Ninety percent of patients who are ...

Ninety percent of patients who are diagnosed with multiple sclerosis initially near with an isolated neurologic fact (e.g., optic nerve, brainstem, or spinal cord involvement). The disease-modifying treatments for multiple sclerosis are mostly effective when they are intrust with an agencyed early in the progression of the disease, however only one third of patients with an initial neurologic incident progress to multiple sclerosis within the nearest year. Currently, no reliable immunologic or radiologic findings identify patients who are more likely to progres to multiple sclerosis. Berger and associates examined the utility of pair antibody markers in the prediction of later conversion to clinically definite multiple sclerosis.

The application of mind enrolled 119 consecutive patients presenting to an academic neurology referral center with an initial neurologic result all of whom had magnetic resonance imaging (MRI) scans showing multiple white-matter lesions and oligoclonal bands in succession examination of cerebrospinal fluid. Sixteen patients were exclud from analysis. All patients received 1000 mg of intravenous methylprednisolone for three to five days at their initial presentation. later evaluation for disease progression was performed each three months for an average follow-up duration of 509 month Patients with a relapsing issue not caused by an obvious external trigger (fever heat, infection, or drugs) were holded to have clinically definite multiple sclerosis. Before steroid treatment was administered, serum samples were assayed for antibodies against sum of two units myelin-related proteins: myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP) The reflection cohort was 71 percent female and had an average age of 32 years at presentation.

Serum titers for the pair anti-MOG and anti-MBP were existing in 21 percent of patients; 41 percent were seropositive for anti-MOG antibodies barely and 38 percent were seronegative for the two anti-MOG and anti-MBP antibody markers. Progression to clinically definite multiple sclerosis occurr in 95 percent of subject of attention subjects with positive titers for one as well as the other anti-MOG and anti-MBP, compared with a relapse rate of 23 percent in bodys who were seronegative for the couple antibodies. Eighty-three percent of patients with solitary anti-MOG seropositivity relapsed. The mean extent of time until relapse was 75 month in those with the pair antibody markers and 45.1 month in patients lacking either marker. Those with sole anti-MOG antibodies had an average relapse time of 146 month Compared with patients without either marker, seropositivity for anti-MOG increased the risk of relapse 32-fold while seropositivity for the one and the other markers increased the risk 76 times. The number of white-matter lesions seen forward MRI scan of the brain at initial presentation was higher in patients with the one and the other antibodies than in those without anti-MOG and anti-MBP; however, this number was not an independent predictor of disease progression in multivariate analysis.

The authors bring to an end that seropositivity for antibodies against sum of two units myelin-related proteins in patients with an initial neurologic occurrence is associated with a higher rate of conversion to clinically definite multiple sclerosis and a shorter time interval until relapse occurred

Berger T et al. Antimyelin antibodies as a predictor of clinically definite multiple sclerosis after a first demyelinating end N Engl J Med July 10 2003;349:139-45

COPYRIGHT 2004 American Academy of Family Physicians

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