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      The long-term outcomes of CIS patients in the Barcelona inception cohort: Looking back to recognize aggressive MS

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      , , , , , , , , , , , , , , , , , , , , , , , , , , , ,
      Multiple Sclerosis (Houndmills, Basingstoke, England)
      SAGE Publications
      Clinically isolated syndromes, multiple sclerosis, MRI, prognosis, disease-modifying treatment, prediction

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          Abstract

          Objective:

          To explore the long-term outcomes of patients with clinically isolated syndromes from the Barcelona cohort.

          Methods:

          We selected patients with a follow-up longer than 10 years to (1) estimate the risks of multiple sclerosis (MS) and disability accumulation according to the baseline number of T2 lesions and to compare treated versus untreated patients and early versus delayed treatment, and (2) to study baseline features of patients with aggressive MS (Expanded Disability Status Scale (EDSS) ⩾6.0 at 10 years).

          Results:

          In all, 401 patients were included (mean follow-up of 14.4 (standard deviation of 2.9) years). A higher number of T2 lesions was associated with an earlier MS diagnosis and an earlier risk of irreversible disability. Early treatment was associated with a decreased risk of EDSS of 3.0: adjusted hazard ratio = 0.4, 95% confidence interval = (0.2, 0.7). Patients with aggressive MS differed in their baseline brain magnetic resonance images: The median (interquartile range) number of T2 lesions and contrast-enhancing lesions (CEL) was 71 (28–95) versus 7 (1–19) and 3 (1–24) versus 0 (0–1), respectively. The cut-offs that better classified patients with aggressive MS were 20 for T2 lesions and 2 for CEL.

          Conclusion:

          Although MS natural history is changing, a high lesion load at onset is helpful to identify patients at risk of presenting an aggressive MS.

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          Most cited references21

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          Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).

          J. Kurtzke (1983)
          One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
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            Is Open Access

            Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria

            New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Ann Neurol 2011
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              Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria".

              New diagnostic criteria for multiple sclerosis integrating magnetic resonance image assessment with clinical and other paraclinical methods were introduced in 2001. The "McDonald Criteria" have been extensively assessed and used since 2001. New evidence and consensus now strengthen the role of these criteria in the multiple sclerosis diagnostic workup to demonstrate dissemination of lesions in time, to clarify the use of spinal cord lesions, and to simplify diagnosis of primary progressive disease. The 2005 Revisions to the McDonald Diagnostic Criteria for MS should simplify and speed diagnosis, whereas maintaining adequate sensitivity and specificity.
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                Author and article information

                Contributors
                Journal
                Mult Scler
                Mult Scler
                MSJ
                spmsj
                Multiple Sclerosis (Houndmills, Basingstoke, England)
                SAGE Publications (Sage UK: London, England )
                1352-4585
                1477-0970
                15 October 2019
                November 2020
                : 26
                : 13
                : 1658-1669
                Affiliations
                [1-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [2-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [3-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain/ Department Preventive Medicine and Epidemiology, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [4-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [5-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [6-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain/Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK/Luton and Dunstable University Hospital, University College London, London, UK
                [7-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [8-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [9-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [10-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [11-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [12-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [13-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [14-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [15-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [16-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [17-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [18-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [19-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [20-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [21-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [22-1352458519877810]Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [23-1352458519877810]Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [24-1352458519877810]Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [25-1352458519877810]Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [26-1352458519877810]Unitat d’Estadística i Bioinformatica, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
                [27-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [28-1352458519877810]Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
                [29-1352458519877810]Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain/Division of Neurology, University of Toronto, St Michael’s Hospital, Toronto, ON, Canada
                Author notes
                [*]M Tintore Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Servei de Neurologia/Neuroimmunologia, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Pg. Vall d’Hebron 119-129, Barcelona 08035, Spain. mtintore@ 123456cem-cat.org
                Article
                10.1177_1352458519877810
                10.1177/1352458519877810
                7604549
                31610739
                547e1477-84fb-4a30-a053-8cf823e34f6c
                © The Author(s), 2019

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 8 March 2019
                : 6 August 2019
                Funding
                Funded by: european regional development fund, FundRef https://doi.org/10.13039/501100008530;
                Funded by: instituto de salud carlos iii, FundRef https://doi.org/10.13039/501100004587;
                Funded by: genzyme, FundRef https://doi.org/10.13039/100004329;
                Funded by: red española de esclerosis múltiple, FundRef https://doi.org/10.13039/501100007747;
                Funded by: Ministry of Economy and Competitiveness in Spain, ;
                Funded by: Ajuts per donar Suport als Grups de Recerca de Catalunya, ;
                Funded by: agència de gestió d’ajuts universitaris i de recerca, FundRef https://doi.org/10.13039/501100003030;
                Categories
                Original Research Papers
                Custom metadata
                ts1

                Immunology
                clinically isolated syndromes,multiple sclerosis,mri,prognosis,disease-modifying treatment,prediction

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