Contributions
Abstract: P466
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: Infratentorial and spinal cord lesions are frequently present in multiple sclerosis. Their location suggests an important role in motor function and consequently lesions in these areas often contribute to disability. The aim of this study was to determine whether infratentorial and spinal cord lesions cumulatively predict disability progression better than these locations separately.
Methods: We included 156 patients from the Amsterdam MS cohort shortly after their first clinical event. Patients were followed for 6 (n=156) and a subset for 11 years (n=95). Baseline (BL) brain and spinal cord MRI were performed and lesions were counted per region (supratentorial, infratentorial and spinal cord). Expanded Disability Status Scale (EDSS) was obtained, and in order to determine EDSS-plus progression also the 25-foot walk test and 9-hole peg test were measured at BL and after 6 and 11 years. Patients were divided into 4 groups according to MRI lesion location at BL: 1. Patients with both spinal cord and infratentorial lesions (n=54, 34.6%); 2. Patients with spinal cord lesions but no infratentorial lesions (n=58, 37.2%); 3. Patients with infratentorial but no spinal cord lesions (n=15, 9.6%); 4. Patients without spinal cord and infratentorial lesions (n=29, 18.6%). Logistic regression was performed to determine the risk for EDSS- and EDSS-plus progression after 6 and 11 years.
Results: Median EDSS was 2.0 (IQR 1.5-3.0) at BL, 2.5 (IQR 1.5-3.5) after 6 years and 3.0 (IQR 2.0-4.0) after 11 years. Fifty-one patients (32.7%) showed EDSS-progression after 6 years and 48 (50.5%) after 11 years. EDSS-plus progression after 6 years was seen in 66 patients (50.0%) and in 55 patients (66.3%) after 11 years. Odds ratios showed trends towards spinal cord lesions alone having more impact than infratentorial and spinal cord lesions together. Sub-analyses comparing patients with and without spinal cord lesions showed a higher risk for EDSS progression after 6 years (OR 2.8; p=0.027) and after 11 years (OR 4.1; p=0.009). For patients with infratentorial lesions versus patients without infratentorial lesions no difference was found.
Conclusions: Our results suggest that the presence of spinal cord lesions tends to be more important for predicting EDSS progression than infratentorial lesions. Adding up both spinal cord lesions and infratentorial lesions did not result in a better prediction of disability.
Disclosure: I. Dekker received speaking honoraria from Roche and funding from the Dutch MS Society, grant number 14-358e
M.H. Sombekke has nothing to disclose
L.J. Balk has nothing to disclose
J.J.G. Geurts is an editor of MS journal and serves on the editorial boards of Neurology and Frontiers of Neurology and is president of the Netherlands organization for health research and innovation and has served as a consultant for Merck-Serono, Biogen, Novartis, Genzyme and Teva Pharmaceuticals.
F. Barkhof serves as editorial board member of Brain, European Radiology, Neurology, Multiple Sclerosis Journal and Radiology. He has accepted consulting fees from Bayer-Schering Pharma, Biogen-IDEC, TEVA, Merck-Serono, Novartis, Roche, Jansen Research, Genzyme-Sanofi, IXICO Ltd, GeNeuro, Apitope Ltd and speaker fees from Biogen-IDEC and IXICO. Has received grants from AMYPAD(IMI), EuroPOND (H2020), UK MS Society, Dutch MS Society, PICTURE (IMDI-NWO), NIHR UCLH Biomedical Research Centre (BRC), ECTRIMS-MAGNIMS.
B.M.J. Uitdehaag has received personal compensation for consulting from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and TEVA.
J. Killestein reports grants and personal fees from Biogen Idec, Novartis, Merck Serono, TEVA, Genzyme. Grants and other from Biogen Idec, Novartis, TEVA, Bayer Schering Pharma, Glaxo Smith Kline, Merck Serono
M.P. Wattjes reports personal fees from Biogen, Novartis, Sanofi-Genzyme, IXICO, Roche, Merck-Serono, Springer
Abstract: P466
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: Infratentorial and spinal cord lesions are frequently present in multiple sclerosis. Their location suggests an important role in motor function and consequently lesions in these areas often contribute to disability. The aim of this study was to determine whether infratentorial and spinal cord lesions cumulatively predict disability progression better than these locations separately.
