What factors affect conversion to clinically definite MS?

  • For MS to be formally diagnosed, patients must experience at least two attacks of neurological symptoms (e.g., blurred vision) at different times.
  • A single seizure is called the first demyelinating event (FDE) or clinically isolated syndrome.
  • Australian researchers have developed a model to identify predictors of progression, taking into account the role of multiple factors.

In a study supported by MS Australia, researchers examined genetic, neurological, MRI and environmental risk factors that may predict progression from a first demyelinating event (FDE; first attack and precursor of MS) ​​to clinically established MS.

Previous studies have mainly focused on one or two factors in combination, but this study really looks at multiple factors to understand what drives progression to MS.

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Published in brain communication215 participants who experienced FDE between 2003 and 2006 were recruited into the Ausimmune study.

Baseline data was collected including demographics, time spent outdoors, physical activity, and MRI. Blood samples were also taken to determine vitamin D levels, antibodies to Epstein-Barr virus (EBV) and human herpesvirus 6, and to examine genetic factors that might contribute to progression.

The researchers followed the participants, and follow-up data was collected two to three years later. This included whether or not any of the participants developed MS and whether there were any changes in environmental exposure during the follow-up period.

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Of the participants for whom follow-up data were available, 77% had a second demyelinating event and were therefore diagnosed with clinically definite MS within the two to three year period.

Using the data, researchers developed a model and found that the best predictors of progression from FDE to clinically definite MS were:

  • younger age at FDE;
  • to be a smoker to begin with;
  • lower sun exposure;
  • lesions in specific regions of the brain at baseline and;
  • certain inherited genes
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There was no association between EBV and herpesvirus 6 antibody levels or vitamin D levels and progression to clinically established MS.

This study provides significant and clinically relevant information on several factors that may influence whether someone with FDE eventually develops MS.

Studies like these are essential to help us understand the complex interaction between environmental and genetic factors that can lead to MS.

Interestingly, given the wide range of treatments currently available to people with FDE, studies like this are becoming increasingly difficult as these treatments alter the course of MS.

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