Abstract Details

Title Tumefactive Demyelination at Multiple Sclerosis Onset Associates With Less Severe Long-term Disability

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-006

Objective To determine whether frequency of spinal cord lesions and progressive disease, and severity of long-term disability differ between tumefactive (TMS) and non-tumefactive multiple sclerosis (nTMS).

Background Tumefactive demyelination affects ~2% of people with MS and frequently represents the index attack in TMS. Symptomatic onset is often more severe in TMS than in nTMS. Whether clinical outcomes differ between groups warrants investigation.

Design/Methods Individuals ≥ 18 years fulfilling 2024 McDonald Criteria were stratified into cohorts: 1) TMS with ≥ 1 tumefactive (≥ 2 cm in diameter) lesion at presentation, 2) nTMS. EDSS at last follow-up, cord lesion presence/location, progressive disease, and disease modifying therapy (DMT) exposure were compared via Kruskal-Wallis and Chi-Square tests. Multivariate logistic regression evaluated likelihood of progressive disease, adjusting for age, sex, disease duration, spinal cord lesions, any DMT exposure, and early induction therapy.

Results A total of 226 individuals were included: nTMS (n=158) and TMS (n=68). Median age and follow-up time of the total cohort was 48 (IQR 40,58) and 8.5 (2.3,17.0) years, respectively. nTMS had a higher frequency of spinal cord lesions (83% vs. 50%, p<0.001), lateral tract lesions (77% vs. 40%, p<0.001), upper cervical cord (C1-C3) lesions (61% vs. 24%; p<0.001), progressive disease course (32% vs. 6%, p<0.001), and severe (>5.5) EDSS at last follow-up (19% vs. 5%, p<0.006). nTMS experienced a longer time to DMT (19 [5.0,75.0] vs. 4.5 [2.0,9.3] months; p<0.001) and high-efficacy DMT (78.5 [18.3,109.3] vs. 9.0 [3.0,35.0] months; p<0.001) initiation. After adjustment, nTMS were approximately 5 times more likely to experience progressive disease than TMS (OR:5.1; p=0.02).

Conclusions

Individuals with TMS are less likely to develop spinal cord disease, progressive disease, and severe disability compared with nTMS. Variation in DMT exposure may influence but does not fully account for dissimilar rates of progressive disease and severe disability among cohorts.

Authors/Disclosures
Albert Aboseif, DO (Mayo Clinic Rochester) PRESENTER	Dr. Aboseif has received research support from the Eugene & Marcia Applebaum Fellowship Grant.
Nur Neyal, MD (Mayo Clinic)	Dr. Neyal has nothing to disclose.
Elizabeth Atkinson	Ms. Atkinson has nothing to disclose.
Caitlin Tarlton, MD (NSHA)	Dr. Tarlton has nothing to disclose.
Christopher Schwarz	The institution of Christopher Schwarz has received research support from NIH.
Paul Decker (Mayo Clinic)	Paul Decker has nothing to disclose.
Matthew Kosel	Mr. Kosel has nothing to disclose.
Jiye Son, MD	Dr. Son has nothing to disclose.
Mark Keegan, MD, FAAN (Mayo Clinic)	Dr. Keegan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Keegan has received publishing royalties from a publication relating to health care. Dr. Keegan has received publishing royalties from a publication relating to health care.
Kejal Kantarci, MD (Mayo Clinic)	The institution of Dr. Kantarci has received research support from Eli Lilly. The institution of Dr. Kantarci has received research support from NIH. The institution of Dr. Kantarci has received research support from ADDF. The institution of Dr. Kantarci has received research support from Eisai. The institution of Dr. Kantarci has received research support from BioArctic.
Orhun H. Kantarci, MD	Dr. Kantarci has nothing to disclose.
W. O. Tobin, PhD, MBBCh, BAO, FAAN (Mayo Clinic)	Dr. Tobin has received publishing royalties from a publication relating to health care.
Burcu Zeydan, MD (Mayo Clinic)	The institution of Dr. Zeydan has received research support from National Institutes of Health.

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