A New and Rare Actinote Hübner (Lepidoptera: Nymphalidae: Heliconiinae: Acraeini) from Southeastern Brazil.

The present paper describes a new species of Actinote (Nymphalidae, Heliconiinae, Acraeini), Actinote keithbrowni Freitas, Francini & Mielke sp. nov., from southeastern Brazil, based on morphological and molecular data. The new species is very similar in wing pattern to Actinote eberti, within what we term the "light-gray mimicry complex." The host plants and immature stages of the new species are unknown. Actinote keithbrowni sp. nov. is one of the rarest species of Actinote from Brazil: in total, only eight individuals of this species are known from a narrow region of the Itatiaia massif despite years of collecting effort in that region since the 1940s.

Patient-reported outcomes with subcutaneous immunoglobulin in chronic inflammatory demyelinating polyneuropathy: the PATH study.

BACKGROUND AND PURPOSE: Chronic inflammatory demyelinating polyneuropathy (CIDP) causes weakness which adversely impacts function and quality of life (QOL). CIDP often requires long-term management with intravenous or subcutaneous immunoglobulin. The Polyneuropathy and Treatment with Hizentra® (PATH) study showed that subcutaneous immunoglobulin (SCIG) was efficacious in CIDP maintenance. Here, patient-reported outcomes in patients on SCIG are assessed. METHODS: Subjects stabilized on intravenous immunoglobulin were randomly allocated to receive weekly 0.2 or 0.4 g/kg bodyweight of 20% SCIG (IgPro20) or placebo. Overall QOL/health status was assessed using the EuroQoL 5-Dimension (EQ-5D) health profile and visual analog scale, treatment satisfaction was assessed with the Treatment Satisfaction Questionnaire for Medicine (TSQM) and work-related impact was assessed with the Work Productivity and Activity Impairment Questionnaire for General Health (WPAI-GH). The EQ-5D health profile was assessed in terms of the percentage of subjects maintained or improved at week 25 of SCIG therapy on each of the EQ-5D domains versus baseline after intravenous immunoglobulin stabilization. TSQM and WPAI-GH were assessed by median score changes from baseline to week 25. RESULTS: In total, 172 subjects were randomized to placebo (n = 57), 0.2 g/kg IgPro20 (n = 57) and 0.4 g/kg IgPro20 (n = 58). Significantly higher proportions of IgPro20-treated subjects improved/maintained their health status on the EQ-5D usual activities dimension, and in additional dimensions (mobility and pain/discomfort) in sensitivity analyses. TSQM and WPAI-GH scores were more stable with IgPro20 treatment compared with placebo. CONCLUSIONS: IgPro20 maintained or improved QOL in most subjects with CIDP, consistent with the PATH study findings that both IgPro20 doses were efficacious in maintaining CIDP.

Overlooked South American noctuid species: revalidation of Feltia llanoi stat. rev. and redescription of Feltia brachystria (Lepidoptera: Noctuidae).

Feltia llanoi (Köhler, 1953) stat. rev. and its hitherto senior subjective synonym Feltia brachystria (Hampson, 1903) are two species of noctuid moths with unusual broadly bipectinate antenna and restricted distribution in central eastern Argentina, southern Brazil, and Uruguay. Examination of the type of specimens and further material from several collections indicates that these names are not synonyms, but valid species, and reveal the occurrence of F. llanoistat. rev. in Brazil. Therefore, F. llanoistat. rev. and F. brachystria are redescribed and the former name is reinstated to species, including taxonomic comments, illustration of some characters of taxonomic importance, and of structures of the male and female genitalia. The species are compared with similar-looking and supposedly closely related species, such as F. chilensis (Hampson, 1903), F. carolia (Schaus, 1929), and F. gypaetina (Guenée, 1852). Additionally, in order to stabilize nomenclature, a lectotype for F. llanoistat. rev. is designated, and Agrotis daguerrei Köhler, 1961 is here recognized as a junior subjective synonym of F. llanoistat. rev. (syn. nov.).

Feltia submontana (Noctuidae, Noctuinae): Redescription, Taxonomy, Life Cycle, and Spatial Distribution of a Neglected South American Potential Pest Species.

