Dr Olga Ciccarelli, PhDOlga Ciccarelli, PhD
A recent study found that MRI abnormalities such as early focal inflammatory disease activity and spinal cord lesions seen around the time of presentation with clinically isolated syndrome and throughout the first few years after disease onset predict the development of long-term outcomes in relapse-onset multiple sclerosis.

Researchers aimed to identify early MRI predictors of long-term outcomes in relapse-onset multiple sclerosis including secondary progressive disease course, physical disability, and cognitive performance, and to do so, studied a cohort of subjects with clinically isolated syndrome suggestive of multiple sclerosis who underwent MRI scans around the time of presentation and follow-up MRI scans after 1 and 3 years. Additionally, the long-term prognostic value of established MRI measures available clinically and early changes in brain and spinal cord volume in the earliest stages of disease were also investigated.

“These findings suggest that the accrual of focal lesions in clinically-eloquent sites and the extent of early inflammatory disease activity are important predictors of long-term disability and secondary progression in relapse-onset multiple sclerosis,” wrote the authors, led by Olga Ciccarelli, PhD, NMR Research Unit, UCL Institute of Neurology, and National Institute of Health Research University College London Hospitals Biomedical Research Center.1 “Conventional MRI measures available in routine clinical practice may be useful in counselling patients with CIS and early multiple sclerosis about long-term disease course and might be helpful in personalizing treatment plans.”

Between 1994 and 2004 subjects 16–50 years of age seen at the National Hospital for Neurology and Neurosurgery and Moorsfields Eye Hospital in London with clinically isolated syndrome suggestive of multiple sclerosis were invited to participated in a longitudinal clinical and imaging study. Subjects were assessed clinically and with MRI within 3 months of presentation of symptoms and returned for clinical and MRI follow-up after 1, 3, and 5 years.

Of the 178 subjects enrolled subjects at baseline, 166 were followed up after a mean of 15.1 years and were assessed to determine disease course: 119 (72%) had multiple sclerosis, 45 (27%) remained as clinically isolated syndrome, and 2 (1%) developed other disorders. Disease course and physical disability were assessed at 15 years by phone in 47 (29%) of patients. Of those with multiple sclerosis, 94 (57%) had relapsing-remitting and 25 (15%) had secondary progressive disease.

Cognition and self-reported fatigue were assessed in 104 (63%) of patients at 15 years and researchers reported that 21 (20%) had impaired performance on the PASAT and 27 (26%) on the SDMT, all of which had multiple sclerosis. Fatigue Severity Scale scores in the fatigued range were reported in 31 (30%) of patients, 29 of which had multiple sclerosis.

“The major, novel findings of this work include: (i) a consistent association of spinal cord lesions, both at the time of presentation and new spinal cord lesions over the first 3 years of follow-up, with development of secondary progressive multiple sclerosis and physical disability after 15 years; (ii) a consistent association of asymptomatic gadolinium-enhancing lesions seen at the time of clinically isolated syndrome with the development of secondary progressive multiple sclerosis and later physical and cognitive performance; and (iii) a stronger association of MRI measures of focal inflammatory disease activity (i.e. lesions) with long-term disease course, compared with brain and spinal cord atrophy, in the earliest stages of relapse-onset multiple sclerosis,” Ciccarelli and colleagues wrote.

These findings suggest that early focal inflammatory disease activity and spinal cord lesions are predictors of long-term disease outcomes in patients with relapse-onset multiple sclerosis. The MRI metrics, which are available in clinical practice, can be helpful when counseling patients about a treatment plan.
REFERENCE
Brownlee W, Altmann D, Prados F, et al. Early imaging predictors of long-term outcomes in relapse-onset multiple sclerosis. Brain. 2019;142(8):2276–2287. doi: 10.1093/brain/awz156.