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

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.

Clinically isolated syndrome, oligoclonal bands and multiple sclerosis

“…In a recent study carried out by Schwenkenbecher et al, OCBs were associated with a slight increase on conversion rate to MS, but with no statistical significance. 12,17 However, in our analysis, we did not find significant differences on disease outcome associated with clinical presentation symptom, which is consistent with the results obtained in other research studies. 13,15 In our cohort 76.80% of the patients converted to MS, which is in accordance with the results obtained by a recent multicenter study.…”

“…2). 13,17 Furthermore, the present data further underline the inverse association between age at disease onset and risk of conversion into MS. 13 Some authors suggest that clinical presentation at baseline affects MS conversion risk (with brainstem and spinal cord symptoms associated with higher conversion rates, whereas optic neuritis predicts a stable disease course). 17 In contrast, other studies showed that positive OCBs patients are at a much higher risk of converting to MS and within a shorter period of time.…”

“…6 Therefore, in the present study, we intended to compare clinical and laboratory features between MS converters and non-converters. 17 In contrast, other studies showed that positive OCBs patients are at a much higher risk of converting to MS and within a shorter period of time. In our cohort, the presence of OCBs at baseline did not accurately predict conversion to MS or an inferior elapsed time until MS diagnosis (Fig.…”

“…In a recent study carried out by Schwenkenbecher et al, OCBs were associated with a slight increase on conversion rate to MS, but with no statistical significance. 17 In contrast, other studies showed that positive OCBs patients are at a much higher risk of converting to MS and within a shorter period of time. 13,15 In our cohort 76.80% of the patients converted to MS, which is in accordance with the results obtained by a recent multicenter study.…”

Clinically and Radiological isolated syndrome (MS risk)

“…Regarding results of OCB, 75% of patients with CIS have positive OCB in CSF while in RIS only 23% has positive results. These results was partially agreed with [18][19][20][21][22][23][24][25] they mentioned that, Sixty to seventy percent of patients with CIS have positive OCBs and with [26] he reported that the positive OCB were detected in 61% of patients with CIS [27]. Found CSF oligoclonal banding having sensitivity between 69-91% for diagnosis of MS.…”