Feltia submontana (Köhler, 1961) is redescribed based on specimens from Northwestern Argentina and Central and Southeastern Brazil. Taxonomic comments, photographs of the adults, characters of taxonomic importance, and illustrations of structures of the labial palpus, legs, and male and female genitalia are provided. The species is compared with similar-looking and supposedly closely related species, such as F. hispidula (Guenée, 1852) and F. lilacina (Zerny, 1916). The species, originally described for Argentina, is reported for Brazil for the first time. Most Brazilian specimens come from the "Cerrado" but also from Southeastern Atlantic Forests. The life cycle of F. submontana specimens collected in Planaltina, Distrito Federal, Brazil, is described; the species probably has only a single generation per year and imagines are on the wing in the late autumn and early winter months; the last instar prepupa and pupa pass through aestival diapause. The abundance of F. submontana relative to other species of Agrotis Ochsenheimer, 1816, and Feltia Walker, 1856, in the above-cited locality is accessed through 4 years of standardized collecting with light trap; the species is the second most abundant species of these genera in the area, with about one fifth of the captures, second only to A. ipsilon (Hufnagel, 1766), with about two thirds of the captures, and about two times more abundant than F. subterranea (Fabricius, 1794); the latter two are regarded as important pest species in South America.

Spodoptera marima: a New Synonym of Spodoptera ornithogalli (Lepidoptera: Noctuidae), with Notes on Adult Morphology, Host Plant Use and Genetic Variation Along Its Geographic Range.

Spodoptera marima (Schaus, 1904) and Spodoptera ornithogalli (Guenée, 1852) are noctuid moths recognized for their economic importance in the New World. Historically, they have been considered cryptic species, being supposedly differentiated from each other by the absence of sexual dimorphism in S. marima, subtle differences in coloration on the hindwings and scale tufts of the ovipositor and the shape of male valva. The species are allopatric: North and Central America for S. ornithogalli and South America for S. marima. Previous phylogenetic studies using multilocus DNA sequences including a few specimens of S. marima suggested these species merge into a single clade. Here, we performed a comparative analysis to elucidate further their taxonomic status, using specimens of S. marima from various localities in Brazil. These species were recovered in the phylogenetic analysis as consistently mixed with each other in a major well-supported clade within Spodoptera. The existence of a spatial pattern for genetic structure was not clearly supported when two biogeographic regions (Neotropics and Neartic) were taken in separation; however, an individual-level isolation by distance was significant. The morphological characters traditionally used to differentiate the species were also not consistent. Therefore, we now consider S. marima a new junior synonym of S. ornithogalli. Results on host plant use demonstrated that it is a polyphagous species using more than 200 plants, which may mediate phenotypic variation along its geographical range.

Uncovered Diversity of a Predominantly Andean Butterfly Clade in the Brazilian Atlantic Forest: a Revision of the Genus Praepedaliodes Forster (Lepidoptera: Nymphalidae, Satyrinae, Satyrini).

The genus Praepedaliodes Forster, 1964, the only representative of the mega-diverse mostly Andean Pedaliodes complex lineage in the Brazilian Atlantic Forest, is revised. Prior to this study, four species were known, P. phanias (Hewitson, 1862), P. granulata (Butler, 1868), P. amussis (Thieme, 1905) and P. exul (Thieme, 1905). Here, a further six are described, all from SE Brazil, expanding to 10 the number of species in this genus. Lectotypes are designated for P. phanias, P. granulata and P. amussis. The genus is most diverse in the Serra da Mantiqueira (São Paulo, Rio de Janeiro, Minas Gerais) and in the Serra Geral (Paraná, Santa Catarina) with seven species occurring in both ranges. Praepedaliodes phanias is the most widespread species and the only one found in the western part of the Atlantic Forest; only this species and P. duartei Dias, Dolibaina & Pyrcz n. sp. occurring to near sea level. Other species, P. zaccae Dolibaina, Dias & Pyrcz n. sp., P. francinii Freitas & Pyrcz n. sp., P. sequeirae Pyrcz, Dias & Dolbaina n. sp., P. landryi Pyrcz & Freitas n. sp. and P. pawlaki Pyrcz & Boyer n. sp. are strictly montane and the highest species richness is reached at 1400-1800 m. One species, P. sequeirae n. sp., is a narrow endemic found only at timberline in the Agulhas Negras massif above 2300 m. Immature stages are described for two species, P. phanias and P. landryi n. sp. Molecular data (barcode region of cytochrome oxidase, subunit I) and adult morphology, including male and female genitalia, support the genus as monophyletic, belonging to a predominantly Andean clade of the Pedaliodes Butler, 1867 complex. Morphological evidences, in particular female genitalia comparative analysis, indicate the genera Physcopedaliodes Forster, 1964 and Panyapedaliodes Forster, 1964 as possibly the closest relatives to Praepedaliodes. Molecular data are inconclusive in this respect.

