The authors report the case of a 47-year-old black man with a history of Multiple Sclerosis who was found dead in a bathtub, head above water, with a body temperature of 105.7 F. Results of a complete autopsy and toxicologic screen were negative.

Individuals with Multiple Sclerosis, if immersed in hot water, develop motor weakness, which may be so severe as to prevent them from getting out of the water, whether they be in a bathtub or whirlpool bath.

In this case, the individual was trapped in a bathtub in which there was a continuous flow of hot water. This overwhelmed an already impaired ThermoRegulatory mechanism, causing Hyperthermia and death.

A 27-year-old white woman with a history of Multiple Sclerosis was found dead lying on a lounger, clad in a bathing suit. She had been sunbathing for 4 hours.

Significant autopsy findings consisted of numerous variably sized DeMyelinated plaques involving the PeriVentricular Cerebral White Matter and Cerebellum.

Elevation of core temperature in patients with Multiple Sclerosis leading to transient or permanent adverse Neurologic signs and symptoms has been documented for more than 60 years.

This case illustrates that a modestly increased core body temperature, even from a usually innocuous activity such as sunbathing, may be fatal in patients with Multiple Sclerosis.

Objective
To investigate whether supplementation with Fish Oil given together with dietary advice and Vitamin supplementation influenced the clinical outcome in newly diagnosed Multiple Sclerosis (MS) patients.

Material And Methods
Sixteen consecutive, newly diagnosed patients with Multiple Sclerosis were recruited to an open intervention study.

They were given dietary advice and supplemented with 0.9 g/day of Long-Chain Marine Fatty Acids and Vitamins.

The patients were followed for 2 years with respect to dietary habits, blood parameters and Neurological assessment including exacerbation rate.

Results
There was a significant reduction in the mean annual exacerbation rate and the mean Expanded Disability Status Scale (EDSS) as compared to pre-study values.

The Plasma total phospholipid n-3 fatty acids increased and n-6 fatty acids decreased significantly.

Conclusions
The results suggest that Fish Oil supplementation given together with Vitamins and dietary advice can improve clinical outcome in patients with newly diagnosed MS.

Context
Magnetic Resonance Imaging (MRI) data suggest that the extent of Brain Atrophy in patients with Multiple Sclerosis (MS) is related to the severity of disease.

Objective
To evaluate whether Ventricular diameter determined by TransCranial Sonography (TCS) is a marker of Brain Atrophy and is correlated with disability, Cognitive performance, and Mood.

Subjects And Methods
We examined 74 subjects with MS and 74 age- and sex-matched control subjects with TCS and assessed the transverse diameter of the Third Ventricle and the Frontal Horns of the Lateral Ventricles.

Quantitative Neurological examination was performed in subjects with MS using the Expanded Disability Status Scale. All subjects with MS underwent MRI, the Brief Repeatable Battery of NeuroPsychological Tests for MS, and standardized tests for Mood Disorders.

Results
TransCranial Sonographic measurements of Ventricular diameter closely matched MRI measurements (Spearman rank correlation, r=0.7-0.9; P<.01).

The Ventricular diameters were significantly larger in subjects with MS than in healthy age- and sex-matched control subjects.

The measurement of the diameter of the Third Ventricle obtained by TCS or MRI and the measurement of disability obtained with the Expanded Disability Status Scale were significantly correlated (Spearman rank correlation, r = 0.4; P<.01).

The correlation between the diameter of the Frontal Horns and disability was substantially lower for both NeuroImaging techniques.

In addition, TCS and MRI data correlated significantly with the majority of NeuroPsychological tests; no correlation was found between the diameter of the Ventricles and depression scales.

Conclusion
As Ventricular diameter is related to the status of disability and may also indicate disease progression, we propose measurement of the diameter of the Third Ventricle with TCS as a quick and easy surrogate marker for serial follow-up examinations in patients with MS.

Arch Neurol 2000;57:1289-1292

Objective
Visual Evoked Potentials (VEPs) are a very useful tool in diagnosis of Multiple Sclerosis (MS). Nevertheless, in some cases of the disease, VEPs are normal.

The aim of this study was to evaluate the diagnostic value of focal checkerboard reversal stimulation based on Opto-Acoustic modulation generated by a Scanning Laser Ophthalmoscope (SLO) in patients whose standard Neuro-Ophthalmological work-up was normal.

Methods
We prospectively studied 185 MS patients. In this cohort we found 30 patients with Definite MS and normal NeuroOphthalmological work-up and we studied the diagnostic yield of focal visual stimulation in these patients.

We performed focal SLO-elicited VEPs with two different spatial distributions: a central 8 x 8 degrees square field and a central 8 x 8 degrees exclusion square.

The results were analyzed in terms of age of the patient, course of the disease, and disability evaluated on the Expanded Disability Status Scale (EDSS).

Results
Mean latencies of focal VEPs were increased in MS patients compared to controls.

In MS, focal stimulation allowed dysfunction of the visual system to be detected in 50% of patients who have been classified as normal according to conventional VEPs.

VEP abnormalities were found to be correlated with the EDSS score (P<0.001) and the course of the disease (P<0.05).

Conclusion
We have demonstrated the value of focal VEPs in MS diagnosis using SLO-based techniques.

Further prospective work in patients with Possible and Probable MS should enable an evaluation of the sensitivity and specificity of this method in the early diagnosis of MS.