Methods: We included 156 patients from the Amsterdam MS cohort shortly after their first clinical event. Patients were followed for 6 (n=156) and a subset for 11 years (n=95). Baseline (BL) brain and spinal cord MRI were performed and lesions were counted per region (supratentorial, infratentorial and spinal cord). Expanded Disability Status Scale (EDSS) was obtained, and in order to determine EDSS-plus progression also the 25-foot walk test and 9-hole peg test were measured at BL and after 6 and 11 years. Patients were divided into 4 groups according to MRI lesion location at BL: 1. Patients with both spinal cord and infratentorial lesions (n=54, 34.6%); 2. Patients with spinal cord lesions but no infratentorial lesions (n=58, 37.2%); 3. Patients with infratentorial but no spinal cord lesions (n=15, 9.6%); 4. Patients without spinal cord and infratentorial lesions (n=29, 18.6%). Logistic regression was performed to determine the risk for EDSS- and EDSS-plus progression after 6 and 11 years.
Results: Median EDSS was 2.0 (IQR 1.5-3.0) at BL, 2.5 (IQR 1.5-3.5) after 6 years and 3.0 (IQR 2.0-4.0) after 11 years. Fifty-one patients (32.7%) showed EDSS-progression after 6 years and 48 (50.5%) after 11 years. EDSS-plus progression after 6 years was seen in 66 patients (50.0%) and in 55 patients (66.3%) after 11 years. Odds ratios showed trends towards spinal cord lesions alone having more impact than infratentorial and spinal cord lesions together. Sub-analyses comparing patients with and without spinal cord lesions showed a higher risk for EDSS progression after 6 years (OR 2.8; p=0.027) and after 11 years (OR 4.1; p=0.009). For patients with infratentorial lesions versus patients without infratentorial lesions no difference was found.
Conclusions: Our results suggest that the presence of spinal cord lesions tends to be more important for predicting EDSS progression than infratentorial lesions. Adding up both spinal cord lesions and infratentorial lesions did not result in a better prediction of disability.
Disclosure: I. Dekker received speaking honoraria from Roche and funding from the Dutch MS Society, grant number 14-358e
M.H. Sombekke has nothing to disclose
L.J. Balk has nothing to disclose
J.J.G. Geurts is an editor of MS journal and serves on the editorial boards of Neurology and Frontiers of Neurology and is president of the Netherlands organization for health research and innovation and has served as a consultant for Merck-Serono, Biogen, Novartis, Genzyme and Teva Pharmaceuticals.
F. Barkhof serves as editorial board member of Brain, European Radiology, Neurology, Multiple Sclerosis Journal and Radiology. He has accepted consulting fees from Bayer-Schering Pharma, Biogen-IDEC, TEVA, Merck-Serono, Novartis, Roche, Jansen Research, Genzyme-Sanofi, IXICO Ltd, GeNeuro, Apitope Ltd and speaker fees from Biogen-IDEC and IXICO. Has received grants from AMYPAD(IMI), EuroPOND (H2020), UK MS Society, Dutch MS Society, PICTURE (IMDI-NWO), NIHR UCLH Biomedical Research Centre (BRC), ECTRIMS-MAGNIMS.
B.M.J. Uitdehaag has received personal compensation for consulting from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and TEVA.
J. Killestein reports grants and personal fees from Biogen Idec, Novartis, Merck Serono, TEVA, Genzyme. Grants and other from Biogen Idec, Novartis, TEVA, Bayer Schering Pharma, Glaxo Smith Kline, Merck Serono
M.P. Wattjes reports personal fees from Biogen, Novartis, Sanofi-Genzyme, IXICO, Roche, Merck-Serono, Springer