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Journal of Neurology

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01-12-2019 | Multiple Sclerosis | Original Communication

Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey

Authors: Franco Granella, Elena Tsantes, Stefania Graziuso, Veronica Bazzurri, Girolamo Crisi, Erica Curti

Published in: Journal of Neurology | Issue 12/2019

Abstract

Background

Spinal cord (SC) involvement correlates with poor prognosis in patients with multiple sclerosis (MS). Nevertheless, there is no consensus on the use of SC-MRI at follow-up, mainly because of the belief that SC lesions are nearly always symptomatic.

Objectives

The aim of the present study was to investigate the frequency of asymptomatic SC combined unique activity (CUA, new/enlarging T2 or gadolinium-positive [Gd+] lesions) on MRI in a cohort of patients diagnosed with clinically isolated syndrome (CIS) or relapsing–remitting MS (RRMS).

Methods

We retrospectively investigated all scans showing SC-CUA in patients with CIS or RRMS referred to a single Italian MS centre. We determined whether they were symptomatic and whether they had associated brain radiological activity.

Results

In 340 SC-MRI scans with SC-CUA (230 patients), SC-CUA was asymptomatic in 31.2%; 12.1% of SC-CUA had neither clinical activity nor brain radiological activity (44.5% and 25.4%, respectively, considering only follow-up SC-CUA). At multivariate analysis asymptomatic SC-CUAs were associated with older age at onset (34.0 ± 10.37 vs 31.0 ± 9.99 years, p = 0.006), non-spinal onset (76.4 vs 47.4%, p < 0.001), lower EDSS score at MRI (1.8 ± 0.93 vs 2.4 ± 1.28, p = 0.001) and lower number of Gd+ SC lesions (0.1 ± 0.33 vs 0.3 ± 0.54, p = 0.04), compared to symptomatic SC-CUAs.

Conclusions

A substantial proportion of our patients had SC-CUA without clinical symptoms and/or without concomitant brain MRI activity. In these patients, SC-CUA was the only sign of disease activity, suggesting that regular SC-MRI follow-up is required for reliable assessment of radiological activity and may improve the management of patients with MS.

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Title: Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey
Authors: Franco Granella
Elena Tsantes
Stefania Graziuso
Veronica Bazzurri
Girolamo Crisi
Erica Curti
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Multiple Sclerosis
Cranial MRI
Published in: Journal of Neurology / Issue 12/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09526-3

At a glance: The STEP trials

Springer Medicine

Spinal cord lesions are frequently asymptomatic in relapsing–remitting multiple sclerosis: a retrospective MRI survey

Abstract

Background

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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