Immature Stages of Six Species of Adelpha Hübner (Lepidoptera: Nymphalidae: Limenitidinae) from Southern Brazil Coastal Forests.

Six species of Adelpha Hübner from Balneário Barra do Sul (Santa Catarina) and Morretes (Paraná) were collected as eggs or larvae and reared in captivity, aiming to provide descriptions and photography of the immature stages and imagoes. The species studied were Adelpha radiata radiata Fruhstorfer; Adelpha serpa serpa (Boisduval); Adelpha plesaure plesaure Hübner; Adelpha thesprotia (C. Felder & R. Felder); Adelpha lycorias lycorias (Godart); and Adelpha capucinus velia (C. Felder & R. Felder). Two new records of host plants were provided, Tapirira guianensis Aubl. for A. radiata radiata and Heteropterys for A. capucinus velia. This study provides a summary of host plants and the seasonality of occurrence of immature stages of these species. Data were organized in photographic plates that could be useful for the identification process.

Skipper Richness (Hesperiidae) Along Elevational Gradients in Brazilian Atlantic Forest.

Hesperiidae are claimed to be a group of elusive butterflies that need major effort for sampling, thus being frequently omitted from tropical butterfly surveys. As no studies have associated species richness patterns of butterflies with environmental gradients of high altitudes in Brazil, we surveyed Hesperiidae ensembles in Serra do Mar along elevational transects (900-1,800 m above sea level) on three mountains. Transects were sampled 11-12 times on each mountain to evaluate how local species richness is influenced by mountain region, vegetation type, and elevational zones. Patterns were also analyzed for the subfamilies, and after disregarding species that exhibit hilltopping behavior. Species richness was evaluated by the observed richness, Jacknife2 estimator and Chao 1 estimator standardized by sample coverage. Overall, 155 species were collected, but extrapolation algorithms suggest a regional richness of about 220 species. Species richness was far higher in forest than in early successional vegetation or grassland. Richness decreased with elevation, and was higher on Anhangava mountain compared with the two others. Patterns were similar between observed and extrapolated Jacknife2 richness, but vegetation type and mountain richness became altered using sample coverage standardization. Hilltopping species were more easily detected than species that do not show this behavior; however, their inclusion did neither affect estimated richness nor modify the shape of the species accumulation curve. This is the first contribution to systematically study highland butterflies in southern Brazil where all records above 1,200 m are altitudinal extensions of the known geographical ranges of skipper species in the region.

Euptychia boulleti (Le Cerf) n. comb. (Lepidoptera: Nymphalidae: Satyrinae), a rare and endangered butterfly from Southeastern Brazil.

This paper discusses the systematic position of the rare and endangered satyrine butterfly Caenoptychia boulleti Le Cerf, the only included species in Caenoptychia (type species), based on adult morphology and molecular data. The results showed that Caenoptychia Le Cerf belongs to the Euptychia Hübner clade, and the genus is synonymized with Euptychia, new synonymy. Euptychia boulleti (Le Cerf) is a new combination. The male genitalia of E. boulleti showed at least one important synapomorphy with the other species of Euptychia, which is the presence of a posterior projection of the tegumen above the uncus. Molecular data reinforces the position of Caenoptychia within the genus Euptychia.

The Lepidoptera associated with forestry crop species in Brazil: a historical approach.

