A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes

Karen K Chung, Daniel Altmann, Frederik Barkhof, Katherine Miszkiel, Peter A Brex, Jonathan O'Riordan, Michael Ebner, Ferran Prados, M Jorge Cardoso, Tom Vercauteren, Sebastien Ourselin, Alan Thompson, Olga Ciccarelli, Declan T Chard

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: Clinical outcomes in multiple sclerosis (MS) are highly variable. We aim to determine the long-term clinical outcomes in MS, and to identify early prognostic features of these outcomes.

METHODS: One hundred thirty-two people presenting with a clinically isolated syndrome were prospectively recruited between 1984 and 1987, and followed up clinically and radiologically 1, 5, 10, 14, 20, and now 30 years later. All available notes and magnetic resonance imaging scans were reviewed, and MS was defined according to the 2010 McDonald criteria.

RESULTS: Clinical outcome data were obtained in 120 participants at 30 years. Eighty were known to have developed MS by 30 years. Expanded Disability Status Scale (EDSS) scores were available in 107 participants, of whom 77 had MS; 32 (42%) remained fully ambulatory (EDSS scores ≤3.5), all of whom had relapsing-remitting MS (RRMS), 3 (4%) had RRMS and EDSS scores >3.5, 26 (34%) had secondary progressive MS (all had EDSS scores >3.5), and MS contributed to death in 16 (20%). Of those with MS, 11 received disease-modifying therapy. The strongest early predictors (within 5 years of presentation) of secondary progressive MS at 30 years were presence of baseline infratentorial lesions and deep white matter lesions at 1 year.

INTERPRETATION: Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, whereas others ran a more favorable long-term course. These outcomes could, in part, be predicted by radiological findings from within 1 year of first presentation. ANN NEUROL 2020;87:63-74.

Original languageEnglish
Pages (from-to)63-74
Number of pages12
JournalAnnals of Neurology
Volume87
Issue number1
DOIs
Publication statusPublished - Jan 2020

Cite this

Chung, Karen K ; Altmann, Daniel ; Barkhof, Frederik ; Miszkiel, Katherine ; Brex, Peter A ; O'Riordan, Jonathan ; Ebner, Michael ; Prados, Ferran ; Cardoso, M Jorge ; Vercauteren, Tom ; Ourselin, Sebastien ; Thompson, Alan ; Ciccarelli, Olga ; Chard, Declan T. / A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes. In: Annals of Neurology. 2020 ; Vol. 87, No. 1. pp. 63-74.
@article{aa19da6901544e11bbd6509d5264621a,
title = "A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes",
abstract = "OBJECTIVE: Clinical outcomes in multiple sclerosis (MS) are highly variable. We aim to determine the long-term clinical outcomes in MS, and to identify early prognostic features of these outcomes.METHODS: One hundred thirty-two people presenting with a clinically isolated syndrome were prospectively recruited between 1984 and 1987, and followed up clinically and radiologically 1, 5, 10, 14, 20, and now 30 years later. All available notes and magnetic resonance imaging scans were reviewed, and MS was defined according to the 2010 McDonald criteria.RESULTS: Clinical outcome data were obtained in 120 participants at 30 years. Eighty were known to have developed MS by 30 years. Expanded Disability Status Scale (EDSS) scores were available in 107 participants, of whom 77 had MS; 32 (42{\%}) remained fully ambulatory (EDSS scores ≤3.5), all of whom had relapsing-remitting MS (RRMS), 3 (4{\%}) had RRMS and EDSS scores >3.5, 26 (34{\%}) had secondary progressive MS (all had EDSS scores >3.5), and MS contributed to death in 16 (20{\%}). Of those with MS, 11 received disease-modifying therapy. The strongest early predictors (within 5 years of presentation) of secondary progressive MS at 30 years were presence of baseline infratentorial lesions and deep white matter lesions at 1 year.INTERPRETATION: Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, whereas others ran a more favorable long-term course. These outcomes could, in part, be predicted by radiological findings from within 1 year of first presentation. ANN NEUROL 2020;87:63-74.",
author = "Chung, {Karen K} and Daniel Altmann and Frederik Barkhof and Katherine Miszkiel and Brex, {Peter A} and Jonathan O'Riordan and Michael Ebner and Ferran Prados and Cardoso, {M Jorge} and Tom Vercauteren and Sebastien Ourselin and Alan Thompson and Olga Ciccarelli and Chard, {Declan T}",
note = "{\circledC} 2019 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.",
year = "2020",
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Chung, KK, Altmann, D, Barkhof, F, Miszkiel, K, Brex, PA, O'Riordan, J, Ebner, M, Prados, F, Cardoso, MJ, Vercauteren, T, Ourselin, S, Thompson, A, Ciccarelli, O & Chard, DT 2020, 'A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes' Annals of Neurology, vol. 87, no. 1, pp. 63-74. https://doi.org/10.1002/ana.25637

