Contribution of the symptomatic lesion in establishing MS diagnosis and prognosis
| Autor: | Joaquín Castilló, Ingrid Galán, Susana Otero-Romero, Manuel Comabella, Breogán Rodríguez-Acevedo, Cristina Auger, Alex Rovira, Raquel Mitjana, Xavier Montalban, Georgina Arrambide, Berta Pujal, Carlos Nos, María Jesús Arévalo, Mar Tintoré, Angela Vidal-Jordana, Jaume Sastre-Garriga, Jordi Río, Luciana Midaglia, Carmen Tur |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Asymptomatic Diagnosis Differential Lesion Disability Evaluation 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Prospective Studies Prospective cohort study Clinically isolated syndrome Expanded Disability Status Scale medicine.diagnostic_test business.industry Multiple sclerosis McDonald criteria Magnetic resonance imaging Prognosis medicine.disease Magnetic Resonance Imaging Surgery 030104 developmental biology Spinal Cord Multivariate Analysis Female Neurology (clinical) Radiology medicine.symptom business Biomarkers 030217 neurology & neurosurgery Brain Stem Demyelinating Diseases Follow-Up Studies |
| Zdroj: | Neurology. 87:1368-1374 |
| ISSN: | 1526-632X 0028-3878 |
| Popis: | Objective: To study the contribution of the symptomatic lesion in establishing multiple sclerosis (MS) diagnosis and prognosis. Methods: We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort of 1,107 patients recruited for clinical and brain MRI follow-up from 1995 to 2014. Eligible patients (n = 954) were divided into 4 groups according to baseline MRI: patients with a normal MRI (n = 290); patients with a single asymptomatic lesion (n = 18); patients with a single cord/brainstem symptomatic lesion (n = 35); and patients with more than 1 lesion (n = 611). For each group, we studied the risk of second attack, with 2005 McDonald MS and Expanded Disability Status Scale 3.0, using univariable and multivariable regression models adjusted by age, sex, oligoclonal bands, and disease-modifying treatments. We tested the diagnostic performance of a modified dissemination in space (DIS) criterion that includes symptomatic lesions in the total count and compared it to the DIS criteria (at least 1 asymptomatic lesion in at least 2 of the 4 MS characteristic MS locations) for all patients and for the subgroup of patients with brainstem or spinal cord topography. Results: Patients with a cord/brainstem single symptomatic lesion have a higher risk of second attack and disability accumulation than patients with 0 lesions but have a similar risk compared to patients with 1 asymptomatic lesion. Diagnostic properties are reasonably maintained when the symptomatic lesion qualifies for DIS. Conclusions: Despite the recommendations of the 2010 McDonald criteria, symptomatic lesions should be taken into account when considering the diagnosis and prognosis of patients with CIS. |
| Databáze: | OpenAIRE |
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