Highlights
- •There is an emerging need to identify predictive factors that anticipate conversion from CIS to MS.
- •70% of 64 CIS patients converted to MS during a follow-up period of at least 24 months.
- •We demonstrated independent predictive value for conversion to MS in high number (>10) T2 hyperintense lesions on baseline brain MRI, OCB positivity, and subclinical multimodal EP abnormality.
Abstract
Background
Multiple sclerosis (MS) begins with an acute clinical attack (clinically isolated
syndrome) in approximately 85% of patients. The conversion rate from clinically isolated
syndrome to multiple sclerosis has been documented at 30% to 82% in previous studies.
When an individual presents for evaluation after a single episode of inflammation
of the CNS, several decisions regarding follow-up in subsequent years need to be made,
including that of whether or not to start a therapy. There is, therefore, an emerging
need to identify the predictive factors that anticipate conversion from CIS to MS.
Methods
This paper presents a single-center prospective longitudinal study aimed at identification
of the most powerful independent predictors for conversion from CIS to MS, utilizing
the 2010 McDonald MS criteria and focusing on selected demographic, clinical, radiographical
(magnetic resonance imaging – MRI), cerebrospinal fluid (predominantly oligoclonal
bands – OCB) and electrophysiological parameters (multimodal sensory and motor-evoked
potentials – EP). Two independent outcomes meeting MS criteria are evaluated: development
of second clinical relapse (clinically definite multiple sclerosis) and progression
in magnetic resonance imaging (based on new MRI T2 brain and/or spinal cord lesions).
CIS patients were followed clinically and MRI was repeated at one and two years within
the course of a follow-up period of at least 24 months (median 27, range 24–36 months).
Results
Of the 64 CIS patients enrolled who completed at least a 2-year follow-up period (42
women and 22 men, median age 36.5, range 22–66 years), 45 (70.3%) (29 women and 16
men, median age 38; range 22–66 years) fulfilled the 2010 McDonald criteria for MS
by dissemination in space (DIS) and time (DIT) over the follow-up period. Twenty-nine
CIS patients converted to MS through a clinically symptomatic attack, and 16 CIS patients
developed new T2 lesions on MRI, while 19 patients without progression remained stable
as CIS. Confirmed among potential predictors for the conversion of CIS patients to
MS were increased (>10) baseline MRI T2-hyperintense lesions (odds ratio (OR) 3.107,
p = 0.046), OCB positivity (OR 5.958, p = 0.003) and subclinical EP abnormality (OR
14.400, p = 0.003). Multivariate statistical models (logistic regression and Cox proportional
hazards regression models) confirmed these parameters as independent predictors of
high sensitivity (84%) and acceptable specificity (63%).
Conclusion
In addition to accepted predictors for the conversion of CIS to MS (i.e. baseline
MRI T2 lesion load and OCB positivity), already implemented in current diagnostic
criteria for MS, this study demonstrates, in addition, the high predictive value of
subclinical multimodal evoked potential abnormalities.
Keywords
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Article info
Publication history
Published online: June 03, 2020
Accepted:
June 2,
2020
Received in revised form:
May 24,
2020
Received:
April 29,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
