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PLoS One. 2014 Mar 5;9(3):e90509. doi: 10.1371/journal.pone.0090509. eCollection 2014.

Radiologically isolated syndrome: 5-year risk for an initial clinical event.

Author information

1
University of Texas Southwestern Medical Center, Department of Neurology & Neurotherapeutics, Clinical Center for Multiple Sclerosis, Dallas, Texas, United States of America.
2
University of Istanbul, Department of Neurology, Cerrahpasa School of Medicine, Istanbul, Turkey.
3
Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota, United States of America.
4
Mt. Sinai School of Medicine, Department of Neurology, Radiology and Neuroscience, New York, New York, United States of America.
5
Barrow Neurological Institute, Department of Neurology, Phoenix, Arizona, United States of America.
6
Cleveland Clinic Lou Ruvo Center for Brain Health, Department of Neurology, Las Vegas, Nevada, United States of America.
7
MS Center of Catalunya Cemcat and Magnetic Resonance Unit, Vall d'Hebron Hospital, Barcelona, Spain.
8
University of Florence, Department of Neurology, Florence, Italy.
9
Centre Hospitalo Universitaire Bordeaux, Bordeaux, France.
10
Centre Hospitalo Universitaire Strasbourg, Strasbourg, France.
11
Centre Hospitalo Universitaire Purpan, Toulouse, France.
12
Centre Hospitalo Universitaire Salengro, Lille, France.
13
University of Siena, Department of Medicine, Surgery & Neuroscience, Siena, Italy.
14
University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy.
15
Yale University, Departments of Neurology and Diagnostic Radiology, New Haven, Connecticut, United States of America.
16
Hôpital Pasteur, Service de Neurologie, Nice, France.

Abstract

OBJECTIVE:

To report the 5-year risk and to identify risk factors for the development of a seminal acute or progressive clinical event in a multi-national cohort of asymptomatic subjects meeting 2009 RIS Criteria.

METHODS:

Retrospectively identified RIS subjects from 22 databases within 5 countries were evaluated. Time to the first clinical event related to demyelination (acute or 12-month progression of neurological deficits) was compared across different groups by univariate and multivariate analyses utilizing a Cox regression model.

RESULTS:

Data were available in 451 RIS subjects (F: 354 (78.5%)). The mean age at from the time of the first brain MRI revealing anomalies suggestive of MS was 37.2 years (y) (median: 37.1 y, range: 11-74 y) with mean clinical follow-up time of 4.4 y (median: 2.8 y, range: 0.01-21.1 y). Clinical events were identified in 34% (standard error=3%) of individuals within a 5-year period from the first brain MRI study. Of those who developed symptoms, 9.6% fulfilled criteria for primary progressive MS. In the multivariate model, age [hazard ratio (HR): 0.98 (95% CI: 0.96-0.99); p=0.03], sex (male) [HR: 1.93 (1.24-2.99); p=0.004], and lesions within the cervical or thoracic spinal cord [HR: 3.08 (2.06-4.62); p=<0.001] were identified as significant predictors for the development of a first clinical event.

INTERPRETATION:

These data provide supportive evidence that a meaningful number of RIS subjects evolve to a first clinical symptom. An age <37 y, male sex, and spinal cord involvement appear to be the most important independent predictors of symptom onset.

PMID:
24598783
PMCID:
PMC3943959
DOI:
10.1371/journal.pone.0090509
[Indexed for MEDLINE]
Free PMC Article
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