***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / methods : One hundred and fifteen patients with clinical ly isolated optic neuritis underwent magnetic resonance imaging ( MRI ) of the brain and spinal cord within 3 months of the onset of symptoms . Results : Eighty one ( 70 % ) patients had brain lesions and 31 ( 27 % ) had cord lesions . Cord lesions were seen in 12 % with a normal brain MRI , 21 % with between one and eight brain lesions , and 45 % with nine or more brain lesions . When the new diagnostic criteria for MS were applied , MRI cord imaging used for evidence of dissemination in time and space allowed a diagnosis of MS in only one additional asymptomatic patient at 1 year , two additional asymptomatic patients at 3 years . Conclusions : Using existing criteria , spinal cord imaging rarely contributes to the diagnosis in patients with clinical ly isolated optic neuritis A prospect i ve study in patients with a clinical acute isolated brainstem or spinal cord disorder was undertaken . The aim was to evaluate the predictive value of IgG intrathecal  synthesis  ( through the detection of oligoclonal b and s in CSF ) and MRI lesions at presentation , for the subsequent progression to multiple sclerosis . Forty four patients took part in this study : 22 had a brainstem disorder and 22 a spinal cord disorder . After a mean period of 26 ( SD 22 ) months , 30 patients ( 68.2 % ) developed clinical ly definite multiple sclerosis . The remaining 14 patients were followed up for more than seven years . Twenty six ( 59.1 % ) patients had oligoclonal b and s in CSF , with a sensitivity of 80.0 % , specificity of 85.7 % , and a predictive value of 92.2 % . Magnetic resonance imaging showed disseminated white matter lesions in 22 patients ( 50.0 % ) , with a sensitivity of 60.0 % , a specificity of 71.4 % , and a predictive value of 81.7 % . The difference between patients with multiple sclerosis and patients without the disease was statistically significant for the findings of an IgG intrathecal synthesis ( P < 0.001 ) . It was only borderline for the MRI findings ( P = 0.052 ) . Thus the detection of an intrathecal synthesis at presentation seemed to be a better prognostic indicator of the progression to multiple sclerosis in patients affected by acute isolated brainstem or spinal cord syndromes OBJECTIVE To assess efficacy , safety , and tolerability of every-other-day interferon beta-1b treatment in patients with a first clinical event suggestive of multiple sclerosis ( MS ) ( clinical ly isolated syndrome ) . METHODS We conducted a multicenter , r and omized , double-blind , placebo-controlled trial . Patients with a first clinical demyelinating event and at least two clinical ly silent brain MRI lesions were r and omized to interferon beta-1b ( IFNB-1b ) 250 mug subcutaneously ( SC ) every other day ( EOD ) ( n = 292 ) or placebo ( n = 176 ) , until clinical ly definite MS ( CDMS ) was diagnosed or they had been followed for 24 months . RESULTS After 2 years , 45 % of placebo patients had converted to CDMS ( Kaplan-Meier estimate ; primary outcome measure ) and 85 % fulfilled the McDonald criteria ( co- primary outcome measure ) . Overall interferon beta-1b delayed the time to diagnosis of CDMS ( p < 0.0001 ) and McDonald MS ( p < 0.00001 ) . Hazard ratios ( 95 % CI ) were 0.50 ( 0.36 to 0.70 ) for CDMS and 0.54 ( 0.43 to 0.67 ) for McDonald MS favoring treatment with IFNB-1b . Treatment was well tolerated , as indicated by the low rate of patients dropping out of the study before CDMS was reached ( 6.6 % overall , 7.2 % in the IFNB-1b group ) . CONCLUSIONS Interferon beta-1b 250 mug subcutaneously every other day delayed conversion to clinical ly definite multiple sclerosis , and should be considered as a therapeutic option in patients presenting with a first clinical event suggestive of multiple sclerosis Abstract We evaluated the risk of developing clinical ly definite multiple sclerosis ( CDMS ) after an acute attack of isolated optic neuritis ( ON ) in 112 patients , in relation to demographic and para clinical findings . Patients were examined by  brain MRI , CSF analysis , and multiple evoked potentials ( EPs ) ;  10 were lost to follow-up , and the other 102 were enrolled in