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Clinically isolated syndromes and multiple sclerosis: prospective clinical and MRI follow up after 30 years and features at earlier time-points

Chung, Karen Ka Yan; (2020) Clinically isolated syndromes and multiple sclerosis: prospective clinical and MRI follow up after 30 years and features at earlier time-points. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

This thesis is based on a 30-year follow-up study of a cohort of people who initially presented, in the 1980’s, with clinically isolated syndromes (CIS), suggestive of relapse-onset multiple sclerosis (MS). The main aims were: 1) to study the very long-term outcome of the cohort, with particular attention on those who have fared well over time, 2) review the idea and definition of ‘benign’ MS, a controversial entity, and 3) to identify any potential early clinical and radiological features, of 30-year outcome. MS is a very heterogenous condition and biomarkers of long-term prognostication remain limited. With the increasing range of disease modifying therapies available, it is important that treatment decisions should, as far as possible, involve a personalized risk-benefit analysis. At 30 years, I found that the clinical outcomes of the cohort were diverse. Approximately a third remained CIS, and two thirds developed MS. Within the MS group, who were largely untreated, ~40% remained ambulatory, ~35% had developed significant disability, and 20% had died related to their MS. Comparisons between the ambulatory MS group and CIS group, showed that the groups were not significantly different across several clinical measures. In this cohort, the strongest early predictors of 30-year outcomes identified were radiological features. The presence of MRI white matter lesions in specific locations in the brain, within one year of presentation, were able to predict 30-year clinical outcomes with accuracies in the 70-75% range. These results could potentially be applied in a clinical setting and help inform treatment decisions.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: Clinically isolated syndromes and multiple sclerosis: prospective clinical and MRI follow up after 30 years and features at earlier time-points
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/10093964
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