Possible Prognostic Value of Cerebrospinal Fluid in Clinically Isolated Syndrome (P1.231)

OBJECTIVE: To find possible correlation between cerebrospinal fluid (CSF) markers in patients with clinically isolated syndrome (CIS) and clinical outcome during four-year follow-up. BACKGROUND: CIS is characterised as a first demyelinating event with clear risk of multiple sclerosis (MS) development. CIS diagnosis is based on magnetic resonance imaging (MRI) and CSF analysis. Still no reliable prognostic markers are available. DESIGN/METHODS: 124 patients with CIS were included in the study. All patients had at least 2 lesions on MRI and positive CSF oligoclonal bands (OCB). CSF was obtained in every patient within 4 months after first symptoms, before any treatment. Following CSF parameters were examined: total cell count, protein level, IgM and IgG level, IgM, IgG index, OCB. After CIS diagnosis all patients started interferon-beta treatment and were examined every three months during four-year follow-up (relapse rate, Expanded Disability Status Scale - EDSS). Clinical data (time to clinically definite MS (CDMS), time to six-month confirmed progression, EDSS after two and four years of the follow-up) were correlated with CSF parameters using T-test, Pearson correlation and logistic regression. RESULTS: 72 patients (58%) converted to CDMS and 17 patients (14%) achieved confirmed progression during four-year follow-up. Patients with confirmed progression showed at baseline lower number of OCB (T-test, p<0.018). Same parameter significantly predicted confirmed progression using logistic regression (p= 0.013). No other significant correlation was found between tested CSF parameters and clinical outcome. CONCLUSIONS: Surprisingly lower number of OCB at baseline was associated with higher risk of confirmed progression. Possibly low inflammatory activity at baseline with lower OCB production can be connected with predominantly neurodegenerative process and therefore earlier disability progression. Analysis of baseline CSF is still worth further research in relation to MS prognosis. Study Supported by: MSM 0021620849, MSM 0021620812, NT13237-4/2012, PRVOUK-P26/LF1/4 and RVO-VFN64165/2012. Disclosure: Dr. Krasulova has nothing to disclose. Dr. Havrdova has received personal compensation for activities with Bayer Pharmaceuticals Corp., Biogen Idec, Genzyme Corp., Novartis, Serono Inc., and Teva Neuroscience. Dr. Havrdova has received research support from the Czech Ministries of Education and Health. Dr. Kemlink has nothing to disclose. Dr. Uher has nothing to disclose. Dr. Tyblova has received personal compensation for activities with Biogen Idec, Sanofi-Aventis Pharmaceuticals Inc., Teva Neuroscience, and Merck Serono. Dr. Tyblova has received research support from Biogen Idec. Dr. Volna has nothing to disclose. Dr. Mrazova has nothing to disclose. Dr. Horakova has received personal compensation for activities with Biogen Idec, Novartis, Merck Serono, Teva Neuroscience, and Bayer Schering. Dr. Horakova has received research support from Biogen Idec.