Clinical Correlation of Multiple Sclerosis Immunopathologic Subtypes. (9th November 2021)

• Record Type: Journal Article
• Authors: Tobin, W. Oliver; Kalinowska-Lyszczarz, Alicja; Weigand, Stephen D.; Guo, Yong; Tosakulwong, Nirubol; Parisi, Joseph E.; Metz, Imke; Frischer, Josa M.; Lassmann, Hans; Brück, Wolfgang; Linbo, Linda; Lucchinetti, Claudia F.
• Is Part Of: Neurology. Volume 97:Number 19(2021)
• Page Start: e1906
• Page End: e1913
• Publication Date: 2021-11-09
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012782
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Background and Objectives: The goal of this work was to compare clinical characteristics across immunopathologic subtypes of patients with multiple sclerosis. Methods: Immunopathologic subtyping was performed on specimens from 547 patients with biopsy- or autopsy-confirmed CNS demyelination. Results: The frequency of immunopathologic subtypes was 23% for pattern I, 56% for pattern II, and 22% for pattern III. Immunopatterns were similar in terms of age at autopsy/biopsy (median age 41 years, range 4–83 years, p = 0.16) and proportion female (54%, p = 0.71). Median follow-up after symptom onset was 2.3 years (range 0–38 years). In addition to being overrepresented among autopsy cases (45% vs 19% in biopsy cohort, p < 0.001), index attack-related disability was higher in pattern III vs II (median Expanded Disability Status Scale score 4 vs 3, p = 0.02). Monophasic clinical course was more common in patients with pattern III than pattern I or II (59% vs 33% vs 32%, p < 0.001). Similarly, patients with pattern III pathology were likely to have progressive disease compared to patients with patterns I or II when followed up for ≥5 years (24% overall, p = 0.49), with no differences in long-term survival, despite a more fulminant attack presentation. Conclusion: All 3 immunopatterns can be detected in active lesions, although they are found less frequently later into the disease due to the lower number of active lesions. Pattern III is associated with a more fulminant initial attack than either pattern I or II. Biopsied patients appear to have similar long-term outcomes regardless of their immunopatterns. Progressive disease is less associated with the initial immunopattern and suggests convergence into a final common pathway related to the chronically denuded axon.