Baseline and Follow-Up MRI Predictors of Long-Term Prognosis in Pediatric MS

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A baseline MRI assessment and subsequent clinical and MRI monitoring during the first 2 years of pediatric multiple sclerosis onset can likely provide insights into 9-year prognosis.

A baseline magnetic resonance imaging (MRI) assessment and subsequent clinical and MRI monitoring during the first 2 years of multiple sclerosis (MS) onset in children can likely provide insights into patients’ 9-year prognosis, according to study results published in the Annals of Neurology.

This longitudinal, observational study included data from clinical and MRI assessments at disease onset and after 1 and 2 years from 123 children (mean age, 14.4 years) with relapsing-remitting MS. Study investigators conducted a clinical follow up in these patients at 9 years and used Cox proportional hazard and multivariable regression models to examine independent predictors of time to first relapse and outcomes at 9 years.

Overall, the median duration from disease onset to the first relapse was 1.7 years. Predictors of time to first relapse included optic nerve lesions (hazard ratio [HR], 2.10; 95% CI, 1.12-3.91; P =.02) and high-efficacy disease-modifying therapy exposure (HR, 0.31; 95% CI, 0.12-0.72; P =.005). The baseline predictors of the per-year relapse rate were the presence of cerebellar (P <.001), cervical cord lesions (P =.003), and high-efficacy treatment exposure (P =.01).

A baseline predictor of 9-year disability worsening included the presence of optic nerve involvement (odds ratio [OR], 6.45; 95% CI, 1.48-30.49; P =.01). Additionally, the 1-year Expanded Disability Status Scale (EDSS) change (OR, 26.05; 95% CI, 4.32-345.76; P<0.001) and 2-year EDSS change (OR, 16.38; 95% CI, 1.99-228.36; P=0.02) predicted 9-year disability worsening. Regarding 2-year variables, at least 2 new T2-lesions in 2 years predicted disability worsening at 9 years (OR, 4.91; 95% CI, 0.73-46.58; P =.02).

According to multivariable linear regression models, predictors of higher 9-year EDSS scores included the baseline EDSS score (95% CI, 0.41-0.75; P<0.001), presence of brainstem lesions (95% CI, 0.01-0.61; P=0.04), number of cervical cord lesions (95% CI, -0.02-0.46; P=0.05), EDSS changes from baseline to 1 year (95% CI, 0.62-0.96; P<0.001) and 2 years (95% CI, 0.21-0.88; P<0.001), and at least 2 new T2-lesions at 1 year (95% CI, 0.03-0.52; P=0.03) and 2 years (95% CI, 0.11-0.60; P=0.01).

A limitation of this study was the lack of a standardized MRI protocol, which did not allow for the measurement of brain and spinal cord atrophy in these patients.

The study investigators concluded that “an accurate clinical and MRI monitoring during the first 2 years of disease has proven to represent a powerful tool for counseling patients about long-term prognosis and personalizing treatment strategies.”


De Meo E, Bonacchi R, Moiola L, et al. Early predictors of 9-year disability in pediatric multiple sclerosis. Ann Neurol. Published online February 17, 2021. doi:10.1002/ana.26052