Contributions
Abstract: 186
Type: Oral
Abstract Category: Pathology and pathogenesis of MS - Imaging
Background: Natural history studies have identified demographic and clinical factors associated with earlier onset of secondary progression in patients with relapse-onset multiple sclerosis (MS). These include age, sex, the nature of the presenting symptoms and the recovery from the first attack. There has been little previous investigation of MRI predictors of secondary progressive disease course in patients with relapse-onset MS.
Objective: To investigate early MRI predictors of secondary progressive disease course in patients with a clinically isolated syndrome (CIS).
Methods: We studied 164 prospectively recruited CIS patients who had MRI scans of the brain and spinal cord within 3 months of onset. Baseline MRI variables included lesion load (brain T2-hyperintense and non-enhancing T1-hypointense lesion number and volume), lesion location (periventricular, juxtacortical, infratentorial, spinal cord), lesion activity (gadolinium-enhancing lesion number) and atrophy measures (normalised whole brain volume, upper cervical cord cross-sectional area). The symptomatic lesion was excluded. The patients were followed up after approximately 15 years and MS was diagnosed using the McDonald 2010 criteria. At 15 years disease course was classified as CIS, relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). A multivariable binary logistic regression model was used to identify independent MRI predictors of secondary progressive disease course at 15 years with adjustment for age, sex, CIS type and disease-modifying treatment.
Results: After a mean of 15.1 years (range 11.2-19.7 years), 45 (27%) patients remained CIS, 95 (58%) had RRMS and 24 (15%) had SPMS. In the multivariable binary logistic regression model, spinal cord lesions (odds ratio [OR] 3.85, 95%CI 1.39-10.7, p=0.010), non-enhancing T1-hypointense brain lesion volume (OR 1.64, 95%CI 1.06-2.54 p=0.027) and with borderline significance infratentorial lesion number (OR 1.20, 95%CI 0.97-1.50, p=0.087) were associated with SPMS after 15 years.
Conclusion: In patients with CIS, spinal cord, infratentorial and non-enhancing T1-hypointense brain lesions are associated with a higher probability of SPMS, rather than RRMS or CIS after 15 years. These findings suggest that lesions in clinically-eloquent sites and a greater extent of neuroaxonal loss within brain white matter lesions may be potential mechanisms that contribute to the development of SPMS.
Disclosure:
Dr Brownlee has nothing to disclose.
Dr Altmann has nothing to disclose.
Dr Miszkiel has nothing to disclose.
Dr Eshaghi has received MAGNIMS and Multiple Sclerosis International Federation McDonald fellowships.
Prof Gandini Wheeler-Kingshott Is on the editorial board of Functional Neurology and receives research grants (PI and co-applicant) from ISRT, EPSRC, Wings for Life, UK MS Society, Horizon2020, Biogen and Novartis.
Prof Miller has received honoraria through payments to UCL Institute of Neurology from Biogen-Idec, Novaritis, Bayer-Schering and Mitsubishi Pharma Europe.
Prof Ciccarelli is an Associate Editor of Neurology and serves as a consultant for GE Healthcare, Novartis, Roche, Biogen, Genzyme and Teva.
Abstract: 186
Type: Oral
Abstract Category: Pathology and pathogenesis of MS - Imaging
Background: Natural history studies have identified demographic and clinical factors associated with earlier onset of secondary progression in patients with relapse-onset multiple sclerosis (MS). These include age, sex, the nature of the presenting symptoms and the recovery from the first attack. There has been little previous investigation of MRI predictors of secondary progressive disease course in patients with relapse-onset MS.
Objective: To investigate early MRI predictors of secondary progressive disease course in patients with a clinically isolated syndrome (CIS).
Methods: We studied 164 prospectively recruited CIS patients who had MRI scans of the brain and spinal cord within 3 months of onset. Baseline MRI variables included lesion load (brain T2-hyperintense and non-enhancing T1-hypointense lesion number and volume), lesion location (periventricular, juxtacortical, infratentorial, spinal cord), lesion activity (gadolinium-enhancing lesion number) and atrophy measures (normalised whole brain volume, upper cervical cord cross-sectional area). The symptomatic lesion was excluded. The patients were followed up after approximately 15 years and MS was diagnosed using the McDonald 2010 criteria. At 15 years disease course was classified as CIS, relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). A multivariable binary logistic regression model was used to identify independent MRI predictors of secondary progressive disease course at 15 years with adjustment for age, sex, CIS type and disease-modifying treatment.
Results: After a mean of 15.1 years (range 11.2-19.7 years), 45 (27%) patients remained CIS, 95 (58%) had RRMS and 24 (15%) had SPMS. In the multivariable binary logistic regression model, spinal cord lesions (odds ratio [OR] 3.85, 95%CI 1.39-10.7, p=0.010), non-enhancing T1-hypointense brain lesion volume (OR 1.64, 95%CI 1.06-2.54 p=0.027) and with borderline significance infratentorial lesion number (OR 1.20, 95%CI 0.97-1.50, p=0.087) were associated with SPMS after 15 years.
Conclusion: In patients with CIS, spinal cord, infratentorial and non-enhancing T1-hypointense brain lesions are associated with a higher probability of SPMS, rather than RRMS or CIS after 15 years. These findings suggest that lesions in clinically-eloquent sites and a greater extent of neuroaxonal loss within brain white matter lesions may be potential mechanisms that contribute to the development of SPMS.
Disclosure:
Dr Brownlee has nothing to disclose.
Dr Altmann has nothing to disclose.
Dr Miszkiel has nothing to disclose.
Dr Eshaghi has received MAGNIMS and Multiple Sclerosis International Federation McDonald fellowships.
Prof Gandini Wheeler-Kingshott Is on the editorial board of Functional Neurology and receives research grants (PI and co-applicant) from ISRT, EPSRC, Wings for Life, UK MS Society, Horizon2020, Biogen and Novartis.
Prof Miller has received honoraria through payments to UCL Institute of Neurology from Biogen-Idec, Novaritis, Bayer-Schering and Mitsubishi Pharma Europe.
Prof Ciccarelli is an Associate Editor of Neurology and serves as a consultant for GE Healthcare, Novartis, Roche, Biogen, Genzyme and Teva.