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Predicting Conversion to MS - The Role of a History Suggestive of Demyelination

Published online by Cambridge University Press:  02 December 2014

Sarah A. Morrow ,
J. Alexander Fraser ,
David Nicolle  and
Marcelo Kremenchutzky
Sarah A. Morrow*
Affiliation:
State University of New York, Buffalo, The Jacobs Neurological Institute, Buffalo, New York, U.S.A
J. Alexander Fraser
Affiliation:
Department of Ophthalmology, University of Western Ontario, London, Ontario, Canada Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
David Nicolle
Affiliation:
Department of Ophthalmology, University of Western Ontario, London, Ontario, Canada
Marcelo Kremenchutzky
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
*
The Jacobs Neurological Institute, Buffalo General Hospital, 100 High Street, Buffalo, New York, 14215, U.S.A.
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Abstract

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Background:

The ability to predict conversion to multiple sclerosis (MS) accurately when assessing a patient with a clinically isolated syndrome (CIS) is of paramount importance.Magnetic resonance imaging (MRI) is the best paraclinical tool currently available; however the significance of a history of an event suggestive of demyelination prior to CIS presentation has not been evaluated.

Methods:

Aretrospective chart review of all optic neuritis cases presenting as CIS to a single neuro-ophthalmologist in London, Ontario between 1990 to 1998 was performed. Data were collected regarding demographics, past medical history, history of present illness, and family history. Conversion to MS was determined by the McDonald criteria after ten years of follow-up. Bayesian statistics and logistic regression were used to determine the best predictors of conversion to MS from CIS.

Results:

One hundred and sixteen optic neuritis subjects were included in the analysis. After ten years, 42.2% had converted to MS. The best predictor of future conversion remained at least one brain lesion, disseminated in space, on MRI (sensitivity 0.90, specificity 0.75). However, if the subject additionally had a history suggestive of a demyelinating event in the past that had not been confirmed clinically, the specificity increased to 0.96. These two traits taken together had an odds ratio of 27.8 for conversion to MS in the next ten years (p<0.001).

Conclusions:

A history of an event suggestive of demyelination prior to presenting with optic neuritis as CIS increases the ability of the clinician to predict conversion to MS in the next ten years.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 4 , July 2010 , pp. 488 - 491
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Optic Neuritis Treatment Group. Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up. Arch Neurol. 2008;65:727–32.Google Scholar
2. Optic Neuritis Study Group. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthal. 2003;121:944–9.Google Scholar
3. Optic Neuritis Study Group. Neurologic impairment 10 years after optic neuritis. Arch Neurol. 2004;61:1386–9.Google Scholar
4. Morrissey, SP, Miller, DH, Kendall, BE, Kingsley, DP, Kelly, MA, Francis, DA, et al. The significance of brain magnetic resonance imaging abnormalities at presentation with clinically isolated syndromes suggestive of multiple sclerosis. A 5-year follow-up study. Brain, 1993;116(Pt 1):135–6.CrossRefGoogle ScholarPubMed
5. O’Riordan, JI, Thompson, AJ, Kingsley, DP, MacManus, DG, Kendall, BE, Rudge, P, et al. The prognostic value of brain MRI in clinically isolated syndromes of the CNS. A 10-year follow-up. Brain. 1998;121(Pt 3):495–503.Google Scholar
6. Brex, PA, Ciccarelli, O, O’Riordan, JI, Sailer, M, Thompson, AJ, Miller, DH. A longitudinal study of abnormalities on MRI and disability from multiple sclerosis. N Engl J Med. 2002;346:158–64.Google Scholar
7. Polman, CH, Reingold, SC, Edan, G, Filippi, M, Hartung, HP, Kappos, L, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol. 2005;58: 840–6.CrossRefGoogle Scholar
8. Champs Study Group. Interferon beta-1a for optic neuritis patients at high risk for multiple sclerosis. Am J Ophthal. 2001;132: 463–71.Google Scholar
9. Kappos, L, Polman, CH, Freedman, MS, Edan, G, Hartung, HP, Miller, DH, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006;67:1242–9.Google Scholar
10. Comi, G, Filippi, M, Barkhof, F, Durelli, L, Edan, G, Fernandez, O, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001;357: 1576–82.CrossRefGoogle ScholarPubMed
11. Comi, G, Martinelli, V, Rodegher, M, Moiola, L, Bajenaru, O, Carra, A, et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet. 2009;374(9700):1503–11.CrossRefGoogle ScholarPubMed
12. Rudick, RA, Fisher, E, Lee, JC, Duda, JT, Simon, J. Brain atrophy in relapsing multiple sclerosis: relationship to relapses, EDSS, and treatment with interferon beta-1a. Mult Scler. 2000;6:365–2.Google Scholar
13. Yoshida, EM, Rasmussen, SL, Steinbrecher, UP, Erb, SR, Scudamore, CH, Chung, SW, et al. Fulminant liver failure during interferon beta treatment of multiple sclerosis. Neurology. 2001;56:1416.Google Scholar
14. Galetta, SL, Markowitz, C. US FDA-approved disease-modifying treatments for multiple sclerosis: review of adverse effect profiles. CNS Drugs. 2005;19:239–2.Google Scholar
15. Debouverie, M, Moreau, T, Lebrun, C, Heinzlef, O, Brudon, F, Msihid, J. A longitudinal observational study of a cohort of patients with relapsing-remitting multiple sclerosis treated with glatiramer acetate. Eur J Neurol. 2007;14:1266–74.Google Scholar
16. Barkhof, F, Filippi, M, Miller, DH, Scheltens, P, Campi, A, Polman, CH, et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite mulltiple sclerosis. Brain. 1997; 120:2059–69.Google Scholar
17. Masjuan, J, Alvarez-Cermeno, JC, Garcia-Barragan, N, Diaz-Sanchez, , Espino, M, Sadaba, MC, et al. Clinically isolated syndromes: a new oligoclonal band test accurately predicts conversion to MS. Neurology. 2006;66:576–8.Google Scholar
18. Tintore, M, Rovira, A, Rio, J, Tur, C, Pelayo, R, Nos, C, et al. Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology. 2008;70:1079–83.Google Scholar
19. McDonald, WI, Compston, A, Edan, G, Goodkin, D, Hartung, H-P, Lublin, FD, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121–7.CrossRefGoogle ScholarPubMed
20. Reiber, H, Thompson, EJ, Grimsley, G, Bernardi, G, Adam, P, Monterio de Almeida, S, et al. Quality assurance for cerebrospinal fluid protein analysis: international consensus by an Internet-based group discussion. Clin Chem Lab Med. 2003;41:331–7.Google Scholar
21. Soderstrom, M, Ya-Ping, J, Hillert, J, Link, H. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50:708–14.Google Scholar
22. Mowry, EM, Pesic, M, Grimes, B, Deen, SR, Bacchetti, P, Waubant, E. Clinical predictors of early second event in patients with clinically isolated syndrome. J Neurol. 2009;256:1061–6.CrossRefGoogle ScholarPubMed