Baseline and follow-up MRI predictors for long-term prognosis in pediatric MS

A baseline magnetic resonance imaging (MRI) scan followed by clinical and MRI monitoring during the first 2 years of multiple sclerosis (MS) onset in children may likely provide insight 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 exams at the onset of disease and after 1 and 2 years of 123 children (mean age 14.4 years) with relapsing-remitting MS. Study investigators performed 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 time from the onset of the disease to the first relapse was 1.7 years. Optic nerve lesions (hazard ratio) were predictors of the time to first relapse [HR]2.10; 95% CI, 1.12-3.91; P = 0.02) and highly effective disease-modifying therapy exposure (HR 0.31; 95% CI 0.12-0.72; P = 0.005). The baseline predictors of relapse rate per year were the presence of cerebellum (P <0.001), collar lesions (P = 0.003), and highly potent treatment exposure (P = 0.01).

A base predictor of disability worsening after 9 years was the presence of optic nerve involvement (odds ratio) [OR]6.45; 95% CI, 1.48-30.49; P = 0.01). In addition, the 1-year change in the extended disability status scale (EDSS) (OR, 26.05; 95% CI, 4.32-345.76; P <0.001) and the 2-year EDSS change (OR, 16.38; 95% CI, 1.99-228.36; P = 0.02) predicted a deterioration of the disability by 9 years. For 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 = 0.02).

According to multivariable linear regression models, predictors of higher 9-year EDSS scores included the EDSS baseline score (95% CI, 0.41-0.75; P <0.001) and the 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 after 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 the measurement of brain and spinal cord atrophy in these patients.

The study’s researchers concluded that “close clinical and MRI monitoring during the first two years of illness is an effective tool in advising patients on 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

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