Managerialcase study. At a project implementation level one of the most significant and positive unforeseen impacts of REAP has been the opportunity for project participants to develop an informal network beyond their own institutions allowing access to a range of expertise and experience that was otherwise unavailable to them. At a project level REAP has also provided a platform for dialogue between the Institutes of Technology and national agencies including the Ministry of Education and the Higher Education Authority and as a result, enabling the project to provide input to policy and strategy. UL was first involved in student mobility with the Erasmus programme (then Socrates) in 1999. Furthermore, they are an active participant in the Lifelong Learning Programme (LLP) for students and staff such as Comenius, Leonardo da Vinci and Grundtvig. The University of Latvia is currently involved in five Erasmus Mundus projects which include staff mobility, both academic and administrative.

Question 121 A 25-year-old woman, pregnant in her second trimester, starts to experience chorea and bilateral ankle arthralgia but has no past history of rheumatic chorea. In the first hour, her erythrocyte sedimentation rate is 70. Could this be no more than chorea gravidarum?

Question 122 Is valproate as equally effective as haloperidol in the treatment of chorea, in particular rheumatic chorea?

Question 123 Does a lesion of Guillain-Mollaret's triangle in the brain stem cause a type of myoclonus other than symptomatic palatal myoclonus?

Question 124 1. In West's syndrome, after the fits have been suppressed, for how long should treatment with adrenocorticotrophic hormone (ACTH) continue? 2. Does complete suppression of resistant infantile myoclonic jerks by ACTH characterize West's syndrome?

Question 125 Are anticholinergics the first line of treatment for primary torsion dystonia?

Question 126 Can multiple sclerosis (MS) be associated with lack of vitamin D, lack of sunlight or low fish/cod-liver oil in the diet? By looking at the epidemiology (none at the equator; more outside 40 latitude, both north and south; less on top of Swiss mountains than in the Swiss valleys; more in fishing coastal towns and in Eskimos) this seems to be very important. Vitamin D modulates the immune system and active vitamin D given to rats with experimental MS (acute encephalomyelitis) lowers the monocyte count in cerebrospinal fluid (CSF) by 90% in 72 hours with return of power to their limbs. Japanese MS patients who ate plenty of fish were found to have vitamin-D-receptor pleomorphism. The staple grains and cereals (wheat, barley, oats) eaten in Scandinavian and northern European countries contain phytic acid, which blocks vitamin D absorption, and rice is the only cereal free of phytic acid. Are there any studies where low vitamin D levels in blood are associated with MS relapse?

Question 127 What are the diagnostic criteria of 'definitive' multiple sclerosis (MS) - as taught to a medical student? We have found different information from different sources.

Question 128 How reliable is a CT-brain scan with contrast in showing MS lesions as enhancing lesions in the presence of a contraindication to use MRI?

Question 129 Is magnetic resonance (MR) spectroscopy of value in differentiating multiple sclerosis from cerebral autosomal dominant arteriopathy with subcortical infarctions (CADASIL)?

Question 130 Does hemiplegia due to multiple sclerosis present with hemiparesis rather than dense hemiplegia (which is more characteristic of a stroke)? Other than age, what are the clinical signs that would help differentiate between the two?