, 28 September 2012 (UTC)

If we use two names only when it is commonly done in other authoritative sources then I don't see us creating a problem unless I'm missing something. Biosthmors (talk) 23:49, 28 September 2012 (UTC)

There is an interesting paper on how natural or man-made electrical fields might be involved through dielectrophoretic forces on the protein lipids of the myelin, which may be worth including. The study of the influence of atmospheric electromagnetic factors on human health is beginning to grow rapidly. Canbay C “The essential environmental cause of multiple sclerosis disease” PIER (Progr In Electromagnet Res.) 101: 375-391; (2010) http://www.jpier.org/PIER/pier101/25.09112604.pdf Diagnostic2 (talk) October 28th, 2012. —Preceding undated comment added 18:01, 28 October 2012 (UTC)

See WP:MEDRS. Electromagnetism is not considered an important factor in MS. WP:WEIGHT applies for this. JFW | T@lk 23:40, 28 October 2012 (UTC)

Who has studied electromagnetism as regards MS and has therefore concluded it is not important? If this is a new area of study it may not yet be possible to tell how important it will turn out to be. Canbay's mathematical support for dielectrophoretic lipid disruption of myelin looks worthy of further investigation. Diagnostic2 (talk) October 29th 2012. —Preceding undated comment added 11:20, 29 October 2012 (UTC)

I am surprised that this book, written by professor of emergency medicine George Jelinek, isn't mentioned anywhere here although it summarizes a great deal of evidence about health benefits of low saturated fat diet and high doses of Vitamin D. Is there any reason for that? I can't believe that wikipedia contributors aren't aware of this book... Riose (talk) 19:06, 5 November 2012 (UTC)

ISBN 1742371795 - the main perspectives in this book, at least judging from the Amazon write-up, are quite significantly at odds with current professional recommendations. I would have difficulty quoting from it without some sort of secondary source supporting its acceptance as a legitimate opinion. JFW | T@lk 21:07, 5 November 2012 (UTC)

Well, I have read this book and it contains a very good summary of currently available 'alternative' treatments. It's just not one of those believe-in-something-and-it-will-come-true books, the author cites literaly hundreds of papers published in respectable journals. He himself publishes in respectable journals. So if you don't mind, I'll mention this book on "Treatment of multiple sclerosis" page, just after Swank Multiple Sclerosis Diet.Riose (talk) 12:07, 6 November 2012 (UTC)

You don't need my permission, but consensus would be good. JFW | T@lk 22:12, 6 November 2012 (UTC)

Early in the article it states "Decreased sunlight exposure has been linked with a higher risk of MS.[17] Decreased vitamin D production and intake has been the main biological mechanism used to explain the higher risk among those less exposed to sun."[17][18][19]

Where as in: Epidemiology it states There is a north-to-south gradient in the northern hemisphere and a south-to-north gradient in the southern hemisphere, with MS being much less common in people living near the equator.[1][66] Climate, sunlight and intake of vitamin D have been investigated as possible causes of the disease that could explain this latitude gradient....A relationship between season of birth and MS has also been found which lends support to an association with sunlight and vitamin D.

For example fewer people with MS are born in November as compared to May.[68] Please correct. — DocOfSoc • Talk • 04:26, 23 November 2012 (UTC) — DocOfSoc • Talk • 04:18, 24 November 2012 (UTC)

Both these mean the same thing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:34, 23 November 2012 (UTC)

WRONG!!! Read it again! — DocOfSoc • Talk • 04:18, 24 November 2012 (UTC)

If you are born in Nov your mother was exposed to sunlight during much of your gestation. If you are born in May your mother was exposed to little sunlight during your gestation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:03, 24 November 2012 (UTC)

That's only correct for the northern hemisphere. The majority of the world's population is in that hemisphere, but that's a rather weak justification. It would be better to say "If you are born in autumn your mother was exposed to sunlight... If you are born in spring your mother was exposed to little sunlight...".-gadfium 05:15, 24 November 2012 (UTC)

Agree it could be clearer. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:42, 24 November 2012 (UTC)

The section "Classification" refers specifically to the clinical classification, as opposed to possible pathological classifications currently under research. I propose to change the section's name for "Clinical classification" or better "Clinical courses".

--Juansempere (talk) 15:30, 14 December 2012 (UTC)

I will perform the change now. If anybody disagrees, just revert it.

--Juansempere (talk) 01:29, 17 December 2012 (UTC)

This article was the subject of an educational assignment in 2013 Q3. Further details were available on the "Education Program:Case Western Reserve University/ANTH 302 Darwinian Medicine (Fall 2013)" page, which is now unavailable on the wiki.

