Abstract:
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Purpose: In many cases, a clinically isolated syndrome (CIS) of the brainstem, optic nerve, spinal cord, or several regions, is the presenting attack of multiple sclerosis (MS). The conversion to MS (i.e., occurrence of a second attack) has been shown to be related to the results of paraclinical tests such as brain MR imaging and CSF analysis. The aim of this study was to compare the rates of conversion to clinically definite MS (CDMS) among the various topographical clinical syndromes at presentation, depending on the initial brain MR imaging findings.
Methods and Materials: We studied 380 consecutive patients presenting with a CIS: 148 (39%) with optic neuritis, 99 (26%) with brainstem syndrome, 99 (26%) with spinal cord syndrome, and 34 (9%) with a polyregional syndrome. Mean clinical follow-up was 31+/-22 months. The rates of conversion to clinically definite MS among the different clinical syndromes were compared. In a subgroup of patients, baseline (n=280) and one year (n=229) brain MR scans were obtained and the criteria for dissemination in space (at least 3 of the Barkhof criteria) and time (new T2 lesion on the follow-up MR exam) according to the McDonald criteria were assessed.
Results: The rate of conversion to clinically definite MS in patients with optic neuritis was lower than that in polyregional syndromes (22% vs 40%; p= 0.031), brainstem syndromes (34%; p = 0.043) or spinal cord syndromes (34%; p=0.042). Patients presenting with optic neuritis showed a lower rate of dissemination in space as compared to brainstem syndromes (29% vs 51%; p =0.003) and polyregional syndromes (50%; p=0.042), and a lower rate of dissemination in time (31%) as compared to spinal cord syndromes (52%; p=0.008), brainstem syndromes (55%; p=0.004) or polyregional syndromes (60%; p=0.015). These differences disappeared when analysing only the patients with an abnormal baseline MR exam (presence of at least one subclinical T2 focal brain lesion of the type seen in MS).
Conclusion: Patients presenting with optic neuritis showed a higher percentage of normal brain MR exams at presentation and a lower rate of conversion to clinically-definite MS as compared to the other types of CIS. When the baseline MR exam demonstrated subclinical events, however, there were no significant differences among the various clinical groups with respect to the rate of conversion to MS. These results support the prognostic value of baseline MR imaging in CIS patients.
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Gispert MD, S,
Conversion to Multiple Sclerosis after a Clinically Isolated Syndrome: Differences Depending on the Topography. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105397.html
