Long-term disability progression in primary progressive multiple sclerosis: a 15-year study.

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Prognostic markers for primary progressive multiple sclerosis (PPMS) evolution are crucial for patient management.
• Current clinical assessments may not fully capture the long-term disease trajectory.

Purpose of the Study:

• To evaluate the added value of magnetic resonance imaging (MRI) measures of brain and cervical cord damage in predicting long-term clinical worsening in PPMS.
• To compare the predictive power of combined clinical and imaging data versus clinical assessment alone.

Main Methods:

• Conventional and diffusion tensor MRI scans of the brain and cervical cord were acquired at baseline and 15 months in 54 PPMS patients.
• Clinical evaluations were performed at 5 and 15 years in 49 patients.
• Linear regression models analyzed lesion load, atrophy, mean diffusivity, and fractional anisotropy as predictors of 15-year disability change (Expanded Disability Status Scale).

Main Results:

• Ninety percent of patients showed disability progression at 15 years.
• Integrating clinical and imaging variables at 15 months predicted 15-year disability changes better (R2 = 61%) than clinical factors at 5 years (R2 = 57%).
• The combined model predicted long-term disability change within one point for 77.6% of patients.

Conclusions:

• Integration of clinical and imaging measures enhances the prediction of long-term disability progression in PPMS.
• This combined approach can identify at-risk PPMS patients four years earlier than clinical assessment alone.
• MRI-derived prognostic markers offer valuable insights into PPMS evolution.