Cortical lesions predict disease progression and disability accumulation

The presence and number of cortical lesions (CLs) at the time of MS diagnosis predicted the development of secondary progressive MS (SPMS) and disability accumulation in a 20-year follow-up study. The analysis also showed that a 1.5T MRI scan at diagnosis could be used as a prognostic tool for SPMS and disease burden [1].

Recent studies have confirmed that CLs are predictive of the development of progressive MS and worsening of disability in MS patients [2,3]. The objective of this study, presented by Dr Gian Marco Schiavi (University of Verona, Italy), was to assess the prognostic value of CLs after 20 years when CLs were determined at an early stage of the disease. For this purpose, 220 patients with MS (relapsing-remitting MS, n=162; clinically isolated syndrome, n=45; primary progressive MS, n=12) were followed for a median of 20 years. At diagnosis and within 4 years of the clinical onset of the disease, they underwent a 1.5T brain MRI and a spinal cord MRI scan. The number of CLs, the number of white matter lesions, and the presence of spinal cord lesions were evaluated. Primary endpoints were the correlation of early MRI features with conversion to SPMS types and Expanded Disability Status Scale (EDSS) scores at the end of follow-up.

After 20 years of follow-up, 152 patients were relapsing-remitting, 44 had converted to SPMS, and 12 continued with clinically isolated syndromes. Post-hoc analyses showed that the number of CLs at diagnosis was higher in patients who converted to SPMS (mean 6.28) than in non-SPMS patients (mean 1.16; P<0.001). Moreover, higher EDSS scores were associated with higher numbers of CLs at baseline (P<0.001). Corresponding mean EDSS scores ranged from 1.5 in patients without CLs to 6.0 in patients with >3 CLs at baseline.

Dr Schiavi concluded that their data supports the notion that the presence of CLs at the time of diagnosis is associated with long-term disability and transition to a secondary progressive disease course. Nevertheless, further research is needed to validate CLs as a biomarker for clinical practice, e.g. whether CL burden can be used to guide therapeutic decision-making in MS.

1. Schiavi GM, et al. Cortical lesions at diagnosis predict conversion to secondary progressive multiple sclerosis and accumulation of disability: a 20-year follow-up study. P105, ECTRIMS 2021 Virtual Congress, 13­–15 October.
2. Scalfari A, et al. Neurology. 2018;90(24):e2107–e2118.
3. Haider L, et al. Brain. 2021;144(5):1384–1395.

 

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Posted on 9 December, 202125 March, 2024