Contributions
Abstract: 157
Type: Scientific Session
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: While most people with multiple sclerosis (MS) develop neurological impairments over time, some develop little detectable disability even after two or more decades. There have been few magnetic resonance imaging (MRI) studies of predictors of such a long-term MS outcome.
Objective: To investigate early MRI predictors of an expanded disability status scale (EDSS) score ≤3.5, i.e. no mobility impairment, or EDSS >3.5, 30 years after onset of a clinically isolated syndrome (CIS).
Method: This study is based on data from the 30-year follow-up of the first London CIS cohort. PD/T2-weighted brain lesion counts, and lesion location (periventricular, juxtacortical, deep white matter, infratentorial), were assessed on baseline, 1-year, and 5-years scans. At 30 years disease course was classified as CIS, MS with EDSS ≤3.5, MS with EDSS >3.5, or death relating to MS (EDSS 10). A logistic regression model was used to identify early MRI predictors of EDSS ≤3.5 and EDSS >3.5 outcomes at 30 years.
Results: After a mean of 30.1 years, outcomes were known in 120/132 (91%) participants. At 30 years, 35 (29%) had relapsing-remitting (RR) MS, 26 (22%) secondary progressive MS, and for 16 (13%) MS contributed to their death. Thirty-two patients (27%) had an EDSS ≤3.5, all of whom remained in the RR phase. Presence of baseline infratentorial (OR 20.3, p < 0.0001) and 1-year deep white matter (OR 14.9, p < 0.0001) lesions were the most significant early MRI predictors associated with a 30-year EDSS >3.5. In those with no baseline infratentorial and no deep white matter lesions one year after CIS, the estimated risk of EDSS >3.5 at 30 years was 13% (95%CI 0-26%); in those with both baseline infratentorial and 1-year deep white matter lesions, the estimated risk was 94% (95%CI 83-100%).
Conclusions: The presence of infratentorial and deep white matter lesions early in the course of relapse-onset MS are associated with higher levels of disability three decades later.
Disclosure: Karen Chung has received honoraria for travel and meetings from Teva and Biogen-Idec, and has received honoraria from Biogen-Idec and Roche for speaking at meetings.
Daniel Altmann has nothing to disclose.
Frederik Barkhof serves as a consultant for Bayer Schering Pharma, Sanofi-Aventis, Genzyme, Biogen-Idec, Teva, Novartis, Roche, Synthon BV and Jansen Research.
Olga Ciccarelli received research funding from: UK and National MS Societies, Rosetrees trust, and NIHR UCLH BRC. She is a consultant for Novartis, Roche, and Teva. She is an Associate Editor for Neurology.
Declan Chard has received honoraria (paid to his employer) from Excemed for faculty-led education work; had meeting expenses funded by Merck, MS Trust, National MS Society, Novartis, Société des Neurosciences and Swiss MS Society; and has previously held stock in GlaxoSmithKline.
This study was funded by a grant from the MS Society of Great Britain and Northern Ireland
Abstract: 157
Type: Scientific Session
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Introduction: While most people with multiple sclerosis (MS) develop neurological impairments over time, some develop little detectable disability even after two or more decades. There have been few magnetic resonance imaging (MRI) studies of predictors of such a long-term MS outcome.
Objective: To investigate early MRI predictors of an expanded disability status scale (EDSS) score ≤3.5, i.e. no mobility impairment, or EDSS >3.5, 30 years after onset of a clinically isolated syndrome (CIS).
Method: This study is based on data from the 30-year follow-up of the first London CIS cohort. PD/T2-weighted brain lesion counts, and lesion location (periventricular, juxtacortical, deep white matter, infratentorial), were assessed on baseline, 1-year, and 5-years scans. At 30 years disease course was classified as CIS, MS with EDSS ≤3.5, MS with EDSS >3.5, or death relating to MS (EDSS 10). A logistic regression model was used to identify early MRI predictors of EDSS ≤3.5 and EDSS >3.5 outcomes at 30 years.
Results: After a mean of 30.1 years, outcomes were known in 120/132 (91%) participants. At 30 years, 35 (29%) had relapsing-remitting (RR) MS, 26 (22%) secondary progressive MS, and for 16 (13%) MS contributed to their death. Thirty-two patients (27%) had an EDSS ≤3.5, all of whom remained in the RR phase. Presence of baseline infratentorial (OR 20.3, p < 0.0001) and 1-year deep white matter (OR 14.9, p < 0.0001) lesions were the most significant early MRI predictors associated with a 30-year EDSS >3.5. In those with no baseline infratentorial and no deep white matter lesions one year after CIS, the estimated risk of EDSS >3.5 at 30 years was 13% (95%CI 0-26%); in those with both baseline infratentorial and 1-year deep white matter lesions, the estimated risk was 94% (95%CI 83-100%).
Conclusions: The presence of infratentorial and deep white matter lesions early in the course of relapse-onset MS are associated with higher levels of disability three decades later.
Disclosure: Karen Chung has received honoraria for travel and meetings from Teva and Biogen-Idec, and has received honoraria from Biogen-Idec and Roche for speaking at meetings.
Daniel Altmann has nothing to disclose.
Frederik Barkhof serves as a consultant for Bayer Schering Pharma, Sanofi-Aventis, Genzyme, Biogen-Idec, Teva, Novartis, Roche, Synthon BV and Jansen Research.
Olga Ciccarelli received research funding from: UK and National MS Societies, Rosetrees trust, and NIHR UCLH BRC. She is a consultant for Novartis, Roche, and Teva. She is an Associate Editor for Neurology.
Declan Chard has received honoraria (paid to his employer) from Excemed for faculty-led education work; had meeting expenses funded by Merck, MS Trust, National MS Society, Novartis, Société des Neurosciences and Swiss MS Society; and has previously held stock in GlaxoSmithKline.
This study was funded by a grant from the MS Society of Great Britain and Northern Ireland