March 1st, 2004
Boston Cure Project
A major concern for people with early-stage MS is whether and/or when they will face serious disability as a result of their disease. Having advance information about their risk of disability would be valuable in terms of making plans for the future as well as making treatment decisions.
Hoping to develop better prognostic tools, a group of researchers decided to scan and then track over time people with "clinically isolated syndrome" or CIS (i.e., one MS-like symptom that may develop into definite MS) to see whether there are any early MRI characteristics that can predict eventual disability. They enrolled 42 people with CIS, gave them each an MRI, and then followed them over an average of 8 years (a relatively long time). After assessing which subjects converted to definite MS and tracking their EDSS progression, the researchers studied the baseline MRIs to determine which features correlated with faster progression to 3.0. They found that the best predictor of faster progression was the presence of two or more T2-weighted infratentorial lesions (lesions in the lower part of the brain, e.g., the cerebellum). T1-weighted measurements did not provide any prognostic value.
One explanation for this finding is that since the infratentorial region
is near the spinal cord, infratentorial lesions may be associated with
spinal cord disease. Spinal cord lesions may themselves be as good or even
better at predicting long-term disability; however, at the time the study
began participants were not routinely given a spinal MRI. So for now the
presence of 2+ infratentorial lesions seems to be the best predictor of
long-term disability in early MS, with the prognostic value of spinal cord
lesions yet to be determined.
Copyright © 2004, Boston Cure Project