Early clinical markers of aggressive multiple sclerosis

Area of Science:

• Neurology
• Clinical Neuroscience
• Epidemiology

Background:

• Aggressive multiple sclerosis (MS) leads to rapid disability accumulation.
• Early identification of aggressive MS is crucial for timely intervention.
• Limited research exists on early clinical markers for aggressive MS.

Purpose of the Study:

• To identify early clinical markers for predicting aggressive multiple sclerosis (MS).
• To develop and validate a predictive model for aggressive MS.
• To optimize treatment strategies for the aggressive MS subtype.

Main Methods:

• Retrospective analysis of MS patients from the MSBase observational study.
• Inclusion criteria: EDSS within 12 months of onset, ≥2 EDSS scores, ≥10 years follow-up.
• Bayesian model averaging used to identify predictors (age, baseline EDSS, pyramidal signs) in the first year; validated in the Swedish MS Registry.

Main Results:

• Three key predictors identified: age > 35 at onset, EDSS ≥ 3 in the first year, and pyramidal signs in the first year.
• The model demonstrated significant predictive power (AUC = 0.80 in MSBase, AUC = 0.75 in Swedish registry).
• High-risk group (all three predictors present) showed 32% likelihood of aggressive MS; low-risk group (no predictors) had 1.4% risk.

Conclusions:

• Older age at symptom onset, greater early disability, and pyramidal signs are significant early indicators of aggressive multiple sclerosis.
• These clinical markers can aid in identifying patients who will develop aggressive MS.
• Early identification facilitates optimized treatment for the aggressive MS subtype.