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Multiple sclerosis risk in radiologically uncovered asymptomatic possible inflammatory-demyelinating disease

Department of Neurology, Istanbul University, Cerrahpasa School of Medicine, Turkey

S Saip

Department of Neurology, Istanbul University, Cerrahpasa School of Medicine, Turkey

A Altintas

Department of Neurology, Istanbul University, Cerrahpasa School of Medicine, Turkey

A Jacob

Division of Neurology, The Walton Centre for Neurology and Neurosurgery, UK

BM Keegan

Department of Neurology, Mayo Clinic College of Medicine, USA

OH Kantarci

Department of Neurology, Mayo Clinic College of Medicine, USA kantarci.orhun{at}mayo.edu

Background

Natural history of patients with incidentally discovered lesions that fulfill magnetic resonance imaging (MRI) criteria for multiple sclerosis (MS) in the absence of objective clinical symptoms suggestive of central nervous system (CNS) inflammatory-demyelinating disease is not well defined.

Objective

We evaluated the risk of developing symptomatic MS in patients with radiologically uncovered asymptomatic possible inflammatory-demyelinating disease (RAPIDD).

Methods

We identified and longitudinally followed a cohort of 22 patients from two tertiary care MS centers: Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey, and Mayo Clinic, Rochester, Minnesota, after an initial MRI study fulfilling the Barkhof–Tintore MRI criteria completed for other reasons unrelated to MS.

Results

Eight of 22 patients developed an objective clinical symptom consistent with a CNS inflammatory-demyelinating syndrome and fulfilled dissemination in space and time criteria for definite MS. Median age at the time of diagnosis of MS was 44.8 years (range 28.3–71.4 years). Time taken for the development of definite MS was studied by survival analysis. Cumulative event rates were; 12 months: 9%, 24 months: 15%, 36 months: 30.4%, and 60 months: 44.6%. Six of 22 patients were followed beyond 60 months. Two of these six patients developed MS later (at 66 and 112 months, respectively). Three patients remained asymptomatic despite follow-up of 10 years.

Conclusions

Patients with RAPIDD develop MS at a similar rate to treated patients (and less frequently than placebo groups) with clinically isolated syndromes from prior randomized controlled studies. Some patients with RAPIDD continue to have radiological evolution of subclinical disease without MS symptoms despite long follow-up periods.

Key Words: asymptomatic • multiple sclerosis • natural history • radiologically isolated syndrome • RAPIDD

Multiple Sclerosis, Vol. 15, No. 8, 918-927 (2009)
DOI: 10.1177/1352458509106214


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