Despite the long history of forestry activity in Brazil and its importance to the national economy, there is still much disorder in the information regarding pests of forestry species. Considering the importance of the entomological knowledge for the viability of silvicultural management, this work aimed to gather information on the species of Lepidoptera associated with forestry crops within Brazil using a historical approach. Through a literature review, all registered species of Lepidoptera related to forestry crops in Brazil from 1896 to 2010 were identified. The historical evaluation was based on the comparison of the number of published articles, species richness, and community similarities of the Lepidoptera and their associated forest crops, grouped in 10-year samples. A total of 417 occurrences of Lepidoptera associated with forestry species were recorded, from which 84 species are related with 40 different forestry crops. The nocturnal Lepidoptera were dominant on the records, with Eacles imperialis magnifica Walker as the most frequent pest species cited. Myrtaceae was the most frequent plant family, with Cedrela fissilis as the most cited forestry crop species. A successional change in both Lepidoptera species and their host plants was observed over the decades. The richness of lepidopteran pest species increased over the years, unlike the richness of forestry crop species. This increase could be related to the inefficient enforcement of sanitary barriers, to the increase of monoculture areas, and to the adaptability of native pests to exotic forestry species used in monoculture stands.

A new genus and species of Euptychiina (Lepidoptera: Nymphalidae: Satyrinae) from southern Brazil.

This paper describes a new genus and a new species of Euptychiina from open grassland habitats (campos de cima da serra) in southern Brazil. The systematic position of this new taxon is discussed based on morphological and molecular data, and it is considered sister to Taydebis Freitas. Since the campos vegetation is considered endangered due to anthropogenic activities, this butterfly species deserves attention and should be included in future conservation plans for this biome.

[Comparison between German and Turkish descent in ischemic stroke. Risk factors, initial findings, rehabilitative therapy, and social consequences]. / Vergleich deutscher und türkischer Patienten mit ischämischem Schlaganfall. Risikofaktoren, Befunde bei Aufnahme, poststationäre Therapie und soziale Konsequenzen.

BACKGROUND: Until now no data has been available on possible specific features of the Turkish minority in Germany with respect to stroke. PATIENTS AND METHODS: We compared 20 Turkish stroke patients with matched German controls analyzing risk factors, findings at admission, rehabilitative treatments, and psychosocial aspects. RESULTS: In the Turkish group the interval between onset of symptoms and admission was longer (532 min vs 255 min, P < 0.01). All other findings during acute treatment and rehabilitation were comparable. At follow-up after 22 months, the Barthel index was 90 for the Turks and 100 for the Germans. The Turkish patients reported more consultations with physicians than their German counterparts (68 vs 12 per year, P < 0.01). Scores for quality of life and outcome did not differ. The Turkish patients more frequently required care and had a higher degree of disability. CONCLUSIONS: Turkish stroke patients have a longer time to admission. Risk factors, findings at admission, and treatment in the acute phase and rehabilitation are comparable. Several findings point towards a different health behavior. These results highlight the need for specific education of the Turkish population in Germany.

Flip-flopping fractional flux quanta.

The d-wave pairing symmetry in high-critical temperature superconductors makes it possible to realize superconducting rings with built-in pi phase shifts. Such rings have a twofold degenerate ground state that is characterized by the spontaneous generation of fractional magnetic flux quanta with either up or down polarity. We have incorporated pi phase-biased superconducting rings in a logic circuit, a flip-flop, in which the fractional flux polarity is controllably toggled by applying single flux quantum pulses at the input channel. The integration of p rings into conventional rapid single flux quantum logic as natural two-state devices should alleviate the need for bias current lines, improve device symmetry, and enhance the operation margins.

Thrombolysis (different doses, routes of administration and agents) for acute ischaemic stroke.

