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BMC Neurol. 2009 May 20;9:19. doi: 10.1186/1471-2377-9-19.

MRI characteristics are predictive for CDMS in monofocal, but not in multifocal patients with a clinically isolated syndrome.

Author information

1
MS Center, Department of Neurology, VU Medical Center, Amsterdam, the Netherlands. jm.nielsen@vumc.nl

Abstract

BACKGROUND:

To diagnose multiple sclerosis (MS), evidence for dissemination in space and time is required. There is no clear definition on how symptoms and signs of a patient indicate clinical dissemination in space. To provide a uniform approach on this subject, a clinical classification system was described recently differentiating patients with mono- and multifocal clinical presentation. Here we assess the predictive value of clinically defined dissemination in space at first presentation for time to clinically definite MS (CDMS).

METHODS:

Four hundred and sixty-eight patients with a first episode suggestive of MS were classified as clinically mono- or multifocal by two neurologists blinded to magnetic resonance imaging (MRI) results. These patients were part of the BENEFIT study in which 292 patients were randomized to interferon beta-1b (IFNB-1b) and 176 to placebo. By using Kaplan-Meier statistics the risk for CDMS was studied in mono- and multifocal patients of the placebo group, both with and without taking into account MRI measures of potential prognostic relevance.

RESULTS:

Time to CDMS was similar in monofocal and multifocal patients. In monofocal patients, the risk for CDMS over 2 years was significantly higher when >or= 9 T2 lesions or at least one Gd-enhancing lesion were present at the first event or 3 or 6 months after the first event. In patients with multifocal presentation, these MRI measures had no significant added value in predicting time to CDMS.

CONCLUSION:

These data indicate that a carefully performed neurological assessment of symptoms and signs, combined with lesions on MRI, is important for defining the risk of conversion to CDMS.

TRIAL REGISTRATION:

The Benefit trial has been registered under NCT00185211 http://www.clinicaltrials.gov.

PMID:
19457248
PMCID:
PMC2702360
DOI:
10.1186/1471-2377-9-19
[Indexed for MEDLINE]
Free PMC Article

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