a prospect i ve study ( follow-up duration 6.3 ± 2.2 years ) . Of these , 37 ( 36.3 % ) developed CDMS after a mean interval of 2.3 ± 1.6 years . The risk of developing CDMS was 13 % after 2 years , 30 % after 4 , 37 % after 6 , and 42 % after 8 and 10 years . Gender , age , and season of ON onset did not affect the risk . MS occurred in 37 of 71 patients ( 52.1 % ) with one MRI lesion or more ; no patient with a normal MRI developed the disease . MS developed more frequently in patients with intrathecal IgG synthesis than in those without ( 43 % vs. 28 % ) , but the difference was not statistically significant . Multiple EPs showed a slight predictive value only including somatosensory EPs of the lower limb . Multiple sclerosis was mild in most cases ( EDSS 2.2 ± 1.9 ) . The EDSS was less than 4 in 32 cases ( 86 % ) , between 4 and 6 in 2 ( 5 % ) , higher than 6.5 in 3 ( 8 % ) BACKGROUND AND PURPOSE Various authors have developed criteria to classify MR imaging findings that suggest the possibility of multiple sclerosis . The purpose of this study was to evaluate and compare the capacity of three sets of MR imaging criteria for predicting the conversion of isolated demyelinating syndromes to clinical ly definite multiple sclerosis . METHODS Seventy patients with clinical ly isolated neurologic symptoms suggestive of multiple sclerosis were prospect ively studied with MR imaging .  The MR imaging findings were evaluated by two independent neuroradiologists who were blinded to clinical follow-up data . Based on the clinical outcome at follow-up ( presence of a second attack that established clinical ly definite multiple sclerosis ) , the sensitivity , specificity , accuracy , positive predictive value , and negative predictive value of the criteria proposed by Paty et al , Fazekas et al , and Barkhof et al were calculated . RESULTS Clinical ly definite multiple sclerosis developed in 22 ( 31 % ) patients after a mean follow-up time of 28.3 months . The criteria proposed by Paty et al and those proposed by Fazekas et al showed identical results : sensitivity , 86 % ; specificity , 54 % ; accuracy , 64 % ; positive predictive value , 46 % ; and negative predictive value , 89 % . The criteria proposed by Barkhof et al showed the following : sensitivity , 73 % ; specificity , 73 % ; accuracy , 73 % ; positive predictive value , 55 % ; and negative predictive value , 85 % . CONCLUSION The four dichotomized MR imaging parameters proposed by Barkhof et al are more specific and accurate than the criteria proposed by Paty et al or Fazekas et al for predicting conversion to clinical ly definite multiple sclerosis BACKGROUND Several controlled studies provide evidence that treatment with interferon beta in patients with a first event suggestive of multiple sclerosis ( MS ) delays conversion to clinical ly definite MS ( CDMS ) . Our aim was to determine whether early initiation of treatment with interferon beta prevents development of confirmed disability in MS . METHODS In the initial placebo-controlled phase of the double-blinded BENEFIT study , patients with a first event suggestive of MS and a minimum of two clinical ly silent lesions in MRI were r and omised to receive either interferon beta-1b 250 microg ( n=292 ) or placebo ( n=176 ) subcutaneously every other day for 2 years , or until diagnosis of CDMS . Patients were then eligible to enter the follow-up phase with open-label interferon beta-1b . In the current prospect ively planned analysis 3 years after r and omisation , the effects of early interferon beta-1b treatment were compared with those of delayed treatment initiated after diagnosis of CDMS or after 2 years on the study . The primary outcomes of this ITT analysis were time to diagnosis of CDMS , time to confirmed exp and ed disability status scale ( EDSS ) progression , and score on a patient-reported functional assessment scale ( FAMS-TOI ) . This trial is registered with Clinical Trials.gov , number NCT00185211 . FINDINGS Of the 468 patients originally r and omised , 418 ( 89 % ) entered the follow-up phase ; 392 ( 84 % ) completed 3 years ' post-r and omisation follow-up . After 3 years , 99 ( 37 % ) patients in the early group developed CDMS compared with 85 ( 51 % ) patients in the