T2 lesions independently predict early conversion to SPMS

Results from a 10-year longitudinal study showed that cervical spinal cord T2 lesions independently predict early conversion to secondary progressive MS (SPMS). The occurrence and number of T2 lesions at the time of a clinically isolated syndrome (CIS) were significantly higher in patients who converted to SPMS than patients who did not. These results highlight the importance of SC-T2L at CIS diagnosis [1].

Brain MRI T2 lesions (B-T2L) at time of CIS are a well-known risk factor for developing SPMS. However, longitudinal data studying the influence of cervical spinal cord T2 lesions (SC-T2L) are lacking. The prognostic value of SC-T2L on MRI performed at the time of CIS was assessed in a retrospective study of prospectively gathered data of patients with a CIS suggestive of demyelinating disease. All participants had a brain and cervical spinal cord MRI at diagnosis. Dr Laura Lacruz-Ballester (Health Research Institute La Fe, Spain) presented the results.

The study cohort consisted of 242 patients, with a mean age of 32 years and 71.1% women. Mean follow up was 12.7 years. Of these 242 patients, 205 (85.6%) were treated; 87 (41.8%) began treatment after the first relapse, and 120 (58.2%) after the second relapse. Of the CIS patients, 224 (92.6%) had a second relapse; 36 (14.9%) evolved to SPMS. The median total number of B-T2L lesions was higher in SPMS (20.5) than in relapsing-remitting MS/CIS patients (11.9; P=0.009). So was the number of SC-T2L lesions (1.75 vs 1.0; P=0.00005). Dr Lacruz-Ballester said: “In a regression model, adjusting for sex, age, treatment initiation at CIS, B-T2L, SC-T2L, and the presence of oligoclonal bands, SC-T2L was the only independent factor to predict conversion to SPMS, with an odds ratio of 2.2 (95% CI 1.06–4.97).”

Dr Lacruz-Ballester concluded that this data should stimulate studies of how spinal cord lesions can trigger neurodegeneration in progressive MS, for example by inducing corticospinal tract atrophy, or via a chronic inflammatory mechanism.

1. Lacruz-Ballester L. Cervical spinal cord T2 lesions independently predict early conversion to secondary progressive multiple sclerosis: a longitudinal 10-year study. OP137, ECTRIMS 2021 Virtual Congress, 13–15 October.

 

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Posted on 9 December, 202125 March, 2024