A prospective, observational study on conversion of clinically isolated syndrome to multiple sclerosis during 4-year period (MS NEO study) in Taiwan

Abstract

Importance CIS to MS conversion rates vary depending on population cohorts, initial manifestations, and durations of follow-up. Objective To investigate conversion rate of patients from CIS to MS and the prognostic significance of demographic and clinical variables in Taiwanese population. Design Nationwide, prospective, multi-centric, observational study from November 2008 to November 2014 with 4 years follow-up. Setting Multi-centre setting at 5 institutions in Taiwan. Participants 152 patients having single clinical event potentially suggestive of MS in last 2 years were enrolled as consecutive sample. 33 patients were lost to follow-up and 16 patients did not complete the study.103 patients completed the study. Intervention(s) (for clinical trials) or exposure(s) (for observational studies) Natural progression from first episode of CIS to MS or NMO was observed. Main outcome(s) and measure(s) Variables analysed were ‘proportion of patients converting to MS or NMO after first episode of CIS’, ‘duration between first episode of neurological event and diagnosis of MS’, ‘status of anti-AQP4 IgG’ and ‘length of longest contiguous spinal cord lesion in MS patients’. Association between baseline characteristics and progression to MS from CIS was analyzed using multiple logistic regression. Multivariate time dependent effect of baseline characteristics on progression to MS was plotted. Results 14.5% patients with CIS converted to MS after 1.1 ± 1.0 years with greater predisposition (18.8%) in those having syndromes referable to the cerebral hemispheres. Conversion rate from ON to MS was 9.7%. 90.9% patients had mild disease course. 46.7% patients had abnormal MRIs at baseline, with 0.6±0.5 contrast enhanced lesions. ‘Below normal BMI’ and ‘MRI lesion load (≥ 4 lesions)’ were identified as risk indicators for the development of MS. Amongst the patients who developed NMO as diagnosed by modern criteria, 80% were positive for anti-AQP4 IgG antibody. Conclusions and relevance ‘Below normal BMI’ and ‘number of demyelinating lesions (≥4)’ are significant predictors of conversion from CIS to MS. A low conversion rate to MS in Taiwanese CIS patients and majority of them having a mild course and minimal disability suggest the roles of geographic, genetic and ethnic factors. Trial registration Non-trial observational study.

Specific dietary interventions to tackle obesity should be a routine part of recommended MS care – No

“…8 This issue becomes even more confusing when presented with findings from a 4-year prospective study following 153 clinically isolated syndrome cases. In contrast with previous studies, the authors found that being underweight was a significant predictor of conversion from a clinically isolated syndrome to MS. 9 Moreover, these findings are in agreement with a Canadian case control study including 197 cases. An inverse association was observed between a high BMI and risk of MS.…”

Association of body mass index with progression and prediction of multiple sclerosis

“…In one of them, BMI has shown a correlation with the progression of the disease and a higher frequency of relapses but was in no correlation with the prediction of the conversion from a clinically isolated syndrome to MS. 55 In other studies it was shown that in a population of MS patients during the one year follow-up there was an increase in physical disability, but there were minimal pieces of evidence that BMI was a predictive factor for this change. 56 Taiwanese researchers have shown that the BMI values below the normal range with more than four demyelinating lesions are a strong predictor for the conversion from a clinically isolated syndrome to MS. 57 It was also confirmed that the BMI values affected the prediction of cognitive disorders in patients suffering from MS. 58 So far, in several studies, the BMI has been stu-died as a factor influencing the onset of MS. Results of this study showed that BMI affected the progression and prediction of the disease, but not the degree of physical disability of patients with MS. To prevent these undesirable effects, it is very important to emphasise that this environmental factor is suitable for modification.…”

Nonlesional diffusely abnormal appearing white matter in clinically isolated syndrome: Prevalence, association with clinical and MRI features, and risk for conversion to multiple sclerosis

“…DAWM was associated with individuals in the high‐risk stratum, which had to meet one of the two known high‐risk features, either modified Barkhof criteria, or the presence of more than one enhancing lesion. The modified Barkhof criteria were incorporated into the 2010 McDonald diagnostic criteria because of their strong prognostic power, 40,41 which has been confirmed in multiple studies 26,28,32,42–45 . Satisfying the modified Barkhof criteria also indicates the MRI meets the 2005 McDonald dissemination in space criteria.…”