Information sourced from NEJM Journal Watch:
Asymptomatic Spinal Cord Lesions in Clinically Isolated Syndrome
Spinal cord lesions at presentation are associated with poor outcomes.
Spinal cord lesions are often observed in patients with multiple sclerosis (MS) and are thought to portend a poor prognosis.
To verify that these lesions are associated with worse outcomes, investigators conducted a prospective cohort study of 131 patients with nonspinal presentation of clinically isolated syndrome (CIS) who underwent spinal cord and brain imaging at baseline and at follow-up a median of 5.2 years later.
Patients classified as disabled — with an expanded disability status score (EDSS) of ≥3.0 — had significantly more spinal cord and brain lesions at baseline than patients with an EDSS of <3.0. Patients with an EDSS of ≥3.0 also had increase in the number of spinal cord lesions or the volume of brain lesions at follow-up. Combined brain and spinal cord lesions at baseline and over time explained 37% of worsening disability at 5 years.
The number of spinal cord lesions at presentation is an independent risk factor for future disability. An EDSS of ≥3.0 at 5 years is an important landmark, as it divides MS prognosis into the worse half and better half. One should consider imaging the cervical spinal cord at presentation to establish a baseline and to help determine disease severity.
Robert T. Naismith, MD reviewing Brownlee WJ et al. Mult Scler 2016 Aug 1.
Brownlee WJ et al. Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome. Mult Scler 2016 Aug 1; [e-pub].
[Free full-text Mult Scler article PDF | PubMed® abstract]
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