A longitudinal study of abnormalities on MRI and disability from multiple sclerosis: Brex PA, Ciccarelli O, O’Riordan J, Sailer M, Thompson AJ, Miller DH. N Engl J Med 2002;346:158–164

Abstract

In patients with optic neuritis and other isolated syndromes clinically suggestive of demyelinating disease, the presence of white matter lesions on magnetic resonance imaging (MRI) of the brain increases the likelihood that multiple sclerosis (MS) will develop months or years later. This study sought to determine the relation between early lesion volume, changes in volume, and long-term disability in this group of patients. Seventy-one patients with isolated syndromes (36 with optic neuritis) were followed in a serial MRI study for a mean of 14.1 years. Clinically definite MS developed in 48 patients (68%) and probable MS in a further five (7%). Clinically definite MS developed in 44 of the 50 patients (88%) with abnormal results on MRI at presentation and in four of 21 patients (19%) with normal results on MRI. Overall, 49 of 50 patients with abnormal MRIs (98%) had clinical or radiologic evidence of multiphasic disease consistent with MS. The median Expanded Disability Status Scale (EDSS; possible range, 0 to 10, with a higher score indicating a greater degree of disability) score at follow-up for those with MS was 3.25 (range, 0 to 10); 31 percent had an EDSS score of 6 or more (including three patients whose deaths were due to MS). The EDSS score at 14 years correlated moderately with lesion volume on MRI at five years and with the increase in lesion volume over the first five years. The authors conclude that in patients who first present with isolated syndromes suggestive of MS, the increases in the volume of the lesions seen on MRI of the brain in the first five years may correlate with the degree of long-term disability from MS. This relation is only moderate, so the volume of the lesions alone may not be an adequate basis for decisions about the use of disease-modifying treatment.—Nancy J. Newman