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Under "Research", alemtuzumab has now had 2 clinically significant phase 3 trials published in the Lancet in Nov 2012, so it should be changed to say that it has been tested in a phase 3 trial; I have written about these under the 'CD52' wiki page which could be linked at this point, saying for example: "A number of treatments that may curtail attacks or improve function are under investigation. Emerging agents for RRMS that have shown promise in phase 2 trials include daclizumab (trade name Zenapax), rituximab, dirucotide, BHT-3009, cladribine, dimethyl fumarate, estriol, laquinimod, PEGylated interferon-β-1a,[78] minocycline, statins, temsirolimus and teriflunomide.[77] A phase 3 trial in November 2012 demonstrated some clinical benefit from alemtuzumab (trade name Campath), which targets CD52". Remd104 (talk) 00:44, 29 December 2012 (UTC)

Except the manufacturer of Campath is trying to stop it from being authorised for this indication. How about we wait for a secondary source, which shouldn't be long in coming? JFW | T@lk 23:59, 29 December 2012 (UTC)

Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template..--Canoe1967 (talk) 00:03, 30 December 2012 (UTC)

I agree, new studies are good, but the page remains factually incorrect in stating that alemtuzumab remains a phase 2 study drug: there are now 2 phase 3 studies on it. There are concerns that the manufacturer of Campath is considering increasing the price but going to do so in negotiation with organisations such as NICE, but I wasn't aware that the manufacurer was trying to stop it being authorised?— Preceding unsigned comment added by Remd104 (talk • contribs) 29 December 2012

I am setting this edit request back to "answered" in light of the above response from Jfdwolff (talk · contribs). You are welcome to continue discussion on this talk page to build consensus, but please do not re-activate the edit request unless there is consensus for this edit. —KuyaBriBri^Talk 15:55, 2 January 2013 (UTC)

Yes there are review articles that put new meds in proper perspective. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:39, 2 January 2013 (UTC)

Seems I was wrong about the licensing: the manufacturer seems to have applied for a license with EMEA. JFW | T@lk 23:21, 2 January 2013 (UTC)

The blood–brain barrier IS NOT a capillary system this must be corrected. Easy to verify Blood–brain barrier Nini00 (talk) 09:50, 30 January 2013 (UTC)

I have changed the article to: The blood–brain barrier is a part of the capillary system that prevents the entry of T cells into the central nervous system.--Garrondo (talk) 11:08, 30 January 2013 (UTC)

Clive Burr: — Preceding unsigned comment added by SFtheGreat (talk • contribs) 19:36, 13 March 2013 (UTC)

Just I would like to add that there is new drug approved for MS. US Food and Drug Administration (FDA) has approved dimethyl fumarate (Tecfidera, Biogen Idec) for the treatment of relapsing-remitting multiple sclerosis (MS). Mar 27, 2013 citation- http://www.medscape.com/viewarticle/781450?src=wnl_edit_newsal&uac=167846CN — Preceding unsigned comment added by 70.44.253.137 (talk) 01:19, 29 March 2013 (UTC)

These two images are the same. Thus IMO we only need the one. Maybe which everyone it is should be in the history section as it fits better there. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:56, 2 June 2013 (UTC)

They are two different patients, and have different symptoms, as the female has clear spasticity problems in hands while male has mainly walking problems. Moreover, I purpousedly left one as created, and animated the other one so as to emphasize walking difficulties in the first, and historical aspects in the second. I disagree that they fit better in history section: symptoms depicted are still valid today, specially since there are not any free videos of an MS patient available showing motor symptoms. I would rather leave the two until there is a better image for the symptoms section. If I had to choose I would leave the animated one in the symptoms section, since the author made no special contributions to the study of MS (only potographs of the 2 patients shown and a third one) so the historical value is only as a curiosity. Also, animation has taken 3 hours of work and IMO has greater medical value. --Garrondo (talk) 21:22, 2 June 2013 (UTC)

Okay sounds reasonable. Adjusted formatting abit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:25, 2 June 2013 (UTC)

• We discuss pathophysiology twice in the lead.

You have fixed it, havent you?.--Garrondo (talk) 15:44, 3 June 2013 (UTC)

• With respect to signs and symptoms while any can happen nearly it would be useful to know which are more common.

Point is that being lesions semi random all commented are quite common. I would nevertheless try to find some data on prevalence of symptoms.--Garrondo (talk) 15:44, 3 June 2013 (UTC)

For example Compston lancet article is similarly unspecific: In most patients, clinical manifestations indicate the involvement of motor, sensory, visual, and autonomic systems but many other symptoms and signs can occur (table). Few of the clinical features are disease-specific, but particularly characteristic are Lhermitte's symptom (an electrical sensation running down the spine or limbs on neck flexion) and the Uhthoff phenomenon (transient worsening of symptoms and signs when core body temperature increases, such as after exercise or a hot bath).--Garrondo (talk) 15:50, 3 June 2013 (UTC)

• Not sure about the need to contain the complicated term, maybe just link to it? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:10, 3 June 2013 (UTC)

I am not following you: which word?--Garrondo (talk) 15:44, 3 June 2013 (UTC)

Just the changes I made. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 3 June 2013 (UTC)

Regarding the EDSS comment on my talk page: I have searched for the term in pubmed and from the first abstracts I have found it appears capitalized in half of them, so probably it does not really matter as long as we are systematic.

