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Multiple sclerosis
Original research
Early factors associated with later conversion to multiple sclerosis in patients presenting with isolated myelitis
  1. Olwen C. Murphy1,2,
  2. Loulwah Mukharesh2,
  3. Andrea Salazar-Camelo1,
  4. Carlos A. Pardo1,2,
  5. Scott D. Newsome1,2
  1. 1 Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
  2. 2 Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
  1. Correspondence to Dr Scott D. Newsome, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; snewsom2{at}jhmi.edu

Abstract

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.

Data availability statement

No data are available. Data for this study cannot be shared due to IRB-restrictions related to patient confidentiality.

https://doi.org/10.1136/jnnp-2020-325274

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    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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    Footnotes

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.