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

Karen K. Chung (Lead / Corresponding author), 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

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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 2019.

Original languageEnglish
Number of pages11
JournalAnnals of Neurology
Early online date6 Nov 2019
DOIs
Publication statusPublished - 25 Nov 2019

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Multiple Sclerosis
Observational Studies
Magnetic Resonance Imaging
Chronic Progressive Multiple Sclerosis
Relapsing-Remitting Multiple Sclerosis

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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. 2019.
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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 2019.",
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.}",
year = "2019",
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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 2019, 'A 30-Year Clinical and Magnetic Resonance Imaging Observational Study of Multiple Sclerosis and Clinically Isolated Syndromes', Annals of Neurology. 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. (Lead / Corresponding author); 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, 25.11.2019.

Research output: Contribution to journalArticle

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.

PY - 2019/11/25

Y1 - 2019/11/25

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 2019.

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 2019.

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DO - 10.1002/ana.25637

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JO - Annals of Neurology

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