@article{f6b0f9ca0bd24c19b81444a055af2235,
title = "Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome",
abstract = "BACKGROUND: Technological advancements in neuroimaging and the increased use of these diagnostic modalities are responsible for the discovery of incidentally identified anomalies within the CNS. In addition to the identification of unanticipated brain MRI abnormalities suggestive of demyelinating disease in patients undergoing neuroimaging for a medical reason other than evaluation for multiple sclerosis (MS), asymptomatic spinal cord lesions are periodically identified. OBJECTIVE: To determine if asymptomatic spinal cord lesions are associated with clinical progression in subjects with radiologically isolated syndrome (RIS). METHODS: A retrospective review of RIS cases at the University of California, San Francisco Multiple Sclerosis Center was performed. The presence of asymptomatic cervical spinal cord MRI lesions was analyzed as a potential predictor for clinical progression. RESULTS: Twenty-five of 71 subjects with RIS possessed findings within the cervical spine that were highly suggestive of demyelinating disease. Of these subjects, 21 (84%) progressed clinically to clinically isolated syndrome (n = 19) or primary progressive multiple sclerosis (n = 2) over a median time of 1.6 years from the date of RIS identification (interquartile range 0.8-3.8). The sensitivity, specificity, and positive predictive value of an asymptomatic spinal cord lesion for subsequent development of either a first demyelinating attack or primary progressive MS were 87.5%, 91.5%, and 84%, respectively. The odds ratio of clinical progression was 75.3 (95% confidence interval 16.1-350.0, p < 0.0001). This association remained significant after adjusting for potential confounders. CONCLUSION: These findings suggest that the presence of asymptomatic spinal cord lesions place subjects with RIS at substantial risk for clinical conversion to either an acute or progressive event, a risk that is independent of brain lesions on MRI.",
author = "Okuda, {D. T.} and Mowry, {E. M.} and Cree, {B. A C} and Crabtree, {E. C.} and Goodin, {D. S.} and E. Waubant and D. Pelletier",
note = "Funding Information: Dr. Okuda has received funding for travel or speaker honoraria from the National MS Society and MS Association of America; and receives research support from Pfizer Inc. and EMD Serono, Inc. Dr. Mowry receives research support from the National MS Society and the NIH. Dr. Cree has served as a consultant for Biogen Idec, Elan Corporation, and Teva Pharmaceutical Industries Ltd.; and receives research support from BioMS Medical, EMD Serono, Inc., Genentech Inc., the NIH, and the National MS Society. Dr. Crabtree serves as a consultant or on speakers' bureaus for Bayer Schering Pharma, Biogen Idec, Teva Pharmaceutical Industries Ltd., and EMD Serono, Inc. Dr. Goodin has served on scientific advisory boards and served as a consultant for Bayer Schering Pharma and Merck Serono; has received funding for travel or speaker honoraria from Bayer Schering Pharma, Teva Pharmaceutical Industries Ltd., and Merck Serono; serves as Editor-in-Chief for the International MS Journal ; has received research support from Bayer Schering Pharma and Novartis; and has served as an expert witness in medico-legal cases. Dr. Waubant serves on scientific advisory boards for the NIH and Actelion Pharmaceuticals Ltd.; has received free drugs for ongoing trials from Pfizer Inc., Sanofi-Aventis, and Biogen Idec; served as a one-time ad hoc consultant from Artielle ImmunoTherapeutics, Inc.; and receives research support from the National MS Society, The Immune Tolerance Network, and the Nancy Davis Foundation. Dr. Pelletier serves as a consultant for Biogen Idec, Bayer Schering Pharma, Genentech, Inc., and SYNARC Inc.; serves on speakers' bureaus for Biogen Idec and Teva Pharmaceutical Industries Ltd.; and receives research support from Biogen Idec, the NIH, and the National MS Society.",
year = "2011",
month = feb,
day = "22",
doi = "10.1212/WNL.0b013e31820d8b1d",
language = "English (US)",
volume = "76",
pages = "686--692",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "8",
}