Contributions
Abstract: P1052
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: There are very few studies assessing the relapse in MS patients.
Objective: To analyze the relationship between: (1) clinical manifestation of the relapse and location of Gadolinium enhancing (Gd+) lesions; (2) severity of the relapse and number of Gd+ lesions.
Methods: An analysis of basal data of a subset of 33 patients from 2 different phase-IV, multicenter, double-blind, randomized clinical trials that showed non-inferiority of different routes and doses of methylprednisolone (MP) (ClinicalTrials.gov NTC 007537 and NTC 01986998). Clinical manifestations were classified as brainstem-cerebellum, spinal cord, optic neuritis and others. EDSS score previous and at baseline were analyzed. Relapses were classified as mild, moderate or severe. Brain MRI was assessed at the moment of relapse before MP treatment. Number and location (periventricular, subcortical, yuxtacortical, brainstem and cerebellum) of Gd+ lesions were analyzed. Associations were studied using univariate analysis.
Results: 72% of patients were women. Mean age was 37,7±8,7 years, a median previous EDSS score was 2.5 [interquartile range (IQR):1.5-3] and baseline EDSS score was 3.5 [IQR: 2.5-4.25]. Clinical manifestation of relapses: 51,5% spinal cord, 27,3% brainstem-cerebellum, 6,1% optic neuritis and 15,2% others. The severity of the relapse was moderate in 80,6%, mild in 12,9% and severe in 6,5%.
75,8% of patients had Gd+ lesions and the median number of Gd+ lesions was 2 [IQR 0,5-4]. 51,5% had subcortical Gd+ lesions, 42.4% periventricular, 21,2% yuxtacortical lesions, 18,2% brainstem and 18,2% cerebellum. Gd+ lesions in brain MRI were found in 58.8% of patients with spinal cord relapses, in 100% of those with optic neuritis and in 100% of brainstem-cerebellum relapses.
The univariate analysis showed no correlation between the severity of the relapse and the number of Gd+ lesions. Brainstem-cerebellum relapses were associated with presence of Gd+ lesions in symptomatic location more than other clinical manifestations (p=0.03).
Conclusions: Most patients with a relapse showed several Gd+ lesions in brain MRI, even when the clinical manifestation was outside the brain. No relationship has been found between the severity of the relapse and the number of Gd+ lesions. Brainstem-cerebellum relapses seem to have a better clinical-radiological correlation than other types of relapse. A large study involving spinal MRI would be necessary to confirm these findings.
Disclosure: Both clinical trials were funded by grants of Health Institute Carlos III (EC07/90278 and (EC11/132).
Authors declare no conflicts of interest.
Abstract: P1052
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 21 Imaging
Background: There are very few studies assessing the relapse in MS patients.
Objective: To analyze the relationship between: (1) clinical manifestation of the relapse and location of Gadolinium enhancing (Gd+) lesions; (2) severity of the relapse and number of Gd+ lesions.
Methods: An analysis of basal data of a subset of 33 patients from 2 different phase-IV, multicenter, double-blind, randomized clinical trials that showed non-inferiority of different routes and doses of methylprednisolone (MP) (ClinicalTrials.gov NTC 007537 and NTC 01986998). Clinical manifestations were classified as brainstem-cerebellum, spinal cord, optic neuritis and others. EDSS score previous and at baseline were analyzed. Relapses were classified as mild, moderate or severe. Brain MRI was assessed at the moment of relapse before MP treatment. Number and location (periventricular, subcortical, yuxtacortical, brainstem and cerebellum) of Gd+ lesions were analyzed. Associations were studied using univariate analysis.
Results: 72% of patients were women. Mean age was 37,7±8,7 years, a median previous EDSS score was 2.5 [interquartile range (IQR):1.5-3] and baseline EDSS score was 3.5 [IQR: 2.5-4.25]. Clinical manifestation of relapses: 51,5% spinal cord, 27,3% brainstem-cerebellum, 6,1% optic neuritis and 15,2% others. The severity of the relapse was moderate in 80,6%, mild in 12,9% and severe in 6,5%.
75,8% of patients had Gd+ lesions and the median number of Gd+ lesions was 2 [IQR 0,5-4]. 51,5% had subcortical Gd+ lesions, 42.4% periventricular, 21,2% yuxtacortical lesions, 18,2% brainstem and 18,2% cerebellum. Gd+ lesions in brain MRI were found in 58.8% of patients with spinal cord relapses, in 100% of those with optic neuritis and in 100% of brainstem-cerebellum relapses.
The univariate analysis showed no correlation between the severity of the relapse and the number of Gd+ lesions. Brainstem-cerebellum relapses were associated with presence of Gd+ lesions in symptomatic location more than other clinical manifestations (p=0.03).
Conclusions: Most patients with a relapse showed several Gd+ lesions in brain MRI, even when the clinical manifestation was outside the brain. No relationship has been found between the severity of the relapse and the number of Gd+ lesions. Brainstem-cerebellum relapses seem to have a better clinical-radiological correlation than other types of relapse. A large study involving spinal MRI would be necessary to confirm these findings.
Disclosure: Both clinical trials were funded by grants of Health Institute Carlos III (EC07/90278 and (EC11/132).
Authors declare no conflicts of interest.