title: Contribution of the symptomatic lesion in establishing MS diagnosis and prognosis.
abstract: OBJECTIVE
  To study the contribution of the symptomatic lesion in establishing multiple sclerosis (MS) diagnosis and prognosis.
  
  
  METHODS
  We performed an observational study based on a prospective clinically isolated syndrome (CIS) cohort of 1,107 patients recruited for clinical and brain MRI follow-up from 1995 to 2014. Eligible patients (n = 954) were divided into 4 groups according to baseline MRI: patients with a normal MRI (n = 290); patients with a single asymptomatic lesion (n = 18); patients with a single cord/brainstem symptomatic lesion (n = 35); and patients with more than 1 lesion (n = 611). For each group, we studied the risk of second attack, with 2005 McDonald MS and Expanded Disability Status Scale 3.0, using univariable and multivariable regression models adjusted by age, sex, oligoclonal bands, and disease-modifying treatments. We tested the diagnostic performance of a modified dissemination in space (DIS) criterion that includes symptomatic lesions in the total count and compared it to the DIS criteria (at least 1 asymptomatic lesion in at least 2 of the 4 MS characteristic MS locations) for all patients and for the subgroup of patients with brainstem or spinal cord topography.
  
  
  RESULTS
  Patients with a cord/brainstem single symptomatic lesion have a higher risk of second attack and disability accumulation than patients with 0 lesions but have a similar risk compared to patients with 1 asymptomatic lesion. Diagnostic properties are reasonably maintained when the symptomatic lesion qualifies for DIS.
  
  
  CONCLUSIONS
  Despite the recommendations of the 2010 McDonald criteria, symptomatic lesions should be taken into account when considering the diagnosis and prognosis of patients with CIS.
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. mtintore@cem-cat.org.
authors: Mar
authors: M
authors: Tintore
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Susana
authors: S
authors: Otero-Romero
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Jordi
authors: J
authors: Río
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Georgina
authors: G
authors: Arrambide
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Berta
authors: B
authors: Pujal
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Carmen
authors: C
authors: Tur
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Ingrid
authors: I
authors: Galán
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Manuel
authors: M
authors: Comabella
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Carlos
authors: C
authors: Nos
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: María Jesús
authors: MJ
authors: Arévalo
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Angela
authors: A
authors: Vidal-Jordana
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Joaquin
authors: J
authors: Castilló
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Breogán
authors: B
authors: Rodríguez-Acevedo
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Luciana
authors: L
authors: Midaglia
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Raquel
authors: R
authors: Mitjana
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Cristina
authors: C
authors: Auger
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Jaume
authors: J
authors: Sastre-Garriga
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Àlex
authors: À
authors: Rovira
authors: From Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Department of Neurology/Neuroimmunology (M.T., S.O.-R., J.R., G.A., B.P., C.T., I.G., M.C., C.N., M.J.A., A.V.-J., J.C., B.R.-A., L.M., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (R.M., C.A., À.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
authors: Xavier
authors: X
authors: Montalban
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001933:Brain Stem / Q000000981:diagnostic imaging*; D003711:Demyelinating Diseases / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers