Early Spinal Cord damage is associated with accumulation of disability

Brownlee WJ, Altmann DR, Alves Da Mota P, Swanton JK, Miszkiel KA, Wheeler-Kingshott CG, Ciccarelli O, Miller DH.Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome. Mult Scler. 2016 Aug 1. pii: 1352458516663034. [Epub ahead of print]

OBJECTIVE: To investigate longitudinal changes in spinal cord lesions and atrophy in patients with a non-spinal clinically isolated syndrome (CIS), and how they relate to the development of disability.

METHODS:In all, 131 patients with a non-spinal CIS had brain and spinal cord imaging at the time of CIS and approximately 5 years later (median: 5.2 years, range: 3.0-7.9 years). Brain magnetic resonance imaging (MRI) measures consisted of T2-hyperintense and T1-hypointense lesion loads plus brain atrophy. Spinal cord MRI measures consisted of lesion number and the upper cervical cord cross-sectional area (UCCA). Disability was measured using the Expanded Disability Status Scale (EDSS). 

RESULTS:During follow-up, 93 (71%) patients were diagnosed with MS. Baseline spinal cord lesion number, change in cord lesion number and change in UCCA were independently associated with EDSS (R2 = 0.53) at follow-up. Including brain T2 lesion load and brain atrophy only modestly increased the predictive power of the model (R2 = 0.64).

CONCLUSION:Asymptomatic spinal cord lesions and spinal cord atrophy contribute to the development of MS-related disability over the first 5 years after a non-spinal CIS.

This study is apt post today as the Brownlee brothers are going for gold in Rio 2016 as Great Britains triatheletes? Wonder if there is any relationship….Come on Yorkshire!

This study reports of imaging studies of people during their first noticable CNS inflammatory event. These people had symptoms associated with brain lesions and not spinal cord lesions (which were clinically silent) and had brain and spinal cord images 5 years later.

Over 70% of the people with the clinically isolated syndrome went on to be diagnosed with MS and it was found that people with high spinal cord lesions at baseline and those that had atrophy of the spinal cord had accumulated most disability. Brain shrinkage and brain lesion load only exhibited a small additional amount of predictive power. These could contribute to disability. This is not surprising and again, whilst imaging shows prognostic features, at the individual level it is not going to be predictive with 100% confidence. 

However, that spinal lesions correlate with EDSS disability is hardly surprising as EDSS is heavily biased towards walking and lower limb activity and the more lesions you have in the cord, the more damage to the nerve signals coming from the legs to the brain and back again is going to happen. If you see cervical atrophy then this is not good news as this is a tip of an iceberg of nerve damage that MRI is missing and will contribute to walking issues, more on that from DrK

It is all well and dandy watching and waiting and imaging people for 5 years, but surely we want to be treating people as early as possible and showing that 5 years down the line disability has not been accumulated so those early lesions would be irrelevant 5 years down the line

Although the Aussies got a day off, with a temporary brake on medal accumulation but one of our Team EU in France has put in the kilometers for us.

P.S. Don’t fall off your bike

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