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Conversion from clinically isolated syndrome to multiple sclerosis: A large multicentre study.

J Kuhle1, G Disanto2, R Dobson2

  • 1Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, UK/ Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Switzerland.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|February 15, 2015
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Summary
This summary is machine-generated.

Predicting multiple sclerosis (MS) progression from clinically isolated syndrome (CIS) involves identifying key biomarkers. Oligoclonal bands, MRI lesion load, and age at CIS are strong predictors of conversion to clinically definite MS.

Keywords:
Clinically definite multiple sclerosis (CDMS)Epstein-Barr nuclear antigen 1 (EBNA-1)clinically isolated syndrome (CIS)oligoclonal bands (OCBs)serum 25-hydroxyvitamin D3 (25-OH-D)

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Area of Science:

  • Neurology
  • Immunology
  • Biochemistry

Background:

  • Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system.
  • Clinically isolated syndrome (CIS) is the first neurological episode suggestive of MS.
  • Predicting conversion from CIS to clinically definite MS (CDMS) is crucial for early treatment and management.

Purpose of the Study:

  • To identify clinical and biochemical predictors of conversion from CIS to CDMS.
  • To validate established predictors in a large, international cohort.
  • To explore novel biomarkers, including vitamin D levels and Epstein-Barr virus titers, for predicting MS conversion.

Main Methods:

  • A multicenter study involving 1047 CIS cases with a minimum of two years of follow-up.
  • Analysis of serum samples for 25-hydroxyvitamin D3, cotinine, and IgG titers against EBNA-1 and cytomegalovirus.
  • Assessment of clinical presentation, MRI T2-hyperintense lesions, and cerebrospinal fluid (CSF) markers including oligoclonal bands (OCBs) and IgG index.

Main Results:

  • Conversion to CDMS occurred in 623 cases during a median follow-up of 4.31 years.
  • Independent predictors of CDMS conversion included OCBs, number of T2 lesions, and age at CIS.
  • Lower 25-hydroxyvitamin D3 levels showed a univariable association with CDMS, which diminished in multivariable analysis.

Conclusions:

  • MRI lesion load, OCBs, and age at CIS are confirmed as the strongest independent predictors of conversion to CDMS.
  • The role of vitamin D in MS progression warrants further investigation.
  • Cerebrospinal fluid oligoclonal bands were associated with higher EBNA-1 IgG titers.