Research: risk of MS after optic neuritis

Epub: D’Alessandro et al. Risk of multiple sclerosis following clinically isolated syndrome: a 4-year prospective study. Neurol. 2013 Feb.

The aim of the study was to estimate the rate of conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and to investigate variables predicting conversion in a cohort of patients presenting with symptoms suggestive of MS. Patients with a first symptom suggestive of MS in the preceding 6 months and exclusion of other diseases were enrolled in an observational prospective study from December 2004 through June 2007. Conversion from CIS to MS according to both McDonald and Clinically Defined Multiple Sclerosis (CDMS) criteria was prospectively recorded until March 2010. The multivariate Cox proportional hazard model was used to assess the best predictive factors of conversion from CIS to MS. Among 168 patients included in the analysis, 122 converted to MS according to McDonald criteria whereas 81 converted to MS according to CDMS criteria. The 2-year probability of conversion was 57 % for McDonald Criteria and 36 % for CDMS criteria. Variables at enrolment significantly associated with conversion according to McDonald criteria were age and positivity for Barkhof criteria, and according to Poser’s CDMS criteria, age, positivity for Barkhof criteria and no disease modifying therapy. In this large prospective cohort study the conversion rate from CIS to MS in patients presenting with recent symptoms suggestive of MS was within the range of previous observational studies and lower than that reported in the placebo arm of randomized trials. We confirm the prognostic value of MRI in addition to the previous experimental data on the protective role of disease-modifying therapies.

The Poser criteria are based on clinical outcomes and the 2001 McDonald criteria induced the value of MRI into the diagnosis of MS. The Barkhof criteria is a variant of the 2005 McDonald criteria, which was updated in 2010 to be the 2010 McDonald criteria. There features of MRI diagnosis can for example be seen here. However in brief it indicates that if you have optic neuritis then you are at risk of developing multiple sclerosis in this study about 60% converted to MS in 2 years. There are a number of studies treating optic neuritis with nerve protectors to see if they may be useful for progressive MSers, but one would like to see the effect of potent DMT used at this stage to see if you can stop MS in its tracks. I think there is a good possibility it could, hopefully we will get the answer to this one day.

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