delayed treatment group . Early treatment reduced the risk of CDMS by 41 % ( hazard ratio 0.59 , 95 % CI 0.44 - 0.80 ; p=0.0011 ; absolute risk reduction 14 % ) compared with delayed treatment . Over 3 years , 42 ( 16 % ) patients in the early group and 40 ( 24 % ) in the delayed group had confirmed EDSS progression ; early treatment reduced the risk for progression of disability by 40 % compared with delayed treatment ( 0.60 , 0.39 - 0.92 ; p=0.022 ; absolute risk reduction 8 % ) . The FAMS-TOI score was high and stable in both groups over the 3-year period ( p=0.31 ) . INTERPRETATION Our data suggest that early initiation of treatment with interferon beta-1b prevents the development of confirmed disability , supporting its use after the first manifestation of relapsing-remitting MS BACKGROUND Several studies have confirmed the predictive value of baseline and follow-up magnetic resonance ( MR ) imaging variables for conversion to clinical ly definite multiple sclerosis ( CDMS ) , depending on the population , follow-up duration , and treatment intervention . However , the timing of follow-up imaging and the effect of treatment intervention on the predictive value of baseline MR imaging variables require further elucidation . OBJECTIVES To assess the prognostic value of baseline MR imaging variables for conversion to CDMS over 3 years and whether this was affected by treatment intervention and ( 2 ) to assess the increased risk for conversion posed by dissemination in time on follow-up MR imaging . DESIGN Cohort study . SETTING Multicenter r and omized clinical trial . PATIENTS Four hundred sixty-eight patients with a clinical ly isolated syndrome who had an initial clinical demyelinating event within the past 60 days who received early treatment ( 3 years of interferon beta-1b ) or delayed treatment ( placebo first , followed by > or = 1 year of interferon beta-1b ) . Intervention Magnetic resonance imaging . Main Outcome Measure Time to CDMS . RESULTS The overall conversion rate to CDMS was 42 % . Barkhof criteria with the strongest prognostic value were the presence at baseline of at least 9 T2-weighted lesions ( hazard ratio [ HR ] , 1.64 ; 95 % confidence interval [ CI ] , 1.15 - 2.33 ; P = .006 ) and at least 3 periventricular lesions ( 1.66 ; 1.14 - 2.41 ; P = .009 ) . No specific advantage was noted in using a fixed cutoff of at least 3 Barkhof criteria ( HR , 1.31 ; 95 % CI , 0.95 - 1.79 ; P = .10 ) . The prognostic value of all MR imaging criteria was unaffected by treatment intervention ( P > or = .20 for all ) . Dissemination in time result ed in increased risk for CDMS only in patients without dissemination in space at baseline and was most informative at the 9-month MR imaging ( HR , 2.72 ; 95 % CI , 1.26 - 5.87 ; P = .01 ) . CONCLUSIONS The modified Barkhof criteria showed moderate predictive value for conversion to CDMS , although all patients had received interferon beta-1b therapy for at least 1 year . The predictive value was unaffected by treatment intervention . Follow-up MR imaging was most informative after 9 months in patients without dissemination in space at baseline BACKGROUND The number and volume of abnormalities on baseline brain magnetic resonance images in patients with initial findings suggestive of multiple sclerosis are known to predict outcome in terms of disability . However , no long-term data exist on specific locations or types of lesions . OBJECTIVE To assess the long-term predictive value of baseline magnetic resonance imaging parameters , including location of lesions and gadolinium-enhancing and hypointense lesions in patients with initial findings suggestive of multiple sclerosis for the occurrence of clinical ly relevant disability as defined by an Exp and ed Disability Status Scale score of 3 . PATIENTS After a median follow-up period of 8.7 years , the medical records of 42 patients were review ed and assessed for time until patients received an Exp and ed Disability Status Scale score of 3 . Magnetic resonance imaging parameters were dichotomized according to maximum accuracy and then used to calculate hazard ratios using the Cox 
    Output:
    
A combination of  simplified MRI criteria  with CSF might be the best approach for an early MS diagnosis .