Abstract
ObjectiveThere is an ongoing search for markers useful in monitoring and predicting disease activity at the early stage of multiple sclerosis (MS). The goals of this study were to prospectively evaluate the changes in parameters of multimodal evoked potentials (EP) and cognition within a 3-year follow-up period in patients with clinically isolated syndrome (CIS), and to assess the prognostic value of baseline findings with regard to the disease outcomes.MethodsIn 29 patients (20 women, nine men, mean age 31.1) multimodal (visual, brainstem auditory, somatosensory, event-related) EP and neuropsychological tests (NT) were performed at baseline (T0) and after 1 (T1) and 3 (T3) years. Their results were compared longitudinally between baseline, T1, and T3. Baseline results confirmed conversion of CIS into multiple sclerosis (MS) and disability level at T1 and T3 using multiple comparisons and a logistic regression model.ResultsApart from mean N13/P16 SEP (somatosensory evoked potentials) amplitude (lower at T1 and T3 than at baseline (T0 1.02 ± 0.37 μV, T1 0.90 ± 0.26 μV, T3 0.74 ± 0.32 μV, p < 0.05 for both comparisons), no significant changes of EP or NT parameters were found in longitudinal assessment. Baseline P300 Pz latency was longer for the patients with MS than for those with CIS at T1 (352.69 vs. 325.56 ms). No predictive value was shown for any of the analyzed baseline variables with regard to conversion from CIS into MS.SignificanceBaseline ERP abnormalities were associated with their short-term conversion into MS. ERP are worth considering in multimodal EP evaluation at the early stage of MS.
Highlights
Isolated syndrome (CIS) is defined as the first clinical episode, suggestive of multiple sclerosis (MS) [1]
Apart from mean N13/P16 somatosensory evoked potentials (SEP) amplitude (lower at T1 and T3 than at baseline (T0 1.02 ± 0.37 μV, T1 0.90 ± 0.26 μV, T3 0.74 ± 0.32 μV, p < 0.05 for both comparisons), no significant changes of evoked potentials (EP) or neuropsychological tests (NT) parameters were found in longitudinal assessment
Within the first year of the follow-up, disease-modifying treatment (DMT) was instituted in 25 patients: interferon beta (IFN β) in 23 cases and glatiramer acetate in 2 cases Table 2)
Summary
Isolated syndrome (CIS) is defined as the first clinical episode, suggestive of multiple sclerosis (MS) [1]. According to the current version of McDonald’s criteria [1], some patients with CIS can be already diagnosed with MS, which allows clinicians to initiate early disease-modifying treatment (DMT) In those who do not fulfill the criteria for dissemination in time, a cautious follow-up is recommended, in order to recognize the development of active relapsing-remitting MS in a timely manner. In a multi-center European study [2], as much as 27% of patients remained with CIS without satisfying McDonald’s criteria after 15 years of follow-up Due to such a high variability of a further disease course, there is an ongoing search for predictive biomarkers, already applicable at this early stage, which would allow clinicians to stratify the risk of highly active MS and individualize therapeutic approaches [3]. There is relevant evidence for the predictive value of magnetic resonance imaging (MRI) measures and presence of oligoclonal bands of Ig in cerebrospinal fluid (CSF), while the role of clinical issues, environmental factors (vitamin D deficiency, Epstein-Barr virus infection, smoking), and biochemical/immunological markers remains disputable [2,3,4]
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