Objective To identify early clinical and paraclinical factors that may help predict later conversion to multiple sclerosis (MS) in patients presenting with isolated myelitis (ie, ‘transverse myelitis’ without clinical or radiological evidence of inflammation/demyelination elsewhere in the central nervous system).
Methods In this retrospective cohort study, we included patients with isolated myelitis who were followed clinically and radiologically at our specialised myelopathy clinic. We excluded patients with MS at the onset, aquaporin-4-IgG seropositivity, myelin oligodendrocyte glycoprotein-IgG seropositivity or other identified aetiology. Logistic regression was used to identify factors predictive of conversion to MS (defined by the 2017 McDonald criteria).
Results We included 100 patients, followed for a median of 4.3 years. Conversion to MS occurred in 25 of 77 patients (32%) with short-segment myelitis (longest lesion spanning <3 vertebral segments on MRI) as compared with 0 of 23 patients (0%) with longitudinally extensive myelitis (p=0.002). Among patients with short-segment myelitis, factors identified as highly predictive of conversion to MS using multivariate logistic regression included cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCB) (OR (OR) 9.2, 95% CI 2.1 to 41.0, p=0.004), younger age (OR 1.1 for each year younger, 95% CI 1.0 to 1.1, p=0.04) and longer follow-up (OR 1.3 for each year longer, 95% CI 1.0 to 1.6, p=0.04). Conversion to MS occurred at a median of 2.8 years after myelitis onset.
Conclusions Short-segment MRI cord lesion(s), CSF-restricted OCB, younger age and longer follow-up are all factors predictive of conversion to MS in patients presenting with isolated myelitis.
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Contributors OCM designed and conceptualised the study; acquired the data; analysed the data; drafted and revised the manuscript for intellectual content. LM acquired the data; analysed the data; revised the manuscript for intellectual content. AS-C acquired the data; analysed the data; revised the manuscript for intellectual content. CAP designed and conceptualised the study; revised the manuscript for intellectual content. SDN designed and conceptualised the study; analysed the data; drafted and revised the manuscript for intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SDN has received consultant fees for scientific advisory boards from Biogen, Genentech, Celgene, EMD Serono, Novartis, is a clinical adjudication committee member for a medDay Pharmaceuticals clinical trial, and has received research funding (paid directly to institution) from Biogen, Novartis, Genentech, National MS Society, Department of Defense and Patient Centered Outcomes Institute.
Patient consent for publication Not required.
Ethics approval Johns Hopkins University Institutional Review Board approval was obtained for this study, with requirements for patient consent waived. Data for this study cannot be shared due to IRB-restrictions related to patient confidentiality.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. Data for this study cannot be shared due to IRB-restrictions related to patient confidentiality.
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