Sage Journals: Discover world-class research

Abstract

Objective: To study the long-term outcome and persistence of two patterns of cervical spinal cord abnormality in early relapsing—remitting multiple sclerosis (RRMS).

Methods: RRMS patients with a spinal cord MRI performed during the first 3 years of the disease, a control MRI 5 years later and who have been followed up at least 10 years were included. Patients were grouped according the T2 spinal cord MRI into: (A) nodular pattern, if one or more focal lesions were present; and (B) diffuse pattern, defined as a poorly demarcated high signal area. The end point was defined as the time to reach an Expanded Disability Status Score (EDSS) of 4.0.

Results: Twenty-five patients were included; 12 in group A and 13 in group B. Three patients in group A and 9 in group B reached EDSS 4, in a mean time of 11 years in group A and 7 years in group B (log rank 10.3, p = 0.001). Multivariate Cox regression analysis assessing the risk of EDSS 4.0 including sex, age, number of relapses in the first 2 years, number of T2 brain lesions and spinal cord pattern showed higher risk for the diffuse pattern (hazard ratio 7.2, 95% confidence interval 1.4—36.4). Control MRI showed the persistence of the diffuse pattern in all patients, and the development of diffuse pattern in two patients with basal nodular lesions.

Conclusions: The diffuse abnormality in cervical spinal cord at the beginning of the disease is persistent and predicts a worse prognosis in RRMS patients.

Keywords

MRI multiple sclerosis prognosis relapsing—remitting spinal cord

Get full access to this article

View all access options for this article.

References

Confavreux C. and Vukusic S. Natural history of multiple sclerosis: a unifying concept. Brain 2006; 129: 606-616.

Fisniku LK , Brex PA , Altmann DR , Miszkiel KA , Benton CE , Lanyon R. , et al. Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain 2008; 131: 808-817.

Minneboo A. , Barkhof F. , Polman CH , Uitdehaag BM , Knol DL and Castelijns JA Infratentorial lesions predict long-term disability in patients with initial findings suggestive of multiple sclerosis. Arch Neurol 2004; 61: 217-221.

Honig LS and Sheremata WA Magnetic resonance imaging of spinal cord lesions in multiple sclerosis. J Neurol Neurosurg Psychiatry 1989; 52: 459-466.

Tartaglino LM , Friedman DP , Flanders AE , Lublin FD , Knobler RL and Liem M. Multiple sclerosis in the spinal cord: MR appearance and correlation with clinical parameters. Radiology 1995; 195: 725-732.

Bot JC , Barkhof F. , Polman CH , Lycklama à Nijeholt GJ , de Groot V. , Bergers E. , et al. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 2004; 62: 226-333.

Lycklama G. , Thompson A. , Filippi M. , Miller D. , Polman C. , Fazekas F. , et al. Spinal-cord MRI in multiple sclerosis. Lancet Neurol 2003; 2: 555-562.

Nijeholt GJ , van Walderveen MA , Castelijns JA , van Waesberghe JH , Polman C. , Scheltens P. , et al. Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms. Brain 1998; 121: 687-697.

Langer-Gould A. , Popat RA , Huang SM , Cobb K. , Fontoura P. , Gould MK , et al. Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review. Arch Neurol 2006; 63: 1686-1691.

10.

Kidd D. , Thorpe JW , Thompson AJ , Kendall BE , Moseley IF , MacManus DG , et al. Spinal cord MRI using multi-array coils and fast spin echo. II. Findings in multiple sclerosis. Neurology 1993; 43: 2632-2637.

11.

Filippi M. , Campi A. , Colombo B. , Pereira C. , Martinelli V. , Baratti C. , et al. A spinal cord MRI study of benign and secondary progressive multiple sclerosis. J Neurol 1996; 243: 502-505.

12.

Lycklama à Nijeholt GJ , Barkhof F. , Scheltens P. , Castelijns JA , Ader H. , van Waesberghe JH , et al. MR of the spinal cord in multiple sclerosis: relation to clinical subtype and disability. Am J Neuroradiol 1997; 18: 1041-1048.

13.

Bonek R. , Orlicka K. and Maciejek Z. Demyelinating lesions in the cervical cord in multiple sclerosis 10 years after onset of the disease. Correlation between MRI parameters and clinical course. Neurol Neurochir Pol 2007; 41: 229-233.

14.

Poser CM , Paty DW , Scheinberg L. , McDonald WI , Davis FA , Ebers GC , et al. New diagnostic criteria for multiple sclerosis guidelines for research protocols. Ann Neurol 1983; 13: 227-231.

15.

Lublin FD and Reingold SC Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46: 907-911.

16.

Nijeholt GJ , Bergers E. , Kamphorst W. , Bot J. , Nicolay K. , Castelijns JA , et al. Post-mortem high-resolution MRI of the spinal cord in multiple sclerosis: a correlative study with conventional MRI, histopathology and clinical phenotype. Brain 2001; 124: 154-166.

17.

Bergers E. , Bot JC , van der Valk P. , Castelijns JA , Lycklama a Nijeholt GJ , Kamphorst W. , et al. Diffuse signal abnormalities in the spinal cord in multiple sclerosis: direct postmortem in situ magnetic resonance imaging correlated with in vitro high-resolution magnetic resonance imaging and histopathology . Ann Neurol 2002; 51: 652-656.

18.

Bot JC and Barkhof F. Spinal-cord MRI in multiple sclerosis: conventional and nonconventional MR techniques. Neuroimaging Clin N Am 2009 ; 19: 81-99.

Early diffuse demyelinating lesion in the cervical spinal cord predicts a worse prognosis in relapsing—remitting multiple sclerosis

Abstract

Keywords

Get full access to this article

References