Abstract Details

Title Early Factors Associated with Later Conversion to Multiple Sclerosis in Patients Presenting with Isolated Myelitis

Topic Multiple Sclerosis

Presentation(s) S24 - Pregnancy, Pediatric MS, and Early MS (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Objective To define the rate of conversion to multiple sclerosis (MS) in a cohort of patients presenting with isolated myelitis, and to identify clinical and/or paraclinical factors at baseline that are associated with this conversion.

Background In patients presenting with myelitis without clinical or radiological evidence of demyelination elsewhere in the central nervous system (i.e. isolated myelitis), it remains challenging to predict risk of later conversion to MS.

Design/Methods From a carefully defined population of patients who attended our specialized myelopathy clinic from 2007-2017 and underwent detailed evaluation for etiologic cause(s) of myelopathy, we identified patients diagnosed with isolated myelitis who were subsequently followed clinically and radiologically. We excluded patients who were neuromyelitis optica (NMO)-IgG-positive, patients in whom the diagnosis of myelitis was uncertain, or in whom appropriate imaging was not completed.

Results We identified 100 patients meeting our inclusion criteria, of whom 48 have been phenotyped in detail to date. Over a median follow-up period of 3.9 years, 21% of these converted to MS (defined by McDonald 2017 criteria), 4% developed other relapsing neuroinflammatory disorders, and 75% did not develop any clinical or radiological evidence of a relapsing or progressive disorder. Compared to patients who remained monophasic, factors at baseline associated with later conversion to MS included younger age at onset of myelitis (p=0.02), longer time to nadir of presenting syndrome (p=0.01), CSF-restricted oligoclonal bands (p=0.002), elevated CSF IgG index (p<0.001), cord lesion(s) spanning <3 contiguous vertebral segments on MRI spine (p=0.006) and/or multifocal lesions on MRI spine (p=0.006).

Conclusions In patients presenting with isolated myelitis, the rate of conversion to MS over the medium-term is relatively low. We have identified factors at baseline which can help stratify this risk, thereby identifying patients at high-risk of developing MS who warrant more intensive clinical and imaging monitoring or consideration of early initiation of disease-modifying therapy.

Authors/Disclosures
Olwen Murphy, MD (Johns Hopkins Hospital) PRESENTER	Dr. Murphy has nothing to disclose.
Loulwah Mukharesh, MD	Dr. Mukharesh has nothing to disclose.
Carlos A. Pardo-Villamizar, MD (Johns Hopkins U, Med Dept of Neurology)	The institution of Dr. Pardo-Villamizar has received research support from National Institutes of Health. The institution of Dr. Pardo-Villamizar has received research support from Bart McLean Fund for Neuroimmunology Research .
Scott D. Newsome, DO, FAAN (Johns Hopkins Hospital)	Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Newsome has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Newsome has received research support from Biogen. The institution of Dr. Newsome has received research support from Genentech/Roche. The institution of Dr. Newsome has received research support from Department of Defense. The institution of Dr. Newsome has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Newsome has received research support from National MS Society. The institution of Dr. Newsome has received research support from The Stiff Person Syndrome Research Foundation. The institution of Dr. Newsome has received research support from Lundbeck. The institution of Dr. Newsome has received research support from Sanofi. Dr. Newsome has received personal compensation in the range of $10,000-$49,999 for serving as a Lead PI for Clinical Trial with Roche.

��ɫ��

��ɫ��