title: Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients.
abstract: BACKGROUND
  Subclinical demyelinating lesions may occur in the brains of asymptomatic individuals.
  
  
  OBJECTIVE
  To describe the clinical and magnetic resonance imaging (MRI) follow-up of patients with subclinical demyelinating lesions that fulfill the Barkhof/Tintoré criteria.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University-affiliated teaching hospitals.
  
  
  METHODS
  Fifty-three women and 17 men with subclinical demyelinating lesions (mean age, 35.63 years).
  
  
  METHODS
  Cerebrospinal fluid, MRI, and visual evoked potential measurements.
  
  
  METHODS
  All patients underwent their first brain MRI for various medical problems that were not suggestive of multiple sclerosis (MS). The patients' physicians proposed that they undergo paraclinical studies (blood, cerebrospinal fluid, and visual evoked potential analysis) and follow-up with MRI.
  
  
  RESULTS
  Twenty-three patients (33%) had clinical conversion: 6 to optic neuritis, 6 to myelitis, 5 to brainstem symptoms, 4 to sensitive symptoms, 1 to cerebellar symptoms, and 1 to cognitive deterioration. The mean time between the first brain MRI and the first clinically isolated syndrome was 2.3 years (range, 0.8-5.0 years). Twelve patients had been treated with immunomodulators after a clinically isolated syndrome. Examination of pejorative markers for clinical conversion showed that sex, number of T2 lesions, presence of oligoclonal bands, and IgG index were not statistically different in patients with MS determined by MRI compared with clinically definite MS. Visual evoked potential abnormalities, young age, and gadolinium enhancement on follow-up MRI were more frequent in clinically definite MS than in MS determined by MRI.
  
  
  CONCLUSIONS
  In this cohort, we determined the rate of clinical conversion (33%) during a mean follow-up of 5.2 years. To our knowledge, this is the first clinically isolated syndrome cohort with preclinical follow-up. Early treatment of these patients with MS determined by MRI should be discussed.
authors: Departments of Neurology, University of Nice Sophia Antipolis, 06002 Nice, France. lebrun.c@chu-nice.fr
authors: Christine
authors: C
authors: Lebrun
authors: Caroline
authors: C
authors: Bensa
authors: Marc
authors: M
authors: Debouverie
authors: Sandrine
authors: S
authors: Wiertlevski
authors: David
authors: D
authors: Brassat
authors: Jerome
authors: J
authors: de Seze
authors: Lucien
authors: L
authors: Rumbach
authors: Jean
authors: J
authors: Pelletier
authors: Pierre
authors: P
authors: Labauge
authors: Bruno
authors: B
authors: Brochet
authors: Ayman
authors: A
authors: Tourbah
authors: Pierre
authors: P
authors: Clavelou
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D018450:Disease Progression; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D006801:Humans; D007525:Isoelectric Focusing / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000503:physiopathology; D009460:Neurologic Examination; D010775:Photic Stimulation / Q000379:methods; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult; D005719:gamma-Globulins / Q000378:metabolism
chemical_list: D005719:gamma-Globulins; D002097:C-Reactive Protein