Combining clinical and MRI markers enhances prediction of 12-year disability in multiple sclerosis.

What is it about?

Disease progression and treatment efficacy vary considerably among individuals with multiple sclerosis. Unfortunately, reliable predictors of disease outcomes in individual patients are lacking. Today, more effective tratments are usually prescribed, when first line treatment fails. Ussually, there is no individualized treatment. This study investigated, if it is possible to predict disability progression over long-term follow-up in individual MS patients and if this approach is feasible in clinical practice. We established composite score system enabling us to predict (with over 90% specificity) who will be clinicaly stable or progressing. This approach could be applied in 30-40% of our patients (the rest of patients were in "grey zone"). Analysis: Our composite score consist of evaluation of: number or volume of T2 lesions at baseline, normalized volume of thalamus or corpus callosum at baseline, brain volume loss of corpus callosum or whole brain over first 12 months on treatment, EDSS change over 12 months and number of new T2 lesions over 12 months. For each marker was established cut-off value.

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Why is it important?

Using this strategy, we could early initiate treatment with more effective disease-modifying treatments in patients at highest risk of developing permanent disability. This individualized therapy could save time (save brain damage) and provide valuable information for therapeutic decisions in early stages of disease. We suggest that that early escalation of therapy in patients at highest risk has potential to prevent or delay development of secondary progressive disease.

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