BACKGROUND: Thrombolytic therapy is effective for acute myocardial infarction, a disease with some similarities to acute ischaemic stroke. Meta-analyses suggest a net benefit in acute ischaemic stroke. OBJECTIVES: To assess different thrombolytic agents, and different regimens, in acute ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register (last searched to June 2003), MEDLINE (1966 to July 2003) and EMBASE (1980 to July 2003). We handsearched four Japanese journals, contacted researchers and pharmaceutical companies, and attended relevant conferences. SELECTION CRITERIA: Randomised and quasi-randomised trials of different doses of a thrombolytic agent, or different agents, or the same agent given by different routes, in people with confirmed acute ischaemic stroke. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial eligibility and quality, and extracted the data. MAIN RESULTS: Ten trials involving 1641 patients, 8 conducted in Japan, 1 in China and 1 in the USA, were included. Concealment of allocation was poorly described. Different doses (of tissue plasminogen activator or urokinase) were compared in seven trials (n = 1072 patients). Different agents (tissue plasminogen activator versus urokinase; tissue-cultured urokinase versus conventional urokinase) were compared in three trials (n = 688 patients). One trial compared different routes of administration (intravenous plus intraarterial tissue plasminogen activator versus intraarterial tissue plasminogen activator alone, n = 35 patients). As some trials compared different agents and different doses, some patients contributed to two analyses. A higher dose of thrombolytic therapy was associated with a three-fold increase in fatal intracranial haemorrhages (Odds ratio (OR) 3.25, 95% confidence interval (CI) 1.32 to 7.97) compared with a lower dose of the same agent (based on 16 events among 539 higher-dose patients and 4 events among 533 lower-dose patients in 7 trials). There was no statistically significant difference in early (OR 1.01, 95% CI 0.58 to 1.74) or late (OR 0.94, 95% CI 0.58 to 1.53) deaths between lower and higher doses. Data were inadequate to assess the effect of dose on functional outcome. No statistically significant difference was shown between different thrombolytic agents tested. The data from the pilot trial comparing different routes of administration were inconclusive. REVIEWERS' CONCLUSIONS: These scant data suggest that higher doses of thrombolytic agents may lead to higher rates of bleeding. However, the evidence is inadequate to conclude whether lower doses of thrombolytic agents are more effective than higher doses, or whether one agent is better than another, or which route of administration is the best, in acute ischaemic stroke.

Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation.

OBJECTIVES: To examine a very large dataset to provide a robust answer to the question of whether visible infarction on computed tomography was (a) an independent predictor of functional outcome at all times up to 48 hours after stroke, and (b) independently associated with haemorrhagic transformation, with or without antithrombotic treatment. METHODS: The study assessed associations between visible infarction, time to randomisation, baseline neurological deficit, stroke syndrome, allocated aspirin or heparin treatment, recurrent haemorrhagic stroke, early death and six month functional outcome in the International Stroke Trial. RESULTS: Of 12 550 patients, 6267 (50%) had visible infarction up to 48 hours after stroke. The prevalence of visible infarction increased with increasing time from onset and extent of the stroke syndrome. Visible infarction was independently associated with increased death within 14 days (odds ratio (OR) 1.17, 95% CI 1.02 to 1.35), and of death or dependency at six months (OR 1.42, 95% CI 1.31 to 1.55), an absolute increase of 13%, or 130 per 1000 more dead or dependent patients with visible infarction than without it. There was no significant independent relation between visible infarction and fatal or non-fatal haemorrhagic transformation, or interaction between visible infarction and aspirin or heparin treatment allocation with six month functional outcome. CONCLUSIONS: Visible infarction on computed tomography up to 48 hours after stroke is an independent adverse prognostic sign.

Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack.

BACKGROUND: After a first ischaemic stroke, further vascular events due to thromboembolism (especially myocardial infarction and recurrent stroke) are common and often fatal. Anticoagulants could potentially reduce the risk of such events, but any benefits could be offset by an increased risk of fatal or disabling haemorrhages. OBJECTIVES: The objective of this review was to assess the effect of prolonged anticoagulant therapy (compared with placebo or open control) following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register. We contacted companies marketing anticoagulant agents. The most recent search for this review was carried out in August 2002. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing at least one month of anticoagulant therapy with control in people with previous presumed non-cardioembolic ischaemic stroke or transient ischaemic attack. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS: Eleven trials involving 2487 patients were included. The quality of the 9 trials which predated routine computerised tomography scanning and the use of the International Normalised Ratio to monitor anticoagulation was poor. There was no evidence of an effect of anticoagulant therapy on either the odds of death or dependency (two trials, odds ratio 0.83, 95% confidence interval [CI] 0.52 to 1.34) or of 'non-fatal stroke, myocardial infarction, or vascular death' (four trials, odds ratio 0.96, 95% CI 0.68-1.37). Death from any cause (odds ratio 0.95, 95% CI 0.73 to 1.24) and death from vascular causes (odds ratio 0.86, 95% CI 0.66 to 1.13) were not significantly different between treatment and control. The inclusion of two recent completed trials did not alter these conclusions. There was no evidence of an effect of anticoagulant therapy on the risk of recurrent ischaemic stroke (odds ratio 0.85, 95% CI 0.66 to 1.09). However, anticoagulants increased fatal intracranial haemorrhage (odds ratio 2.54, 95% CI 1.19 to 5.45), and major extracranial haemorrhage (odds ratio 3.43, 95% CI 1.94 to 6.08). This is equivalent to anticoagulant therapy causing about 11 additional fatal intracranial haemorrhages and 25 additional major extracranial haemorrhages per year for every 1000 patients given anticoagulant therapy. REVIEWER'S CONCLUSIONS: Compared with control, there was no evidence of benefit from long-term anticoagulant therapy in people with presumed non-cardioembolic ischaemic stroke or transient ischaemic attack, but there was a significant bleeding risk.

