Neurology/Neurosurgery, July 2003 Journal Scan
July 10, 2003 (Volume 349, Number 2)
Berger T, Rubner P, Schautzer F, et al.
The New England Journal of Medicine. 2003;349(2):139-145
Multiple sclerosis (MS) is an inflammatory relapsing or progressive disease that affects the central nervous system white matter and is a major cause of disability among young adults. Of interest, the exact etiology and pathophysiology of MS is unknown, although some proposed mechanisms include infection, autoimmunity, bystander demyelination, and hereditary. Because many MS patients initially present with a clinically isolated syndrome, it would be useful to identify specific markers that may help predict early conversion to clinically definite MS. Berger and colleagues examined whether the presence of serum antibodies against myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP) in patients with a clinically isolated syndrome predicted the interval to conversion to clinically definite MS.
In total, 103 patients with a clinically isolated syndrome were identified and enrolled in the study. To be included in the analysis, patients had to have positive findings on cerebral magnetic resonance imaging (MRI) and oligoclonal bands in the cerebrospinal fluid. Each patient received an initial treatment of 1000 mg of intravenous methylprednisolone therapy for 3-5 consecutive days. The serum samples for anti-MOG and anti-MBP were collected at baseline (before the administration of methylprednisolone). Neurologic assessments were performed at the start of the analysis and every 3 months to determine disease progression or relapse. The follow-up period lasted at least 12 months, and none of the patients were lost to follow-up during the study period.
The study group consisted of 73 women and 30 men with a mean age at disease onset of 32.0 years (range, 13 to 54 years). With regard to the presence of antibodies, 22 patients (21%) were seropositive for both anti-MOG and anti-MBP antibodies, 42 patients (41%) were seropositive for only anti-MOG antibodies and 39 patients (38%) were seronegative for both antibodies. Interestingly, the antibody status was not associated with the type of clinical syndrome or outcome. The results demonstrated that the initial detection of serum antibodies against MOG and MBP in patients with a clinically isolated syndrome predicted early conversion to clinically definite MS. Conversely, the lack of antibodies suggested the patients would remain disease-free for several years.
Notably, patients with anti-MOG and anti-MBP antibodies had relapses more often and earlier than the patients without the antibodies. The data revealed 83% and 95% of the patients who were seropositive for only anti-MOG antibodies and both anti-MOG and anti-MBP, respectively, had a first relapse during the mean follow-up period of 52 months. In contrast, 77% of the patients who were found to be seronegative for both anti-MOG and anti-MBP antibodies remained relapse-free during the mean follow-up period.
The findings of the study are extremely interesting and may have a definite impact on the counseling and subsequent management of patients with a clinically isolated syndrome suggestive of MS. Further investigation is warranted.
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