Researeach: Predicting development of SPMS

Epub: Calabrese et al. The changing clinical course of multiple sclerosis: A matter of grey matter. Ann Neurol. 2013 Mar. doi: 10.1002/ana.23882.

BACKGROUND: Clinical and neuroimaging parameters predictive of the changing clinical course of multiple sclerosis (MS) from relapsing remitting to secondary progressive have not been clarified yet. We specifically designed a prospective five-year longitudinal study aimed at assessing demographic, clinical and magnetic resonance imaging (MRI) parameters that could predict the changing clinical course of MS. 

METHODS: At study entry and after 5 years, clinical and MRI (i.e., grey matter and white matter lesions, including spinal cord lesions, global and regional cortical thinning) parameters were assessed in a training set of 334 consecutive relapsing remitting MS patients and in an independent validation set of 84 relapsing remitting MS patients. 

RESULTS: Sixty-six (19.7%) relapsing remitting MS patients changed their clinical course during the study and entered into the secondary progressive phase. Age (p=0.001,OR=1.2), cortical lesion volume (p<0.001,OR=1.7) and cerebellar cortical volume (p<0.001, OR=0.2) at study entry were found to predict the changing clinical course. The model including only these three variables correctly identified 252/268 (94.0%) patients that maintained the relapsing remitting course and 58/66 (87.8%) patients that became secondary progressive (cross-validated error rate: 7.2%). When applied on the validation set, the model obtained a similar error rate (8.4%). 

DISCUSSION: A prediction model based on age, cortical lesion load and cerebellar cortical volume explains suitably the probability of relapsing remitting MS patients to evolve into the progressive phase. Grey matter damage appears to play a pivotal role in determining the changing clinical course of MS.

Yesterday Prof G did a post on the the work of Scalfari et al. that showed that (1) male sex, (2) older age of MS onset and (3) high early MS relapse rate are predictor earlier onset of SPMS. This study says (1) Age (2) Grey matter lesion volume and (3) cerebellar grey matter volume were predictors of people that are likely to develop SPMS.

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