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Abstract
Objective: To study the contribution of the symptomatic lesion in establishing multiple sclerosis (MS) diagnosis and prognosis.
Methods: We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort of 1,107 patients recruited for clinical and brain MRI follow-up from 1995 to 2014. Eligible patients (n = 954) were divided into 4 groups according to baseline MRI: patients with a normal MRI (n = 290); patients with a single asymptomatic lesion (n = 18); patients with a single cord/brainstem symptomatic lesion (n = 35); and patients with more than 1 lesion (n = 611). For each group, we studied the risk of second attack, with 2005 McDonald MS and Expanded Disability Status Scale 3.0, using univariable and multivariable regression models adjusted by age, sex, oligoclonal bands, and disease-modifying treatments. We tested the diagnostic performance of a modified dissemination in space (DIS) criterion that includes symptomatic lesions in the total count and compared it to the DIS criteria (at least 1 asymptomatic lesion in at least 2 of the 4 MS characteristic MS locations) for all patients and for the subgroup of patients with brainstem or spinal cord topography.
Results: Patients with a cord/brainstem single symptomatic lesion have a higher risk of second attack and disability accumulation than patients with 0 lesions but have a similar risk compared to patients with 1 asymptomatic lesion. Diagnostic properties are reasonably maintained when the symptomatic lesion qualifies for DIS.
Conclusions: Despite the recommendations of the 2010 McDonald criteria, symptomatic lesions should be taken into account when considering the diagnosis and prognosis of patients with CIS.
GLOSSARY
- aHR=
- adjusted hazard ratio;
- CDMS=
- clinically definite multiple sclerosis;
- CI=
- confidence interval;
- CIS=
- clinically isolated syndrome;
- DIS=
- disseminated in space;
- DIT=
- disseminated in time;
- DMT=
- disease-modifying treatment;
- EDSS=
- Expanded Disability Status Scale;
- MS=
- multiple sclerosis;
- OB=
- oligoclonal bands
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received September 16, 2015.
- Accepted in final form June 13, 2016.
- © 2016 American Academy of Neurology
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