title: Association of asymptomatic spinal cord lesions and atrophy with disability 5 years after a clinically isolated syndrome.
abstract: BACKGROUND
  Spinal cord pathology is an important substrate for long-term disability in multiple sclerosis (MS).
  
  
  OBJECTIVE
  To investigate longitudinal changes in spinal cord lesions and atrophy in patients with a non-spinal clinically isolated syndrome (CIS), and how they relate to the development of disability.
  
  
  METHODS
  In all, 131 patients with a non-spinal CIS had brain and spinal cord imaging at the time of CIS and approximately 5 years later (median: 5.2 years, range: 3.0-7.9 years). Brain magnetic resonance imaging (MRI) measures consisted of T2-hyperintense and T1-hypointense lesion loads plus brain atrophy. Spinal cord MRI measures consisted of lesion number and the upper cervical cord cross-sectional area (UCCA). Disability was measured using the Expanded Disability Status Scale (EDSS). Multiple linear regression was used to identify independent predictors of disability after 5 years.
  
  
  RESULTS
  During follow-up, 93 (71%) patients were diagnosed with MS. Baseline spinal cord lesion number, change in cord lesion number and change in UCCA were independently associated with EDSS ( R2= 0.53) at follow-up. Including brain T2 lesion load and brain atrophy only modestly increased the predictive power of the model ( R2= 0.64).
  
  
  CONCLUSIONS
  Asymptomatic spinal cord lesions and spinal cord atrophy contribute to the development of MS-related disability over the first 5 years after a non-spinal CIS.
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: W J
authors.initials: WJ
authors.lastname: Brownlee
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: Altmann
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Alves Da Mota
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Swanton
authors.affiliation: Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: K A
authors.initials: KA
authors.lastname: Miszkiel
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/Brain Connectivity Center, C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Cam Gandini
authors.initials: CG
authors.lastname: Wheeler-Kingshott
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/Biomedical Research Centre, NIHR University College London Hospitals, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Ciccarelli
authors.affiliation: Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, London, UK/Biomedical Research Centre, NIHR University College London Hospitals, London, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000175:diagnosis; D001921:Brain / Q000473:pathology; D003711:Demyelinating Diseases / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000473:pathology*; D055815:Young Adult
keywords: Clinically isolated syndrome; MRI; multiple sclerosis; spinal cord