Loading...
Several studies have demonstrated greater disability at follow-up for patients with clinically isolated syndromes suggestive of increased multiple sclerosis (MS) risk who present with asymptomatic spinal cord lesions during their first demyelinating event (NEJM JW Neurol Oct 2016 and Mult Scler 2016; 23:665). In the present study, investigators recruited 178 patients within 12 months after first MS symptoms — 84 patients with symptomatic spinal cord lesions, 42 patients with asymptomatic spinal cord lesions, and 52 without spinal cord lesions.
Follow-up lasted at least 24 months (median, 6 years). Overall, 39.3% reached Expanded Disability Status Scale (EDSS) score 3 (moderate disability), 6.2% reached EDSS 6.0 (needing a cane to ambulate), 22% had worsening on the 25-foot timed walk, and 13% had worsening on the 9-hole peg test. Patients with asymptomatic spinal cord lesions did not differ from those with no spinal cord lesions in time to each of the disability measures but showed a trend toward shorter time to a second event. Also, no difference in any disability outcome at follow-up was observed between those with or without spinal cord lesions, regardless of whether the lesions were symptomatic or not.
Dekker I et al. Asymptomatic spinal cord lesions do not predict the time to disability in patients with early multiple sclerosis. Mult Scler 2018 Apr; 24:481. (https://doi.org/10.1177/1352458517736147)
Comment
The presence of spinal cord lesions is often regarded as a poor prognostic marker. However, this study did not find such as association. The precise reasons for the discrepancy remain unclear. Perhaps this cohort had a more favorable overall prognosis, follow-up was not long enough, or treatment altered the natural history. On balance, the presence of spinal cord lesions may be a mild prognostic indicator with much heterogeneity. Symptomatic or asymptomatic spinal cord lesions should not be an absolute indicator of a concerning prognosis, but one factor to consider among many.