A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes. / Chung, Karen K; Altmann, Daniel; Barkhof, Frederik; Miszkiel, Katherine; Brex, Peter A; O'Riordan, Jonathan; Ebner, Michael; Prados, Ferran; Cardoso, M Jorge; Vercauteren, Tom; Ourselin, Sebastien; Thompson, Alan; Ciccarelli, Olga; Chard, Declan T.

In: Annals of Neurology, Vol. 87, No. 1, 01.2020, p. 63-74.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes

AU - Chung, Karen K

AU - Altmann, Daniel

AU - Barkhof, Frederik

AU - Miszkiel, Katherine

AU - Brex, Peter A

AU - O'Riordan, Jonathan

AU - Ebner, Michael

AU - Prados, Ferran

AU - Cardoso, M Jorge

AU - Vercauteren, Tom

AU - Ourselin, Sebastien

AU - Thompson, Alan

AU - Ciccarelli, Olga

AU - Chard, Declan T

N1 - © 2019 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.

PY - 2020/1

Y1 - 2020/1

N2 - OBJECTIVE: Clinical outcomes in multiple sclerosis (MS) are highly variable. We aim to determine the long-term clinical outcomes in MS, and to identify early prognostic features of these outcomes.METHODS: One hundred thirty-two people presenting with a clinically isolated syndrome were prospectively recruited between 1984 and 1987, and followed up clinically and radiologically 1, 5, 10, 14, 20, and now 30 years later. All available notes and magnetic resonance imaging scans were reviewed, and MS was defined according to the 2010 McDonald criteria.RESULTS: Clinical outcome data were obtained in 120 participants at 30 years. Eighty were known to have developed MS by 30 years. Expanded Disability Status Scale (EDSS) scores were available in 107 participants, of whom 77 had MS; 32 (42%) remained fully ambulatory (EDSS scores ≤3.5), all of whom had relapsing-remitting MS (RRMS), 3 (4%) had RRMS and EDSS scores >3.5, 26 (34%) had secondary progressive MS (all had EDSS scores >3.5), and MS contributed to death in 16 (20%). Of those with MS, 11 received disease-modifying therapy. The strongest early predictors (within 5 years of presentation) of secondary progressive MS at 30 years were presence of baseline infratentorial lesions and deep white matter lesions at 1 year.INTERPRETATION: Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, whereas others ran a more favorable long-term course. These outcomes could, in part, be predicted by radiological findings from within 1 year of first presentation. ANN NEUROL 2020;87:63-74.

AB - OBJECTIVE: Clinical outcomes in multiple sclerosis (MS) are highly variable. We aim to determine the long-term clinical outcomes in MS, and to identify early prognostic features of these outcomes.METHODS: One hundred thirty-two people presenting with a clinically isolated syndrome were prospectively recruited between 1984 and 1987, and followed up clinically and radiologically 1, 5, 10, 14, 20, and now 30 years later. All available notes and magnetic resonance imaging scans were reviewed, and MS was defined according to the 2010 McDonald criteria.RESULTS: Clinical outcome data were obtained in 120 participants at 30 years. Eighty were known to have developed MS by 30 years. Expanded Disability Status Scale (EDSS) scores were available in 107 participants, of whom 77 had MS; 32 (42%) remained fully ambulatory (EDSS scores ≤3.5), all of whom had relapsing-remitting MS (RRMS), 3 (4%) had RRMS and EDSS scores >3.5, 26 (34%) had secondary progressive MS (all had EDSS scores >3.5), and MS contributed to death in 16 (20%). Of those with MS, 11 received disease-modifying therapy. The strongest early predictors (within 5 years of presentation) of secondary progressive MS at 30 years were presence of baseline infratentorial lesions and deep white matter lesions at 1 year.INTERPRETATION: Thirty years after onset, in a largely untreated cohort, there was a divergence of MS outcomes; some people accrued substantial disability early on, whereas others ran a more favorable long-term course. These outcomes could, in part, be predicted by radiological findings from within 1 year of first presentation. ANN NEUROL 2020;87:63-74.

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