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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
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Acute Clinical Events Identified as Relapses With Stable Magnetic Resonance Imaging in Multiple Sclerosis
Antoine Gavoille1,2,3, Fabien Rollot4,5, Romain Casey4,5
1Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France.
JAMA Neurology
|July 1, 2024
Summary
Acute clinical events with stable MRI (ACES) represent a significant portion of multiple sclerosis relapses. These events are linked to increased disability and disease progression, highlighting the need for further research into their underlying mechanisms and management.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Understanding the relationship between clinical relapses and radiological activity is crucial for multiple sclerosis (MS) patient management and treatment development.
- Distinguishing between relapses with clear MRI evidence and those without is essential for accurate diagnosis and prognosis.
Purpose of the Study:
- To investigate clinical events identified as relapses that lack corresponding new T2 or gadolinium-enhanced T1 lesions on brain and spinal cord MRI.
- To compare the clinical outcomes and disease progression associated with these 'acute clinical events with stable MRI' (ACES) versus relapses with active MRI (RAM).
Main Methods:
- A multicenter observational cohort study utilizing data from the French MS registry (January 2015 - June 2023).
- Inclusion criteria: relapsing-remitting MS patients with clinical relapse events and MRI scans within specified timeframes before and after the event.
- Classification of events into RAM (new MRI lesions) or ACES (no new MRI lesions).
Main Results:
- Of 31,885 clinical events, 637 (26.1%) were classified as ACES.
- ACES were more frequent in patients on highly effective disease-modifying therapies (DMTs), with longer disease duration, and those experiencing fatigue.
- ACES were associated with significant Expanded Disability Status Scale (EDSS) increases, higher relapse rates, confirmed disability accrual, relapse-associated worsening, and increased risk of transition to secondary progressive MS compared to RAM.
- ACES rates remained stable across different DMTs, unlike RAM rates which decreased with treatment efficacy.
Conclusions:
- The study introduces the concept of ACES in MS, accounting for approximately one-fourth of clinically identified relapses.
- ACES are associated with significant disability progression and increased risk of long-term worsening, independent of traditional radiological markers.
- The findings underscore the importance of recognizing ACES in MS patient care and suggest that current DMTs may not fully mitigate these events.
