Conversion of clinically isolated syndrome to multiple
sclerosis: a prospective study

J 2020

Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study

KOLČAVA, Jan, Jan KOČICA, Monika HULOVÁ, Ladislav DUŠEK, Magda HORÁKOVÁ et. al.

Basic information

Original name

Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study

Authors

KOLČAVA, Jan (203 Czech Republic, belonging to the institution), Jan KOČICA (203 Czech Republic, belonging to the institution), Monika HULOVÁ (203 Czech Republic, belonging to the institution), Ladislav DUŠEK (203 Czech Republic, belonging to the institution), Magda HORÁKOVÁ (203 Czech Republic, belonging to the institution), Miloš KEŘKOVSKÝ (203 Czech Republic, belonging to the institution), Jakub STULÍK (203 Czech Republic, belonging to the institution), Marek DOSTÁL (203 Czech Republic, belonging to the institution), Matyáš KUHN (203 Czech Republic, belonging to the institution), Eva VLČKOVÁ (203 Czech Republic, belonging to the institution), Josef BEDNAŘÍK (203 Czech Republic, belonging to the institution) and Yvonne BENEŠOVÁ (203 Czech Republic, guarantor, belonging to the institution)

Edition

MULTIPLE SCLEROSIS AND RELATED DISORDERS, OXFORD, ELSEVIER SCI LTD, 2020, 2211-0348

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.339

RIV identification code

RIV/00216224:14110/20:00117598

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.msard.2020.102262

UT WoS

000599869900018

Keywords in English

Clinically isolated syndrome; Evoked potentials; Magnetic resonance; Multiple sclerosis; Oligoclonal bands

Abstract

V originále

Background: Multiple sclerosis (MS) begins with an acute clinical attack (clinically isolated syndrome) in approximately 85% of patients. The conversion rate from clinically isolated syndrome to multiple sclerosis has been documented at 30% to 82% in previous studies. When an individual presents for evaluation after a single episode of inflammation of the CNS, several decisions regarding follow-up in subsequent years need to be made, including that of whether or not to start a therapy. There is, therefore, an emerging need to identify the predictive factors that anticipate conversion from CIS to MS. Methods: This paper presents a single-center prospective longitudinal study aimed at identification of the most powerful independent predictors for conversion from CIS to MS, utilizing the 2010 McDonald MS criteria and focusing on selected demographic, clinical, radiographical (magnetic resonance imaging - MRI), cerebrospinal fluid (predominantly oligoclonal bands - OCB) and electrophysiological parameters (multimodal sensory and motor-evoked potentials - EP). Two independent outcomes meeting MS criteria are evaluated: development of second clinical relapse (clinically definite multiple sclerosis) and progression in magnetic resonance imaging (based on new MRI T2 brain and/or spinal cord lesions). CIS patients were followed clinically and MRI was repeated at one and two years within the course of a follow-up period of at least 24 months (median 27, range 24-36 months). Results: Of the 64 CIS patients enrolled who completed at least a 2-year follow-up period (42 women and 22 men, median age 36.5, range 22-66 years), 45 (70.3%) (29 women and 16 men, median age 38; range 22-66 years) fulfilled the 2010 McDonald criteria for MS by dissemination in space (DIS) and time (DIT) over the follow-up period. Twenty-nine CIS patients converted to MS through a clinically symptomatic attack, and 16 CIS patients developed new T2 lesions on MRI, while 19 patients without progression remained stable as CIS. Confirmed among potential predictors for the conversion of CIS patients to MS were increased (>10) baseline MRI T2-hyperintense lesions (odds ratio (OR) 3.107, p = 0.046), OCB positivity (OR 5.958, p = 0.003) and subclinical EP abnormality (OR 14.400, p = 0.003). Multivariate statistical models (logistic regression and Cox proportional hazards regression models) confirmed these parameters as independent predictors of high sensitivity (84%) and acceptable specificity (63%). Conclusion: In addition to accepted predictors for the conversion of CIS to MS (i.e. baseline MRI T2 lesion load and OCB positivity), already implemented in current diagnostic criteria for MS, this study demonstrates, in addition, the high predictive value of subclinical multimodal evoked potential abnormalities.

Links

MUNI/A/1325/2019, interní kód MU

Name: Diagnostika a patofyziologie neuropatické bolesti (Acronym: PNB)

Investor: Masaryk University, Category A

NV15-32133A, research and development project

Name: Predikce konverze klinicky izolovaného syndromu do roztroušené sklerózy pomocí pokročilých technik zobrazení magnetickou rezonancí

Citovat

KOLČAVA, Jan, Jan KOČICA, Monika HULOVÁ, Ladislav DUŠEK, Magda HORÁKOVÁ, Miloš KEŘKOVSKÝ, Jakub STULÍK, Marek DOSTÁL, Matyáš KUHN, Eva VLČKOVÁ, Josef BEDNAŘÍK and Yvonne BENEŠOVÁ. Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study. MULTIPLE SCLEROSIS AND RELATED DISORDERS. OXFORD: ELSEVIER SCI LTD, 2020, vol. 44, SEP 2020, p. 1-10. ISSN 2211-0348. Available from: https://dx.doi.org/10.1016/j.msard.2020.102262.

