01/17/2002 (Volume 346, Number 3)
Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH
The New England Journal of Medicine. 2002;346(3):158-164
In the evaluation of multiple sclerosis (MS), magnetic resonance imaging (MRI) plays a key role in identifying clinical and subclinical lesions. Limited information is known about the relationship between early findings on MRI in patients with isolated syndromes (optic neuritis, brain-stem or spinal cord syndromes) and the development of subsequent disability from MS. Brex and colleagues conducted a study to examine the relationship between early lesion volume, changes in volume, and long-term disability.
The study group (n = 109) was initially recruited for clinical and MRI examinations at baseline and after approximately 1 year. Additional evaluations were performed at 5 years (n = 89) and 10 years (n = 81). In total, 71 patients with isolated syndromes were re-evaluated after a mean of 14.1 years. The degree of disability was assessed with the use of Kurtzke's Expanded Disability Status Scale (EDSS; possible range, 0-10, the higher score indicating a greater degree of disability).
Clinically definite MS developed in 48 of the 71 patients (68%) with a median EDSS score of 3.25 (range, 0-10). In total, 25 of the 36 patients (69%) with optic neuritis developed clinically definite MS, followed by 9 of the 14 patients (64%) with brain-stem syndrome, and 14 of the 21 patients (67%) with spinal cord syndromes. For patients with abnormal MRI scans at baseline, 44 of 50 patients (88%) developed clinically definite MS compared with 4 of the 21 patients (19%) with normal scans at baseline. Notably, the EDSS score at 14 years correlated moderately with lesion volume on MRI at 5 years (r = 0.60) and with the increase in lesion volume over the first 5 years (r = 0.61). The results of the study demonstrate that for patients with isolated syndromes and early MS (first 5 years of disease), lesion volume on MRI is of prognostic value in the assessment of future disability risk. However, caution should be taken in using the degree of lesion volume on imaging as the sole indicator for the use of disease-modifying therapy in patients with MS.
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