--Garrondo (talk) 15:44, 3 June 2013 (UTC)

Okay. We at Wikipedia seem to capitalize rarely. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 3 June 2013 (UTC)

• There's a spelling error in the first paragraph. "Disease is more common in women and the onset tipically occurs in young adults" should read "Disease is more common in women and the onset typically occurs in young adults".--StuartLivings 06:56 5 June 2013 (UTC)

Thanks a lot for your comment. Corrected.--Garrondo (talk) 09:18, 5 June 2013 (UTC)

• Any chance someone could mention Low-Dose Naltrexone? It does work you know.

I deem myself qualified by virtue of Patientibus Cognesemus, but my latin is rubbish. Living with MS is like trying to live with a wetsuit on. The mask blurs your vision, the snorkel and regulator fumble your speech, the wetsuit is too tight around the middle, it's drying out so you're stiff all the time, you're tired from simply trying to move and breathe with the heavy tanks on your back, the flippers stymie your steps and throw you off balance. I took half dose Minocycline for 3 months. It might have been little more than a placebo effect, but it seemed to be doing something. One thing you should know about MS: it makes you fight like a cornered animal.Shtanto (talk) 20:43, 3 February 2014 (UTC)

We need refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:08, 3 February 2014 (UTC)

Again, in the lead is asserted that MS is autoimmune, which is in fact supported by a lot of sources, but as far as I know there is also a lot of sources saying that it is idiopatic or challenging the autoimmunity hipothesis. The reference to the autoimmunity or at least a remark about the disagreement should be stated.

Just to support my point, here is a recent review questioning the primary autoimmunity

Juansempere (talk) 22:02, 10 June 2013 (UTC)

Is there a pubmed indexed source? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:55, 11 June 2013 (UTC)

Clarified. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:02, 11 June 2013 (UTC)

I see 2014 reviews classifying it as autoimmune. I will post them here and we can discuss further if needed. TylerDurden8823 (talk) 07:58, 12 October 2014 (UTC)

At this edit Doc James tweaked the wording, but it still seems not quite right. Surely the intended factor in the source isn't just whether someone is environmentally exposed to the agent so much as whether they are (to some extent) infected by it. Am I missing a subtlety of definition here? If so, I suspect many readers will miss it too. LeadSongDog come howl! 14:20, 13 June 2013 (UTC)

Adjusted further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:42, 14 June 2013 (UTC)

I am of the opinion that this image does not add enough and thus should be removed. We already have one image in this section and one that is more specific at that. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:58, 14 June 2013 (UTC)

I would rather have the two, but since you have been the second person to raise the issue and it is quite reasonable, I have eliminated it myself.--Garrondo (talk) 19:42, 14 June 2013 (UTC)

Thanks Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:06, 16 June 2013 (UTC)

Were in the source does it state the relapse rate is rarely greater than 1.5 per year? "Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors with a rate rarely above one and a half per year." pmid18970977 Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:31, 16 June 2013 (UTC)

Section clinical course: New episodes occur erratically but the rate seldom exceeds 1·5 per year. With time, recovery from each episode is incomplete and persistent symptoms accumulate.--Garrondo (talk) 07:25, 17 June 2013 (UTC)

I do not get the fraction. Are they not discrete integers? How does one have 1.5 acute episoids? Should it not be either 1 or 2? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:13, 17 June 2013 (UTC)

It says that the mean number of episodes in a year for a normal individual is 1.5. Obvioulsy an individual a specific year will have 1 or 2 but not 1.5. --Garrondo (talk) 11:27, 17 June 2013 (UTC)

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Subsection 2.2, Paragraph 3: "An explanation for this could be that some kind of infection, produced by a widespread microbe rather than a rare one, is the origin of the disease.[6] Proposed mechanisms, including the hygiene hypothesis and the prevalence hypothesis. The hygiene hypothesis proposes..." I got caught up on the incomplete sentence, but otherwise, great read! Ril3yj1mes (talk) 08:32, 22 June 2013 (UTC)

Done Yes. I think it was intended to read: "Proposed mechanisms include the hygiene hypothesis and the prevalence hypothesis.", because the 2 following sentences proceed to elaborate on these hypotheses. I changed it accordingly. Thank you for pointing it out. Begoon ^talk 10:17, 22 June 2013 (UTC)

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Please note there are spelling errors in the 5th paragraph of the text: "symptoms usually appear in episoids of sudden worsening (called relapses, exacerbations, bouts, attacks, or "flare-ups") or gradually over time with worsening neurologic function.[5] A combination of these two parterns may also occur.[5]. "episoids" should read "episodes" and "parterns" should read "patterns"

Best wishes.AppGirl (talk) 22:46, 22 June 2013 (UTC)AppGirl AppGirl (talk) 22:46, 22 June 2013 (UTC)

Fixed. Thanks.-gadfium 22:50, 22 June 2013 (UTC)