Fadda G, et al. - Using deformation based morphometry, mixed effects modeling and semiparametric smoothing methods, researchers evaluated how early in the multiple sclerosis course a ‘surface-in' process of injury suggesting progressive biology may begin. Thalamus was focused which notably has both cerebrospinal fluid (CSF) interface and a white matter interface. They prospectively followed 27 children with multiple sclerosis and 73 children with monophasic demyelination with yearly brain scans. As controls, 282 healthy children with serial scans were involved. Children with multiple sclerosis and children with monophasic demyelination showed volume loss in thalamic regions adjacent to the white matter relative to healthy controls. However, only children with multiple sclerosis displayed an additional ‘surface-in' gradient of thalamic injury on the ventricular side, which was noticeable in the first year of clinical disease and worsened over time. Overall, they concluded that a multiple sclerosis-disease specific ‘surface-in' process of damage could manifest at the earliest stages of the disease.