@article{1721016,
   author = {Kolčava, Jan and Kočica, Jan and Hulová, Monika and Dušek, Ladislav and Horáková, Magda and Keřkovský, Miloš and Stulík, Jakub and Dostál, Marek and Kuhn, Matyáš and Vlčková, Eva and Bednařík, Josef and Benešová, Yvonne},
   article_location = {OXFORD},
   article_number = {SEP 2020},
   doi = {http://dx.doi.org/10.1016/j.msard.2020.102262},
   keywords = {Clinically isolated syndrome; Evoked potentials; Magnetic resonance; Multiple sclerosis; Oligoclonal bands},
   language = {eng},
   issn = {2211-0348},
   journal = {MULTIPLE SCLEROSIS AND RELATED DISORDERS},
   title = {Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study},
   url = {https://www.sciencedirect.com/science/article/pii/S2211034820303382?via%3Dihub},
   volume = {44},
   year = {2020}
}

TY  - JOUR
ID  - 1721016
AU  - Kolčava, Jan - Kočica, Jan - Hulová, Monika - Dušek, Ladislav - Horáková, Magda - Keřkovský, Miloš - Stulík, Jakub - Dostál, Marek - Kuhn, Matyáš - Vlčková, Eva - Bednařík, Josef - Benešová, Yvonne
PY  - 2020
TI  - Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study
JF  - MULTIPLE SCLEROSIS AND RELATED DISORDERS
VL  - 44
IS  - SEP 2020
SP  - 1-10
EP  - 1-10
PB  - ELSEVIER SCI LTD
SN  - 22110348
KW  - Clinically isolated syndrome
KW  - Evoked potentials
KW  - Magnetic resonance
KW  - Multiple sclerosis
KW  - Oligoclonal bands
UR  - https://www.sciencedirect.com/science/article/pii/S2211034820303382?via%3Dihub
L2  - https://www.sciencedirect.com/science/article/pii/S2211034820303382?via%3Dihub
N2  - Background: Multiple sclerosis (MS) begins with an acute clinical attack (clinically isolated syndrome) in approximately 85% of patients. The conversion rate from clinically isolated syndrome to multiple sclerosis has been documented at 30% to 82% in previous studies. When an individual presents for evaluation after a single episode of inflammation of the CNS, several decisions regarding follow-up in subsequent years need to be made, including that of whether or not to start a therapy. There is, therefore, an emerging need to identify the predictive factors that anticipate conversion from CIS to MS. Methods: This paper presents a single-center prospective longitudinal study aimed at identification of the most powerful independent predictors for conversion from CIS to MS, utilizing the 2010 McDonald MS criteria and focusing on selected demographic, clinical, radiographical (magnetic resonance imaging - MRI), cerebrospinal fluid (predominantly oligoclonal bands - OCB) and electrophysiological parameters (multimodal sensory and motor-evoked potentials - EP). Two independent outcomes meeting MS criteria are evaluated: development of second clinical relapse (clinically definite multiple sclerosis) and progression in magnetic resonance imaging (based on new MRI T2 brain and/or spinal cord lesions). CIS patients were followed clinically and MRI was repeated at one and two years within the course of a follow-up period of at least 24 months (median 27, range 24-36 months). Results: Of the 64 CIS patients enrolled who completed at least a 2-year follow-up period (42 women and 22 men, median age 36.5, range 22-66 years), 45 (70.3%) (29 women and 16 men, median age 38; range 22-66 years) fulfilled the 2010 McDonald criteria for MS by dissemination in space (DIS) and time (DIT) over the follow-up period. Twenty-nine CIS patients converted to MS through a clinically symptomatic attack, and 16 CIS patients developed new T2 lesions on MRI, while 19 patients without progression remained stable as CIS. Confirmed among potential predictors for the conversion of CIS patients to MS were increased (>10) baseline MRI T2-hyperintense lesions (odds ratio (OR) 3.107, p = 0.046), OCB positivity (OR 5.958, p = 0.003) and subclinical EP abnormality (OR 14.400, p = 0.003). Multivariate statistical models (logistic regression and Cox proportional hazards regression models) confirmed these parameters as independent predictors of high sensitivity (84%) and acceptable specificity (63%). Conclusion: In addition to accepted predictors for the conversion of CIS to MS (i.e. baseline MRI T2 lesion load and OCB positivity), already implemented in current diagnostic criteria for MS, this study demonstrates, in addition, the high predictive value of subclinical multimodal evoked potential abnormalities.
ER  -

KOLČAVA, Jan, Jan KOČICA, Monika HULOVÁ, Ladislav DUŠEK, Magda HORÁKOVÁ, Miloš KEŘKOVSKÝ, Jakub STULÍK, Marek DOSTÁL, Matyáš KUHN, Eva VLČKOVÁ, Josef BEDNAŘÍK and Yvonne BENEŠOVÁ. Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study. \textit{MULTIPLE SCLEROSIS AND RELATED DISORDERS}. OXFORD: ELSEVIER SCI LTD, 2020, vol.~44, SEP 2020, p.~1-10. ISSN~2211-0348. Available from: https://dx.doi.org/10.1016/j.msard.2020.102262.

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