Homocysteine in cerebrovascular disease: an independent risk factor for subcortical vascular encephalopathy.

Hyperhomocysteinemia is a risk factor for obstructive large-vessel disease. Here, we studied plasma concentrations of homocysteine and vitamins in patients suffering from subcortical vascular encephalopathy (SVE), a cerebral small-vessel disease leading to dementia. These results were compared to the homocysteine and vitamin plasma concentrations from patients with cerebral large vessel disease and healthy control subjects. Plasma concentrations of homocysteine, vascular risk factors and vitamin status (B6, B12, folate) were determined in 82 patients with subcortical vascular encephalopathy, in 144 patients with cerebral large-vessel disease and in 102 control subjects. Patients with SVE, but not those with cerebral large-vessel disease, exhibited pathologically increased homocysteine concentrations in comparison with control subjects without cerebrovascular disease. Patients with SVE also showed lower vitamin B6 values in comparison to subjects without cerebrovascular disease. Logistic regression analysis showed that homocysteine is associated with the highest risk for SVE (odds ratio 5.7; CI 2.5-12.9) in comparison to other vascular risk factors such as hypertension, age and smoking. These observations indicate that hyperhomocysteinemia is a strong independent risk factor for SVE.

Changes in coagulation and fibrinolysis markers in acute ischemic stroke treated with recombinant tissue plasminogen activator.

BACKGROUND AND PURPOSE: Shifts of the balance between coagulation and fibrinolysis play a crucial role in pathogenesis and treatment of cerebral ischemia. In this study, we characterized the kinetics of hemostatic abnormalities induced by acute ischemic stroke and its thrombolytic (recombinant tissue plasminogen activator [rtPA]) or anticoagulant (heparin) treatment. METHODS: Systemic generation of molecular markers of hemostasis (fibrin monomer, D-dimer, thrombin-antithrombin complex, and fibrinopeptide 1.2) was monitored in acute ischemic stroke, and the effects of thrombolytic and anticoagulant treatments were analyzed. RESULTS: Thrombolysis with rtPA induced a massive response of markers of coagulation activation and fibrin formation that peaked after 1 to 3 hours and persisted for up to 72 hours. In contrast, only minor hemostatic changes were induced by acute ischemic stroke itself. Administration of heparin did not significantly affect these hemostatic abnormalities. CONCLUSIONS: This first characterization of the coagulation activation induced by rtPA treatment for acute ischemic stroke and the failure to abolish such hemostatic abnormalities by heparin may be of value for further refinement of the currently discussed thrombolytic therapy and the controversial adjunctive anticoagulant prophylaxis in stroke patients.

Interferon-gamma-inducing factor (IL-18) and interferon-gamma in inflammatory CNS diseases.

OBJECTIVE: To examine the intrathecal production of a newly identified cytokine, interferon-gamma-inducing factor (IL-18), together with interferon-gamma itself, in inflammatory diseases of the CNS (i.e., bacterial meningitis, viral meningoencephalitis, and MS). RESULTS: IL-18 concentrations in CSF were significantly increased in bacterial meningitis and tended toward increased levels in viral meningoencephalitis. In contrast, IL-18 was detectable only in a few patients with MS and healthy controls. Interestingly, interferon-gamma was significantly increased selectively in CSF of patients with viral meningoencephalitis. CONCLUSION: The observation of an intrathecal release of IL-18 in patients with meningitis argues for a pathophysiologic role of this novel cytokine in immunity against invading microorganisms the CNS.