Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis.

Philipp Schwenkenbecher,Martin Stangel,Paul Bronzlik,Thomas Skripuletz,Ulrich Wurster,Refik Pul,Kurt-Wolfram Sühs,Lena Bönig,Anastasia Sarikidi

doi:10.3390/ijms18102061

Abstract

While the revised McDonald criteria of 2010 allow for the diagnosis of multiple sclerosis (MS) in an earlier stage, there is still a need to identify the risk factors for conversion to MS in patients with clinically isolated syndrome (CIS). Since the latest McDonald criteria were established, the prognostic role of cerebrospinal fluid (CSF) and visual evoked potentials (VEP) in CIS patients is still poorly defined. We conducted a monocentric investigation including patients with CIS in the time from 2010 to 2015. Follow-ups of 120 patients revealed that 42% converted to MS. CIS patients with positive oligoclonal bands (OCB) were more than twice as likely to convert to MS as OCB negative patients (hazard ratio = 2.6). The probability to develop MS was even higher when a quantitative intrathecal IgG synthesis was detected (hazard ratio = 3.8). In patients with OCB, VEP did not add further information concerning the conversion rate to MS. In patients with optic neuritis and negative OCB, a significantly higher rate converted to MS when VEP were delayed. In conclusion, the detection of an intrathecal IgG synthesis increases the conversion probability to MS. Pathological VEP can help to predict the conversion rate to MS in patients with optic neuritis without an intrathecal IgG synthesis.

Highlights

A clinically isolated syndrome (CIS) is defined as a first episode of neurological symptoms caused by inflammation leading to demyelination in the central nervous system (CNS) [1,2]
A follow-up of 120 patients with CIS revealed that 50 patients (42%) converted to Multiple sclerosis (MS) according to the McDonald criteria of 2010, while 70 patients (58%) were assessed as stable CIS (Table 1)
The majority of patients diagnosed with optic neuritis as the first clinical episode showed a stable course and only 27% of patients converted to MS

Summary

Introduction

A clinically isolated syndrome (CIS) is defined as a first episode of neurological symptoms caused by inflammation leading to demyelination in the central nervous system (CNS) [1,2]. According to the latest revision of the McDonald criteria for the diagnosis of MS from 2010, patients can be diagnosed with MS after a single clinical episode when cranial magnetic resonance imaging (MRI) detects CNS lesions in typical CNS areas together with an asymptomatic contrast enhancing lesion, fulfilling the criteria of dissemination in space and time [4]. CSF inflammatory changes and delayed evoked potentials are characteristic findings in patients with a demyelinating disease [8]. Another study confirmed the crucial role of OCB for prognosis of CIS patients when applying the McDonald criteria of 2010 [15]. Because the prognostic role of CSF findings in patients with CIS according to the latest McDonald criteria is still poorly defined, we performed a thorough evaluation of CSF parameters. The role of visual evoked potential as an additional prognostic marker was investigated

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