An Integrated Model Of Risk Factors For Predicting The Early Occurrence Of A Second Attack In Patients With Clinically Isolated Syndromes (P1.224)

OBJECTIVE: to investigate risk factors for the early development of clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndromes (CIS) BACKGROUND: the identification of CIS patients with a high risk to have an early second attack represents the main purpose of diagnostic criteria and of clinicians in everyday clinical practice. DESIGN/METHODS: This retrospective study included patients admitted to our Department within 3 months from CIS onset. We evaluated baseline clinical data as well as MRI, multimodal evoked potentials (EPs), Vitamin D and CSF data and assessed their prognostic value for early development of CDMS. RESULTS: 227 CIS patients have been identified. 154 (67.8 %) were females and the median age at CIS onset was 31.9 years (SD 9.4). Among them, 21 patients (9%) at 6 months developed CDMS, 43 (19%) at 12 months, 71 (31%) at 24 months and 120 (52.9 %) patients during the entire follow up (6.82 yrs SD 2.78). In a multivariate logistic regression model, a high score at multimodal evoked potentials at baseline increased the risk of a relapse at 6 months (OR: 1.74; 95% CIs: 1.49-15.93; p .04); the risk of developing CDMS at 12 and 24 months was significantly related to the presence of CSF oligoclonal bands [respectively: OR 3.1 (CIs 1.04-7.98), p 0.05; OR 3.57 (CIs 1.27-11.98), p 0.02). A high number (> 9 T2 lesion at baseline brain MRI were he most important prognostic factor for the development of the disease in the long term [OR 5.7 (CIs 2.09-12.77), p 0.01). The prognostic value of Vitamin D level will be examined. CONCLUSIONS: The concurrent presence of CSF OBs, a high number of T2 lesions and a high multimodal EPs score at baseline was associated with an overall CDMS rate of 40 % at 12 months (p<0.01). Thus, the integration of all risk factors at clinical presentation is useful for an accurate estimate of the absolute risk of early clinical relapse.