Prediction the dirty word of clinical neuroscience


Location of first attack predicts the site of subsequent relapses in multiple sclerosis.Tsantes E, Leone MA, Curti E, Cantello R, Vecchio D, Granella F.J Clin Neurosci. 2020. pii: S0967-5868(19)32470-1.

Predictors of attack location in relapsing-remitting multiple sclerosis (RRMS) are poorly known. It has been suggested that the site of the first relapse may influence the location of the subsequents. We aimed to ascertain this hypothesis in a sample of patients consecutively recruited in two Italian MS Centres, with at least two MS attacks. The following data were collected from medical records: demographic data, locations involved in the first two (or three) MS attacks (optic nerve, spinal cord, brain stem/cerebellum, cerebral hemispheres, according to symptoms presented), time elapsed between relapses and onset of disease-modifying treatment (DMT). We enrolled 199 patients (67% females; MS onset age 30.0 ± 8.69 years), in 148 of whom we could define the precise attack location. In 70/148 patients (47%) the second attack involved exactly the same location as the first. There was an increased risk of relapsing in the same location of the first attack when this involved the optic nerve (OR 4.5, 95% CI 2.2-9.2, p < 0.0001), the brainstem/cerebellum (OR 3.5, 95% CI 1.7-6.9, p < 0.0001), or the spinal cord (OR 3.0, 95% CI 1.5-5.9, p = 0.001). The location of third relapse (N = 90) was equally influenced by the site of first attack. In 24 patients with optic neuritis in both the two first attacks, the side coincided in 50% of cases. The location of first attack has a major role in influencing the site of subsequent ones in RRMS.

OD odd ratio. OD 3 three timesmore likely OD 4 four times more likely

The suggestion is there that the site of damage may be the site of damage again. Here it occurs 50% of the time, which means 50% of the time it does not. So can the location of the lesion predict you future? The answer is clearly no and so prediction is over used, however it can help inform your future risks and this may help you decide on your treatment course or other choices

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  • How does location help decide stuff? Are lesions in certain areas worse than others? eg. Spine vs optic nerve? (Though i’d like to keep eyesight and my mobility 🙂 And don’t most people have their first attack in one of a couple of locations? How are they ordered?

    • If you have a lesion in your brain and that lesion says controls vision, then you may go blind, double vision etc, if it is in the cerebellum (cauliflower looking structure) your balance may go.
      If you get lesions in the brain stem this can be dangerous because this is where your vital organs heart/lung are controlled.

      How are they ordered…It’s on thing that Amazon don’t do yet:-)

      • Ha. Not something i’d want on Prime 🙂
        In terms of informing risks though & treatment decisions, isn’t it all just random? Like your summary of the article says. Just because you had one attack in an area of your brain that wasn’t as ‘bad’ first time, doesn’t mean you won’t get brain stem next time the lesions decide to rear their ugly heads, they’re not planning where they’re going to spring up per se? So in a way, going on a stronger treatment because your first one was on brain stem, your second one might be in an area that isn’t as affected? Or going on a weaker treatment off the bat, because it was in an area that didn’t have much effect doesn’t predict that it won’t be stem next time? Hope that makes sense!

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