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Multiple sclerosis should not be diagnosed unless there is evidence that two or more different regions of the central white matter have been affected at different times A diagnosis of clinically definite disease can be made in patients with a relapsing-remitting course and evidence on examination of at least two lesions involving different regions of the central white matter The diagnosis is probable in patients with multifocal white matter disease but only one clinical attack, or with a history of at least two clinical attacks but signs of only a single lesion

Vitamin E deficiency may produce a disorder somewhat similar to Friedreich s ataxia (see below) There is spinocerebellar degeneration involving particularly the posterior columns of the spinal cord and leading to limb ataxia, sensory loss, absent tendon reflexes, slurring of speech, and, in some cases, pigmentary retinal degeneration The disorder may occur as a consequence of malabsorption or on a hereditary basis Treatment is with -tocopheryl acetate (eg, Aquasol E capsules or drops) as discussed in 29

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At least partial recovery from acute exacerbations can reasonably be expected, but further relapses may occur without warning, and there is no means of preventing progression of the disorder Some disability is likely to result eventually, but about half of all patients are without significant disability even 10 years after onset of symptoms Recovery from acute relapses may be hastened by treatment with corticosteroids, but the extent of recovery is unchanged A high dose (eg, prednisone, 60 or 80 mg) is given daily for 1 week, after which medication is tapered over the following 2 or 3 weeks Such a regimen is often preceded by methylprednisolone, 1 g intravenously for 3 days Long-term treatment with corticosteroids provides no benefit and does not prevent further relapses In patients with relapsing-remitting or secondary progressive disease, treatment with -interferon or with daily subcutaneous administration of glatiramer acetate reduces the frequency of exacerbations Natalizumab, an alpha4 integrin antagonist that reduces the development of brain lesions in experimental models, reduces the relapse rate

Solution to Exercise 21-1. For the first exercise in this chapter, we re going to bring back the good old Box class from earlier in the book. It s a quick and easy class, with Length, Width, and Height properties, and a quick method to display a box. Here s the code for the class:

The term spasticity is commonly used for an upper motor neuron deficit, but it properly refers to a velocity-dependent increase in resistance to passive movement that affects different muscles to a different extent, is not uniform in degree throughout the range of a particular movement, and is commonly associated with other features of pyramidal deficit It is often a major complication of stroke, cerebral or spinal injury, static perinatal encephalopathy, and multiple sclerosis Physical therapy with appropriate stretching programs is important during rehabilitation after the development of an upper motor neuron lesion and in subsequent management of the patient The aim is to prevent joint and muscle contractures and perhaps to modulate spasticity Drug management is important also, but treatment may increase functional disability when increased extensor tone is providing additional support for patients with weak legs Dantrolene weakens muscle contraction by interfering with

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(The iTunes library contains a list of all tracks you ve imported from CDs or downloaded from the Internet, or that exist on your hard drive Basically, the library contains your entire music collection, which can be viewed in different ways) Before getting into this script, let s look at some of the AppleEvents supported by iTunes iTunes scripting services To see what scripting services iTunes supports, Open the Script Editor, select File Open Dictionary, and choose iTunes from the list (see figure 77) The left window lists the scripting services iTunes supports All scriptable applications export a dictionary of services that developers can read from the Script Editor As I pointed out earlier, commands are in plain font and objects are italicized To get more information about a command or object, click on its name For example, figure 7.

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